Alanine aminotransferase as a marker of non-alcoholic fatty liver disease in relation to type 2 diabetes mellitus and cardiovascular disease

Diabetes Metab Res Rev. 2006 Nov-Dec;22(6):437-43. doi: 10.1002/dmrr.666.


For a long time, hepatic steatosis was believed to be a benign condition. Only recently, liver steatosis, also termed non-alcoholic fatty liver disease (NAFLD), has gained much interest. In most cases of NAFLD, a condition regarded as the hepatic component of the metabolic syndrome, the enzyme alanine aminotransferase (ALT) is elevated and consequently has been used as a marker for NAFLD. More recently, several cross-sectional and prospective studies have demonstrated associations of this liver enzyme with features of the metabolic syndrome and type 2 diabetes mellitus. This review discusses the biochemical and metabolic properties of ALT, its applicability as a marker of NAFLD and describes its possible role in the pathogenesis of the metabolic syndrome and type 2 diabetes mellitus and subsequent cardiovascular disease. In addition, treatment strategies to ameliorate NAFLD and the associated risks are discussed.

Publication types

  • Review

MeSH terms

  • Adipose Tissue / enzymology
  • Alanine Transaminase / analysis
  • Alanine Transaminase / metabolism*
  • Animals
  • Biomarkers / analysis*
  • Cardiovascular Diseases / etiology*
  • Diabetes Mellitus, Type 2 / etiology*
  • Fatty Liver / complications
  • Fatty Liver / diagnosis*
  • Fatty Liver / therapy
  • Female
  • Humans
  • Liver / enzymology
  • Male
  • Metabolic Syndrome / complications
  • Risk Factors


  • Biomarkers
  • Alanine Transaminase