The Construction and Performance Evaluation of a Risk Prediction Model for Nonalcoholic Steatohepatitis Based on Serological Markers

Objective To understand the profile of serum lipid composition in type 2 diabetes mellitus (T2DM) patients with nonalcoholic simple fatty liver (NAFL) and nonalcoholic steatohepatitis (NASH), and to screen potential serum markers of NASH. Methods A total of 40 patients with T2DM and comorbid non-alcoholic fatty liver disease (NAFLD) who underwent liver biopsy were selected from September 2014 to October 2017 in the Department of Endocrinology, the Third Central Hospital of Tianjin. According to the results of liver biopsy (SAF score), they were divided into NAFL group (22 cases) and NASH group (18 cases). Medical profiles of the two groups were extracted and compared, ultra-high performance liquid chromatography-mass spectrometry was used for serum lipidomics analysis. T test was used to determine statistical significance between the groups. Logistic stepwise regression analysis and receiver operating characteristic (ROC) curve analysis were used to screen potential serum markers for NASH in T2DM. Results The liver stiffness, NASH score, aspartate aminotransferase (AST), alkaline phosphatase, gamma-glutamyltransferase (GGT), fasting blood glucose and serum ferritin levels were higher in NASH group than those in NAFL group (t=-2.76--2.06, all P<0.05). Phosphatidylcholine (35∶4)[PC (35∶4)], PC (36∶1) [PC (18∶1/18∶0)], PC (38∶3), PC (44∶5), phosphatidyl-ethnolamine (36∶2)[PE (36∶2)], PE (34∶1) c[PE-NMe2 (18∶1/16∶0)], PE (34∶1) [PE(20∶1/14∶0)], phosphatidyl serine (33∶0) [PS(33∶0)], triglyceride (54∶2)[TG (54∶2)], sphingomyelin (37∶1)[SM (37∶1)], SM (39∶1), SM (40∶1), glucosylceramide (40∶2)[GlcCer (40∶2)] were higher in NASH group than those in NAFL group (t=-2.930--1.380, all P<0.05). The levels of PC (38∶5),PC (38∶6),TG (52∶4),TG (54∶4),TG (54∶5),TG (57∶6), TG (58∶4), TG (60∶6) decreased in NASH group (t=1.982-2.431, all P<0.05); The levels of PC (36∶1) [PC (19∶1/17∶0)], PE (38∶1), PE (39∶1), TG (52∶1), N-palmitoyl phenylalanine were significantly higher in NASH group than those in NAFL group, with statistically significant differences (-3.789--2.837, P<0.005). Logistic stepwise regression analysis showed that increased PC (36∶1) and PE (38∶1) were risk factors for NASH progression in patients with T2DM complicated with NAFLD [P=0.026, 0.013, OR (95%CI): 1.213 (1.076-1.301), 1.119 (1.015-1.243)]. ROC curve analysis showed that the areas under curves of PC (36∶1) and PE (38∶1) were 0.803 and 0.785, respectively, with sensitivity 94.4% and specificity 72.7%, all higher than those of ALT, AST and GGT (the areas under the curve were 0.689, 0.734 and 0.741, the sensitivity was 72.2%, 77.8% and 77.8%, and the specificity was 68.2%, 63.6% and 68.2% respectively). Conclusions In patients with type 2 diabetes, glycero phospholipids, sphingolipids and TG changed significantly in NASH compared with NAFL. In patients with T2DM and fatty liver, PC (36∶1) and PE(38∶1) might be potential bio markers for NASH diagnosis. Key words: Diabetes mellitus, type 2; Fatty liver; Lipidomics

