INTRODUCTION: Nonalcoholic fatty liver disease (NAFLD) is characterized by a wide spectrum of liver damage, ranging from simple macrovesicular steatosis to steatohepatitis [nonalcoholic steatohepatitis (NASH)], cirrhosis, and liver carcinoma. AIM: This study assessed reliable markers of NASH such as clinical risk factors, levels of aspartate aminotransferase, alanine aminotransferase, and metabolic syndrome. PATIENTS AND METHODS: Of 250 overweight/obese patients who were consecutively surveyed for fatty liver appearance by ultrasonography, only 99 patients with NAFLD agreed to undergo liver biopsy. Determination of liver transaminases, clinical and biochemical variables, and histological assessment were performed in all patients. Overweight and obesity were defined as BMI of 25 kg/m or more and 30 kg/m or more, respectively. RESULTS: The severity of inflammation and fibrosis was increased in patients with NAFLD and elevated enzymes, but no significant difference was found in the histological assessment when comparing them with patients with NAFLD and normal enzymes in terms of steatosis, inflammation, and fibrosis. A multivariate analysis using five parameters [obesity, diabetes mellitus, homeostasis model assessment insulin resistance (HOMA-IR), triglyceride levels≥150 mg/dl, and metabolic syndrome] selected on the basis of the results of the univariate analysis showed that only both HOMA-IR and metabolic syndrome were significant prognostic factors for progression from simple steatosis to NASH (risk ratio: 5.21, 95% confidential interval: 1.24-24.15, P=0.01 and risk ratio: 6.241, 95% confidential interval: 0.187-15.652, P<0.01, respectively). CONCLUSION: Aminotransferase per se cannot be used as an alternative marker to assess progression of simple steatosis into NASH, and the presence of metabolic syndrome and HOMA-IR more than 2.7 were independent risk factors for this progression. © 2013 Egyptian Liver Journal.
