My ALT and AST are not high. How to diagnose fatty liver?

Question

Hi doctor,

I had an abdominal ultrasound and consulted two gastroenterologists. One doctor told me that I have a fatty liver, and another doctor told me that I do not have a fatty liver. Can you please tell me whether I have a fatty liver or not? I usually drink three glasses of wine each week, and I do exercise regularly.

My AST and ALT are normal, but I am lacking the aldehyde dehydrogenase 2 gene. Due to it, I have a flushed face after taking a little alcohol. My AST and ALT do not get elevated after alcohol consumption. Thus, it is not a good indicator of fatty liver in my case. I have attached the reports.

Kindly review and suggest.

Answer 1

Hi,

Welcome to icliniq.com.

I understand your concern.

I have gone through the report (attachment removed to protect patient identity). Nonalcoholic fatty liver disease (NAFLD) or nonalcoholic steatohepatitis (NASH) are both spectrums of fat-related liver disease. As the name implies, it is nonalcoholic, which means that it is not associated with alcohol intake.

I expect that you take a limited amount of alcohol within safer limits (less than fourteen standard drinks per week). So I do not think that you would develop raised ALT (alanine transaminase) or AST (aspartate transaminase) due to alcohol consumption. Since NAFLD and NASH are prevalent conditions, they need to be excluded by doing certain tests.

NAFLD occurs when there is steatosis or fat within the liver, and there is no inflammation that tends to increase ALT or AST.

On the other hand, NASH is a condition where there is fat presenting with inflammation in the liver, and it is depicted by raised ALT and AST. I believe that you do not have NAFLD or NASH because all the results are normal, and the ultrasound of the liver is completely normal and does not show any fat deposition.

Ultrasound is a good initial investigation to detect fat in the liver. If you are concerned about the fat in the liver, then you can do a fibroscan of the liver, which is also called transient elastography of the liver. This tells the amount of fat present in the liver.

I hope this helps you.

Thank you.