What are the new healthy ranges for serum ALT levels. How do these updated guidelines impact liver disease detection. What factors influence ALT levels in blood. How should clinicians interpret and act on ALT test results.

Redefining Healthy ALT Ranges: A Paradigm Shift in Liver Disease Assessment

The traditional normal range for serum alanine aminotransferase (ALT) levels has long been used as a key indicator of liver health. However, recent research suggests that these established ranges may be outdated and potentially misleading. A groundbreaking study by Prati and associates has proposed new, lower thresholds for healthy ALT levels, which could have significant implications for the detection and management of liver diseases, particularly chronic hepatitis C virus (HCV) infections.

Traditional vs. Proposed Healthy ALT Ranges

• Traditional normal range: 30-50 U per L (typically cited as 40 U per L)
• Proposed healthy range for men: ≤30 U per L
• Proposed healthy range for women: ≤19 U per L

These new ranges are based on a comprehensive four-year study of first-time blood donors, providing a more accurate representation of truly healthy individuals. The stark difference between the traditional and proposed ranges raises important questions about our current approach to liver disease screening and diagnosis.

The Impact of Updated ALT Ranges on Liver Disease Detection

Adopting the new, lower ALT thresholds could significantly enhance our ability to identify individuals at risk for liver disease, particularly those with chronic HCV infections. The study found that using these updated ranges increased the sensitivity for detecting liver abnormalities in anti-HCV-positive individuals, albeit with a slight decrease in specificity.

How does this change in ALT range affect liver disease detection rates? The increased sensitivity means that more cases of potential liver disease would be flagged for further investigation. This could lead to earlier detection and intervention for conditions that might have otherwise gone unnoticed under the traditional ALT range guidelines.

Factors Influencing ALT Levels: Beyond Liver Health

While ALT levels are primarily associated with liver function, several other factors can influence these readings. Understanding these variables is crucial for accurate interpretation of ALT test results.

Key Factors Affecting ALT Levels

• Body Mass Index (BMI): Higher BMI is associated with elevated ALT levels
• Gender: Men typically have higher ALT levels than women
• Age: ALT levels tend to decrease with age
• Glucose intolerance: Can lead to increased ALT levels
• Hyperlipidemia: Often correlated with higher ALT readings

These factors underscore the importance of considering a patient’s overall health profile when interpreting ALT results. A slightly elevated ALT level in an individual with obesity or hyperlipidemia may not necessarily indicate liver disease, but rather reflect these underlying conditions.

Clinical Implications: Balancing Sensitivity and Specificity

The proposed lower ALT ranges present both opportunities and challenges for clinical practice. While they offer the potential for earlier detection of liver diseases, they also raise concerns about overdiagnosis and unnecessary patient anxiety.

How should clinicians approach this new paradigm? One suggested approach is to combine the new lower thresholds with adjustments for BMI and gender. This nuanced strategy could help strike a balance between improved detection rates and avoiding undue concern in otherwise healthy individuals.

Potential Outcomes of Adopting Lower ALT Thresholds

1. Increased detection of chronic HCV cases
2. Earlier intervention in progressive liver diseases
3. Higher number of patients requiring further evaluation
4. Potential for increased patient anxiety
5. Need for more liver function tests and follow-ups

Clinicians must weigh these factors carefully when deciding how to implement the new ALT guidelines in their practice.

The Rancho Bernardo Study: Age-Related ALT Decreases

Further complicating the interpretation of ALT levels is the finding from the Rancho Bernardo Study that ALT levels tend to decrease with age. This age-related decline adds another layer of complexity to the already multifaceted issue of ALT interpretation.

How does age affect ALT levels? The study suggests that as individuals grow older, their baseline ALT levels naturally decrease. This means that what might be considered a normal ALT level for a younger adult could actually be indicative of liver dysfunction in an older patient.

