Pratt et al 20) also indicated that cessation of drug treatment is the best way to confirm the relationship between a drug and ALT elevation. In an Italian population, 45.6% of altered liver tests have been attributed to excessive alcohol intake (≥28 g/day) 35, while in a US national population survey, excessive alcohol (>1 time/day) is a crucial cause of ALT elevation, second only to hepatitis C virus (HCV) infection 11), however, alcohol intake might be a time-and dose-dependent covariate that influences ALT activity. Your liver is a vital organ located in the upper right-hand side of the abdominal cavity, just inferior to the diaphragm in the right superior part of the abdominal cavity and under your right ribs just beneath your right lung – filling much of the right hypochondriac and epigastric regions and extending into the left hypochondriac region. 2001;50(8):1844–1850. A nurse or lab tech will take a sample of your blood, usually from a vein in your arm. The AST blood test has a normal range of 10-40 units per liter. Diabetes. ALT is an enzyme that is produced primarily in the liver, but can also be found in the pancreas, kidneys, muscles, and heart. Archives of internal medicine. The intestinal mucosa releases this hormone in response to proteins and fats in the small intestine. The intrinsic mechanism between celiac disease is not known. An initial step in detecting liver damage is a simple blood test to determine the level of certain liver enzymes (proteins) in the blood. The alanine aminotransferase (ALT) test is a blood test that checks for liver damage. You have a family history of liver disease. However, this range may vary depending on the type of technique and protocols used by the lab. Along with other substances such as Albumin, Aspartate Aminotransferase and Bilirubin, this substance is tested to check the health of the liver. These smaller particles are more accessible to digestive enzymes from the pancreas. Suh S-Y, Choi S-E, Ahn H-Y, Yang H-M, Kim Y-I, Sung N-J. Of note, coffee intake might be a protective factor against ALT elevation. This ratio may be used to distinguish between different causes of liver damage and to help recognize heart or muscle injury. ALT values are often compared to the results of other tests such as alkaline phosphatase (ALP), total protein, and bilirubin to help determine which form of liver disease is present. 2003;37(5):1202–1219. 2000;342(17):1266–1271 https://www.nejm.org/doi/full/10.1056/NEJM200004273421707, Watkins PB, Kaplowitz N, Slattery JT, Colonese CR, Colucci SV, Stewart PW, Harris SC. The hepatopancreatic sphincter usually remains contracted until a peristaltic wave in the duodenal wall approaches it. 2003;98(5):960–967. ALT elevation is an available auxiliary measurement in the diagnosis of autoimmune hepatitis 34). The American journal of gastroenterology. Slightly high ALT levels may be caused by: Moderately high ALT levels may be because of: ALT usually is done as part of a group of liver function tests called a liver panel. ALT is an enzyme found mostly in the cells of the liver and kidney. Here’s an easy way to find out your AST:ALT ratio: divide your AST level as shown on your blood test results by your ALT level. 2006;24(8):1197–1205. Bile salts affect fat globules (clumped molecules of fats) much like a soap or detergent would affect them. Jaundice, a yellowing of the skin and mucous membranes due to accumulation of bile pigment, has several causes. In spite of the non-linear correlation between the degree of ALT elevation and the histologic severity of NAFLD 31), a mild ALT elevation is largely attributed to NAFLD. ALT helps turn L-alanine and alpha-ketoglutarate into glucose that can be used for energy (via pyruvate) and L-glutamate which can be eliminated as waste or used to build new proteins [6, 7, 8, 9].ALT Blood Test 2000;342(17):1266–1271. