Proportion of NAFLD patients with normal ALT value in overall NAFLD patients: a systematic review and meta-analysis

Ma, Xuefeng; Liu, Shousheng; Zhang, Jie; Dong, Mingjie; Wang, Yifen; Wang, Mengke; Xin, Yongning

doi:10.1186/s12876-020-1165-z

Cited by 110 publications

(73 citation statements)

References 28 publications

(44 reference statements)

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“…On the other hand, 60% of the patients with NAFLD had normal ALT. These figures are in line with data from the general population and suggest the development of NAFLD may be occult[ 58 , 59 ]. This finding emphasizes the need for sensitive diagnostic tools in this at-risk population.…”

Section: Discussionsupporting

confidence: 87%

Prevalence and predictors of nonalcoholic fatty liver disease in South Asian women with polycystic ovary syndrome

Shengir¹,

Krishnamurthy²,

Ghali³

et al. 2020

WJG

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BACKGROUND Polycystic ovary disease (PCOS) may be a risk factor for nonalcoholic fatty liver disease (NAFLD) due to common pathogenetic pathways, including insulin resistance and obesity. Both PCOS and NAFLD are more severe in South Asian women. Data on NAFLD in South Asian women with PCOS are lacking. AIM To investigate prevalence and predictors of NAFLD and liver fibrosis in PCOS patients from South Asia. METHODS We conducted an observational routine screening program by means of transient elastography (TE) with associated controlled attenuation parameter (CAP). NAFLD was defined as CAP ≥ 288 decibels per meter. Significant liver fibrosis (stage 2 and higher out of 4) was defined as TE measurement ≥ 8.0 kilopascals. Elevated alanine aminotransferase (ALT) was defined as ALT > 24 IU/L, as per upper limit of normal reported in South Asian women. Biochemical hyperandrogenism was defined as free androgen index > 5. Predictors of NAFLD were determined by logistic regression analysis. RESULTS 101 PCOS patients (mean age 36.3 years) with no significant alcohol intake or viral hepatitis were included. Prevalence of NAFLD and significant liver fibrosis was 39.6% and 6.9%, respectively. Elevated ALT was observed in 40% and 11.5% of patients with and without NAFLD, respectively. After adjusting for duration of PCOS and insulin resistance measured by homeostasis model for assessment of insulin resistance, independent predictors of NAFLD were higher body mass index [adjusted odds ratio (aOR) 1.30, 95% confidence interval (CI): 1.13-1.52], hyperandrogenism (aOR: 5.32, 95%CI: 1.56-18.17) and elevated ALT (aOR: 3.54, 95%CI: 1.10-11.47). Lifetime cardiovascular risk was higher in patients with NAFLD compared to those without NAFLD (0.31 ± 0.11 vs 0.26 ± 0.13). CONCLUSION Despite their young age, NAFLD diagnosed by TE with CAP is a frequent comorbidity in South Asian women with PCOS and is strongly associated with higher body mass index and hyperandrogenism. Non-invasive screening strategies could help early diagnosis and initiation of interventions, including counselling on weight loss, cardiovascular risk stratification and linkage to hepatology care where appropriate.

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Section: Discussionsupporting

confidence: 87%

Prevalence and predictors of nonalcoholic fatty liver disease in South Asian women with polycystic ovary syndrome

Shengir¹,

Krishnamurthy²,

Ghali³

et al. 2020

WJG

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“… 20 , 21 This method is controversial because some studies illustrated that there is no significant difference in ALT and AST levels between patients with NAFL and NASH. 22 We found elevated ALT and AST levels in NAFL mice, but we could not use these two markers to distinguish NAFL and NASH. This preclinical evidence supports the idea that NAFL cannot be distinguished from NASH using ALT and AST alone.…”

Section: Discussionmentioning

confidence: 68%

Using intestinal flora to distinguish non-alcoholic steatohepatitis from non-alcoholic fatty liver