Implications of Age-Related ALT Decreases

• Need for age-specific ALT reference ranges
• Potential underdiagnosis of liver issues in older adults
• Importance of longitudinal ALT monitoring

These findings emphasize the need for a more personalized approach to interpreting ALT results, taking into account not just gender and BMI, but also age.

Metabolic Syndrome and ALT: A Complex Relationship

The connection between metabolic syndrome and elevated ALT levels adds another dimension to the interpretation of these test results. Studies have shown that individuals with metabolic syndrome often exhibit higher ALT levels, even in the absence of overt liver disease.

What is the significance of elevated ALT in metabolic syndrome patients? While it may not always indicate liver damage, it could be a marker of increased risk for developing non-alcoholic fatty liver disease (NAFLD) or other metabolic-related liver conditions.

Factors to Consider in Metabolic Syndrome Patients

• Insulin resistance
• Abdominal obesity
• Dyslipidemia
• Hypertension

Clinicians should be particularly vigilant when interpreting ALT results in patients with metabolic syndrome, considering the broader context of their metabolic health.

ALT and Chronic HCV: Rethinking Treatment Strategies

The proposed lower ALT thresholds could lead to the identification of more patients with chronic HCV infection. However, this raises questions about treatment strategies, particularly for those with minimally elevated ALT levels.

Should all patients with newly detected HCV based on lower ALT thresholds receive treatment? The answer is not straightforward. Patients with minimally elevated ALT levels often have a more benign disease course, and the benefits of treatment in these cases have not been well-documented.

Considerations for HCV Treatment in Patients with Minimally Elevated ALT

• Liver fibrosis stage
• Viral load
• Patient age and overall health
• Potential treatment side effects
• Patient preference and quality of life considerations

A more nuanced approach to treatment decisions may be necessary, taking into account multiple factors beyond just ALT levels.

Future Directions: Personalized ALT Interpretation and Liver Health Management

As our understanding of ALT levels and their relationship to various health factors evolves, there is a clear need for a more personalized approach to liver health assessment. Future research and clinical practice may focus on developing more sophisticated algorithms for interpreting ALT results.

What might a personalized ALT interpretation model look like? It could potentially incorporate factors such as age, gender, BMI, metabolic health markers, and even genetic predisposition to liver diseases. This holistic approach would provide a more accurate picture of an individual’s liver health and risk factors.

Potential Components of a Personalized ALT Interpretation Model

• Age-adjusted ALT reference ranges
• Gender-specific thresholds
• BMI and body composition considerations
• Metabolic health profile integration
• Genetic risk factor analysis
• Longitudinal ALT trend assessment

By embracing a more comprehensive and individualized approach to ALT interpretation, healthcare providers can make more informed decisions about further testing, monitoring, and treatment strategies for their patients.

The redefinition of normal ALT ranges represents a significant shift in our approach to liver health assessment. While it offers the potential for earlier detection of liver diseases, it also presents challenges in terms of clinical interpretation and patient management. As we move forward, a balanced approach that considers multiple factors and embraces personalized medicine principles will be crucial in maximizing the benefits of this new paradigm while minimizing potential drawbacks. Ongoing research and clinical experience will undoubtedly continue to refine our understanding and application of ALT testing in the pursuit of optimal liver health for all patients.

Updating the Healthy Range for Serum ALT Levels

RICHARD SADOVSKY, M.D.

Am Fam Physician. 2002;66(10):1991-1992

Serum alanine aminotransferase (ALT) levels have been used to evaluate liver disease, but they may fail to identify patents with chronic hepatitis C virus (HCV) who have low levels of liver inflammation. Presently, the normal range for ALT is identified as 40 U per L, with a range from 30 to 50 U per L. The populations used to determine this normal level in the 1980s probably included patients with nonal-coholic fatty liver, which is now acknowledged to be a common cause of chronic liver disease. The prevalence of chronic liver disease may be underestimated if this normal range is used. Prati and associates used the results of a four-year study of first-time blood donors to update the acceptable ALT range and identify a healthy range.

