A Review on Some Biochemical markers in mMetabolic-Associated Fatty Liver Disease

Review on Some Biochemical markers in mMetabolic-Associated Fatty Liver Disease


  • Sarah Ashour Thi -Qar Education Directorate




metabolic-associated fatty liver disease, liver enzyme , lipid profile


Liver is a primary organ for lipid and glucose homeostasis and is the focus of cardio metabolic disease. The  NAFLD definition combines the existence of steatosis in more than 5% of hepatocytes and metabolic risk factors, particularly obesity and T2DM, and exclusion of excessive alcohol consumption defined as ≥ 30 g per day for men and ≥ 20 g per day for women, or other chronic liver diseases  In the year of  2020,  it was  suggested that the nomenclature of nonalcoholic fatty liver disease (NAFLD) should be updated to metabolic-associated fatty liver disease  (MAFLD), Moreover,  it was found that diagnosis of MAFLD should be based on the presence of metabolic dysfunction not the absence of other conditions ,  MAFLD can coexist with other liver diseases and a reference to alcohol should not be included in the MAFLD acronym. Biochemical parameters play a significant role in  the careful diagnosis and also for the risk assessment and adopting treatment that improves clinical outcome.   This article, focused on the nomenclature and diagnosis of metabolic-associated fatty liver disease which before 2020 was called non-alcoholic fatty liver disease, and explain some of the biochemical parameters in this disease.



A. Van Eldere and T. Pirani. Liver intensive care for the general intensivist . Anaesthesia , 2023:1-18. doi:10.1111/anae.15956.

Ahmad Hassan Ali, Gregory F. Petroski, Alberto A. Diaz-Arias , Alhareth Al Juboori , Andrew A. Wheeler , Rama R. Ganga , James B. Pitt , Nicole M. Spencer , Ghassan M. Hammoud , R. Scott Rector,

Elizabeth J. Parks and Jamal A. Ibdah. A Model Incorporating Serum Alkaline Phosphatase for Prediction of Liver Fibrosis in Adults with Obesity and Nonalcoholic Fatty Liver Disease. J. Clin. Med. 2021, 10: 3311.

Amarapurka DN, Amarapurkar AD, Patel ND, et al. Nonalcoholic

steatohepatitis (NASH) with diabetes: predictors of liver fibrosis. Ann

Hepatol. 2006, 5:30–3.

Ana Paula Beltrame Farina Pasinato• Esther Buzaglo Dantas-Corrêa • Leonardo de Lucca Schiavon• Janaína Luz Narciso-Schiavon.Factors Associated with Advanced Fibrosis in Patients with Nonalcoholic Fatty Liver Disease Marina Jarschel Souza • Jessica Goedert Pereira• Ana Carolina de Souza Mangrich. Acta Gastroenterol Latinoam. 2023,53(1):39-48

Angulo P, Hui JM, Marchesini G, et al. The NAFLD fibrosis score: a

noninvasive system that identifies liver fibrosis in patients with NAFLD.

Hepatology. 2007,45:846–54.

Amor, A.J., Pinyol, M., Sola, E., Catalan, M., Cofan, M., Herreras, Z., et al. Relationship between noninvasive scores of nonalcoholic fatty liver disease and nuclear magnetic resonance lipoprotein abnormalities: a focus on atherogenic dyslipidemia. Journal of Clinical Lipidology.2017, 11(2):551e561 e557.

Barusrux S, Nanok C, Puthisawas W, et al. Viral hepatitis B, C infection and genotype distribution among cholangiocarcinoma patients in northeast Thailand. Asian Pac J Cancer Prev. 2012,13: 83–7.

Bedogni G, Miglioli L, Masutti F, Tiribelli C, Marchesini G, Bellentani S. Prevalence of and risk factors for nonalcoholic fatty liver disease: the Dionysos nutrition and liver study. Hepatology. 2005, 42: 44-52.

Berbel, MN.; Pinto, MP. and Ponce, D. BA. Nutritional aspects in acute kidney injury. Rev Assoc Med Bras. 2011, 57:600-606.

