Would you begin semaglutide in a morbidly obese patient with intermittent elevations in ALT (100s) and with significant hepatic steatosis but without significant fibrosis?

How was fibrosis identified? Based on the information provided, if the rest of the serologic workup was negative for liver disease, I would be comfortable starting semaglutide. Its cross-disease benefits are likely to be highly impactful in someone we are assuming has MASLD. Liver biopsy would be us...

In any patient with alanine aminotransferase (ALT) enzyme elevation >100, intermittent, I would consider alternative or coexisting etiologies to metabolic dysfunction-associated steatotic liver disease (MASLD).

Serologic evaluation should include a phosphatidylethanol (PEth) test and elevation of al...

I would start her on a GLP-1 RA, particularly if the patient had DM/pre-diabetic state. This would help reduce weight and decrease insulin resistance. The more dominant causes of morbidity and mortality in those with metabolic syndrome are heart disease and diabetes. Liver disease is number three an...