This newly identified range was then tested for sensitivity and specificity among anti-HCV–positive persons with and without documented liver disease. More than 6,000 healthy blood donors and 209 persons with confirmed anti-HCV were included. The median ALT level in the entire group was 12 U per L, with men having a slightly higher range than women. The sex-specific 95th percentile for ALT among the healthy blood donors was 30 U per L in men and 19 U per L in women, and these were suggested as healthy ALT levels.

When the old normal ALT range was compared with the new healthy range to detect ALT abnormalities among anti-HCV–positive persons, the sensitivity for liver disease of the new range’s gender-specific levels was significantly higher, while the specificity was slightly lower. Persons with a greater body mass index (BMI), glucose intolerance, or hyperlipidemia tended to have higher ALT levels.

The authors conclude that updated normal or healthy guidelines would better identify persons at risk for liver disease. These patients should probably be investigated for liver disease. Flexibility is appropriate considering the impact of other factors that may cause slight elevations of ALT, including obesity and hyperlipidemia.

In an editorial in the same journal, Kaplan legitimizes the findings of this study but puzzles over the implications. He discusses three courses of action: accepting the new lower ALT range, adjusting the current ALT range for effects of BMI and sex, and leaving the current standards alone. He suggests that combining the last two options would be appropriate because adapting the new ALT range would greatly increase the number of persons with ALT elevations who would require evaluation and impose anxiety on many otherwise healthy persons. Although additional patients with chronic HCV infection might be discovered, these patients with minimally elevated ALT levels generally have a more benign disease course that has not been documented to improve with treatment.

Alanine Aminotransferase Decreases with Age: The Rancho Bernardo Study

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“Why are ALT and AST elevated in the blood, what does this mean?” — Yandex Q

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The abbreviation ALT is deciphered as an indicator of blood enzymes of alanine aminotransferase, AsAT – asparagine aminotransferase. Indicators of AST and ALT are included in the study of biochemical blood analysis.

They were discovered in medicine relatively recently. A blood test for AST and ALT is carried out jointly and, accordingly, their norm should be the same, and fully dependent on each other.

Such an indicator of analysis as an increase in ALT and AST in the blood by 2 or more times should make you think about the occurrence of certain diseases. First you need to understand what ALT and AST are. What is the norm of these compounds in the blood and what should be done if at least one indicator is elevated?

What does an increase in ALT and AST above normal mean?

In adults, the content of ALT and AST in different organs is not the same, so an increase in one of these enzymes may indicate a disease in a particular organ.

• ALT (ALAT, alanine aminotransferase) is an enzyme that is found mainly in the cells of the liver, kidneys, muscles, heart (myocardium – heart muscle) and pancreas. When they are damaged, a large amount of ALT is released from the destroyed cells, which leads to an increase in its level in the blood.
• AST (AST, aspartate aminotransferase) is an enzyme that is also found in heart cells (in the myocardium), liver, muscles, nerve tissues, and to a lesser extent in the lungs, kidneys, and pancreas. Damage to the above organs leads to an increase in the level of AST in the blood.

Basically, the norm of ALT and AST in the blood completely depends on the work of the most important parenchymal organ – the liver, which performs such functions as:

1. Protein synthesis.
2. Production of biochemical substances necessary for the body.
3. Detoxification – removal of toxic substances and poisons from the body.
4. Storage of glycogen – a polysaccharide, which is necessary for the full functioning of the body.
5. Regulation of biochemical reactions of synthesis and decay of most microparticles.

Normal blood levels of ALT and AST depend on gender. In an adult woman, the level of ALT and AST does not exceed 31 units / l. In men, normal ALT does not exceed 45 U / l, and AST 47 U / l. Depending on the age of the child, the level of ALT and AST changes, while the content of ALT should not exceed 50 U / l, AST – 140 U / l (from birth to 5 days) and not more than 55 U / l for children up to 9years.

Depending on the equipment that was used for the study, it is possible to vary the norms and reference values ​​of the level of enzymes. An increase in the rate of enzyme renewal, cell damage leads to an increase in the level of transaminases in the blood.