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3268908/, Conry-Cantilena C, VanRaden M, Gibble J, Melpolder J, Shakil AO, Viladomiu L, Cheung L, DiBisceglie A, Hoofnagle J, Shih JW. When the liver is damaged, ALT is released into the blood, usually before more obvious signs of liver damage occur, such as jaundice. https://www.ncbi.nlm.nih.gov/pubmed/15767815, Sass DA, Chang P, Chopra KB. It is well known that ALT elevation is often observed in patients with muscle necrosis 56) and the ALT elevation without evidence of liver disease should be considered due to muscle injury 57). The function of ALT (alanine aminotransferase) is to convert alanine, an amino acid found in proteins, into pyruvate, an important intermediate in cellular energy production. GASTROENTEROLOGY-BALTIMORE THEN PHILADELPHIA- 2003;124(1):71–79. Liver enzymes are substances produced by the liver that can be measured with a blood test. The American journal of gastroenterology. In: Seminars in liver disease: 2001; 2001. pp. I have had a routine blood test that showed my ALT and AST levels were elevated. Then the sphincter relaxes, and bile is squirted into the duodenum. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4305941/, Liangpunsakul S, Chalasani N. Unexplained elevations in alanine aminotransferase in individuals with the metabolic syndrome: results from the third National Health and Nutrition Survey (NHANES III) The American journal of the medical sciences. The liver plays a key role in carbohydrate metabolism by helping maintain concentration of blood glucose within the normal range. Some of these signs and symptoms may include: ALT may also be ordered, either by itself or with other tests, for people who are at an increased risk for liver disease since many people with mild liver damage will have no signs or symptoms. In acute hepatitis, ALT levels usually stay high for about 1-2 months but can take as long as 3-6 months to return to normal. 2005;11(11):1616–1622. An ALT blood test may be helpful in early detection of liver disease. The ALT-to-AST ratio can help your doctor figure out how severe the liver damage is and what might have caused it. The prevalence and etiology of elevated aminotransferase levels in the United States. Diagnosis of hemochromatosis. ALT is more specific for liver injury than AST (SGOT). https://www.jstage.jst.go.jp/article/circj/75/4/75_CJ-10-0465/_pdf/-char/en. Cathy et al 10) reported that approximately 68% of patients with positive HCV-RNA levels have ALT elevations in asymptomatic blood donors who tested positive for antibodies to the HCV (anti-HCV). Clark JM, Brancati FL, Diehl AM. 1997;26(S3):29S–33S, Ruhl CE, Everhart JE. For example, if your AST is 20 U/L and your ALT is 18 U/L, then your ALT ratio would be 1.05, which is within the normal range. In hemolytic jaundice red blood cells are destroyed too rapidly, as happens with an incompatible blood transfusion or a blood infection. Your liver is partially surrounded by the ribs, and extends from the level of the fifth intercostal space to the lower margin of the right rib cage, which protects this highly vascular organ from blows that could rupture it. If you have high levels of AST and/or ALT, it may mean that you have some type of liver damage. In a UK study based on alcohol abusers from different areas worldwide, adults from South Asia were shown to be more susceptible to alcohol-related liver damage and the ALT levels were higher than in European alcohol abusers 14). Thanks for explaining a little more about the mildly elevated & highly elevated levels. The ALT blood test is the exact same test as the SGPT blood test in years past. Viral hepatitis infection is the leading or secondary cause of ALT elevation in populations worldwide 1). It breaks down and stores many of the nutrients absorbed from the intestine that your body needs to function. Your health care provider may order an ALT blood test along with your AST blood test. Aspartate transaminase (AST, formerly referred to as serum glutamic-oxaloacetic transaminase, SGOT) 3. Alanine transaminase or ALT is a liver enzyme alongside AST, or aspartate aminotransferase. A blood sample is drawn from a vein in the arm. http://diabetes.diabetesjournals.org/content/50/8/1844.long, Liu C-M, Tung T-H, Liu J-H, Chen V, Lin C-H, Hsu C-T, Chou P. A community-based epidemiological study of elevated serum alanine aminotransferase levels in Kinmen, Taiwan. Bile is a yellowish-green liquid continuously secreted from hepatic cells. In a US national population-based study 50), BMI lost significance when evaluating the association between obesity and ALT abnormities after adjusting for