We aimed to elucidate the frequency of polymorphic genotypes and alleles of patatin-like phospholipase domain containing 3 rs738409 polymorphism and its possible associations with non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis in a cohort from Turkey.We enrolled 200 patients diagnosed with NAFLD and genotyped for rs738409 I148M polymorphism by real-time polymerase chain reaction, particularly by melting curve analysis. SPSS analysis software was used for statistical significance. Continuous variable values were expressed as mean ± standard deviation. Significant statistical level was chosen as p = 0.05.Our results demonstrate in a cohort from Turkey that rs738409 C > G polymorphism (I148M) of patatin-like phospholipase domain containing 3 gene is significantly able to affect individuals to have NAFLD in unadjusted regression model.Consistent with the previous studies in other populations, our study group showed a significantly higher risk of having NAFLD in unadjusted regression model but not in the adjusted model indicating that non-genetic factors such as age and sex may be responsible for the association. However, independent studies need to validate our findings with a larger group of NAFLD patients, as well as in different ethnic cohorts.

There are few reports on the prognosis of liver-related events in Japanese patients with nonalcoholic fatty liver disease (NAFLD). We undertook an observational study to compare the prognosis between fibrotic and nonfibrotic groups in Japanese NAFLD patients. Prognosis in 393 NAFLD patients who underwent liver biopsy between April 2013 and April 2015 at multiple centers were investigated. The time to onset of liver-related events, cardiovascular events, development of extrahepatic cancers, and death were compared between the pathologically fibrotic nonalcoholic steatohepatitis (NASH) group and nonalcoholic fatty liver (NAFL)+nonfibrotic NASH group. A similar analysis was carried out based on the fibrotic classification diagnosed using four noninvasive fibrosis prediction models. The mean age and body mass index at the time of liver biopsy was 55.7years old and 28.04kg/m2 , respectively The cumulative incidence of liver-related events at 1080days after liver biopsy was 5.79% in the pathologically fibrotic NASH group and 0% in the NAFL+nonfibrotic NASH group, with a significant difference (p=0.0334). The cumulative incidence of liver-related events was significantly higher in the positive group for the prediction model than in the negative group in all four models (all p values were <0.0001). There was no significant difference between the pathologically fibrotic NASH group and NAFL+nonfibrotic NASH group in terms of cumulative incidence of cardiovascular events, development of extrahepatic cancers, and death. The incidence of liver-related events was significantly higher in the fibrotic NASH group than that of the NAFL+nonfibrotic NASH group in Japanese NAFLD patients.

Non-alcoholic fatty liver disease (NAFLD) is a common metabolic disorder in overweight and obese children, and its etiology and pathogenesis remain unclear, lacking effective preventive and therapeutic measures. This study aims to explore the association between whole blood copper, zinc, calcium, magnesium and iron levels and NAFLD in overweight and obese children aged 6 to 17 years, providing a scientific basis for the prevention and intervention of early NAFLD in overweight and obese children. A cross-sectional study design was used to collect relevant data from overweight and obese children who visited the Hunan Children's Hospital from January 2019 to December 2021 through questionnaire surveys. Fasting blood samples were collected from the subjects, and various indicators such as blood glucose, blood lipid, and mineral elements were detected. All children were divided into an overweight group (n=400) and a NAFLD group (n=202). The NAFLD group was divided into 2 subgroups according to the ALT level: A non-alcoholic fatty liver (NAFL) group and a non-alcoholic steatohepatitis (NASH) group. Logistic regression analysis was used to analyze the association between minerals (copper, zinc, calcium, magnesium, and iron) and NAFLD, NAFL and NASH. A total of 602 subjects were included, of whom 73.6% were male, with a median age of 10 (9, 11) years, and a body mass index (BMI) of 24.9 (22.7, 27.4) kg/m2. The intergroup comparison results showed that compared with the overweight group, the NAFLD group had higher levels of age, BMI, diastolic blood pressure (DBP), systolic blood pressure (SBP), triglyceride (TG), low density lipoprotein (LDL), alanine transaminase (ALT) and aspartate aminotransferase (AST), and lower level of high density lipoprotein (HDL). The NAFL group had higher levels of age, BMI, DBP, SBP, ALT, and AST, and lower levels of HDL compared with the overweight group. The levels of age, BMI, DBP, SBP, TG, LDL, ALT, and AST of NASH were higher than those in the overweight group, while the level of HDL was lower than that in overweight group (all P<0.017). After adjusting for a variety of confounders, the OR of NAFLD for the highest quantile of iron was 1.79 (95% CI 1.07 to 3.00) compared to the lowest quantile, and no significant association was observed between copper, zinc, calcium, and magnesium, and NAFLD. The subgroup analysis of NAFLD showed that the OR for the highest quantile of iron in children with NAFL was 2.21 (95% CI 1.26 to 3.88), while no significant association was observed between iron level and NASH. In addition, no significant associations were observed between copper, zinc, calcium, and magnesium levels and NAFL or NASH. High iron level increases the risk of NAFLD (more likely NAFL) in overweight and obese children, while copper, zinc, calcium, magnesium, and other elements are not associated with the risk of NAFLD in overweight and obese children.