Browning JD. Statins and hepatic steatosis: perspectives from the Dallas Heart Study. Hepatology 2006, 44: 466-471.

Browning JD, Szczepaniak LS, Dobbins R, Nuremberg P, Horton JD , Cohen JC, Grundy SM, Hobbs HH. Prevalence of hepatic steatosis in an urban population in the United States: impact of ethnicity. Hepatology. 2004, 40:1387-1395.

Chen KW, Meng FC, Shih YL, Su FY, Lin YP, Lin F, et al. Sex-specific association between metabolic abnormalities and elevated alanine aminotransferase levels in a military cohort: The CHIEF study. Int J Environ Res Public Health .2018, 15(3):545.

Chalasani, N.; Younossi, Z.M.; LaVine, J.E.; Diehl, A.M.; Brunt, E.M.; Cusi, K.; Charlton, M.; Sanyal, A.J. The diagnosis and management of non-alcoholic fatty liver disease: Practice Guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association. Hepatology. 2012, 55: 2005–2023.

Digant Gupta and Christopher G Lis. Pretreatment serum albumin as a predictor of cancer survival: a systematic review of the epidemiological literature. Nutr J. 2010,9:69.

Deprince, A., Haas, J.T., Staels, B. Dysregulated lipid metabolism links NAFLD to cardiovascular disease. Molecular Metabolism. 2020, 42:101092.

DeFilippis, A.P., Blaha, M.J., Martin, S.S., Reed, R.M., Jones, S.R., Nasir, K., et al. Nonalcoholic fatty liver disease and serum lipoproteins: the Multi-Ethnic Study of Atherosclerosis. Atherosclerosis 2013, 227(2):429 - 436.

Eslam, M, Newsome, P.N., Sarin, S.K., Anstee, Q.M., Targher, G., Romero-Gomez, M., Zelber-Sagi, S.;Wong, V.W.-S., Dufour, J.-F.; Schattenberg, J.M., et al. A new definition for metabolic dysfunction-associated fatty liver disease: An international expert consensus statement. J. Hepatol. 2020, 73: 202–209.

Esteghamati A, Jamali A, Khalilzadeh O, Noshad S, Khalili M, Zandieh A, Morteza A, Nakhjavani M. Metabolic syndrome is linked to a mild elevation in liver aminotransferases in diabetic patients with undetectable non-alcoholic fatty liver disease by ultrasound. Diabetol Metab Syndr. 2010,2: 65.

European Association for the Study of the Liver (EASL); European Association for the Study of Diabetes (EASD); European Association for the Study of Obesity (EASO). EASL–EASD–EASO Clinical Practice Guidelines for the management of nonalcoholic fatty liver disease. J. Hepatol. 2016, 64, 1388–1402.

Fatemeh Hadizadeh, Elham Faghihimani, Peyman Adibi. Nonalcoholic fatty liver disease: Diagnostic biomarkers. World J Gastrointest Pathophysiol. 2017, 8(2):11-26

Farrell, G.C.; Chitturi, S.; Lau, G.K.K.; Sollano, J.D. Guidelines for the assessment and management of non-alcoholic fatty liver disease in the Asia–Pacific region: Executive summary. J. Gastroenterol. Hepatol. 2007, 22: 775–777.

Friedman, S.L., Neuschwander-Tetri, B.A., Rinella, M., Sanyal, A.J., . Mechanisms of NAFLD development and therapeutic strategies. Nature Medicine . 2018 ,24(7):908- 922.

Giannini, E. G., Testa, R. & Savarino, V. Liver enzyme alteration: A guide for clinicians. CMAJ .2005, 172: 367–379.

Hossain N, Afendy A, Stepanova M, Nader F, Srishord M, Rafiq N, Goodman Z, Younossi Z. Independent predictors of fibrosis in patients with nonalcoholic fatty liver disease. Clin Gastroenterol Hepatol. 2009,7: 1224-1229.

Haas, J.T., Francque, S., Staels, B.,. Pathophysiology and mechanisms of nonalcoholic fatty liver disease. Annual Review of Physiology .2016, 78:181- 205.