leptin, insulin, and triglyceride concentrations, rather than the waist circumstance, which was representative of the visceral adipose deposition, indicating that BMI might be an intrinsic association between obesity and ALT abnormalities. Â© 2005 - 2020 WebMD LLC. Alanine aminotransferase or ALT (also known as SGPT) is an enzyme your body needs to break down proteins into energy. These distinguishing effects emerged after logistic regression using all of the metabolic syndrome components as covariates. Bile salts aid digestive enzymes. Neuschwander-Tetri BA, Caldwell SH. A randomized controlled trial indicated that the estimated odds ratios of ALT elevation in active treatment groups (including acetaminophen, paracetamol, hydromorphone+acetaminophen, morphine+acetaminophen, and oxycodone+acetaminophen) were 2.57-3.08 compared to the placebo group involving 343 healthy participants, even at the recommended dose 17). Chronic ALT elevation is also found in several non-hepatic disorders, such as celiac disease and muscle injury 53). The liver’s effects on lipid metabolism include oxidizing (breaking down) fatty acids at an especially high rate; synthesizing lipoproteins, phospholipids, and cholesterol; and converting excess portions of carbohydrate molecules into fat molecules. 2002;162(19):2236 https://www.ncbi.nlm.nih.gov/pubmed/12390068, Wickramasinghe S, Corridan B, Izaguirre J, Hasan R, Marjot D. Ethnic differences in the biological consequences of alcohol abuse: a comparison between south Asian and European males. Following is a sample of the results of the Alanine Transaminase (ALT) blood test. 2003;98(5):960–967 https://www.ncbi.nlm.nih.gov/pubmed/12809815, Rehermann B, Nascimbeni M. Immunology of hepatitis B virus and hepatitis C virus infection. 2010;75(4):964–969. Other causes of moderate increases in ALT include obstruction of bile ducts, cirrhosis (usually the result of chronic hepatitis or bile duct obstruction), heart damage, alcohol abuse, and with tumors in the liver. Liver function tests may be part of a regular checkup. ALT activity is a crucial reference indicator in treatment selection and the evaluation of prognosis in patients infected with HBV 5). In addition, macrophages in the liver help destroy damaged red blood cells and phagocytize foreign antigens. It is often ordered in conjunction with aspartate aminotransferase (AST) as part of a liver panel or comprehensive metabolic panel (CMP) to screen for and/or help diagnose liver disease. Determinants of the association of overweight with elevated serum alanine aminotransferase activity in the United States. 2003;98(5):960–967. Other liver functions concern protein metabolism. Less is known about the clinical implications associated with low-normal ALT levels. It has simply been given a new name. New England Journal of Medicine. Detoxifies many poisons and drugs in the blood. Obesity, insulin resistance, and the risk of an elevated alanine aminotransferase activity in the Korean adolescent population. 2010;42(12):882–887. In addition to water, bile contains bile salts, bile pigments (bilirubin and biliverdin), cholesterol, and electrolytes. When the liver is damaged, ALT is released into the blood. 2010;51(6):2193–2213. Other liver function tests measure enzymes that liver cells release in response to damage or disease.Abnormal liver function test results don't always indicate liver disease. Yun JE, Kim SY, Kang H-C, Lee SJ, Kimm H, Jee SH. Clark JM, Brancati FL, Diehl AM. In this case, ALT levels often vary between normal and slightly increased, so the test may be ordered frequently to see if there is a pattern. Most clinical laboratories offer bundled blood tests, which often contain all or most of the following: 1. Why the Test is Performed. Another commonly used medication, statins, also causes mild ALT elevation 18). The normal values range of the AST blood test in males is 10 to 40 units per Liter of Serum and in females, it is 9 to 32 units per Liter of Serum.. Hepatitis C in asymptomatic blood donors. Alt test range. Digestive diseases and sciences. Preparation: You should not eat for 12-14 hrs before the test. 2004;22(4):276–280. The aspartate aminotransferase (AST) test is a blood test that checks for liver damage. Very high