Objective To establish the rabbit model with nonalcoholic fatty liver disease (NAFLD) induced by high-fat diet (HFD) , and to investigate the course of the disease. Methods Forty-nine male healthy New Zealand white rabbits were divided into the control group (n=10) and the HFD group (n=32) by random digit method, and fed with standard diet and HFD, respectively. The HFD group was divided into the 4-week HFD group (HFD-4W, n=8) , 8-week HFD group (HFD-8W, n=8) , 12-week HFD group (HFD-12W, n=8) , and 16-week HFD group (HFD-16W, n=8) , and determined by blood biochemical test and liver pathological examination at each time point, respectively. Another 7 rabbits in the supplementary group were fed with HFD to be randomly included into the 4 HFD groups when the rabbits died. The general condition of the rabbits were observed, and the liver pathology of the rabbits was detected and evaluated by the NAFLD activity score (NAS). According to NAS, all the rabbits were divided into the normal group, nonalcoholic steatohepatitis (NASH) group and potential NASH group. The blood biochemical parameters of serum alanine aminotransferase (ALT) , aspartate aminotransferase (AST) , total bilirubin (TB) , triglyceride (TG) and total cholesterol (TC) were compared among groups. Results One rabbit died of unknown causes at 12 weeks in the control group. One rabbit died at 7 weeks in the HFD-8W group; One rabbit died at 8, 10, and 11 weeks in the HFD-12W group, respectively; Two rabbits died at 8 weeks and one rabbit died at 13 weeks in the HFD-16W group, respectively, and the cause of death was diarrhea. The thickened rabbit liver in the HFD group showed increased volume and faded color, and histopathological examination revealed hepatic steatosis, ballooning degeneration and lobular inflammation. The rabbits were divided into the normal group (n=9) , NASH group (n=19) and potential NASH group (n=13) according to the NAS, and there was no statistically significant difference in the serum ALT, AST and TB among the groups (all P>0.05). Compared with the normal group, the serum TG and TC levels increased in the potential NASH group and NASH group (all P 0.05). Conclusion The rabbit model with NAFLD induced by HFD is easily established, which can simulate the pathological and physiological characteristics of human NAFLD well. Key words: Nonalcoholic fatty liver disease; Models animal; High fat diet

