Spectrum of NAFLD and diagnostic implications of the proposed new normal range for serum ALT in obese women

Sachin S. Kunde, Audrey J. Lazenby, Ronald H. Clements, Gary A. Abrams

Research output: Contribution to journalArticle

142 Citations (Scopus)

Abstract

The upper limit of normal for ALT activity has been recommended to be lowered to ≤30 U/L in men and ≤19 U/L in women. These changes have been suggested to be diagnostically useful in subjects with nonalcoholic fatty liver disease (NAFLD). Our aim was to investigate the prevalence and spectrum of NAFLD with regard to the new ALT guidelines in 233 women with class II/III obesity. We compared our prior reference range for ALT (ULN ≤ 30 U/L in women) with the new standard. Our study demonstrates that only 86 patients (36.9%) would be classified as having normal ALT levels compared with 169 patients (72.5%) by the new and old standards, respectively. In patients with normal ALT activity (new vs. old standard), the prevalence of fatty liver (FL: 39.5% vs 40.2%), portal fibrosis, and steatosis (IPF: 37.2% vs. 33.7%) and nonalcoholic steatohepatitis (NASH: 23.3% vs. 26%) were similar. In comparison, newly defined patients with elevated ALT levels (> 19 U/L) demonstrated an increased prevalence of FL (36%) and IPF (11.6%) but a 23.8% decrease in the prevalence of NASH as compared with the old standard. The sensitivity and specificity for NASH were 42% and 80% (ALT > 30 U/L) compared with 74% and 42% (ALT > 19 U/L). In conclusion, a significant increase in the prevalence of FL and IPF is detected in subjects with elevated ALT levels with the application of the new standard. However, the diagnostic utility for ALT to identify NASH or IPF remains poor, and significant healthcare expenditures may be incurred if this standard is adopted.

Original languageEnglish (US)
Pages (from-to)650-656
Number of pages7
JournalHepatology
Volume42
Issue number3
DOIs
StatePublished - Sep 1 2005

Fingerprint

Reference Values
Serum
Fatty Liver
Health Expenditures
Non-alcoholic Fatty Liver Disease
Fibrosis
Obesity
Guidelines
Delivery of Health Care
Sensitivity and Specificity

ASJC Scopus subject areas

  • Hepatology

Cite this

Spectrum of NAFLD and diagnostic implications of the proposed new normal range for serum ALT in obese women. / Kunde, Sachin S.; Lazenby, Audrey J.; Clements, Ronald H.; Abrams, Gary A.

In: Hepatology, Vol. 42, No. 3, 01.09.2005, p. 650-656.

Research output: Contribution to journalArticle

Kunde, Sachin S. ; Lazenby, Audrey J. ; Clements, Ronald H. ; Abrams, Gary A. / Spectrum of NAFLD and diagnostic implications of the proposed new normal range for serum ALT in obese women. In: Hepatology. 2005 ; Vol. 42, No. 3. pp. 650-656.
@article{2f12a9ce6cdf4f03840f0819697832e0,
title = "Spectrum of NAFLD and diagnostic implications of the proposed new normal range for serum ALT in obese women",
abstract = "The upper limit of normal for ALT activity has been recommended to be lowered to ≤30 U/L in men and ≤19 U/L in women. These changes have been suggested to be diagnostically useful in subjects with nonalcoholic fatty liver disease (NAFLD). Our aim was to investigate the prevalence and spectrum of NAFLD with regard to the new ALT guidelines in 233 women with class II/III obesity. We compared our prior reference range for ALT (ULN ≤ 30 U/L in women) with the new standard. Our study demonstrates that only 86 patients (36.9{\%}) would be classified as having normal ALT levels compared with 169 patients (72.5{\%}) by the new and old standards, respectively. In patients with normal ALT activity (new vs. old standard), the prevalence of fatty liver (FL: 39.5{\%} vs 40.2{\%}), portal fibrosis, and steatosis (IPF: 37.2{\%} vs. 33.7{\%}) and nonalcoholic steatohepatitis (NASH: 23.3{\%} vs. 26{\%}) were similar. In comparison, newly defined patients with elevated ALT levels (> 19 U/L) demonstrated an increased prevalence of FL (36{\%}) and IPF (11.6{\%}) but a 23.8{\%} decrease in the prevalence of NASH as compared with the old standard. The sensitivity and specificity for NASH were 42{\%} and 80{\%} (ALT > 30 U/L) compared with 74{\%} and 42{\%} (ALT > 19 U/L). In conclusion, a significant increase in the prevalence of FL and IPF is detected in subjects with elevated ALT levels with the application of the new standard. However, the diagnostic utility for ALT to identify NASH or IPF remains poor, and significant healthcare expenditures may be incurred if this standard is adopted.",
author = "Kunde, {Sachin S.} and Lazenby, {Audrey J.} and Clements, {Ronald H.} and Abrams, {Gary A.}",
year = "2005",
month = "9",
day = "1",
doi = "10.1002/hep.20818",
language = "English (US)",
volume = "42",
pages = "650--656",
journal = "Hepatology",
issn = "0270-9139",
publisher = "John Wiley and Sons Ltd",
number = "3",