levels of ALT (more than 10 times normal) are usually due to acute hepatitis, sometimes due to a viral infection. Even without other symptoms, ALT will be increased with mild liver damage. This is true of both prescription drugs and some “natural” health products. Normally, ALT levels in the blood are low. ALT stands for alanine aminotransferase, which is another type of liver enzyme. https://www.ncbi.nlm.nih.gov/pubmed/20457548, Stewart SH. AST Blood Test Normal Range. This test measures the level of ALT in the blood and is useful for early detection of liver disease. ALT may be ordered as part of a comprehensive metabolic panel when a person has a routine health examination. Matthews D, Hosker J, Rudenski A, Naylor B, Treacher D, Turner R. Homeostasis model assessment: insulin resistance and β-cell function from fasting plasma glucose and insulin concentrations in man. ALT blood test high The liver carries on many important metabolic activities. Another study also showed an association between persistent ALT elevation and poor survival in 69 autoimmune hepatitis patients 36). Hepatology. Alanine transaminase (ALT, formerly called seru… The liver also stores many substances, including glycogen, iron, and vitamins A, D, and B12. In obstructive jaundice bile ducts are blocked, perhaps by gallstones or tumors. Of these, bile salts are the most abundant and are the only bile components that have a digestive function. What other tests may be performed to help determine the cause of liver damage? They include deaminating amino acids; forming urea; synthesizing plasma proteins such as clotting factors; and converting certain amino acids into other amino acids. Journal of Pediatric Endocrinology and Metabolism. In hepatocellular jaundice the liver is diseased, as in cirrhosis or hepatitis. 2012;45(18):1683–1688 https://www.ncbi.nlm.nih.gov/pubmed/22975640, Yun JE, Kim SY, Kang H-C, Lee SJ, Kimm H, Jee SH. Clinical biochemistry. This result is typical for adult men. ALT is often performed together with a test for AST or as part of a liver panel. You may also have an AST test part of a series of liver function tests. Levels of ALT may also be markedly elevated (sometimes over 100 times normal) as a result of exposure to drugs or other substances that are toxic to the liver or in conditions that cause decreased blood flow (ischemia) to the liver. }); What conditions other than liver problems can cause increased ALT? Footnote: (a) Cross section of a hepatic lobule. The American journal of gastroenterology. 2005;50(1):171–180 https://www.ncbi.nlm.nih.gov/pubmed/15712657, James PT. Digestive and Liver Disease. ALT is short for alanine aminotransferase is also called SGPT (Serum Glutamic-Pyruvic Transaminase) or GPT (Glutamic-Pyruvic Transaminase) or alanine transaminase, which is an enzyme found mostly in the cells of the liver and kidney. The liver is a very essenti… Moderate alcohol intake does not contribute to significant ALT elevation, especially in a normal weight population, due to its potential effect on improvement of insulin sensitivity 15). ALT blood levels are a marker of liver health: low levels typically indicate a healthy liver, while high levels suggest liver damage . NAFLD is a spectrum of clinical and pathologic changes, from fatty liver alone to steatohepatitis 23). If your liver is damaged, it will release more ALT into your blood and levels will rise. 2005;329(3):111–116. CirrhosisÂ (long-term damage and scarring of the liver). What Is an Alanine Aminotransferease Test? In most types of liver diseases, the ALT level is higher than AST and the AST/ALT ratio will be low (less than 1). Liver cells responding to the hormone insulin lower the blood glucose level by polymerizing glucose to glycogen. Both ALT and AST levels usually rise whenever the liver is being damaged, although ALT is more specific for the liver and, in some cases, may be the only one of the two to be increased. Risk factors for serum alanine aminotransferase elevation: A cross-sectional study of healthy adult males in Tokyo, Japan. After a thorough physical exam and evaluation of a person’s medical history, there are several other tests that may be performed as follow up depending on what is suspected to be the cause of liver damage. ALT