Huang, X. J. et al. Aspartate aminotransferase (AST/GOT) and alanine aminotransferase (ALT/GPT) detection techniques. Sensors. 2006, 6: 756–782.

Ioannou GN, Boyko EJ, Lee SP. The prevalence and predictors of elevated serum aminotransferase activity in the United States in 1999-2002. Am J Gastroenterol. 2006, 101: 76-82.

Johnson, R. D., O’Connor, M. L. & Kerr, R. M. Extreme serum elevations of aspartate aminotransferase. Am. J. Gastroenterol.1995, 90:

–1245 .

Joerg Heeren, Ludger Scheja. Metabolic-associated fatty liver disease and lipoprotein metabolism. Elsevier GmbH.2021:1-17

Kawaguchi Kazunori, Yoshio Sakai , Takeshi Terashima, MD et al. Decline in serum albumin concentration is a predictor of serious events in nonalcoholic fatty liver disease. Medicine . 2021, 100:31

Kai Saito, Hitoshi Sugawara , Tamami Watanabe , Akira Ishii2 & Takahiko Fukuchi. A retrospective cross?sectional study for predicting 72?h mortality in patients with serum aspartate aminotransferase levels ? 3000 U/L. Nature research . 2021. doi.org/10.1038%2Fs41598-020-79435-3

Kim WR, Flamm SL, Di Bisceglie AM, et al. Serum activity of alanine aminotransferase (ALT) as an indicator of health and disease. Hepatology. 2008,47:1363–70.

Kwon SS, Lee SG. A high alanine aminotransferase/aspartate

aminotransferase ratio determines insulin resistance and metabolically healthy/ unhealthy obesity in a general adult population in Korea: The Korean national health and nutritional examination survey 2007-2010. Exp Clin Endocrinol Diabetes. 2019, 127(10):677–84.

Kyung-Soo Kim, Sangmo Hong, Hong-Yup Ahn, Cheol-Young Park. Metabolic Dysfunction-Associated Fatty Liver Disease and Mortality: A Population-Based Cohort Study. Diabetes Metab J. 2023, 47:220-231.

Lee CH, Hsieh SY, Chang CJ, et al. Comparison of clinical characteristics of combined hepatocellular-cholangiocarcinoma and other primary liver cancers. J Gastroenterol Hepatol. 2013, 28:122–7.

Lonardo, A.; Bellini, M.; Tondelli, E.; Frazzoni, M.; Grisendi, A.; Pulvirenti, M.; Della Casa, G. Nonalcoholic steatohepatitis and the “bright liver syndrome”: Should a recently expanded clinical entity be further expanded? Am. J. Gastroenterol. 1995, 90: 2072–2074.

Lu CW, Lin MS, Lin YS, Chang IJ, Tsai MH, Wei KL, et al. Aminotransferase ratio is a useful index for hepatosteatosis in children and adolescents: A cross-sectional observational study. Gastroenterol Nurs. 2019,42 (6):486–95.

Majid, A., Sayer, S. A. Relationship between Inflammation Marker and Some Biochemical Parameters in Patients with Acute Renal Injury. Egyptian Journal of Chemistry.2022, 65(5): 665-672.

Mansour-Ghanaei R, Mansour-Ghanaei F, Naghipour M, Joukar F. Biochemical markers and lipid profile in nonalcoholic fatty liver disease patients in the PERSIAN Guilan cohort study (PGCS), Iran. J Family Med Prim Care. 2019, 8:923-8.

Mucinski, J.M., Manrique-Acevedo, C., Kasumov, T., Garrett, T.J.,

Gaballah, A., Parks, E.J.,. Relationships between very low-density lipoproteins- ceramides, -diacylglycerols, and -triacylglycerols in insulinresistant men. Lipids. 2020,55(4):387- 393.

Nie, S.; Tang, L.; Zhang, W.; Feng, Z. CX. Are There Modifiable Risk Factors to Improve AKI? BioMed Res Int. 2017: 560-5634.

