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	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

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 -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, -glutamyltransferase, cholesterol level, and platelet count) had a 96% accuracy to detect . . . [Full Text of this Article]

Hidekatsu Yanai, MD, PhD
Department of Internal Medicine
Sapporo Self-Defense Force Hospital
Sapporo, Japan

Mie Morimoto, BA
College of Medical Technology
Hokkaido University
Sapporo

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