Objective: To investigate the relationship between gut microbiota structure and biochemical changes in patients with different types of nonalcoholic fatty liver disease (NAFLD), in order to provide evidence for clinical diagnosis and prevention of NAFLD. Methods: Forty-eight NAFLD cases (NAFLD group), 40 NAFLD cases with type 2 diabetes mellitus (NAFLD combined with type 2 diabetes mellitus group) and 30 healthy cases (healthy group) were randomly enrolled, and their body mass index, serum alanine aminotransferase, aspartate aminotransferase, total bilirubin, total cholesterol, triglyceride, high density lipoprotein, low density lipoprotein and uric acid were measured. Serum levels of TNF-alpha and fasting insulin were measured using ELISA, and then insulin resistance index was calculated. The gut microbiota of three groups of subjects was detected using 16S rDNA-based high-throughput sequencing. Lastly, the correlations between the various factors were analyzed. The comparison among groups was conducted by 2 test, and one-way ANOVA was used for comparison among groups with normal distribution and homogeneity of variance. Furthermore, the LSD method was used to compare the two groups. K-W rank sum test was used for comparison among groups without normal distribution or homogeneity of variance. Results: Body mass index, aspartate aminotransferase, triglyceride, total cholesterol, low density lipoprotein, uric acid, tumor necrosis factor-alpha, fasting insulin and insulin resistance index of NAFLD group were higher than healthy group, while the high-density lipoprotein was lower in the healthy group, and the difference was statistically significant (P< 0.05). Compared with NAFLD group, the life expectancy, fasting blood glucose and insulin resistance index of NAFLD combined with type 2 diabetes mellitus group were higher, while the body mass index, aspartic acid aminotransferase, total cholesterol and HDL levels were decreased, and the difference was statistically significant (P< 0.05). NAFLD group (P= 0.016) had decreased abundance of firmicutes than healthy group, and the abundancy of the firmicutes in the NAFLD combined with type 2 diabetes group was significantly lower (P< 0.001). The abundance of bacteroidetes in NAFLD combined with type 2 diabetes group was higher than healthy group, and the difference was statistically significant (P= 0.006). At the "genus level," the abundance of Roseburia and Subdoligranulum in the NAFLD group was decreased, while the Roseburia in the NAFLD group with type 2 diabetes group was significantly lower (P< 0.05). In addition, the abundance of Faecalibacterium, Blautia, Anaerostipes and Fusicatenibacter in NAFLD combined with type 2 diabetes group was lower than healthy group, and the difference was statistically significant (P< 0.001). Fusicatenibacter, Blautia, Anaerostipes, Faecalibacterium, and Roseburia were negatively correlated with fasting blood glucose and insulin resistance index levels (r< 0,P< 0.05), and positively correlated with high-density lipoprotein levels (r> 0,P< 0.05). Fusicatenibacter was negatively correlated with tumor necrosis factor-alpha (r= -0.211,P= 0.044), and Lachnoclostridium was positively correlated with body mass index, alanine aminotransferase, aspartate aminotransferase levels (r> 0,P< 0.05). Fusobacterium was positively correlated with aspartate aminotransferase level (r= 0.245,P= 0.019). Escherichia-shigella was positively correlated with fasting blood glucose, low-density lipoprotein, alanine aminotransferase, aspartate aminotransferase levels (r > 0,P< 0.05). Megamonas was negatively correlated with high-density lipoprotein levels (r= -0.231,P= 0.027). Conclusion: A structural change of gut microbiota had occurred in patients with NAFLD, suggesting changes in some of these bacterial genuses had relation to insulin resistance and inflammatory response, which may become a new target for the treatment of NAFLD.

Genetic variations of three important antioxidative enzymes SOD2, CAT, and GPX1 in nonalcoholic steatohepatitis.

Nonalcoholic steatohepatitis (NASH) is becoming a common cause of liver cirrhosis requiring liver transplantation (LT). Cardiovascular complications related to metabolic syndrome and NASH recurrence in the transplanted liver may affect the outcome of LT in these patients. We compared the outcomes of LT for NASH cirrhosis and alcoholic cirrhosis (ETOH) in a large transplant center. A retrospective chart review was performed for all patients who underwent LT for cryptogenic cirrhosis with the NASH phenotype (the NASH group) or ETOH (the ETOH group) at the University of Miami from January 1997 to January 2007. There was no significant difference in survival between the NASH and ETOH groups, despite a trend toward lower survival in the former (P = 0.1699). Sepsis was the leading cause of posttransplant death in both groups, and it was followed by cardiovascular causes in the NASH group (26% versus 7% in the ETOH group, P = 0.21) and malignancies in the ETOH group (29% versus 0% in the NASH group, P = 0.024). Recurrent steatohepatitis (33% versus 0%, P < 0.0001) and acute rejection (41% versus 23%, P < 0.023) were significantly more frequent in the NASH group than in the ETOH group. There was no difference in graft failure between the groups (24% in the NASH group versus 18% in the ETOH group, P = 0.3973). In conclusion, despite a numerical trend favoring the ETOH group, there were no statistically significant differences in posttransplant survival and cardiovascular mortality between the NASH and ETOH groups. Acute rejection and recurrent steatohepatitis were significantly more frequent in the NASH group but did not lead to higher rates of retransplantation.

