Fibrosure Tests

[adamsp27]

Hi, wanted to get some feedback on what my next step should be. My RUQ continues to be painful, nothing crazy but just a nagging feeling and seems to be getting slightly worse over time. Now I have been making moderate changes to my diet, scores and weight (6’6, 230 – down from 250) but it doesn’t seem to be helping much. My doctor doesn’t seem to be overly concerned and I saw my gastrologist once prior to COVID and he didn’t seem to be concerned either. Now my problem is I have made adjustments to my diet/drinking but I don’t want to take extreme measures if it is unnecessary but if I am at serious risk I am very willing to do so. I have had an ultrasound, CT and two fibrosure tests (outcomes below) and was hoping to get guidance on what I should do next? I was considering the liverfast test but wasn’t sure if there was something I should consider instead? Seems like my scores improved? While my Dr. isn’t overly concerned he is willing to recommend any test to insurance. The most recent test is the first column from June 2021 and the second is from January 2020. My concern is that NASH is still at .50? Is my AST/ALT ratio a concern since it is over 1?

Fibrosis Score .16 .13

Steatosis .38 .67

NASH .50 .50

Weight 233 245

Height 6’6 6’6

ALT 18 38

AST 23 27

[bonardi]

I have the same pain all the time.I am going to do the Fibrofast.test and see how things are progressing.I try my best to eat healthy minimum sugar only one teaspoon in morning coffee..I eat lots of vegetables and only chicken or fish..I feel better sometimes..this liver issues is really a pain in our life.but we have to stay positive..keep talking to your doctor..and do your best at living a normal life good luck praying for us all..

[vandelay]

Your AST and ALT are within normal range so I don’t see any reason to worry about that. I am not familiar with the rest of the tests so I can’t comment on that.

[nash2 Partner]

Well Adam, you are in the hard to know area. If I read this right you have lost some weight and that has helped your liver fat a bit but there is a good chance you are early stage NASH and your fibrosis may be increasing. You might try calculating your Fib-4 score. A low cutoff would say you probably don't need more tests.

fattyliverfoundation.org/fi...

If Fib-4 is higher, since you've had the normal things, I'd see if I could get a Liver MultiScan which is an MRI based test that will really provide the best guidance. In either case, if you are dealing with NASH you should consider not drinking and taking a good look at your lifestyle.

Wayne

[adamsp27 in reply to nash2]

Thanks everybody for the responses. I calculated the Fib-4 score and it was .99 so seems like it is in the normal range. So not really sure what to do next.

[nash2 Partner]

In your weight loss program you are just approaching the range where you have a chance to reduce the damage you have done so best to stay the course. If you are not having some other problem you will probably have some response in a year or so but ideally you should probably lose another 20 pounds. Only bad things happen quickly so patience and being steady are the key. A lot of docs would say that your AST/ALT ratio suggests you have used more alcohol than is good for you. The research is not really entirely clear but food for thought if that is part of your lifestyle.

[Troutwhisperer]

NASH2 is most knowledgeable. His advice always seems to make sense.

Stay the course and you will likely see a benefit.

Best Wishes,

Troutwhisperer

[Whybother]

Just wanted to make a general point on this thread.

I've seen a lot of speculation about the significance of AST/ALT ratio when enzyme values are in the normal range. I'm no expert but have looked around since my ratio has been between 1-1.5 with normal level values (currently 16 AST to 11 ALT) for many years. I've worried a lot since I have some RUQ discomfort and an US found mild fatty liver indications.

But as far as I can tell -- this ratio mostly helpful when one or both enzyme levels are clearly elevated and/or in the context of recent heavy alcohol use since it is believed that the mechanism for the selective AST elevation is an alcohol-related nutritional deficit in vitamin B6. You mostly see these ratios reported for unhealthy people which is why alcoholic LD patients show elevations relative to NAFLD patients, but that is because ALT is often more strongly elevated in NAFLD. When you look for AST/ALT ratios in health control groups (i.e., with normal enzyme levels) they are often > 1. Here are a couple references.

ncbi.nlm.nih.gov/pmc/articl...

pubmed.ncbi.nlm.nih.gov/217...

And here's a graph showing AST tends to be higher than ALT in healthy subjects (in this case adolescents, but seems to apply to adults too).

Graph showing AST values lower than ALT