blood test normal range: Normal ALT are less than 36U/L [7 to 55 units per liter (U/L)]. Some of these include: A liver biopsy may be performed to help determine the cause of liver injury and to evaluate the extent of liver damage. Ruhl CE, Everhart JE. A normal ALT test result can range from 7 to 55 units per liter (U/L). NAFLD in asymptomatic patients is often serendipitously detected by liver biochemistry testing during routine health check-ups 28). Upper limits of normal for alanine aminotransferase activity in the United States population. The alanine aminotransferase (ALT) test is typically used to detect liver injury. International journal of sports medicine. Bile salts also enhance absorption of fatty acids, cholesterol, and the fat-soluble vitamins A, D, E, and K. Low levels of bile salts result in poor lipid absorption and vitamin deficiencies. What is it used for? 1985;28(7):412–419. (ALT used to be called serum glutamic-pyruvic transaminase, or SGPT). Therefore, an ALT of 80 is only mildly elevated and is not indicative of severe liver disease, but it also does not rule it out. The ALT blood test is safe. Unlike hepatitis B virus (HBV) infections, the ALT level is less meaningful for diagnosis and prognosis of hepatitis C virus (HCV) treatment. https://www.ncbi.nlm.nih.gov/pubmed/19217993, Lai M, Hyatt BJ, Nasser I, Curry M, Afdhal NH. An ALT test measures the level of alanine aminotransferase, also called ALT or SGPT. Nonalcoholic fatty liver disease: a clinical review. In addition, the impact of metabolic syndrome components on ALT activities varies to some extent. 2012;55(2):447–454. Gastroenterology. ALT : Alanine aminotransferase (ALT) is present primarily in liver cells. A common clinical scenario is the unanticipated discovery of an abnormal liver test result, obtained when a bundle of tests has been done for other reasons. Some nutrients must be changed (metabolized) in the liver before they can be used for energy or to build and repair body tissues. Evaluation of abnormal liver-enzyme results in asymptomatic patients. International journal of epidemiology. Any elevation in an enzyme level may be a sign of a liver problem, and aspartate aminotransferase (AST) and alanine aminotransferase (ALT) are two of the enzymes central to such an investigation. This impact of metabolic syndrome on ALT elevation, however, is progressive and cumulative with a linear trend 41). Non-alcoholic fatty liver disease (NAFLD) is common in asymptomatic patients, and the prevalence ranges from 10 to 24% worldwide 24). The American journal of clinical nutrition. 2007;47(6):760–767 https://www.ncbi.nlm.nih.gov/pubmed/17928090, Alter HJ, Conry-Cantilena C, Melpolder J, Tan D, Van Raden M, Herion D, Lau D, Hoofnagle JH. Increased in Reye syndrome, with AST. A shot or injection of medicine into the muscle tissue, or strenuous exercise, may increase ALT levels. The possible explanation is that obesity, especially abdominal fat, is potentially involved in the visceral adipose deposition that causes hepatotoxic fatty acids 49). All of the enrolled participants were selected within the upper limit of normal values (the upper limit of normal value is 30 U/l for males and 19 U/l for females) 43). This enzyme is also known as serum glutamic-pyruvic transaminase (SGPT). 2006;97(8):S77–S81. Lorenzo C, Hanley A, Rewers M, Haffner S. The association of alanine aminotransferase within the normal and mildly elevated range with lipoproteins and apolipoproteins: the Insulin Resistance Atherosclerosis Study. Drinking coffee can help to lower ALT levels. 1 Test for hepatitis. The function of ALT is to convert alanine, an amino acid found in proteins, into pyruvate, an important intermediate in cellular energy production. This result is typical for adult men. Order an ALT Blood Test Now - Doctor's Order Included.The Alanine Transaminase (ALT) blood test is an excellent measure of how well your liver is functioning. Most of it is found in the liver [1, 2]. 