Elevated GGT in steatosis (fatty liver disease)?

From the Guidelines

Elevated GGT is commonly seen in steatosis, particularly in alcoholic liver disease, and can be used as a marker for early detection of chronic alcohol misuse 1.

Causes of Elevated GGT in Steatosis

• Alcoholic liver disease: GGT is usually higher in ALD patients compared to those with other liver diseases 1
• Non-alcoholic fatty liver disease (NAFLD): Elevated GGT can be seen in NAFLD, although it is not specific to this condition 1
• Other causes: Elevated GGT can also be seen in other conditions, such as cholestatic liver disease, chronic hepatitis, and drug-induced cholestasis 1

Clinical Significance of Elevated GGT

• Elevated GGT is associated with increased liver and all-cause mortality, including cancer 1
• GGT can be used as a marker for early detection of chronic alcohol misuse, with a sensitivity of 73% 1
• However, serum GGT activity loses its specificity for alcohol in more advanced liver disease, as its activity is elevated in patients with extensive fibrosis regardless of the cause 1

Diagnosis and Management

• The diagnosis of steatosis, including NAFLD and ALD, is frequently suspected upon documentation of excess alcohol consumption and the presence of clinical and/or biological abnormalities suggestive of liver injury 1
• Routine blood tests, such as GGT, AST, and ALT, can indicate early steatosis, while advanced steatosis is suspected if there is decreased albumin, prolonged prothrombin time, increased bilirubin level, or thrombocytopenia 1
• Management of steatosis involves addressing the underlying cause, such as reducing alcohol consumption or managing metabolic syndrome, and may involve medications such as pioglitazone, vitamin E, or liraglutide 1

From the Research

Elevated GGT in Steatosis (Fatty Liver Disease)

Elevated gamma-glutamyltransferase (GGT) levels have been associated with fatty liver disease, also known as steatosis. The following points summarize the relationship between elevated GGT and steatosis:

• Elevated GGT levels are commonly found in patients with non-alcoholic fatty liver disease (NAFLD) 2, 3, 4, 5.
• A study found that serum GGT fractionation by high-performance gel filtration liquid chromatography is potentially useful for the differential diagnosis of alcoholic liver disease (ALD) and NAFLD 2.
• Another study showed that individuals with frequently elevated GGT levels are at a higher risk of developing fatty liver disease compared to those with normal GGT levels 3.
• Elevated GGT levels have been associated with an increased risk of cardiovascular disease in patients with NAFLD, independent of traditional risk factors 4.
• GGT levels have been linked to metabolic syndrome and proinflammatory parameters in the young Roma population in eastern Slovakia 5.
• A study found that GGT levels are associated with mortality outcomes, including all-cause, cancer, and cardiovascular mortality, independently of fatty liver 6.

Key Findings

• Elevated GGT levels are a common feature of NAFLD and ALD 2, 3, 4, 5.
• GGT levels are associated with an increased risk of cardiovascular disease in patients with NAFLD 4.
• GGT levels are linked to metabolic syndrome and proinflammatory parameters 5.
• GGT levels are associated with mortality outcomes, including all-cause, cancer, and cardiovascular mortality, independently of fatty liver 6.

GGT Fractionation

• Serum GGT fractionation by high-performance gel filtration liquid chromatography can be used to differentiate between ALD and NAFLD 2.
• The s-GGT/t-GGT ratios were lowest for the control group and highest for the ALD group, while the f-GGT/t-GGT ratios were highest in the control group and lowest in the ALD group 2.