Andy, thanks for coming in to chat about your blood test results. One of the tests we did looks at how your liver is working, and a couple of the results were slightly higher than we'd normally expect. This can sometimes be a sign that your liver is under a bit of strain.

Now, you mentioned that you don't drink much alcohol, which is good. One possible reason for these results, especially since your weight is on the higher side, is something called 'fatty liver'. That just means there might be a bit of fat building up in the liver.

The reason we want to take this seriously now is because if it's left untreated for many years, it can sometimes lead to more serious liver problems later on. But the good news is that we've caught it early, and there's a lot we can do to reverse or slow down any progression.

Often, the most effective way to manage this is through lifestyle changes, particularly around diet and physical activity. These changes can help reduce the fat in your liver and improve overall liver health.

Before we jump into suggestions, I would love to hear your thoughts:

What changes do you think you could make to your current diet?

How do you feel about your current level of physical activity?

If you are busy or do not enjoy cooking, some patients find meal preparation services helpful. These can be found online and provide simple, healthy meal options that save time and support healthier eating habits, although they can be relatively expensive. Would this be something you feel could work for you?

In terms of exercise, even something as straightforward as a 30-minute daily walk can make a big difference. You might find it helpful to swap short drives for walking or use public transport to increase your daily steps. It doesn't need to be intense; consistency is what matters most.

To be on the safe side, I would like to do a couple more tests and arrange a scan to have a closer look at your liver. It's nothing to panic about, but it's worth keeping an eye on now so it doesn't lead to problems in the future. Once we have all the results, we'll put your numbers into a medical calculator called the NAFLD score, which estimates the risk of your fatty liver progressing to liver damage.

If your risk is high, we'll refer you to a specialist liver team for further assessment and support.

If your risk is low, that's great, we'll just continue monitoring it every three years to keep things on track.

Mildly raised liver enzymes, especially ALT and GGT, in an otherwise well adult with risk factors such as obesity or sedentary lifestyle should raise suspicion of non-alcoholic fatty liver disease (NAFLD). This is often picked up incidentally during routine blood tests.

If the patient had a recent viral illness or was on new medication, a repeat test in 1-2 weeks may help determine if it's a transient rise.

A liver ultrasound and additional tests (e.g. Hepatitis screen, autoimmune panel, metabolic screen) may be appropriate for ongoing abnormal LFTs or when abnormal LFTs are identified for the first time without an apparent cause.

Early detection of NAFLD provides a window for intervention through lifestyle change, reducing the risk of long-term progression to fibrosis or cirrhosis

Understanding LFTs: Key Points for Interpretation

ALT and AST: These are enzymes found in liver cells (hepatocytes). A rise in ALT or AST suggests liver cell irritation or damage (e.g. in NAFLD, viral hepatitis, or drug-induced injury).

ALP and GGT: These are interpreted together to help determine if a raised ALP is due to liver or bone origin:

ALP is found in both the liver and bone. A raised ALP alone could indicate bone disease (e.g. vitamin D deficiency, Paget's disease, bony metastases).

GGT is specific to the liver. If both ALP and GGT are raised, this strongly points to a liver-related cause (e.g. biliary obstruction or fatty liver).

An isolated raised GGT is classically linked to alcohol excess

This station reinforces the importance of interpreting LFTs in clinical context and acting early to prevent long-term liver complications.