NAFLD is typically suggested by which combination?

• A. Normal ALT/AST and no imaging findings
• B. Elevated ALT/AST with hepatic steatosis on imaging
• C. Decreased triglycerides and glucose tolerance
• D. No risk factors

Answer: (B)

NAFLD typically presents when there is evidence of fat in the liver on imaging together with some hepatocellular injury marked by elevated liver enzymes. In practice, mild to moderate rises in ALT (often with AST also up) accompany imaging findings of hepatic steatosis, which strongly points to fatty liver disease in the right clinical setting. Normal enzymes with no imaging evidence of fat, or metabolic abnormalities that don’t fit NAFLD (like decreased triglycerides or excellent glucose tolerance), are less consistent with NAFLD. NAFLD also tends to occur with metabolic risk factors such as obesity and insulin resistance, so lack of risk factors makes NAFLD unlikely.