Background Dyslipidemia typically recognized as high serum triglyceride high low-density lipoprotein cholesterol (LDL-C) or low high-density lipoprotein cholesterol (HDL-C) levels are associated with nonalcoholic fatty liver disease (NAFLD). hepatitis and were not taking lipid-lowering medications from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2010. ALT and AST exhibited non-linear U-shaped associations with LDL-C and HDL-C but not with triglyceride. After adjusting for potential confounders individuals with LDL-C less than 40 and 41-70 mg/dL were associated with 4.2 (95% CI 1.5-11.7 p?=?0.007) and 1.6 (95% CI 1.1-2.5 p?=?0.03) occasions higher odds of Malol abnormal liver enzymes respectively when compared with those with LDL-C values 71-100 mg/dL (reference group). Surprisingly those with HDL-C levels above 100 mg/dL was associated with 3.2 (95% CI 2.1-5.0 p<0.001) occasions higher odds of abnormal liver enzymes compared with HDL-C values of 61-80 mg/dL. Conclusions Both low LDL-C and high HDL-C often viewed as desirable were associated with significantly higher odds of elevated transaminases in the general U.S. adult populace. Our findings underscore an underestimated biological link between lipoprotein metabolism and liver diseases and raise a potential need for liver evaluation among over 10 million people with particularly low LDL-C or high HDL-C in the United States. Introduction Measurement of triglyceride and cholesterol concentrations among different lipoproteins as part of the serum lipid panel is a routine part of cardiovascular disease risk stratification. It is rarely considered a useful screening tool for the evaluation of liver diseases yet there is reason to think Malol otherwise. The liver is the central hub for lipid metabolism and controls the production and clearance of serum Malol lipoproteins  . Hence liver disease is likely to be intimately related to serum lipid levels. Dyslipidemia typically refers to elevated LDL-C or triglyceride Cav2 or low HDL-C a pattern that is associated with cardiovascular risk and is also frequently seen in nonalcoholic fatty liver disease (NAFLD)  . NAFLD a spectrum of disease ranging from hepatic steatosis to nonalcoholic steatohepatitis (NASH) and cirrhosis is the most common form of chronic liver disease and the most likely cause of elevated transaminases in otherwise healthy individuals  . Up to 33-46% of the US population may have NAFLD among whom 3% eventually develop end-stage liver disease -. Hepatic steatosis the critical “first hit” of NAFLD fundamentally results from imbalanced intrahepatic lipid homeostasis leading to triglyceride accumulation . Insulin resistance as seen in metabolic syndrome a common cause of dyslipidemia is thought to be a primary driver of NAFLD    . In population-based epidemiological studies factors associated with elevated ALT include higher age male gender high waist circumference high triglyceride level and biomarkers consistent with insulin resistance . However steatosis does not always concord with dyslipidemia. Two classic examples are abetalipoproteinemia and Malol familial hypobetalipoproteinemia (FHBL) genetic conditions characterized by inadequate assembly and secretion of apolipoprotein B (apoB)-containing lipoproteins from hepatocytes -. Both conditions paradoxically lead to apparently desirable serum lipid profiles but significant hepatic steatosis. Discordance Malol also occurs in cirrhosis even early compensated or occult-cirrhosis in which decreased liver synthetic function results in decreased apolipoprotein synthesis and lipoprotein particle secretion resulting Malol in low circulating LDL-C . For these reasons a serum lipid panel mistakenly considered “optimal” could represent occult liver disease. However this association has not been carefully studied to validate its presence and prevalence. In this context we used data from serial iterations of the National Health and Nutrition Examination Survey (NHANES) and examined the relationship between the values of serum lipid panel and liver transaminases a marker for chronic liver diseases among the US population. Methods Study Population NHANES is a nationally representative cross-sectional study conducted by the National Center for Health Statistics at the Centers for Disease.