Profile of liver enzymes in non-alcoholic fatty liver disease in patients with impaired glucose tolerance and newly detected untreated type


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. [1] 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. [2] 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.[3] 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).


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46 Replies

  • Activity2004

    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, which should prompt clinicians to initiate further diagnostic work-up. Novel cut-offs for liver enzymes are warranted in order to prevent unnecessary diagnostic work-ups as well as early detection of NAFLD to reduce the risk of cirrhosis, hepatocellular carcinoma and CVD in T2DM and IGT patients.

  • Thanks, suramo for the information.

  • People don't accumulate fat because they eat more and exercise less. People accumulate fat because of influence of INSULIN (which no "balanced diet" proponent ever talks). What kicks up INSULIN? Simple answer CARBS the most and so called balanced diet is 60% CARBS. So, INSULIN holds the answers.

    And, to make matters worse, FRUCTOSE (read fruits) is considered healthy. Some even suggested eating 2 mangoes a day. Double whammy.

  • FollowMessage

    suramo-You have obviously presented very valuable data.As a service others,please interpret the data for the benefit of all.

  • ramana42

    Recently i had an interaction with a renown diabetologist affiliated to Apollo hospital. He didn't know that ggt levels in nafld is an important diagnotic as well as prognostic tool. Since then i was looking for an article that can explicitly convey the role of various liver enzymes. It's become clear from the article that

    1) nafld is not a benign condition

    2) alt and ggt levels are raised in nafld associated with t2d and igt.

    3) so far usg and liver biopsy were considered the main diagnostic procedures but now enzyme study can replace an invasive liver biopsy.

    If you have anything more to know we may discuss that out.

  • jan-ran is a live example of what a LC diet can do to ggt.

    Even her expert doctors were surprised as she dropped from 254 U/L. to double digits per her last feedback :)

  • anup

    Yes i know about jan ran. Docs are same everywhere. Don't want to update though have to deal with one subject only 😳😳

  • But, you are a different doctor altogether. A Doctor who reads what a non doctor like me and others had to say, updated knowledge based on literature available and then took the plunge. :)

  • Anup

    Thanks for saying that. 😜

  • Well, ask anyone here who knows you and (s)he would say you deserve all the praise. :)

  • 👍👍

    HU jo dimaag ki batti jala de 😃😃😆😆😝😝😝

  • Dimag ki dahee bhi hotee hai yahin par :D :D :D

  • suramo-a simple question from a lay man.Please correct me if I am wrong.In our digestive system.proteins get digested in the stomach,fats by the liver,carbohydrates in small intestine and fiber in the in large intestine.Can I presume that a balanced diet will help in optimal utilization of all these organs,thereby ensuring that conditions like NFALD are avoided.Is overloading a particular segment cause any complication?

  • ramana42

    Carb digestion starts in mouth. That why loaf tastes sweet on long mastication.

    Stomach is for storage, sterilisation and partial digestion by acid.

    Protein and fat digestion starts from doudenum with the liver and pancreatic enzymes - different than hormones produced by the pancreas. Digestion and absorption continues all throughout the length of small intestine.

    Large bowels mainly for storage of solid waste from food and fibre digestion and production of vit k etc.

    After digestion the carbs, proteins and fats are converted to basic units like glucose, amino acids and fatty acids. It's these basic units that then are converted to various carbs proteins and fats inside our body. Balanced diet is fine but for those who have balanced health and can utilize the food efficiently. For us balanced food is lchf. Apart from vitamins, minerals etc.

  • Great Information bhai suramo

    I always thought my diabetes is due to my fatty liver condition... in my progress report I always mentions my SGPT and SGOT level...

    When our friend Shashikantiyengar achieved remarkable 4.8 Hba1c I looked at his SGPT and SGOT levels... and they were down below 18.(I think around 15).

    I think for PPBS we have low carb diet... but for FBS...we need to focus on liver.

  • cure

    Ya big bro. But i'd love to hear your story. You say you had nash when diagnosed D. Also you reduced your waist circumference by 8". That's a wonderful thing you achieved. How ? Also nash is an advanced diseses with lots of liver fibrosis. Please tell us your story.


  • Bhai suramo there is no story...sometime around 2007 during routine abdominal USG came out Fatty Liver-Nash.

    So I asked doctor about same...he said weight reduction..and exercise will help you...also told me not to worry much about same... It is reversible ..(suggested no treatment,no seriousness-may be he himself was not aware about seriousness about same)

    next year I had blood pressure..and they put me on Telmisartan(40mg)..I kept on enjoying my life...heavy sweets..lots of fruits...

    in 2015 again they told me IGT...My fasting was high (130)..but PP was within limit...(around 140) only once I crossed 150 mark(with high carb diet- break fast pohe/upama,lunch 4 chaptis and rice)

    In jan 2016 full blown Diabetes..with 13.4 Hba1c..fasting 298 pp 398

    was in very depressed if lost everything...and landed here...

    then @anup was fighting with full vigor and advocating LCHF...I started reading about low carb...and found same logical...