Novakovic T, Mekic M, Smilic L, Smilic T, Ini??Kostic B, Jovicevic L, et al. Anthropometric and biochemical characteristics of patients with nonalcoholic fatty liver diagnosed by non?invasive diagnostic methods. Med Arch. 2014, 68:22?6.

Noureddin, M.; Loomba, R. Nonalcoholic fatty liver disease: Indications for liver biopsy and noninvasive biomarkers. Clin. Liver Dis. 2012, 1: 104–107.

Novakovic T, Mekic M, Smilic L, Smilic T, Ini??Kostic B, Jovicevic L, et al. Anthropometric and biochemical characteristics of patients with nonalcoholic fatty liver diagnosed by non?invasive diagnostic methods. Med Arch .2014,68:22?6.

Oh HJ, Kim TH, Sohn YW, Kim YS, Oh YR, Cho EY, et al. Association of serum alanine aminotransferase and ?-glutamyltransferase levels within the reference range with metabolic syndrome and nonalcoholic fatty liver disease. Korean J Hepatol. 2011,17:27–36.

Pantsari, M.W.; Harrison, S.A. Nonalcoholic fatty liver disease presenting with an isolated elevated alkaline phosphatase. J. Clin. Gastroenterol. 2006, 40: 633–635.

Pardhe BD, Shakya S, Bhetwal A, Mathias J, Khanal PR, Pandit R, et al. Metabolic syndrome and biochemical changes among non?alcoholic fatty liver disease patients attending a tertiary care hospital of Nepal. BMC Gastroenterol. 2018,18:109.

Prashanth M, Ganesh HK, Vima MV, John M, Bandgar T, Joshi SR, Shah SR, Rathi PM, Joshi AS, Thakkar H, Menon PS, Shah NS. Prevalence of nonalcoholic fatty liver disease in patients with type 2 diabetes mellitus. J Assoc Physicians India. 2009, 57: 205-210

Ratziu, V.; Bellentani, S.; Cortez-Pinto, H.; Day, C.; Marchesini, G. A position statement on NAFLD/NASH based on the EASL 2009 special conference. J. Hepatol. 2010, 53:372–384.

Rafiq N, Bai C, Fang Y, Srishord M, McCullough A, Gramlich T, Younossi ZM. Long-term follow-up of patients with nonalcoholic fatty liver. Clin Gastroenterol Hepatol 2009; 7: 234-238.

Pollock, G.; Minuk, G.Y. Diagnostic considerations for cholestatic liver disease. J. Gastroenterol. Hepatol. 2017, 32:1303–1309.

Sayer A S, Alsalih Raid M H, Al- Khafaji Adnan T. 2. Biochemical Comparative Study For Study For Serum Oxidant-Antioxidants Status in Elderly Patients With Atrial Fibrillation. World Journal of Pharmacy and Pharmaceutical Sciences. 2017, 6(3).

Samuel, V.T., Shulman, G.I., . Nonalcoholic fatty liver disease as a nexus of metabolic and hepatic diseases. Cell Metabolism. 2018, 27(1):22-41.

Santos, R.D., Valenti, L., Romeo, S.,. Does nonalcoholic fatty liver disease cause cardiovascular disease? Current knowledge and gaps.

Atherosclerosis. 2019,282:110-120.

Santhoshakumari TMJ, Radhika G, Kanagavalli P. A study of anthropometric and lipid profile parameters in non?alcoholic fatty liver disease patients attending a tertiary care hospital at puducherry. IOSR J Dent Med Sci (IOSR-JDMS). 2017,16:33 ?7.

Sheng X, Che H, Ji Q, et al. The Relationship Between Liver Enzymes and Insulin Resistance in Type 2 Diabetes Patients with Nonalcoholic Fatty Liver Disease. Horm Metab Res. 2018,50:397–402.

Sheng Guotai, Nan Peng , Chong Hu, Ling Zhong, Mingchun Zhong and Yang Zou. The albumin-to-alkaline phosphatase ratio as an independent predictor of future nonalcoholic fatty liver disease in a 5-year longitudinal cohort study of a non-obese Chinese population. Lipids in Health and Disease . 2021, 20:50.

