A 65-year-old man presents at a hepatology outpatient clinic for elevated liver tests: ALT = 82 IU/L, AST = 67 UI/L, GGT = 235 IU/L. The alkaline phosphatase and total bilirubin levels are within normal ranges, as well as platelet count and INR.
He has the following metabolic risk profile:
- BMI = 33 kg/m2 (recent weight gain of 5 kg)
- Type 2 diabetes (diagnosed 15 years ago) treated by metformin, semaglutide 1mg/wk and insulin; HbA1c = 7.2%
- High blood pressure (ARB treatment)
- Dyslipidaemia, well controlled under statins
- Hypothyroidism
He performs no physical activity and has no present or former tobacco use.
Regarding alcohol consumption: In the last 7 years he had an alcohol consumption that averages 20 g/day (2 glasses of wine per day). The phosphatidyl ethanol is now 20 mcg/L. He reports one episode of excessive alcohol consumption (70 g/d for one day) 2 months ago (for his anniversary). Seven years ago, he had an excessive alcohol consumption of 50 g/day for 3 years.
Liver workup shows steatosis by ultrasound, a LSM by VCTE of 9.2 kPa (IQR = 20%) and an ELF test of 9.8. He ultimately undergoes a liver biopsy coming back S3A4F3 (SAF scoring).
