Tips for Hepatologist Referral of Patients with Metabolic Dysfunction-Associated Steatotic Liver Disease with Alanine Aminotransferase Levels ≤ 30 U/L
<b>Background/Objectives:</b> The possibility of progressive liver fibrosis remains even when alanine aminotransferase (ALT) levels are <30 IU/L. Therefore, we aimed to investigate factors that can predict fibrosis progression in patients with metabolic dysfunction-associated steatoti...
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| author | Miwa Kawanaka Hideki Fujii Michihiro Iwaki Hideki Hayashi Hidenori Toyoda Satoshi Oeda Hideyuki Hyogo Asahiro Morishita Kensuke Munekage Kazuhito Kawata Tsubasa Tsutsumi Koji Sawada Tatsuji Maeshiro Hiroshi Tobita Yuichi Yoshida Masafumi Naito Asuka Araki Shingo Arakaki Takumi Kawaguchi Hidenao Noritake Masafumi Ono Tsutomu Masaki Satoshi Yasuda Eiichi Tomita Masato Yoneda Akihiro Tokushige Yoshihiro Kamada Hirokazu Takahashi Shinichiro Ueda Shinichi Aishima Ken Nishino Katsunori Ishii Takashi Fushimi Hirofumi Kawamoto Yoshio Sumida Takeshi Okanoue Atsushi Nakajima Japan Study Group of Nonalcoholic Fatty Liver Disease (JSG-NAFLD) |
| author_facet | Miwa Kawanaka Hideki Fujii Michihiro Iwaki Hideki Hayashi Hidenori Toyoda Satoshi Oeda Hideyuki Hyogo Asahiro Morishita Kensuke Munekage Kazuhito Kawata Tsubasa Tsutsumi Koji Sawada Tatsuji Maeshiro Hiroshi Tobita Yuichi Yoshida Masafumi Naito Asuka Araki Shingo Arakaki Takumi Kawaguchi Hidenao Noritake Masafumi Ono Tsutomu Masaki Satoshi Yasuda Eiichi Tomita Masato Yoneda Akihiro Tokushige Yoshihiro Kamada Hirokazu Takahashi Shinichiro Ueda Shinichi Aishima Ken Nishino Katsunori Ishii Takashi Fushimi Hirofumi Kawamoto Yoshio Sumida Takeshi Okanoue Atsushi Nakajima Japan Study Group of Nonalcoholic Fatty Liver Disease (JSG-NAFLD) |
| author_sort | Miwa Kawanaka |
| collection | DOAJ |
| description | <b>Background/Objectives:</b> The possibility of progressive liver fibrosis remains even when alanine aminotransferase (ALT) levels are <30 IU/L. Therefore, we aimed to investigate factors that can predict fibrosis progression in patients with metabolic dysfunction-associated steatotic liver disease (MASLD) with ALT levels ≤ 30 U/L. <b>Methods:</b> This multicenter retrospective cohort study was conducted using data collected between December 1994 and December 2021. Among the 1381 patients with MASLD (CLIONE study) who underwent liver biopsy, we performed decision-tree analysis on factors for stage ≥ 3 in 115 with ALT levels ≤ 30 U/L. Of the 818 patients with MASLD (Kawasaki cohort) who underwent liver biopsy, we included 174 with ALT levels ≤ 30 U/L for validation. <b>Results:</b> In the decision-tree analysis of patients with stage ≥ 3 with ALT levels ≤ 30 U/L, 57% of patients with a fibrosis-4 (FIB-4) index ≥ 2.67 and 70% with both FIB-4 index ≥ 2.67 and type-2 diabetes mellitus (DM) were detected. However, no cases of stage ≥ 3 were observed among patients without type-2 DM with ALT ≤ 30 U/L and a FIB-4 index < 2.67. After verifying the decision-tree analysis, the model construction and validation datasets showed a close correlation. <b>Conclusions:</b> Among patients with MASLD with ALT levels ≤ 30 U/L, those with an FIB-4 index ≥ 2.67, particularly with comorbid type-2 DM, should consider consultation with a hepatologist. |
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| series | Diagnostics |