To investigate the role of myosin light chain kinase (MLCK) in intestinal barrier function in a mouse model with nonalcoholic steatohepatitis (NASH). The C57BL/6 mice were randomly divided into five groups including control group, nonalcoholic fatty liver (NAFL) group, NAFL administrated with MLCK inhibitor ML-7 group, nonalcoholic steatohepatitis (NASH) group, NASH administrated with ML-7 group. Plasma ALT and AST were tested. The degree of liver steatosis was assessed by hematoxylin-eosin staining on liver tissue sections.Intestinal mucosal tight junction was observed by electron microscope. The expression of MLCK on intestinal mucosa was detected by immunohistochemistry staining. The level of lipopolysaccharide (LPS) in portal vein was determined by enzyme linked immune sorbent assay (ELISA). The protein and mRNA expression of inflammatory cytokines in liver tissue were tested using ELISA and real-time PCR. MLCK expression in intestinal mucosa was increased in NASH group compared with control group (P<0.01). The tight junctions of intestinal barrier were disrupted in NASH group and intercellular space was larger than control group [(26.60 ± 1.20) nm vs (14.90 ± 0.33) nm, P<0.05], which were improved after ML-7 administration [(14.9 0 ± 0.67) nm]. The LPS in portal vein was higher in NASH group than control group [(7.260 ± 3.184) U/L vs (2.962 ± 0.845) U/L, P<0.05], suggesting that the permeability of intestinal barrier was impaired, however the level of LPS was reduced by ML-7 [(3.772 ± 1.033) U/L, P<0.05]. ALT and AST in plasma, TNFα and IL-6 in liver tissue, the mRNA levels of TNFα and NF-κB in liver tissue were all elevated in NASH group compared with control group (all P<0.05), which were reduced by MLCK inhibitor ML-7. Epithelia MLCK probably plays a role in intestinal barrier impairment, which is critical to the pathogenesis of NASH.

[Objective] We aimed to evaluate the effectiveness of sound touch elastography (STE) in diagnosing nonalcoholic fatty liver disease (NAFLD). [Methods] A total of 58 patients with nonalcoholic fatty liver (NAFL) and 37 with nonalcoholic steatohepatitis (NASH) were enrolled between January 2018 and January 2023. These patients were assigned to the NAFL and NASH groups, respectively. Additionally, 39 healthy volunteers were selected as the control group. All participants underwent liver STE and sound touch quantification (STQ) examinations. Receiver operating characteristic (ROC) curves were used to compare diagnostic performance among the three groups.[Results] There were significant differences in STE and STQ values among the three groups (P &lt; 0.001). The areas under the ROC curve (AUC) for STE and STQ were 0.833 and 0.710, respectively, between the control and NASH groups; 0.725 and 0.668 between the NASH and NAFL groups; and 0.607 and 0.534 between the control and NAFL groups.[Conclusions] STE and STQ values were significantly higher in the NASH group than in the NAFL and control groups. Additionally, STE values in the NAFL group were higher than those in the control group. STE showed good diagnostic performance in identifying both NAFL and NASH and in distinguishing between the two. The combination of STE with two-dimensional ultrasonography offers significant value in the differential diagnosis across the NAFLD spectrum and is worthy of clinical application and further promotion.

