From the Research
Yes, you can have fatty liver disease with normal liver enzymes, as studies suggest that up to 80% of people with fatty liver may have normal enzyme levels. This is quite common, as many people with fatty liver disease, especially in its early stages, show no elevation in liver enzymes like ALT and AST 1. The absence of elevated liver enzymes does not rule out the presence of fatty liver disease, as fat accumulation can occur without causing immediate cell injury. Diagnosis often requires imaging tests like ultrasound, CT scan, or MRI to detect fat in the liver, regardless of enzyme levels. Even with normal enzymes, fatty liver disease can still progress to more serious conditions like NASH (non-alcoholic steatohepatitis) or cirrhosis if left unaddressed. Some key points to consider:
- Fatty liver disease is the most common cause of chronically elevated liver enzymes, but normal liver enzymes do not exclude the diagnosis 2.
- Nonalcoholic steatohepatitis (NASH) is a particular health concern due to the increased morbidity and mortality associated with progressive disease 3.
- Lifestyle modifications including weight loss, regular exercise, avoiding alcohol, and managing conditions like diabetes and high cholesterol are the primary treatments, regardless of enzyme status.
- Regular monitoring is important even with normal enzymes, as the disease can silently progress 1. It's also worth noting that some studies have investigated the role of noninvasive biomarkers in diagnosis and risk stratification in nonalcoholic fatty liver disease, which may help identify patients with moderate or advanced fibrosis 1. However, the most recent and highest quality study on this topic is from 2020, which highlights the importance of noninvasive biomarkers in diagnosing and managing fatty liver disease 1.