| spelling | doaj-art-e7da1ea2f0914a74a0ff0caa4446ec6b2025-07-11T14:38:01ZengMDPI AGDiagnostics2075-44182025-06-011513159110.3390/diagnostics15131591Tips for Hepatologist Referral of Patients with Metabolic Dysfunction-Associated Steatotic Liver Disease with Alanine Aminotransferase Levels ≤ 30 U/LMiwa Kawanaka0Hideki Fujii1Michihiro Iwaki2Hideki Hayashi3Hidenori Toyoda4Satoshi Oeda5Hideyuki Hyogo6Asahiro Morishita7Kensuke Munekage8Kazuhito Kawata9Tsubasa Tsutsumi10Koji Sawada11Tatsuji Maeshiro12Hiroshi Tobita13Yuichi Yoshida14Masafumi Naito15Asuka Araki16Shingo Arakaki17Takumi Kawaguchi18Hidenao Noritake19Masafumi Ono20Tsutomu Masaki21Satoshi Yasuda22Eiichi Tomita23Masato Yoneda24Akihiro Tokushige25Yoshihiro Kamada26Hirokazu Takahashi27Shinichiro Ueda28Shinichi Aishima29Ken Nishino30Katsunori Ishii31Takashi Fushimi32Hirofumi Kawamoto33Yoshio Sumida34Takeshi Okanoue35Atsushi Nakajima36Japan Study Group of Nonalcoholic Fatty Liver Disease (JSG-NAFLD)Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Okayama 700-8558, JapanDepartment of Hepatology, Graduate School of Medicine, Osaka Metropolitan University, Osaka 545-8586, JapanDepartment of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Yokohama 232-0024, JapanDepartment of Gastroenterology and Hepatology, Gifu Municipal Hospital, Gifu 500-8513, JapanDepartment of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Ogaki 503-8502, JapanLiver Center, Saga University Hospital, Saga 849-8501, JapanHyogo Life Care Clinic Hiroshima, Hiroshima 732-0823, JapanDepartment of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Takamatsu 761-0793, JapanDepartment of Gastroenterology, Kochi Prefectural Hata Kenmin Hospital, Kochi 788-0785, JapanHepatology Division, Department of Internal Medicine II, Hamamatsu University School of Medicine, Shizuoka 431-3192, JapanDivision of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume 830-0011, JapanDivision of Gastroenterology, Department of Internal Medicine, Asahikawa Medical University, Asahikawa 078-8510, JapanFirst Department of Internal Medicine, University of the Ryukyus Hospital, Okinawa 903-0215, JapanDepartment of Hepatology, Shimane University Hospital, Izumo 693-8501, JapanDepartment of Gastroenterology and Hepatology, Suita Municipal Hospital, Osaka 564-8567, JapanDepartment of Gastroenterology and Hepatology, Suita Municipal Hospital, Osaka 564-8567, JapanPathology Division, Shimane University Hospital, Izumo 693-8501, JapanFirst Department of Internal Medicine, University of the Ryukyus Hospital, Okinawa 903-0215, JapanDivision of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume 830-0011, JapanHepatology Division, Department of Internal Medicine II, Hamamatsu University School of Medicine, Shizuoka 431-3192, JapanDivision of Innovative Medicine for Hepatobiliary & Pancreatology, Faculty of Medicine, Kagawa University, Takamatsu 760-0793, JapanDepartment of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Takamatsu 761-0793, JapanDepartment of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Ogaki 503-8502, JapanDepartment of Gastroenterology and Hepatology, Gifu Municipal Hospital, Gifu 500-8513, JapanDepartment of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Yokohama 232-0024, JapanDepartment of Clinical Pharmacology, Therapeutics School of Medicine, University of the Ryukyus, Okinawa 903-0213, JapanDepartment of Advanced Metabolic Hepatology, Osaka University Graduate School of Medicine, Osaka 565-0871, JapanLiver Center, Saga University Hospital, Saga 849-8501, JapanDepartment of Clinical Pharmacology, Therapeutics School of Medicine, University of the Ryukyus, Okinawa 903-0213, JapanDepartment of Scientific Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, JapanDepartment of General Internal Medicine 2, Kawasaki Medical Center, Kawasaki Medical School, Okayama 700-8505, JapanDepartment of General Internal Medicine 2, Kawasaki Medical Center, Kawasaki Medical School, Okayama 700-8505, JapanDepartment of General Internal Medicine 2, Kawasaki Medical Center, Kawasaki Medical School, Okayama 700-8505, JapanDepartment of General Internal Medicine 2, Kawasaki Medical Center, Kawasaki Medical School, Okayama 700-8505, JapanGraduate School of Healthcare Management, International University of Healthcare and Welfare, Tokyo 107-8402, JapanDepartment