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These may be elevated as much as 10-fold. However, the AST and ALT may be normal in some patients with fatty liver or plump asses NASH.In the absence of cirrhosis, an AST-to-ALT ratio of greater than 2 suggests alcohol use, whereas a ratio of less than 1 may occur in patients with NASH.Alkaline phosphataseThis can be elevated in some patients with NASH.Usually, it is less than 2- to 3-times normal.LipidsHyperlipidemia may be present.Increased triglycerides are common in children.Iron studiesElevations in serum ferritin, iron, and/or decreased transferrin saturation may occur in patients with NASH.Although iron overload occurs in a small plump asses proportion plump asses of patients with NASH, these patients have more severe disease. An iron index score may be ordered on a liver biopsy specimen to evaluate for phlebotomy. Hemochromatosis gene testing is recommended when the ferritin is significantly elevated.Viral
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