    About is practiced in home for many was acquainted with herbs and herbal preparation...also during my hobby for dog breeding met many horse breeders..alongwith them tried many herbal formulations on race horses...for which did bit reading about 'Shalihotra'(Ayurveda for Horses).

    Now, about 3 months ago again went for USG..and report says mild fatty liver with mild fatty pancreas.

    Also met one leading doctor from Pune and had discussion with him(he saved my cousin who went in hepatic coma due to heavy drinking) he suggested me for fibrosis scan...which I will get done soon..

    But to my understanding.. for fatty liver we must remove the cause my case it was high carbs consumption and high fruits consumption.I stopped that.

    Now there are many herbs which will help your liver ( besides herbs we don't have any other option to help liver)

    So started amba haldi and haldi pickle..garlic...and trikatu churna..also c vit and e vita doses...

    As Shashikantiyengar suggested started Milk thistle...but then shifted to Livd 38.Now may try Totala kwath. (Shyonak-Oroxylum indicum)

    started losing weight and waist....still losing weight and waist....

    Thanks to anup..and HU...

    You rightly said....HU jo dimag ki batti jala de...

  • cure

    So you didn't have nash. Was nafld. Nash is late stage with lots of fibrosis. Did you get ggt level done ever? Herbs are for self satisfaction. But no harm taking them as long as you consider panacea for D and fatty liver. Nothing works if you continue a high carb diet.

    Great achievement.

  • yeah...ggt was very never high.... u can check my reports here in forum

  • cure

    Ye. Nash would not have reversed. Liver transplant is the answer.

  • suramo Let us see what results I will get in fibro scan...

  • cure

    Only liver biopsy gives confirm diagnosis. I wouldnt advocate. Ggt levels are good enough. Ggt more than 30 is diagnostic.

  • hmmm Bhai suramo I think they should recheck these standard values once again...

    As they suggested Hba1c 6 is ok...on similar lines I think standard values should be further low...

  • cure

    Can't say anything on that issue.

  • cure

    Highly speculative.

  • May be you are true...I never had NASH..may be wrong diagnosis...

    With going low carb and fruit less...we have removed the cause... Now how we can speed up healing process???

    Leaving our liver a very vital organ to nature healing is not good thing...

    Unfortunately..till now we do not have any approved treatment for treating fatty liver..

  • cure

    Only fructose and t2d igt are the cause. Liver has tremendous capacity to regenerate. After liver transplant the donor liver regenerates in 6 odd months. That's the capacity.

  • Shashikantiyengar

    Please tell us how do you manage to walk 6-8 km daily on low carb diet. I'm now a days experiencing muscle cramps. I think depletion of glycogen - liver and muscle - is the cause. What is your experience?

  • Muscle cramps= potassium issue?

  • Anup

    I take black salt with sol kadhi and spinach juice. But can that have depleted our glycogen storage and be a reason?

  • Potassium is one reason for muscle cramps, besides other things like Magnesium. Take a good multi vitamin with these things and see if that helps.

    Glycogen - No, I don't think so.

  • 👍

    I'm taking vit e - seacod too.

  • Has Mg and Potassium?

  • @Anup

    Seacod is vit e. K from rock salt. Mg from bhaji and vegetables. I have been prescribing potklor and vit e for leg cramps. Mg is a trace element we get from many sources. Even tap water has enough quantity. I drink tap water only.

  • Maybe just for experimentation, try a MV which has both and see if that helps.

  • @Anup


  • Night and early morning leg muscles cramps was common earlier

    Started a supplement magnesiumn glycinate which is chelated mg 100mg per day

    Doctors best brand from eBay

    No more cramps now.

    Read at a few sites that mg deficiency is common now and that even soil is depleted of mg

    Diabetics Are also found to have less mg levels

    So started off.

  • Bhai suramo guess your muscle cramps are may be due to hypo caloric diet...

  • cure

    Low carb cause glycogen depletion imho. I'm not taking very low calorie now a days. My weight 68kg for last 3-4 months.

  • Bhai suramo if Glycogen is fully depleted...then Fasting sugar should be sub 100...

    अश्वगंधा और शिलाजीत खाओ ...नवयौवन फार से पाओ ;)

  • 👍

  • I took magnesium for leg calf cramps

  • Shashikantiyengar

    Yes. Potassium and mg are good. I wanted to hear about glycogen depletion. My leg cramps were due to viral fever which exhibited fully for 2-3 days. Now no cramps after taking antihistaminics.

  • This is an oversimplification, ramana42, but it will do. You're right, you can look at it as overloading a segment. The body always looks for balance - homeostasis - in everything. For example, calcium-magnesium, sodium-potassium, rest-work, carbs-fat-protein, etc. By consuming 'food-like' substances, aka processed foods, we upset this balance and that leads to illness.

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