Silvia Sookoian, Gustavo O Castaño, Romina Scian,Tomas Fernández Gianotti, Hernán Dopazo, Cristian Rohr, Graciela Gaj, Julio San Martino, Ina Sevic, Diego Flichman, and Carlos J Pirola. Serum aminotransferases in nonalcoholic fatty liver disease are a signature of liver metabolic perturbations at the amino acid and Krebs cycle level. Am J Clin Nutr. 2016,103:422–34.

Sun DQ, Zheng KI, Xu G, et al. PNPLA3 rs738409 is associated with renal glomerular and tubular injury in NAFLD patients with persistently normal ALT levels. Liver Int. 2019.

Swain M, Nath P, Parida PK, Narayan J, Padhi PK, Pati GK, et al. Biochemical profile of nonalcoholic fatty liver disease patients in eastern India with histopathological correlation. Indian J Clin. Biochem 2017, 32:306?14.

Schaffner, F.; Thaler, H. Nonalcoholic fatty liver disease. Prog. Liver Dis. 1986, 8: 83–298.

Schwabe, R.F., Tabas, I., Pajvani, U.B., 2020. Mechanisms of fibrosis development in nonalcoholic steatohepatitis. Gastroenterology 158(7):1913 - 1928.

Taverna, Myriam, Anne-Lise Marie, Jean-Paul Mira and Bertrand Guidet. . “Specific Antioxidant Properties of Human Serum Albumin.” Annals of Intensive Care. 2013, 3: 4.

Targher, G., Day, C.P., Bonora, E.,. Risk of cardiovascular disease in patients with nonalcoholic fatty liver disease. New England Journal of

Medicine. 2010,363(14):1341e1350.

Umehara T. Nonalcoholic fatty liver disease with elevated alanine

aminotransferase levels is negatively associated with bone mineral density: Cross-sectional study in U.S. adults. PLoS One. 2018,13:e0197900.

Wilfred de Alwis NM, Day CP. Genetics of alcoholic liver disease and nonalcoholic fatty liver disease. Semin Liver Dis .2007, 27: 44-54.

Xuefeng Ma, Shousheng Liu , Jie Zhang1, Mengzhen Dong, Yifen Wang, Mengke Wang1 and Yongning Xin. Proportion of NAFLD patients with normal ALT value in overall NAFLD patients: a systematic review and meta-analysis. BMC Gastroenterology .2020, 20:10.

Yang, Feng, Yao Zhang and Hong Liang. “Interactive Association of Drugs Binding to Human Serum Albumin.” International Journal of Molecular Sciences. 2014 ,15: 3580–95.

Younossi ZM, Koenig AB, Abdelatif D, Fazel Y, Henry L, Wymer M. Global epidemiology of nonalcoholic fatty liver disease-meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology. 2016, 64:73–84.

Younossi ZM, Gramlich T, Matteoni CA, Boparai N, McCullough AJ. Nonalcoholic fatty liver disease in patients with type 2 diabetes. Clin Gastroenterol Hepatol . 2004, 2: 262-265.

Zou Y, Zhong L, Hu C, Sheng G. Association between the alanine

aminotransferase/aspartate aminotransferase ratio and new-onset non-alcoholic fatty liver disease in a nonobese Chinese population: a population-based longitudinal study. Lipids Health Dis .2020, 19(1):245.

zaid, A. k. .; Sayer, S. A. . Association Abnormal Levels of Serum Interleukin-33, Interleukin-23 With Oxidant-Antioxidants Status in Patients With Acute Liver Failure. jsci 2022, 9, 94-99.








How to Cite

A Review on Some Biochemical markers in mMetabolic-Associated Fatty Liver Disease: Review on Some Biochemical markers in mMetabolic-Associated Fatty Liver Disease. (2023). University of Thi-Qar Journal of Science, 10(1). https://doi.org/10.32792/utq/utjsci/v10i1.1043