The perception of non-alcoholic fatty liver disease (NAFLD) as an uncommon and benign condition is rapidly changing. Approximately, 70% type 2 diabetes mellitus (T2DM) patients have a fatty liver, which may follow an aggressive course with necroinflammation and fibrosis.
To assess the profile of liver enzymes in subjects with impaired glucose tolerance (IGT), new onset treatment naive T2DM and normal glucose tolerance (NGT) with and without NAFLD.
NAFLD was significantly associated with higher alanine aminotransferase (ALT) and gamma-glutamyl transferase (GGT) but not ALP levels in IGT and T2DM patients. ALT, GGT significant correlated with waist circumference, body mass index, fasting insulin, homeostatic model assessment- insulin resistance, fasting blood glucose, high density lipoprotein cholesterol and triglyceride. 57% of NAFLD patients had normal ALT between 25 and 40 U/L, 53% of NAFLD subjects had normal GGT between 15 and 30 U/L. ALT <25 U/L and GGT <15 U/L had highest negative predictivity whereas ALT >40 U/L and GGT > 30 U/L had highest positive predictivity for presence of NAFLD in our study sample.
Mild elevations of liver enzymes in the upper normal range are associated with features of metabolic syndrome and NAFLD even in IGT and recently detected T2DM patients. Novel cut-offs for liver enzymes are warranted in order to prevent unnecessary diagnostic work-ups and early detection of NAFLD to reduce the risk of cirrhosis, hepatocellular carcinoma and classical cardiovascular disease in T2DM and IGT patients.
The prevalence of non-alcoholic fatty liver disease (NAFLD) has doubled during the last 20 years and is the number one cause of liver disease in the western countries. But recent data confirm that NAFLD play an equally important role worldwide.  NAFLD is diagnosed in clinical settings using ultrasound imaging as a liver biopsy is not practically feasible. In developing countries like India, affordability of ultrasound imaging modalities may be a crucial factor. Thus World Gastroenterology Organisation guidelines prescribe a hierarchical resource-sensitive approach.  Aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transferase (GGT) and other markers of liver injury may be useful surrogate measures of NAFLD. NAFLD is closely related to insulin resistance, obesity, metabolic syndrome, and diabetes: Triggers for testing of liver enzymes and considering a diagnosis of NAFLD. We need novel cut-offs for liver enzymes as a qualifying criteria for patients to undergo ultrasonography for detection of NAFLD, but there is a paucity of data from Indian literature in this regard. We studied the profile of liver enzymes in NAFLD in patients with impaired glucose tolerance (IGT) and newly detected untreated type 2 diabetes mellitus (T2DM).