Fatty Liver with Normal LFT

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What The Result/Test Means

Having a normal liver function test (LFT) does not always mean that the liver is completely healthy. LFTs assess liver enzymes such as ALT, AST, bilirubin, and ALP, which can show signs of liver injury or problems with liver function. 

Sometimes these enzymes remain within the normal range, especially in the initial stages. You can say that a person can develop fatty liver even when their routine blood tests look normal.

What Are LFTs?

LFTs (liver function tests) are a group of blood tests that help doctors to understand whether the liver is under stress or not; these tests assess different enzymes to analyse liver injury or fat accumulation in the liver cells. LFTs include assessment of ALT, AST, bilirubin, etc. Liver function test results may vary from person to person. ALT and AST are enzymes that can rise when liver cells are injured. However, they are not direct measurements of the amount of fat stored in the liver. Ultrasound can show fat changes in the liver, but routine imaging cannot reliably tell whether inflammation or fibrosis is present or not.

In simple terms, the blood markers may not show accurate fat accumulation or liver injury; other tests may still be needed to understand the amount of liver fat and scarring. 

What It Can And Cannot Prove

LFTs mainly look for changes in certain blood markers related to liver injury and function. They do not directly measure how much fat is stored in the liver or show the amount of liver scarring. 

Common Reasons For The Finding

If fatty liver is found even though the LFT is normal, there can be certain reasons: 

Fat can build up without causing liver enzymes to rise. 

• Overweight or having excess belly fat 
• Insulin resistance or high blood sugar
• High cholesterol or triglycerides 
• Malnutrition or Rapid weight loss
• Having a diet high in sugary drinks, refined foods, or excess calories 
• Excess alcohol consumption
• Certain medical conditions

How It Relates To The Disease

A normal LFT can occur even when fatty liver is present. This is because fatty liver means that extra fat has built up in the liver, while LFTs mainly look for changes in certain blood markers, only linked to liver injury and function. In some cases, fatty liver does not cause enough cell injury to raise ALT or AST. So, the blood markers look completely normal. And a normal LFT does not indicate how much disease has progressed. It cannot tell whether inflammation or fibrosis is present or not. That's why other tests may be needed to understand liver health accurately.

What To Review Next With A Doctor

If there is a high chance of fatty liver disease and the liver function tests still look normal, then you should consult with a specialised doctor about other factors as well, such as:

• Ultrasound reports to understand the change in the liver due to excess fat accumulation.
• Look at AST, ALT, and other blood test results.
• Check the risk of fibrosis with the FIB-4 score or another fibrosis test.
• Ask your doctor about elastography or FibroScan to check liver stiffness.
• Check blood sugar and cholestrol levels on a routine basis.
• Discuss diet plans, physical activity, and weight management strategies to control excess fat buildup.
• Tell your doctor about your previous health conditions and medications you take.
• Ask for regular follow-up.

Monitoring And Follow-Up

Regular follow-ups help check whether fatty liver is improving and whether there are any signs of progression. If you have fatty liver with normal LFTs, follow-up is usually based on overall risk factors:

• Regular liver blood tests or LFTs
• Blood sugar and cholesterol levels
• Check for fibrosis
• Follow lifestyle changes, including weight, diet, and physical activity
• Ultrasounds and other repeated scans when needed 
• Discuss new symptoms with your doctor

Red Flags

In the early stages, fatty liver is often silent and usually has no symptoms. However, certain symptoms should not be ignored because they can point to more serious liver problems. Seek immediate medical advice if you notice:

• Yellowing of the eyes or skin (jaundice)
• Dark urine or unusually pale stools
• Swelling in the stomach, legs or ankles
• Easy bruising or unusual bleeding
• Persistent or worsening pain in the upper-right side of the abdomen
• Severe fatigue or extreme tiredness
• Nausea or vomiting
• Confusion, unusual sleepiness, or difficulty staying alert
• Sudden appetite loss or weight loss

Reference

Fatty Liver - StatPearls - NCBI Bookshelf

Liver function tests and metabolic-associated fatty liver disease: Changes in upper normal limits, does it really matter? - PMC

Diagnosis of NAFLD & NASH - NIDDK

Liver Function Tests - StatPearls - NCBI Bookshelf

Defining ‘Normal’ Liver Function Tests - PMC