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NASH, NALFD or Hemochromatosis?

I'm a 32 year old women of average weight with no history of health problems. I drink moderately (3-5 drinks a week), but have adhered to mostly low-carb/moderate to high fat diet in recent months.

During a regular physical, my AST/ALT tests came back high (ALT=158; AST=49). Everything else was normal, including cholesterol, glucose, thyroid, hepatitis B and C, etc. More tests were ordered and my iron serum and transferrin saturation levels came back high (205 and 69% respectively). My ferritin levels, however, were normal at 55.

The ultrasound showed a fatty liver and the specialist suggested that I have NASH. He recommended eating well/drinking less and getting rechecked in 3 months. Depending on those results, a liver biopsy would be ordered.

I plan to do so, but am still wondering about the transferrin saturation levels. The specialist called it a red herring and didn't have any explanation. I've taken daily supplements of 1000mg of Vitamin C for about 6 months and I know that can increase iron absorbtion levels. I also understand that serum iron fluctuates and may not be a great predictor of iron overload.

I'm of Scotch/English/Dutch heritage and thought that hemochromatosis was a possible diagnosis. Is there any possibility that I'm in an early stage of hemochromatosis and that's why the ferritin levels are not raised? Could this be caused by NASH? Finally, is it not still possible for a NALFD diagnosis? I assume the specialist thought NASH and not NALFD because I'm not overweight.

Any thoughts would be appreciated. My health plan is changing, so I'll be seeing a new specialist. I may wait the three months or consider going in earlier.

Thank you for you thoughts and expertise.  
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233190 tn?1278553401
With a normal ferritin, it would be unlikely that hemochromatosis is present.  An elevated transferrin saturation level is not necessarily predictive of hemochromatosis.

The best test would be a liver biopsy.  There is some recent data showing increasing accuracy with imaging studies like a CT or MRI.  

If there continues to be concern about hemochromatosis, the liver biopsy would be a reasonable procedure.  NASH is certainly possible - repeating the tests after some lifestyle changes (i.e. exercise, weight loss) can be done.  

Just as an fyi - NASH is indeed associated with obesity.  70 percent of NASH patients are obese.  

These options can be discussed with your gastroenterologist.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
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