Fatty Liver · MASLD (formerly NAFLD)

regulates · 2

• →Blood Work · Routine Chemistry

  Fatty liver is one of the commonest causes of a mildly raised ALT on a routine panel: liver cells swollen with triglyceride have leaky membranes, and the enzyme escapes into the blood. The reverse does not hold, though: in metabolic dysfunction-associated steatotic liver disease (MASLD), ALT can be completely normal, so a normal liver panel does not rule it out, and whether there is scarring has to be judged with scores such as FIB-4.

  GUIDE · high

• ↔Hepatitis B

  Whether the upstream cause is the hepatitis B virus or metabolic fatty liver disease (MASLD), liver injury wakes stellate cells that lay down collagen, which builds up into fibrosis and then cirrhosis, and most liver cancers arise on that ground. Hepatitis B has an extra route: viral DNA integrates into liver cells, so cancer can develop even without cirrhosis.

  COHORT · moderateREVIEW · low

contrast · 1

• ≠Milk Thistle

  In a trial of 99 people with steatohepatitis (fatty liver with inflammation) that judged its results by liver biopsy, silymarin at 700 mg three times a day for 48 weeks missed its primary endpoint; the improvement in fibrosis score was only a secondary finding.

  RCT · moderate