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What Your Labs Might Tell You About Your Liver
Essential Lab Tests to Detect Fatty Liver Early
Dominika Budai, M.S.
Physician Reviewed
Fatty liver disease has become increasingly common, often developing silently before symptoms appear. In some cases, it can progress to Metabolic Dysfunction-Associated Steatohepatitis, or MASH, a more serious condition in which fat buildup in the liver triggers inflammation and can lead to scarring of liver tissue. Because early stages rarely cause noticeable symptoms, lab testing plays an important role in identifying potential disease progression. Certain blood tests can help reveal early signs of fibrosis, allowing healthcare providers to monitor liver health and guide treatment decisions early.
What Labs We Look At
At Covenant Metabolic Specialists, your Liver Clinic evaluation visit includes laboratory testing, and results are reviewed during your appointment. We evaluate a Comprehensive Metabolic Panel (CMP), a lipid panel, and Hemoglobin A1c, as diabetes and dyslipidemia are key metabolic risk factors for liver disease.
Complete Metabolic Panel (CMP)
On the CMP, we closely evaluate liver enzymes – specifically AST and ALT.
AST, or aspartate aminotransferase, is an enzyme found in the liver and other tissues that enters the bloodstream when liver cells are damaged. ALT, or alanine aminotransferase, functions similarly and is considered one of the most sensitive indicators of liver injury. Although normal ranges may vary by laboratory, at Covenant we monitor closely for liver enzyme levels above 30 U/L in an effort to detect early changes.
Glucose is also included on the CMP and is important because elevated levels may indicate insulin resistance or diabetes, which is a major risk factor for developing or worsening MASH. Normal fasting glucose levels typically range from 70-99 mg/dL.
Another value we assess is albumin, a protein produced by the liver. Albumin helps reflect the liver's ability to produce essential proteins. Low levels may indicate reduced liver function or more advanced liver disease. A typical normal range for albumin is 3.3-5.5 g/dL. It is important to note that albumin can be low for many reasons unrelated to liver function as well, such as kidney disease or fluid overload.
Lipid Panel
Because dyslipidemia is a risk factor for liver disease, we make sure to review the lipid panel.
HDL, often referred to as your "good" cholesterol should typically be above 40 for men and above 50 for women. LDL, your "bad" cholesterol, is ideally below 100, or below 70 for individuals with a history of heart disease. Triglycerides, which reflect the fat derived from sugars and carbs in your diet, are ideally below 150.
When lipid levels are abnormal, the body often has impaired fat metabolism which leads to excess fatty acids being delivered to and accumulated in the liver. The liver begins storing the excess fat in its cells, causing fatty liver. Over time, the build up of fat can trigger oxidative stress and inflammation, which damages the liver cells and can stimulate the formation of fibrosis, or scar tissue.
Hemoglobin A1c
If you or someone close to you has diabetes, you have most likely heard of A1c. Hemoglobin A1c (HbA1c), is a test that measures the average level of blood glucose over approximately 3 months.
Higher A1c levels indicate chronically elevated blood sugar, and are associated with an increased risk of MASH.
Below 5.7%: Normal
5.7-6.4%: Prediabetes
6.5% and higher: Consistent with diabetes, especially if confirmed on repeat testing.
Conclusion
Fatty liver disease and MASH often develop without noticeable symptoms, which is why routine lab testing is so crucial, especially if you have the risk factors. Monitoring markers such as liver enzymes, glucose, lipid levels, and Hemoglobin A1c can help identify metabolic risk factors and early signs of liver stress before more serious damage occurs. Early detection allows healthcare providers to intervene with lifestyle changes and appropriate treatment to help slow or prevent disease progression.
If you are concerned about your liver health or have risk factors such as diabetes, high cholesterol, or obesity, consider scheduling an evaluation. At Covenant Metabolic Specialists, our team is here to help you better understand your lab results and develop a personalized plan to protect your long-term liver health.
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