Reasons for increasing ALT and AST

Why are ALT and AST elevated in adults, what does this mean? The most likely cause of elevated liver enzymes in the blood are:

1. Hepatitis and other liver diseases (

   cirrhosis of the liver

   , fatty hepatosis – replacement of liver cells with fat cells, liver cancer, etc.).

2. Increased ALT and AST as a result of diseases of other organs (autoimmune thyroiditis, mononucleosis).

3. myocardial infarction

   – this is necrosis (death) of a section of the heart muscle, as a result of which ALT and AST are released into the blood.

4. Diffuse liver disease, which may be caused by alcohol, drugs and/or viral exposure.
5. Extensive injuries with muscle damage, as well as burns, cause an increase in ALT in the blood.
6. Acute and chronic pancreatitis.
7. Metastases or neoplasms in the liver.
8. Reaction to drugs.
9. Taking anabolic steroids.

AST and ALT are important indicators of the condition of various organs. An increase in these enzymes indicates damage to organs such as the liver, heart, muscles, pancreas, etc. Thus, a decrease in their level in the blood occurs independently when the underlying disease is eliminated.

Prevention

In order to ensure that the norm of indicators does not exceed the permissible limits, it is recommended to avoid long-term medications.

If this is not possible due to a chronic disease, then it is better to regularly test for AST so that it is not elevated or a serious increase can be prevented in time. Periodically, you need to visit a gastroenterologist and a hepatologist who can identify a possible disease and prescribe treatment.

What to do if ALT and AST are elevated

In order to quickly and objectively understand the true cause of the increase in the levels of activity of ALT and AST enzymes, it is necessary to additionally pass biochemical tests.

First of all, it is advisable to determine

total bilirubin levels

, alkaline phosphatase and GGTP (gamma-glutamyltransferase) and assess the degree of preservation of the main functions of the liver. To exclude the viral nature of liver damage (acute viral hepatitis), which is also accompanied by an increase in ALT and AST in the blood, you will need to donate blood for specific antigens of viral hepatitis and specific antibodies to these antigens.

In some cases, a PCR test of blood serum for the presence of HBV DNA and HCV RNA is indicated.

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Alanine aminotransferase (AlAT-norm) – analysis at the clinic of Dr. Kulikovich in Dnipro

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Alanine aminotransferase (AlAT, ALT, GPT) is an intracellular enzyme from the group of aminotransferases that catalyze the interconversions of amino acids and keto acids by transferring the amino group.

Highest activity alanine aminotransferase is detected in the liver and kidneys, less – in the heart, skeletal muscles, pancreas, spleen, lungs, erythrocytes. The activity of the enzyme in the blood serum in men is slightly higher than in women. The content of ALT in the blood serum of healthy people is low. But with the destruction or damage of cells rich in ALT (liver, kidneys, myocardium, skeletal muscles), the enzyme is released into the bloodstream, which leads to an increase in its activity in the blood. The level of serum enzyme activity does not always correlate with the severity of organ damage (the extent of necrosis), because ALT does not have organ specificity.

Alanine aminotransferase activity in the body

In viral hepatitis, the degree of increase in alanine aminotransferase activity is usually proportional to the severity of the disease. ALT is a more specific marker of liver disease than AST, despite the simultaneous increase in transaminase levels with damage to liver cells.

In acute cases, the activity of the enzyme in the blood serum may exceed normal values ​​by 50 to 100 times or more. An increase in enzyme activity in viral hepatitis occurs at a very early time – even before the appearance of jaundice in the prodromal period (it is noted in 50% of patients – 5 days before the clinical manifestation of the disease). Enzyme activity is also increased in patients with anicteric form of the disease.

In dynamics, with a favorable course of the process, ALT activity slowly decreases to the initial values ​​within a few weeks. Maintaining a high level of ALT after acute hepatitis suggests a high risk of developing chronic hepatitis. A picture similar to infectious hepatitis is also given by toxic hepatitis with very high ALT and AST values ​​in severe cases. A more moderate increase in ALT activity is observed in alcoholic hepatitis.

