Cumulative effects of excess high-normal alanine aminotransferase levels in relation to new-onset metabolic dysfunction-associated fatty liver disease in China

Figure 1 Schematic description of the study design. 7817 participants with three consecutive health examinations from 2017 to 2019 were analysed to determine the optimal alanine aminotransferase (ALT) cut-off points for the diagnosis of metabolic dysfunction-associated fatty liver disease (MAFLD). A follow-up cohort of 3553 participants who completed their fourth health examination in 2020 was subsequently analysed to calculate the cumulative effects of excess high-normal ALT and explore its association with the risk of new-onset MAFLD. ALT: Alanine aminotransferase; MAFLD: Metabolic dysfunction-associated fatty liver disease; lALT: Low-normal alanine aminotransferase; hALT: High-normal alanine aminotransferase; aALT: Abnormal alanine aminotransferase; ehALT: Excess high-normal alanine aminotransferase.