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In such omega minus three fatty acids patients, elevated bilirubin levels largely result from an increase in the indirect reacting fraction and may reflect alcohol-associated hemolysis.Levels of aspartate aminotransferase (AST) usually are higher than alanine aminotransferase (ALT). The absolute values of serum AST and ALT almost always are less than 500 IU/L.An increase in levels of glutamyl transpeptidase (GGT) may be related to alcohol omega minus three fatty acids use, but this study lacks specificity and sensitivity, and as many as 70% of people who abuse alcohol have normal values.In rare instances, patients with alcoholic steatosis have severe cholestasis.Ballard et al (1961) described 5 patients with alcoholic steatosis omega minus three fatty acids presenting with jaundice. Liver biopsy results in all 5 showed severe steatosis and marked cholestasis with little hepatic fibrosis. Hepatic failure characterized by progressive encephalopathy and coagulopathy developed and led to death in 2 of the patients.In
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