Non-alcoholic fatty liver disease laboratory findings

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Manpreet Kaur, MD [2]

Overview

There are no specific diagnostic laboratory findings associated with non alcoholic fatty liver disease. Laboratory findings include abnormal liver function tests but are unspecific. Other laboratory tests are generally performed to rule out other diagnosis.

Laboratory Findings

• There is no specific laboratory findings diagnostic for non alcoholic fatty liver disease.
• Liver function tests
  • Typical finding include a 2-4 fold elevation of the ALT 
  • An ALT/AST ratio of greater than 1.

• Evaluation for alternative causes of liver disease should be performed.
  • These include HCV serology, serologies for autoimmune hepatitis, and copper studies including serum ceruloplasmin and 24-hour urinary copper if Wilson disease is suspected.

• Fasting plasma glucose testing following an overnight fast is important to look for hyperglycemia, which is an indicator of insulin resistance.
  • Fasting insulin levels can confirm hyperinsulinemia and insulin resistance
• Lipid levels ( serum cholesterol and fasting triglycerides ) should be evaluated
  • Dyslipidemia, beside being a very common finding in NAFLD, is a risk factor that can be modified by dietary and/or pharmacologic intervention.
• Iron studies (in particular elevated ferritin and transferring saturation) are often abnormal in NAFLD
• Some patients with NAFLD may have low titers of autoimmune antibodies.
• Biomarkers
  • CK18 represents a promising biomarker for evaluation of the presence of NASH.
  • A defining characteristic of NASH is cellular death, and serum CK18 levels had been shown to correlate with steatohepatitis.