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Recommendations for investigating liver chemistry abnormalities are unworkable

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  1. Kwo PY, Cohen SM, Lim JK. ACG Clinical Guideline: Evaluation of Abnormal Liver Chemistries. Am J Gastroenterol. 2017;112(1):18–35.
  2. Panteghini M, Adeli K, Ceriotti F, Sandberg S, Horvath AR. American liver guidelines and cutoffs for “normal” ALT: a potential for overdiagnosis. Clin Chem. 2017;63(7):1196–1198.
  3. Angulo P, Hui JM, Marchesini G, et al. The NAFLD fibrosis score: a noninvasive system that identifies liver fibrosis in patients with NAFLD. Hepatology. 2007;45(4):846–854.
  4. Hickman IJ, Jonsson JR, Prins JB, et al. Modest weight loss and physical activity in overweight patients with chronic liver disease results in sustained improvements in alanine aminotransferase, fasting insulin, and quality of life. Gut. 2004;53(3):413–419.
  5. Dixon JB, Bhathal PS, Hughes NR, O’Brien PE. Nonalcoholic fatty liver disease: improvement in liver histological analysis with weight loss. Hepatology. 2004;39(6):1647–1654.
  6. Aune D, Sen A, Prasad M, et al. BMI and all cause mortality: systematic review and non-linear dose-response meta-analysis of 230 cohort studies with 3.74 million deaths among 30.3 million participants. BMJ. 2016;353:i2156.
  7. Prospective Studies Collaboration, Whitlock G, Lewington S, et al. Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies. Lancet. 2009;373(9669):1083–1096.
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Dr. Matney Lloyd, a member of the CAP Chemistry Resource Committee, is medical director of laboratory services, Centura Health, Centennial, Colo. Dr. Bocsi is an assistant professor of pathology, University of Colorado School of Medicine, and associate director of the University of Colorado Hospital’s clinical laboratory, Aurora. David N. Alter, MD, chair of the CAP Chemistry Resource Committee, provided editorial assistance. He is clinical professor of pathology, Michigan State University, and clinical/chemical pathologist and point-of-care testing system medical director, Spectrum Health Regional Laboratory, Grand Rapids, Mich.

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