Non-alcoholic fatty liver disease laboratory findings

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Manpreet Kaur, MD [2]


There are no specific diagnostic laboratory findings associated with non alcoholic fatty liver disease. Laboratory findings include abnormal liver function tests but are unspecific. Other laboratory tests are generally performed to rule out other diagnosis.

Laboratory Findings

  • There is no specific laboratory findings diagnostic for non alcoholic fatty liver disease.[1][2]
  • Liver function tests
    • Typical finding include a 2-4 fold elevation of the ALT 
    • An ALT/AST ratio of greater than 1.

Non-alcoholic fatty liver disease, especially if with cirrhosis, may be associated with thrombocytopenia[3][4].

Fibrosis score

A fibrosis score can be obtained via:

  • Liver biopsy. Various scoring systems exist including the Ishak; however, Ishak deems cirrhosis at a score of 5 or 6[5].
    • F0. No fibrosis
    • F1. Fibrous portal expansion
    • F2. Few septa
    • F3. Bridging fibrosis. Numerous septa
    • F4. Cirrhosis
  • Nonivasive serological liver fibrosis score such as AST to platelet ratio (APRI), and proprietary tests such as: FibroTest, FibroSure, Hepascore, and FibroSpect. An example is based on the "serum hyaluronic acid, procollagen type III N-terminal peptide, and tissue inhibitor of metalloproteinase 1"[6].
    • A score > "9.8 indicates a moderate risk of advanced fibrosis"<ref name="pmid33185364">/
    • A score > "11.3 denotes a high risk of advanced fibrosis"[6]
  • Noninvasive imaging scores such as the Fibroscan.


  1. "Nonalcoholic fatty liver disease: Indications for liver biopsy and noninvasive biomarkers - Noureddin - 2012 - Clinical Liver Disease - Wiley Online Library".
  2. "Nonalcoholic fatty liver disease (NAFLD), including nonalcoholic steatohepatitis (NASH)".
  3. Rivera-Álvarez M, Córdova-Ramírez AC, Elías-De-La-Cruz GD, Murrieta-Álvarez I, León-Peña AA, Cantero-Fortiz Y; et al. (2021). "Non-alcoholic fatty liver disease and thrombocytopenia IV: its association with granulocytopenia". Hematol Transfus Cell Ther. doi:10.1016/j.htct.2021.06.004. PMID 34312112 Check |pmid= value (help).
  4. Panke CL, Tovo CV, Villela-Nogueira CA, Cravo CM, Ferreira FC, Rezende GFM; et al. (2020). "Evaluation of thrombocytopenia in patients with non-alcoholic fatty liver disease without cirrhosis". Ann Hepatol. 19 (1): 88–91. doi:10.1016/j.aohep.2019.05.011. PMID 31575467.
  5. Ishak K, Baptista A, Bianchi L, Callea F, De Groote J, Gudat F; et al. (1995). "Histological grading and staging of chronic hepatitis". J Hepatol. 22 (6): 696–9. doi:10.1016/0168-8278(95)80226-6. PMID 7560864.
  6. 6.0 6.1 Newsome PN, Buchholtz K, Cusi K, Linder M, Okanoue T, Ratziu V; et al. (2021). "A Placebo-Controlled Trial of Subcutaneous Semaglutide in Nonalcoholic Steatohepatitis". N Engl J Med. 384 (12): 1113–1124. doi:10.1056/NEJMoa2028395. PMID 33185364 Check |pmid= value (help).

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