Fatty liver on an incidental scan two years ago and nobody followed it up. Now that I am losing weight I would like to know what to re-measure.
The narrow version of the question is whether normalised enzymes tell you anything about fibrosis, and what the right follow-up measurement is.
I have searched first, so if this is covered somewhere point me at it and I will read it.
dave_SLC said:Fatty liver on an incidental scan two years ago and nobody followed it up.
Liver enzyme update related to liver and MASH: I had mildly elevated ALT/AST at baseline (likely NAFLD). After 10 months on GLP-1 therapy:
| Marker | Baseline | Current | Normal Range |
|---|---|---|---|
| ALT | 57 | 24 | 7-56 U/L |
| AST | 50 | 26 | 10-40 U/L |
| GGT | 87 | 38 | 9-48 U/L |
| ALP | 97 | 79 | 44-147 U/L |
FibroScan also improved — liver stiffness from 9.5 kPa to 5.2 kPa. The evidence for GLP-1 agonists in NAFLD/NASH is very promising.
JessicaH_TX said:Liver enzyme update related to liver and MASH: I had mildly elevated ALT/AST at baseline (likely NAFLD).
Liver imaging follow-up for liver and MASH: FibroScan at baseline showed CAP score 323 dB/m (moderate steatosis) and stiffness 10.8 kPa (possible fibrosis). Diagnosed with NAFLD.
After 15 months: CAP dropped to 226 dB/m (minimal steatosis) and stiffness normalized to 5.9 kPa. Hepatologist says the liver is essentially healing itself as the metabolic stress resolves.
GLP-1 agonists may become first-line NASH therapy. The Phase 3 data on semaglutide for NASH is very promising.
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Shop Reference Standardsdave_SLC said:Fatty liver on an incidental scan two years ago and nobody followed it up.
Can confirm. Same sequence, different timescale. I had assumed I was the exception until I read this.
From the other side of the consultation, briefly.
ATTAIN trial (survodutide) context for liver and MASH: survodutide, a GLP-1/glucagon dual agonist, showed -18.7% body weight at 46 weeks in the Phase 3 ATTAIN trial. NASH resolution was achieved in ~60% of patients[1].
This is relevant to liver and MASH because survodutide's glucagon agonism specifically targets hepatic lipid metabolism — making it potentially the best-in-class agent for NASH/MAFLD comorbid with obesity.
[1] Sanyal AJ, et al. N Engl J Med. 2024.