With cirrhosis of the liver, the levels of transaminases are, depending on the stage of the cirrhotic process, ranging from the upper limit of the norm to a 4-5-fold increase (the level of AsAT is higher than AlAT). 5-10-fold increase in patients with primary or metastatic liver carcinomas (AST higher than ALT), although transaminase levels may be within the normal range in the early stages of malignant organ infiltration.

In myocardial infarction, the level of ALT in the blood serum is significantly lower than that of AST, since its activity in cardiomyocytes is only a small part of the activity of AST. In uncomplicated myocardial infarctions, ALT levels may be normal or mildly elevated. Increasing activity alanine aminotransferase in the blood serum in myocardial infarction may indicate the development of congestion in the liver.

The ratio of AST / ALT activities (de Ritis coefficient) is normally about 0.8-1.0, with enzymemia of hepatic origin (acute viral and toxic hepatitis) it can decrease to 0.2-0.5, with a heart attack myocardium – more than 1.0.

Indications for testing

alanine aminotransferase (AlAT, ALT, GPT)

1. Diagnostics of liver diseases
2. Examination of contact persons in the focus of viral hepatitis
3. Monitoring of patients with hepatitis of various etiologies
4. Donor screening

Exam Preparation : Fasting blood draw.

Test material : blood serum (avoid hemolysis as enzyme activity in erythrocytes is higher than in blood serum).

Method of determination: kinetic (IFCC).

Units : U/l

Reference values ​​(alanine aminotransferase-norm)

Increased values ​​

Increased values ​​of alanine aminotransferase observed in:

1. Necrosis of liver cells of any etiology (viral hepatitis, toxic liver damage, etc.)
2. Shock, hypoxia (e. g. asthma)
3. Right heart failure
4. Major trauma
5. Cirrhosis of the liver
6. Obstructive jaundice
7. Liver cancer (primary and metastatic)
8. Major myocardial infarction
9. Myocarditis
10. Myositis
11. Myodystrophy
12. Fatty liver
13. Chronic alcoholism
14. Severe pancreatitis
15. Severe burns
16. Hemolytic diseases (sometimes)
17. Treatment with hapatotoxic drugs (anabolic steroids, antibiotics, immunosuppressants, contraceptives, anticancer drugs, psychotropic drugs, salicylates, drugs for chemotherapy and anesthesia, sulfanilamide drugs)

The cost of the study “Alanine aminotransferase”

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I have worked as a teacher at the medical academy for 35 years, I have been suffering from rheumatoid arthritis for more than 10 years….

I ended up in a clinic with pancreatic problems. Having passed the diagnostics and the course of treatment, I was satisfied and…

I want to express my heartfelt gratitude to Yuri Nikolayevich Kulikovich for the creation of such a clinic, for the good…

We came from far away, and we were very touched by the care and attention that surrounded us in the Clinic. Thank you very much,…

Complaints about the musculoskeletal system forced me to go to the clinic, my knees and hips hurt…

Complaints about the musculoskeletal system forced me to go to the clinic, my knees and hips hurt. .. , but it’s a shell. The most important thing is that in the process of treatment I…

I am very grateful to the people who work here for the kindness and warmth that they radiate, for the attitude that…

I sincerely thank all the staff of the clinic for the warm professional attitude towards the patient , for…

I am a health worker with 17 years of experience. I work in the Central District Hospital of Verkhnedneprovsk. Until now, in private…

I would like to express my sincere gratitude for the sensitive attitude and professional treatment of everything…

Thank you from the bottom of my heart, Dr. Kulikovich Yu.N., for the creation of a modern center of domestic medicine…

I express my deep gratitude to Comrade Yury Nikolaevich Kulikovich and the medical staff for sensitivity and constant…

The doctor chooses the method of treatment in accordance with the nature of the disease, the healer in accordance with the nature.