Moyana TN. Metabolic dysfunction-associated steatotic liver disease: The question of long-term high-normal alanine aminotransferase as a screening test. World J Gastroenterol 2024; 30(42): 4576-4582 [DOI: 10.3748/wjg.v30.i42.4576]
Corresponding Author of This Article
Terence N Moyana, FRCPC, MD, Full Professor, Department of Pathology and Laboratory Medicine, University of Ottawa and The Ottawa Hospital, 501 Smyth Road, General Campus, Ottawa K1H 8L6, Ontario, Canada. tmoyana@eorla.ca
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Letter to the Editor
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Nov 14, 2024; 30(42): 4576-4582 Published online Nov 14, 2024. doi: 10.3748/wjg.v30.i42.4576
Metabolic dysfunction-associated steatotic liver disease: The question of long-term high-normal alanine aminotransferase as a screening test
Terence N Moyana
Terence N Moyana, Department of Pathology and Laboratory Medicine, University of Ottawa and The Ottawa Hospital, Ottawa K1H 8L6, Ontario, Canada
Author contributions: As the sole author, Moyana TN is responsible for all aspects of the work, including conception, design, research, writing, and finalization of the manuscript.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Terence N Moyana, FRCPC, MD, Full Professor, Department of Pathology and Laboratory Medicine, University of Ottawa and The Ottawa Hospital, 501 Smyth Road, General Campus, Ottawa K1H 8L6, Ontario, Canada. tmoyana@eorla.ca
Received: July 17, 2024 Revised: September 26, 2024 Accepted: October 9, 2024 Published online: November 14, 2024 Processing time: 105 Days and 10.8 Hours
Abstract
The growing prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) is being driven by the obesity epidemic. The quest for solutions continues particularly with regard to early detection. This editorial comments on the utility of long-term high-normal alanine aminotransferase (ALT) in screening for MASLD. Chen et al found that new onset MASLD can be detected by repetitively high normal ALT. Implicit in this concept is the question of what should be the accepted upper limit of normal (ULN) for ALT. It was previously set at 40 IU/L based on studies that included people with subclinical liver disease but the new consensus is 30/19 U/L in healthy males/females. Thus, when Chen et al defines the ULN as 40 U/L, others may view it as excessively high. It is important to recognize the variables affecting ULN e.g. instrumentation, diurnal variations, exercise and ageing. These variables matter when the distinctions are subtle e.g. normal vs high-normal. In this regard, the utility of long-term high normal ALT as a disease marker could be enhanced by combining it with other biomarkers, imaging and MASLD genetics to create machine learning classifiers. All in all, Chen et al’s work on long-term high normal ALT as a marker of new-onset MASLD deserves merit.
Core Tip: High normal alanine aminotransferase (ALT) has potential utility in screening for new-onset metabolic dysfunction-associated steatotic liver disease (MASLD). In view of its biochemistry, the upper limit of normal for ALT has to be interpreted with caution since it can be influenced by various methodologic and physiologic factors. Its utility as a screening tool could be enhanced by combining it with other serum biomarkers, cardiometabolic risk factors, imaging techniques and MASLD genetics to create predictive nomograms or machine learning classifiers.
