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Dr. Keith Roach
To Your Good Health
Dear Dr. Roach: I'm a generally healthy 73-year-old man. I recently had blood work done and was incidentally noted to have high liver tests (ALT and AST). My doctor ordered a sonogram, which said that my liver was "diffusely echogenic, consistent with fatty infiltration." I used to have an occasional drink, but I haven't had any alcohol for months. What should I do now?
I did recently start on a statin, and my liver tests were normal before I started on it. -- R.C.
Answer: With abnormal liver tests and your liver sonogram, I would be concerned that you had metabolic-associated steatotic liver disease. (We used to call this nonalcoholic fatty liver disease.) It's is a very common issue that affects 30% of the population.
Only men who habitually consume less than 2 drinks per day (for women, 1.5 drinks per day) can be considered for this disorder. People who drink more than this amount may have metabolic-dysfunction and alcohol-associated liver disease, or just alcohol-associated liver disease. We worry about these conditions because they can progress to liver fibrosis, and a few people will go on to develop cirrhosis.
In people who have fatty infiltration of the liver and abnormal test results, I recommend further evaluation with a Fib4 test. I used the information you sent me to do this (it's just based on blood test results, all of which you already had), and the Fib4 said that you should get further evaluation. This would be with a noninvasive test called elastography (one brand name is FibroScan), which uses an ultrasound to determine your risk for fibrosis and cirrhosis.
However, your abnormal AST and ALT tests seem like they are more likely due to the statin. Mild elevations are very common and not dangerous to the liver, but I am concerned that your statin is making it seem as though you might have more advanced liver disease.
In my opinion, you should see a gastroenterologist with special expertise in liver disease. Elastography may still be a smart idea because it is possible to have liver fibrosis even with normal liver tests.