of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Osaka 564-0013, JapanDepartment of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Yokohama 232-0024, Japan<b>Background/Objectives:</b> The possibility of progressive liver fibrosis remains even when alanine aminotransferase (ALT) levels are <30 IU/L. Therefore, we aimed to investigate factors that can predict fibrosis progression in patients with metabolic dysfunction-associated steatotic liver disease (MASLD) with ALT levels ≤ 30 U/L. <b>Methods:</b> This multicenter retrospective cohort study was conducted using data collected between December 1994 and December 2021. Among the 1381 patients with MASLD (CLIONE study) who underwent liver biopsy, we performed decision-tree analysis on factors for stage ≥ 3 in 115 with ALT levels ≤ 30 U/L. Of the 818 patients with MASLD (Kawasaki cohort) who underwent liver biopsy, we included 174 with ALT levels ≤ 30 U/L for validation. <b>Results:</b> In the decision-tree analysis of patients with stage ≥ 3 with ALT levels ≤ 30 U/L, 57% of patients with a fibrosis-4 (FIB-4) index ≥ 2.67 and 70% with both FIB-4 index ≥ 2.67 and type-2 diabetes mellitus (DM) were detected. However, no cases of stage ≥ 3 were observed among patients without type-2 DM with ALT ≤ 30 U/L and a FIB-4 index < 2.67. After verifying the decision-tree analysis, the model construction and validation datasets showed a close correlation. <b>Conclusions:</b> Among patients with MASLD with ALT levels ≤ 30 U/L, those with an FIB-4 index ≥ 2.67, particularly with comorbid type-2 DM, should consider consultation with a hepatologist.https://www.mdpi.com/2075-4418/15/13/1591alanine transaminaseFIB-4 indexMASLDNara Declaration 2023diabetes mellitus type-2 |
| spellingShingle | Miwa Kawanaka Hideki Fujii Michihiro Iwaki Hideki Hayashi Hidenori Toyoda Satoshi Oeda Hideyuki Hyogo Asahiro Morishita Kensuke Munekage Kazuhito Kawata Tsubasa Tsutsumi Koji Sawada Tatsuji Maeshiro Hiroshi Tobita Yuichi Yoshida Masafumi Naito Asuka Araki Shingo Arakaki Takumi Kawaguchi Hidenao Noritake Masafumi Ono Tsutomu Masaki Satoshi Yasuda Eiichi Tomita Masato Yoneda Akihiro Tokushige Yoshihiro Kamada Hirokazu Takahashi Shinichiro Ueda Shinichi Aishima Ken Nishino Katsunori Ishii Takashi Fushimi Hirofumi Kawamoto Yoshio Sumida Takeshi Okanoue Atsushi Nakajima Japan Study Group of Nonalcoholic Fatty Liver Disease (JSG-NAFLD) Tips for Hepatologist Referral of Patients with Metabolic Dysfunction-Associated Steatotic Liver Disease with Alanine Aminotransferase Levels ≤ 30 U/L Diagnostics alanine transaminase FIB-4 index MASLD Nara Declaration 2023 diabetes mellitus type-2 |
| title | Tips for Hepatologist Referral of Patients with Metabolic Dysfunction-Associated Steatotic Liver Disease with Alanine Aminotransferase Levels ≤ 30 U/L |
| title_full | Tips for Hepatologist Referral of Patients with Metabolic Dysfunction-Associated Steatotic Liver Disease with Alanine Aminotransferase Levels ≤ 30 U/L |
| title_fullStr | Tips for Hepatologist Referral of Patients with Metabolic Dysfunction-Associated Steatotic Liver Disease with Alanine Aminotransferase Levels ≤ 30 U/L |
| title_full_unstemmed | Tips for Hepatologist Referral of Patients with Metabolic Dysfunction-Associated Steatotic Liver Disease with Alanine Aminotransferase Levels ≤ 30 U/L |
| title_short | Tips for Hepatologist Referral of Patients with Metabolic Dysfunction-Associated Steatotic Liver Disease with Alanine Aminotransferase Levels ≤ 30 U/L |
| title_sort | tips for hepatologist referral of patients with metabolic dysfunction associated steatotic liver disease with alanine aminotransferase levels ≤ 30 u l |
| topic | alanine transaminase FIB-4 index MASLD Nara Declaration 2023 diabetes mellitus type-2 |
| url | https://www.mdpi.com/2075-4418/15/13/1591 |
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