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It is well known that cholinesterase (Acylcholine acylhydrolase 3.11.8.) activity in serum is an important liver function test, and the decrease of the enzyme activity means severe liver damage. On the contrary, our knowledge concerning the elevation of this enzyme activity, except that of nephrosis, is very scanty.Since measurement of cholinesterase using Levine method by us in 1969, five cases with hypercholinesterasenemia have been found. Two out of the five cases were fatty liver. In other cases, no significant histological change was seen except small fat drops found in case These results suggest the following conclusions: 1) Hypercholinesterasenemia is an important sign of fatty liver.2) No fatty change was recognized in three cases with hypercholinesterasenemia.In these cases some unknown mechanism in liver cells is involved.