Evaluation and management of non-alcoholic steatohepatitis

Purpose: Non-alcoholic steatohepatitis (NASH) has been associated with increased cardiovascular disease (CVD) risk compared with individuals without NASH. Recently, the neutrophil/lymphocyte (N/L) ratio and the mean platelet volume (MPV) have been proposed as independent predictors and risk factors of CVD. In this study, we evaluated whether the N/L ratio and MPV provided any additional benefit to the more traditional lipid biomarkers of CVD in a well characterized cohort of NASH patients. Methods: We compared biopsy proven NASH patients with a control group of subjects with no evidence of fatty liver on imaging or who had a normal liver biopsy. Subjects with gastric bypass surgery were excluded. The groups were matched 1:1 based on age, body mass index, gender, diabetes and hypertension. The groups were compared on different indirect markers of cardiovascular risk. Results: There were 93 subjects in each group. Both groups had 50 (53.8%) females. The mean age was 50.4 (+10.5) years in the control group and 50 (+10.9) years in the NASH group. The mean body mass index was 33 for both groups with 73 obese subjects in the control group and 72 in the NASH group. The groups had diabetes present in 32% and hypertension in 48%. The NASH group had significantly lower high density lipoprotein (HDL) levels (45+12.6 mg/dL vs. 52.6+12.9 mg/dL; p <0.002) and higher triglyceride (TG) levels (152 [108, 195] mg/dL vs. 109 [68, 177] mg/dL; p=0.015). The NASH group had a lower N/L ratio (NASH 2.2+1.3 vs. controls 2.8+1.8; p=0.021). There was no significant difference in MPV between the two groups (NASH 10.8+0.92 vs. controls 10.5+0.91; p=0.097). SH patients have increased CVD risk factors but the newly proposed complete blood cell count biomarkers of CVD, N/L ratio and MPV, provide no additional benefit over the more traditional lipid biomarkers.Table: Cardiovascular risk measures

The analysis of lipid metabolism indicators (total cholesterol (TC), triglycerides (TG), high and low density lipoproteins (HDL, LDL), alanine aminotransferase (ALT) activity, aspartate aminotransferase (AST) and vitamin D level (25 (OH) D) by enzyme immunoassay was carried out ) in 75 patients with non-alcoholic fatty liver disease (NAFLD) in combination with osteoarthritis (OA), depending on the stage of NAFLD. The patients were divided as follows: Group IA - 24 (57.1%) patients with non-alcoholic fatty hepatosis (NAFH), IIB - 18 (42.9%) patients with non-alcoholic steatohepatitis (NASH); Group II (comparison group) - 33 (44.0%) patients with OA without NAFLD. All patients showed a decrease in the level of 25 (OH) D, which is more pronounced, with a combination of NAFLC and OA, especially at the stage of steatohepatitis: insufficiency and deficiency of vitamin 25 (OH) D were found in 46 (61.33%) and 29 (38.66%) cases in both groups of patients, respectively (p &lt;0.05). In patients of group II, the 25 (OH) D level was (26.41 ± 1.04) ng/ml, which was lower than in healthy subjects on 27.18% (p &lt;0.05); deficiency of vitamin D was found in 21 (63.63%) cases, deficiency - in 12 (36.36%) cases. A reduced level of vitamin 25 (OH) D is combined with lipid metabolism disorders, as indicated by inverse correlations between the level of total cholesterol, triglycerides and the level of 25 (OH) D. When assessing the indicators of the lipid spectrum of the blood, a significant increase in the level of TC by 44.08% (group IA), 61.62% (group IB) and 24.88% (group II), respectively, compared with healthy persons (p &lt;0,05). The level of TG in patients with NASH was 2.37 times higher than in healthy people (p&lt;0.05); 2.12 times compared with patients with OA (p1&lt;0.05) and 1.3 times compared with patients with IA group (p2&lt;0.05). The content of low density lipoproteins (LDL) in patients of group IA was 1.8 times higher than in healthy patients; in the IB group - 2.02 times; in the second group - 1.07 times (p&lt;0.05). In patients with IB group with NASH, the level of LDL cholesterol was 89.12% higher than in patients with OA (p1&lt;0.05). In contrast, high density lipoproteins (HDL) were lowest in patients with NASH. Comparing this indicator with the level in healthy people, it was reduced by 35.34% (IA group) (p&lt;0.05); by 42.24% (IB group) (p&lt;0.05) and by 17.24% (group II) (p&lt;0.05). In patients with NAFH and NASH, the level of HDL was reduced by 21.87% and 30.20%, respectively, compared with the level of patients with OA (p1&lt;0.05). In NASH, this indicator tended to decrease compared with patients with NAFL (p2&lt;0.05). We found a significant increase of AST level at 1.7; at 3.8; at 1.3 times in IA; IB and II groups, respectively, compared with healthy persons (p&lt;0.05). In the presence of NASH, the AST level was higher than in patients with OA at 2.8 times (p1&lt;0.05), in the presence of NAFH – at 2.2 times (p1&lt;0.05). A similar direction of changes was found in the analysis of ALT activity, which was more pronounced in patients with NASH (p&lt;0.05). In particular, in patients with NASH, an inverse correlation was found between the level of TC and 25 (OH) D (r = -0.7885, p = 0.0008) and an inverse correlation between the level of TG and 25 (OH) D (r = -0.6814, p = 0.0004). An inverse correlation was established between the serum level of vitamin 25 (OH) D and indicators of the functional state of the liver (AST and ALT) in patients with NAFLD in combination with OA (r = -0.7687, p = 0.0007) і (r = -0, 7882, p = 0.0006), respectively.

