Hello, Male, non-smoker, mid-30's. I recently had some routine lab work done (Lipid Panel, CBC, CMP, etc). I got a call from the doctor explaining that my liver enzymes were elevated, namely the ALT and AST. As I recall, the ALT was 129 and the AST was 65. Everything else looked normal except for the lipid panel. I do not recall the LDL or HDL right off hand but the total was over 200 and the TG was in the mid 300's. I have a history of high cholesterol and hypertension. I am being treated for the latter and have been for many years. My BMI at the time of the blood draw was about 28 and had been that (or more) for some time. I've lost about 13 pounds since then as my doctor has asked that I make some lifestyle changes. Still, my BMI is technically overweight and my waist circumference hovers around 40-41 inches. Even though I don't appear to be overweight in general, I've always had a "gut." My doctor was not entirely concerned about these numbers, given the co-factor of hypertension, hypertrygleridemia, etc. He was pretty sure it was a result of fat infiltration of the liver but said he wouldn't want to consider an U/S until I'd had a chance to make lifestyle changes (lose weight, increase exercise, avoid refined carbs, etc). He gave me a lab request and asked me to have it rechecked in a few months, provided that I stick to the regimen. Also, I'd had my lipids checked earlier this year and they were more in range then - Trig: 120. (I didn't have liver enzymes checked earlier in the year, though). That said, 120 isn't normal for me. My TG, when checked throughout my adulthood, have normally been up. I have a major sweet tooth and can't pass up refined carbs. I have a family history of diabetes. My father weighs less than me and was recently diagnosed with Type 2. His sister had it chronically for most of her life. I know that NAFLD is the most common reason that enzymes are elevated and have read that nearly 30 percent of the US has this, which is on par with the percentages with hypertension and elevated triglycerides as well. Does this sound like NAFLD? I've asked around...doctors online as well. I have great trust in my physician and stand by his recommendation but always value another perspective. Thanks!
The views expressed by me are for educational purposes only and do not establish a doctor patient relationship.
This is Dr. D.J., experienced Internal Medicine Specialist.
I am here to address your concerns and provide great service.
This does sound like NAFLD given the overweight status, high triglycerides.
Now, what is your A1c which gives good idea of blood sugar for 3 mth average?
Also have you been checked for hepatitis panel?
I haven't had my a1c checked. Fasting glucose was normal, though.
ok a1c should be checked.
what about hepatitis panel?
Also, I had a screening for HepB and C earlier this year as part of an unrelated employment screening. I was immunized against Heb B as a child...all three doses.
so that is negative.
To me it is likely fatty liver given your other risk factors.
That said, I never received the results of the screen. But I believe they don't follow-up unless something is abnormal. And, in this situation, they definitely would have.
An ultrasound should be ordered however for confirmation.
ok just confirm in that case.
Is abnormal a1c found in patients with normal fasting glucose that often?
...given that other factors such as mine are present?
yes it can be.
From what I
've read online, NAFLD is the most common cause of elevated liver enzymes but that a progression to NASH is less common and usually only found in morbidly obese patients. Again, I'm simply overweight.
that is correct
your risk is low for progression to cirrhosis.
I could push for the ultrasound, but my doctor seemed to think that option would only be explored if the subsequent labs were abnormal. I guess it all depends on individual doctors. I don't know if there are practice guidelines that dictate this.
And as long as you are not gainnig weight, you will be ok.
and yourr triglycerides can be treated with fish oil supplements.
My TG, as I stated in my initial message, were 120 range earlier this year. It nearly tripled. I'd been eating poorly, mainly refined carbs and sweets. I am a vegan, as well. Which I acknowledge does not make one healthy. Packaged foods are often vegan.
US initially is recommended and then can be repated every year.
fish oil has shown some benefits for NAFLD as well.
Is NAFLD prevalent in the non-obese, though? Or could lack of obesity simply be a mitigating factor, preventing progression? (I realize there are limitation with what you can say)
What about Vitamin E?
yes still seen although less common.
yes vitamin E is also good.
but does not address TG.
can take E and fish oil both
When analyzing labs for NAFLD, I assume - in addition to elevated ALT/AST - that TG would be the next thing. One person I spoke with seemed to indicate that TG was the main factor.
and also abdominal girth or waist circumference.
in other words lose belly fat
Well, I have that. I'm at 40 now and just tried on a jacket last night that I wasn't able to fit last year. I fit it now, which means I'd most likely been over 40 inches last year.
there you go
work on the belly fat only
studies show that helps a lot
Waist to height ratio = I've read that waist should be less than half your height. Would that be accurate?
get a personal trainer if possible
work on belly crunches --etc
waist circumference should be less than 38 in
that is how we go by
in male non asian descent
I'm glad you said that. That's the normal value abroad but it seems that here in the States they keep it at 40.
flexibility require based on ethnicity
tape should rest at the top of the hip bone and circle around level. right?
what is yours?
this morning, I checked. It was 40.5
with exhaled air..
ok so you need to work more --almost there
Thanks very much for your time, Dr. I figured I'd get some more input to indicate fatty liver. I trust my doctor but have always valued others' input.
you are on right tract.
track --I meant
Dr, just one more question if you don't mind. I apologize that it's this far after our initial conversation. I spoke to a family member today and was reminded (I'd totally forgotten) that my aunt had NAFLD and it progressed to NASH, then on to cirrhosis. This was the cause of death. Is NAFLD genetic? She was not morbidly obese. A simple yes or no would suffice. Thanks again.