Fatty liver can cause elevated ghrelin, but high ghrelin is not necessarily caused by fatty liver. Fatty liver can lead to destruction and damage of liver cells, and the enzyme alanine aminotransferase is released from the liver cells into the blood circulation, resulting in elevated alanine aminotransferase. Therefore, high alanine aminotransferase can be caused by a fatty liver. However, high alanine aminotransferase is also seen in other conditions, such as heavy alcohol consumption, viral hepatitis, liver cancer, drug damage to the liver, and other factors that can cause liver cell damage all cause high alanine aminotransferase. Further tests, such as abdominal CT, blood test, biochemistry and so on, can be done to further clarify the cause of high alanine aminotransferase. Therefore, high alanine aminotransferase is not necessarily caused by fatty liver, patients with elevated aminotransferase should go to the hospital in time, complete the examination, identify the cause of the disease and then give targeted treatment.