Surrogate Marker Of Nonalcoholic Fatty Liver Disease Research Articles

Ethnicity and Nonalcoholic Fatty Liver Disease in an Obesity Clinic: The Impact of Triglycerides

Nonalcoholic fatty liver disease (NAFLD) is a growing problem that is associated with the metabolic syndrome. The goal of the present study was to evaluate for ethnic differences in NAFLD and clinical correlates of NAFLD. The study population consisted of 567 patients seen at an urban obesity clinic. Elevated aminotransferase levels were used as a surrogate marker for NAFLD. The prevalence of elevated aminotransferases was highest in Hispanics (39%), followed by Caucasians (28%), and African Americans (12%). In univariate analysis, elevated aminotransferase levels were associated with ethnicity (Hispanic > African American, P < 0.001, and Caucasian > African American P = 0.030), hypertriglyceridemia (P < 0.001), and male gender (P < 0.001). The pattern of results was confirmed in multivariate analysis, except that the differences between Caucasians and African Americans was no longer significant. In conclusion, in an obesity clinic population, elevated aminotransferase levels and hypertriglyceridemia were most common in Hispanics and least common in African Americans.

Reply to Alanine Aminotransferase as an Independent Predictor of Incident Nonalcoholic Fatty Liver Disease

First, the relationship between alanine aminotransferase (ALT) and nonalcoholic fatty liver disease (NAFLD) has not yet been clearly established, although increased liver enzymes are usually used as a surrogate marker of NAFLD. Tagher et al. have also noted that liver enzymes may be within the reference interval in up to 70% of patients diagnosed with NAFLD and that the full histological spectrum of NAFLD may be present in patients with normal liver enzymes. Our observations were therefore novel and have potential importance in understanding the relationship between ALT and NAFLD. Furthermore, several issues need to be clarified about ALT, including the isoforms of ALT and the role of different ALT isoforms in humans (1). Second, regarding the adjustment of confounders, such as insulin resistance, we did not perform this study using the euglycemic clamp and cannot comment on Tagher’s concerns about the interrelation between ALT, NAFLD, and insulin resistance as assessed by the euglycemic clamp …

Alanine Aminotransferase as an Independent Predictor of Incident Nonalcoholic Fatty Liver Disease

We read with interest the recent article by Chang et al. (1) reporting that higher serum alanine aminotransferase (ALT) concentrations, within the reference interval, independently predicted the incidence of nonalcoholic fatty liver disease (NAFLD) during a mean follow-up of 2.5 years in a large cohort of apparently healthy Korean men. Several prospective studies have previously shown that increased ALT concentrations, even within the reference interval, also predict the future development of type 2 diabetes (2) and cardiovascular events (3) independently of other known risk factors. In all of these studies, however, increased ALT concentrations have been used as a surrogate marker of NAFLD. Indeed, increased liver enzymes are usually thought to be a consequence (and not a cause) of liver injury in …