Cui

Wang

et al. 2020

J Int Med Res

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Objective To explore specific flora in mouse models of non-alcoholic steatohepatitis (NASH) to improve NASH diagnostic protocols. Methods Sixty mice were divided into normal diet (ND, 20 mice) and high-fat/high-sugar diet (HFSD) groups (40 mice). After 8 weeks of feeding, 10 mice in the ND group and 20 mice in the HFSD group were sacrificed to create the short-term ND and non-alcoholic fatty liver (NAFL) groups, respectively. After 16 weeks of feeding, the remaining mice were sacrificed to create the long-term ND and NASH groups, respectively. We then examined fecal flora, serum biochemical indices, and lipopolysaccharide and tumor necrosis factor-α levels and analyzed liver tissue. Results The relative abundance of Lactobacillus, Desulfovibrio, Ruminiclostridium 9, and Turicibacter differed between NASH and NAFL mice, and the areas under the receiver operating characteristic curve of the four genera for diagnosing NASH were 0.705, 0.734, 0.737, and 0.937. The non-alcoholic fatty liver disease activity score was positively correlated with the relative abundance of Desulfovibrio (r = 0.353), Ruminiclostridium 9 (r = 0.431), and Turicibacter (r = 0.688). Conclusions The relative abundance of Lactobacillus, Desulfovibrio, Ruminiclostridium, and Turicibacter may help distinguish NASH from NAFL.

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“…First, calculation of FIB-4 index requires only four parameters, age, AST, ALT, and platelet count, while calculating the formula of NFS is slightly more complex [ 26 ] ( Table 1 ). Second, FIB-4 index is available even in MAFLD patients with normal ALT levels [ 42 , 43 , 44 ]. A meta-analysis proved that 25% MAFLD patients and 19% NASH patients possess the normal ALT value [ 43 ].…”

Section: The Usefulness Of Fib-4 Index To Evaluating Severe Fibrosmentioning

confidence: 99%

FIB-4 First in the Diagnostic Algorithm of Metabolic-Dysfunction-Associated Fatty Liver Disease in the Era of the Global Metabodemic

Sumida

Yoneda

Tokushige

et al. 2021

Life

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The prevalence of obesity or metabolic syndrome is increasing worldwide (globally metabodemic). Approximately 25% of the adult general population is suffering from nonalcoholic fatty liver disease (NAFLD), which has become a serious health problem. In 2020, global experts suggested that the nomenclature of NAFLD should be updated to metabolic-dysfunction-associated fatty liver disease (MAFLD). Hepatic fibrosis is the most significant determinant of all cause- and liver -related mortality in MAFLD. The non-invasive test (NIT) is urgently required to evaluate hepatic fibrosis in MAFLD. The fibrosis-4 (FIB-4) index is the first triaging tool for excluding advanced fibrosis because of its accuracy, simplicity, and cheapness, especially for general physicians or endocrinologists, although the FIB-4 index has several drawbacks. Accumulating evidence has suggested that vibration-controlled transient elastography (VCTE) and the enhanced liver fibrosis (ELF) test may become useful as the second step after triaging by the FIB-4 index. The leading cause of mortality in MAFLD is cardiovascular disease (CVD), extrahepatic malignancy, and liver-related diseases. MAFLD often complicates chronic kidney disease (CKD), resulting in increased simultaneous liver kidney transplantation. The FIB-4 index could be a predictor of not only liver-related mortality and incident hepatocellular carcinoma, but also prevalent and incident CKD, CVD, and extrahepatic malignancy. Although NITs as milestones for evaluating treatment efficacy have never been established, the FIB-4 index is expected to reflect histological hepatic fibrosis after treatment in several longitudinal studies. We here review the role of the FIB-4 index in the management of MAFLD.

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Proportion of NAFLD patients with normal ALT value in overall NAFLD patients: a systematic review and meta-analysis

Cited by 110 publications

References 28 publications

Prevalence and predictors of nonalcoholic fatty liver disease in South Asian women with polycystic ovary syndrome

Prevalence and predictors of nonalcoholic fatty liver disease in South Asian women with polycystic ovary syndrome

Using intestinal flora to distinguish non-alcoholic steatohepatitis from non-alcoholic fatty liver

FIB-4 First in the Diagnostic Algorithm of Metabolic-Dysfunction-Associated Fatty Liver Disease in the Era of the Global Metabodemic

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