2006;296(1):87–93. In healthy individuals, ALT levels in the blood are low. 1989;10(S 3):S160–S168. In a study based on 84 Japanese autoimmune hepatitis patients, a persistently low ALT level (≤40 U/l) was the threshold value that was associated with improved prognosis 35). Your doctor might recommend ALT if you have symptoms of liver disease or damage, such as: Here are some reasons you might get this test: The ALT test can be done as part of a blood panel during a regular exam. Alimentary pharmacology & therapeutics. An ALT blood test is a type of liver function test. Approximately 40-57% of patients with celiac disease have abnormal liver tests 54). Alanine aminotransferase is associated with metabolic syndrome independently of insulin resistance. ", Nemours Foundation: "Blood Test: Alanine Aminotransferase (ALT, or SGPT). Some medicines can affect the results of this test. ALT levels are usually not as high in chronic hepatitis, often less than 4 times normal. You don't need any special preparation for the ALT test. Levels are normally higher in men. You'll need to know your AST and ALT levels, as determined by a bloodtest. https://www.ncbi.nlm.nih.gov/pubmed/11237179, Matteoni CA, Younossi ZM, Gramlich T, Boparai N, Liu YC, McCullough AJ. New England Journal of Medicine. 2009;58(12):1731–1736. Another viewpoint was that the obesity-ALT elevation association was modulated by insulin resistance. The serum glutamic pyruvic transaminase blood test would measure the amount of alanine aminotransferase that was in the blood just as the current test results do. Clinical features and natural history of nonalcoholic steatosis syndromes. Smart Grocery Shopping When You Have Diabetes, Surprising Things You Didn't Know About Dogs and Cats, Coronavirus in Context: Interviews With Experts. Celiac disease patients with elevated ALT levels should be treated with gluten-free diet; doing so will restore ALT levels to normal in 75-95% of patients within 6 months 55). Doctors often give the ALT test along with other liver tests. 2012;45(18):1683–1688. Risks are usually minor, and can include: You should get your results in about a day. Otherwise, the HCV RNA titer is closely linked to the ALT elevation. Otherwise, the increased creatine kinaseand lactate dehydrogenase activities that occurred following muscle injury should be assayed to identify the cause of ALT elevation 58). Injury to the liver results in release of ALT into the blood. Normal ALT are less than 36U/L [7 to 55 units per liter (U/L)]. The lab report should be interpreted in the context of the clinical situation, the findings on physical examination, and the results of other blood tests. https://www.ncbi.nlm.nih.gov/pubmed/10348825, Angulo P. Nonalcoholic fatty liver disease. The liver also removes toxic substances such as alcohol and certain drugs from blood (detoxification). This makes ALT a useful test for early detection of liver damage. 2000;95(5):1370–1371, Muri Boberg K. Prevalence and epidemiology of autoimmune hepatitis. World J Gastroenterol. An ALT test measures the amount of ALT in the blood to assess if the liver is damaged. Amazingly versatile, your liver performs over 500 functions. The reference interval indicates the normal ranges and the flag indicates a result outside of those ranges. As with ALT, the levels of AST in your blood rise if your liver is damaged. Normal results vary from laboratory to laboratory and might be slightly different for women and children (neonate < 50 U/L). An ALT is a simple blood test with few risks. 2004;28(8):1033–1038. The American journal of cardiology. 15–22. https://www.ncbi.nlm.nih.gov/pubmed/20513004, Miyake Y, Iwasaki Y, Terada R, Takagi S, Okamaoto R, Ikeda H, Sakai N, Makino Y, Kobashi H, Takaguchi K. Persistent normalization of serum alanine aminotransferase levels improves the prognosis of type 1 autoimmune hepatitis. The blood transports fats synthesized in the liver to adipose tissue for storage. https://jamanetwork.com/journals/jama/fullarticle/211014, Ford I, Mooijaart SP, Lloyd S, Murray HM, Westendorp RG, de Craen AJ, Packard CJ, Buckley B, Barlow C, Preiss D. The inverse relationship between alanine aminotransferase in the normal range and adverse cardiovascular and non-cardiovascular outcomes. 2012;25(9-10):945–949. Short-term and light alcohol consumption was not shown to induce significant ALT elevation in adults 12), however, ethnicity differences exist regarding the biological consequences of alcohol abuse 13). 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