ArticleThe American journal of the medical sciences2024
ALT poorly predicts Nonalcoholic Fatty Liver Disease (NAFLD) and liver fibrosis as determined by vibration-controlled transient elastography in adult National Health and Nutrition Examination Survey 2017-2018.
Article in The American journal of the medical sciences, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 1 of them a synthesis that pooled it.
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Who cites it
9 citing papers in PubMed, 1 synthesis or guideline pooled it, 8 citations in OpenAlex.
- The impact of dietary interventions on liver health biomarkers in individuals with metabolic dysfunction-associated steatotic liver disease (MASLD): a systematic literature review and meta-analysis of randomized controlled trials.European journal of nutrition · 2026Pooled it
- Reimbursement restrictions reduce liver fibrosis screening in adults with diabetes in Ontario: a population-based interrupted time series analysis.Scientific reports · 2026Article
- Discordance Between Conventional Ultrasound and Transient Elastography in Hepatic Steatosis Assessment: Clinical Factors Associated with Discrepant Findings.Diagnostics (Basel, Switzerland) · 2026Article
- Imaging-based fibrosis assessment and risk stratification in MASLD.Frontiers in medicine · 2026Review
- Optimal cutoff values of alanine aminotransferase and its derived markers for pediatric MASLD.Frontiers in endocrinology · 2026Article
- Applicability of attenuation imaging and shear wave elastography in non-invasive assessment of liver steatosis and fibrosis in adult patients.Polish journal of radiology · 2026Article
- Correlation between liver stiffness measurement and hepatocellular carcinoma risk: A case control study.Bioinformation · 2026Article
- Efficient and Specific PDGFRβ-Targeting Dual-Mode TAdvanced science (Weinheim, Baden-Wurttemberg, Germany) · 2025Article
- Predictive Value of the Chinese Visceral Adiposity Index for Metabolic Dysfunction-Associated Fatty Liver Disease and Elevated Alanine Aminotransferase Levels in Nonobese Chinese Adults: A Cross-Sectional Study.Journal of inflammation research · 2024Article
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Authors and funding
5 authors at 2 institutions in 1 country.
Funding
Abstract
backgroundNon-alcoholic fatty liver disease is a growing problem in the United States, contributing to a range of liver disease as well as cardiovascular disease. ALT is the most widely used liver chemistry for NAFLD evaluation. We hypothesized that the normal range many laboratories use was too high, missing many patients with clinically important steatosis and/or fibrosis.
methodsThis study utilized 2017-2018 NHANES data including 9254 participants. We compared four different upper limits of normal for ALT with specific measurements of steatosis and liver stiffness as determined by liver elastography with FibroScan®. Liver stiffness was further characterized as showing any fibrosis or advanced fibrosis. After exclusions, our final pool was 4184 for liver stiffness measurement and 4183 for steatosis grade as measured by Controlled Attenuation Parameter (CAP). Using these variables, we performed logistic regression between ALT and CAP, and ALT and fibrosis/advanced fibrosis, and did a Receiver Operating Characteristic curve.
resultsBased on three of the most widely used cut off values for ALT, we found that ALT does not reliably rule out NAFLD in over 50% of cases. It also missed 45.9-64.2% of patients with liver fibrosis.
conclusionsOur study revealed that ALT is an inaccurate marker for NAFLD as measured by FibroScan® with CAP greater than or equal to 300 dB/m. Accuracy improved specific risk factors were considered. These data also showed that ALT was a poor marker for liver fibrosis. We conclude that there is no single ALT level that accurately predicts hepatic steatosis or fibrosis.
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