An Oscillospira decrease coupled to a 2-butanone up-regulation and increases in Ruminococcus and Dorea were identified as gut microbiota signatures of NAFL onset and NAFL-NASH progression, respectively. (Hepatology 2017;65:451-464).

Nonalcoholic fatty liver disease (NAFLD) is a metabolic disorder characterized by excessive triglyceride accumulation in hepatocytes. NAFLD has a multifactorial etiology and a combination of environmental, genetic and metabolic factors play a role in the development of advanced disease. NAFLD consists of a wide spectrum of conditions, ranging from simple steatosis to nonalcoholic steatohepatitis (NASH) which can progress to cirrhosis and hepatocellular carcinoma (HCC). Despite the high prevalence and severity of hepatic illness, NAFLD remains underdiagnosed, because of few symptoms, lack of accurate laboratory markers. The accurate diagnosis of NASH remains dependent on specific histological parameters in liver biopsy. Although liver biopsy remains the ‘gold standard’, there are practical limitations, including costs and risks. There is an increasing requirement for simple, less invasive, highly accurate and affordable screening tools. Aspartate aminotransferase (AST) has been proposed as a noninvasive and available marker for assessment of NASH. A hospital based observational study was carried out for a period of two years in the Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. Data were analyzed by SPSS version 16. Qualitative and quantitative data were analyzed by Chi-square test and student’s t-test respectively. Fifty (50) patients were analysed. Twenty five were NASH and twenty five were non- NASH. AST in NASH group were 55.2 ± 30.1 IU/L and in Non-NASH group were 33.6± 20 IU/L. In NASH group significantly higher percentage of raised AST had NASH compared with normal AST (68% vs.32%).There was significant difference in the NAFLD activity score for diagnosing NASH between elevated and normal AST (P value 0.004). Higher AST values correlated with higher specificity. By multivariate analysis AST were found to be significant. Thus Aspartate aminotransferase (AST) is a good predictor for diagnosing non- alcoholic steatohepatitis (NASH).&#x0D; Bangladesh Med J. 2019 Jan; 48 (1): 44-49