To the Editor: In their Grand Rounds article about nonalcoholic fatty liver disease (NAFLD), Drs Clark and Diehl1 stated that advanced disease, including cirrhosis, may not be detectable by either serum aminotransferases or diagnostic imaging. Although they emphasized the importance of liver biopsy to detect NAFLD, we believe that this conclusion is premature.
The role of liver biopsy in hepatitis C virus is controversial because of the associated costs, staffing issues, and risk of injury.2 Furthermore, it may be possible to detect hepatic fibrosis in patients with NAFLD by the changes of serum biochemical data such as increased levels of γ-glutamyltransferase, leucine aminopeptidase, or alkaline phosphatase; or decreased levels of cholesterol, albumin, or choline esterase; or by the ultrasound imaging changes (decreased echoic intensity or splenomegaly). For instance, Forns et al3 reported that 3 common serum tests (ie, γ-glutamyltransferase, cholesterol level, and platelet count) had a 96% accuracy to detect even mild fibrosis.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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