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

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

doi:10.1186/s12876-020-1165-z

Xuefeng Ma, Yifen Wang + Show 5 more

Open Access

https://doi.org/10.1186/s12876-020-1165-z

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Abstract

BackgroundALT value is often used to reflect the hepatic inflammation and injury in NAFLD patients, but many studies proved that ALT values were normal in many NAFLD patients. The aim of this study was to identify the summarized proportion of NAFLD patients with normal ALT value in the overall NAFLD patients.MethodsElectronic databases PubMed, EMBASE, Ovid, and the Cochrane Library were searched for potential studies published from January 1, 2000 to September 30, 2019. Studies that have reported the number of NAFLD or NASH patients with normal and abnormal ALT value were included and analyzed. s, reviews, case reports, and letters were excluded.ResultsA total of 11 studies with 4084 patients were included for assessing the summarized proportion of NAFLD patients with normal ALT in overall NAFLD patients. As the results shown, the summarized proportion of NAFLD patients with normal ALT value in overall NAFLD patients was 25% (95%CI: 20–31%) which was calculated by the random-effects model. The summarized proportion of NASH patients with normal ALT value in overall NASH patients was 19% (95%CI: 13–27%). Subgroup analysis includes region, study type, diagnostic method, and group size were conducted to investigate the resource of heterogeneity in the summarized proportion of NAFLD and NASH patients with normal ALT value.Conclusions25% NAFLD patients and 19% NASH patients possess the normal ALT value in the clinical manifestation. The value of ALT in the clinical diagnosis of NAFLD and NASH remains need be further testified.

Highlights

Alanine aminotransferase (ALT) value is often used to reflect the hepatic inflammation and injury in Non-alcoholic fatty liver disease (NAFLD) patients, but many studies proved that ALT values were normal in many NAFLD patients
Studies that met the following criteria were included: 1) conducted the case-control, cohort study or cross-sectional analysis; 2) NAFLD was diagnosed by MRI or Ultrasonography and the non-alcoholic steatohepatitis (NASH) was diagnosed by histology; 3) ALT value was measured on the biochemical laboratory; 4) the number of NAFLD or NASH patients with normal and abnormal ALT was reported
The results showed that the NAFLD patients with normal ALT value possess a tightly relationship with diabetes (OR = 2.30, 95% Confidence interval (CI): 1.38–3.82; P < 0.01), hypertension (OR = 2.03, 95% CI: 1.47–2.80; P < 0.56) and metabolic syndrome (OR = 1.42, 95% CI: 1.00–2.00; P = 0.60)

Summary

Introduction

ALT value is often used to reflect the hepatic inflammation and injury in NAFLD patients, but many studies proved that ALT values were normal in many NAFLD patients. Non-alcoholic fatty liver disease (NAFLD) has become the most prevalent chronic liver disease with an estimated prevalence of 25–45% in western countries and 29.62% in Asia [1,2,3,4]. Less ALT can be detected in the serum of health population, once the apoptosis and injury of hepatocytes were occurred, the ALT value in the serum increased significantly [10]. As a standard indicator of liver function, serum ALT value is usual used to reflect hepatic inflammation and liver injury in patients with various chronic liver diseases. In most of the previous studies, the higher ALT values were tightly

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