Tu1032 Relationship Between the Plasma Concentrations of Free Choline and Parameters of Adiposity and Histological Findings in Patients With Nonalcoholic Fatty Liver Disease. a Multicenter Study in Japan

A S L D A b st ra ct s who met at least 1 of the following exclusion criteria (consuming ≥20 g/day of alcohol, testing positive for HBs-Ag or, demonstrating evidence of liver disease other than viral hepatitis, and/or currently taking anti-hypertensive agents, lipid-lowing agents, or antidiabetic agents), the records of 6,370 Japanese subjects were reviewed for identification of subjects meeting the diagnostic criteria for NAFLD (evidence of hepato-renal contrast and liver brightness on abdominal ultrasound) and the variables associated with NAFLD in order to estimate ideal ALT cutoff levels. Results: The results of multivariate analysis of the 1,346 subjects (803 males and 543 females) who met the diagnostic criteria for NAFLD confirmed that the traditional markers of metabolic disease are also markers of NAFLD: high BMI, ALT, TG, HDL-c, UA, and HbA1c levels. Of the significant risk factors for NAFLD, ALT level, one themost common variables in screening for liver disease, was selected for estimation of its cutoff level in diagnosing NAFLD. The area under receiver operating characteristic curve (AUC), cutoff level, sensitivity, specificity, PPV, NPV, and diagnostic accuracy in predicting NAFLD in males were found to be 0.807, 25 IU/l, 75.2%, 71.0%, 63.2%, 81.7%, and 73.1%, respectively, whereas those for females were found to be 0.747, 17 IU/l, 65.8%, 70.5%, 24.2%, 93.5%, and 69.9%, respectively. The sensitivity, specificity, PPV, and diagnostic accuracy results indicate that using a cut-off level of 25 U/L for males and 17 U/L for females allows for diagnosis of NAFLD with a high degree of specificity and accuracy, while the results for NPV indicate the utility of using these levels as tools in the identification of healthy subjects for further research. Conclusions: ALT level was confirmed to be a surrogate marker for NAFLD in addition to markers associated with metabolic diseases. The ALT cutoff level used in NAFLD diagnosis should be revised downward to identify subjects at risk of NAFLD to prevent NAFLD progression and the development of associated diseases.