}

TY - JOUR

T1 - Spectrum of NAFLD and diagnostic implications of the proposed new normal range for serum ALT in obese women

AU - Kunde, Sachin S.

AU - Lazenby, Audrey J.

AU - Clements, Ronald H.

AU - Abrams, Gary A.

PY - 2005/9/1

Y1 - 2005/9/1

N2 - The upper limit of normal for ALT activity has been recommended to be lowered to ≤30 U/L in men and ≤19 U/L in women. These changes have been suggested to be diagnostically useful in subjects with nonalcoholic fatty liver disease (NAFLD). Our aim was to investigate the prevalence and spectrum of NAFLD with regard to the new ALT guidelines in 233 women with class II/III obesity. We compared our prior reference range for ALT (ULN ≤ 30 U/L in women) with the new standard. Our study demonstrates that only 86 patients (36.9%) would be classified as having normal ALT levels compared with 169 patients (72.5%) by the new and old standards, respectively. In patients with normal ALT activity (new vs. old standard), the prevalence of fatty liver (FL: 39.5% vs 40.2%), portal fibrosis, and steatosis (IPF: 37.2% vs. 33.7%) and nonalcoholic steatohepatitis (NASH: 23.3% vs. 26%) were similar. In comparison, newly defined patients with elevated ALT levels (> 19 U/L) demonstrated an increased prevalence of FL (36%) and IPF (11.6%) but a 23.8% decrease in the prevalence of NASH as compared with the old standard. The sensitivity and specificity for NASH were 42% and 80% (ALT > 30 U/L) compared with 74% and 42% (ALT > 19 U/L). In conclusion, a significant increase in the prevalence of FL and IPF is detected in subjects with elevated ALT levels with the application of the new standard. However, the diagnostic utility for ALT to identify NASH or IPF remains poor, and significant healthcare expenditures may be incurred if this standard is adopted.

AB - The upper limit of normal for ALT activity has been recommended to be lowered to ≤30 U/L in men and ≤19 U/L in women. These changes have been suggested to be diagnostically useful in subjects with nonalcoholic fatty liver disease (NAFLD). Our aim was to investigate the prevalence and spectrum of NAFLD with regard to the new ALT guidelines in 233 women with class II/III obesity. We compared our prior reference range for ALT (ULN ≤ 30 U/L in women) with the new standard. Our study demonstrates that only 86 patients (36.9%) would be classified as having normal ALT levels compared with 169 patients (72.5%) by the new and old standards, respectively. In patients with normal ALT activity (new vs. old standard), the prevalence of fatty liver (FL: 39.5% vs 40.2%), portal fibrosis, and steatosis (IPF: 37.2% vs. 33.7%) and nonalcoholic steatohepatitis (NASH: 23.3% vs. 26%) were similar. In comparison, newly defined patients with elevated ALT levels (> 19 U/L) demonstrated an increased prevalence of FL (36%) and IPF (11.6%) but a 23.8% decrease in the prevalence of NASH as compared with the old standard. The sensitivity and specificity for NASH were 42% and 80% (ALT > 30 U/L) compared with 74% and 42% (ALT > 19 U/L). In conclusion, a significant increase in the prevalence of FL and IPF is detected in subjects with elevated ALT levels with the application of the new standard. However, the diagnostic utility for ALT to identify NASH or IPF remains poor, and significant healthcare expenditures may be incurred if this standard is adopted.

UR - http://www.scopus.com/inward/record.url?scp=24144481800&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=24144481800&partnerID=8YFLogxK

U2 - 10.1002/hep.20818

DO - 10.1002/hep.20818

M3 - Article

C2 - 16037946

AN - SCOPUS:24144481800

VL - 42

SP - 650

EP - 656

JO - Hepatology

JF - Hepatology

SN - 0270-9139

IS - 3

ER -