From the Guidelines
Fatty liver disease can indeed cause acute transaminitis, as evidenced by the release of liver enzymes such as ALT and AST into the bloodstream due to hepatocyte damage and inflammation. This condition occurs when fat accumulation in liver cells leads to inflammation, causing the elevation of liver enzymes. According to the most recent study 1, both alcoholic fatty liver disease and non-alcoholic fatty liver disease (NAFLD) can trigger transaminitis, with elevations typically 2-5 times the upper limit of normal, though sometimes higher. The severity of enzyme elevation often correlates with the degree of liver inflammation.
Key Points to Consider
- Fatty liver disease is a spectrum of fat deposition and hepatic inflammation followed by fibrosis due to metabolic insults, as noted in the study 1.
- NAFLD is the most common liver disease in first-world countries, with a prevalence of 20% to 30% in the general population, increasing to 70% with obesity and 90% with diabetes mellitus 1.
- Management of acute transaminitis from fatty liver focuses on addressing the underlying cause, such as limiting alcohol consumption for alcoholic fatty liver or weight loss and metabolic health improvement for NAFLD.
- Regular monitoring of liver enzymes is crucial to track disease progression and response to lifestyle modifications, as recommended in studies 1 and 1.
Recommendations for Practice
- Evaluation for nonalcoholic fatty liver disease should be done at diagnosis and annually thereafter by measuring AST and ALT, as suggested in studies 1 and 1.
- Referral to gastroenterology should be considered for persistently elevated or worsening transaminases, as recommended in studies 1 and 1.
- While no specific medications are universally recommended for acute transaminitis from fatty liver, vitamin E (800 IU daily) may benefit some non-diabetic NAFLD patients, although this is not universally agreed upon and more research is needed to confirm its efficacy.
From the Research
Fatty Liver and Acute Transaminitis
- Fatty liver is a common cause of transaminitis, which is characterized by elevated liver enzymes such as alanine transaminase (ALT) and aspartate transaminase (AST) 2, 3, 4.
- Transaminitis can be caused by various factors, including nonalcoholic fatty liver disease (NAFLD), alcoholic liver disease, viral hepatitis, and hereditary hemochromatosis 2, 3, 4, 5.
- The evaluation of transaminitis typically involves a stepwise approach, including assessment of metabolic syndrome and insulin resistance, complete blood count, measurement of serum albumin, iron, and ferritin, and hepatitis C antibody and hepatitis B surface antigen testing 3, 4.
- In some cases, fatty liver can cause acute transaminitis, which is a sudden and significant elevation of liver enzymes 2, 3.
Diagnosis and Evaluation
- The diagnosis of fatty liver and transaminitis typically involves a combination of laboratory tests, imaging studies, and clinical evaluation 2, 6, 3, 4, 5.
- Liver blood tests, including ALT, AST, and alkaline phosphatase, are commonly used to evaluate hepatobiliary disease 6, 5.
- Imaging studies, such as ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI), may be used to evaluate the liver and bile ducts 6.
- A liver biopsy may be considered in some cases to confirm the diagnosis or to stage the disease 5.