 |
 |
|
Home |
Current Issue |
Past Issues |
In the Clinic |
ACP Journal Club |
CME |
Collections |
Audio/Video |
Mobile |
Subscribe |
Tools |
Help |
ACP Online
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Summaries for Patients are a service provided by Annals to help patients better understand the complicated and often mystifying language of modern medicine.
SUMMARIES FOR PATIENTS
New Definitions for Healthy Ranges of Alanine Aminotransferase, a Blood Test of Liver Function
2 July 2002 | Volume 137 Issue 1 | Page I-37
Summaries for Patients are presented for informational purposes only. These summaries are not a substitute for advice from your own medical provider. If you have questions about this material, or need medical advice about your own health or situation, please contact your physician. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the American College of Physicians-American Society of Internal Medicine.
The summary below is from the full report titled "Updated Definitions of Healthy Ranges for Serum Alanine Aminotransferase Levels." It is in the 2 July 2002 issue of Annals of Internal Medicine (volume 137, pages 1-9). The authors are D Prati, E Taioli, A Zanella, E Della Torre, S Butelli, E Del Vecchio, L Vianello, F Zanuso, F Mozzi, S Milani, D Conte, M Colombo, and G Sirchia.
What is the problem and what is known about it so far?
Alanine aminotransferase (ALT) is a blood test that doctors often use to evaluate patients for liver disease. High levels of ALT in a patient's blood suggest that he or she has liver disease. However, the test is not perfect. Many patients with liver disease have normal ALT levels. Infection with hepatitis C virus (HCV) and fatty deposits in the liver are two common reasons why people have abnormal ALT levels. The current "normal" ranges of ALT were defined before we knew about or could test for these conditions. As a result, some of the people considered "normal" (free of liver disease) when these ranges were established actually had HCV infection or fatty liver disease. The true normal values for ALT may be lower than the levels that laboratories currently consider normal. Knowing what ALT levels most accurately identify people with and without liver disease would be helpful.
Why did the researchers do this particular study?
To define new normal ranges for ALT among a group of people known not to have HCV infection or a fatty liver.
Who was studied?
6835 blood donors in Italy who had negative results on tests for HCV infection and 209 who were found to have HCV infection.
How was the study done?
The researchers measured ALT levels in all of the blood donors. They also collected information related to each person's risk for liver disease, including body size and other factors related to fatty liver. They then measured the ALT levels in patients who were unlikely to have liver disease, including HCV infection and fatty liver. Last, they applied these new ranges to the patients known to have HCV infection to see how many would have abnormal ALT levels according to the new definition of normal.
What did the researchers find?
The new upper limit of normal range for ALT (30 U/L for men and 19 U/L for women) were substantially lower than the levels that laboratories currently consider to be the upper range of normal (40 U/L for men and 30 U/L for women). Using these new definitions of normal, the researchers could more accurately identify the patients with HCV infection than they could using the old ranges.
What were the limitations of the study?
The researchers were unable to test whether the new ALT ranges could more accurately identify patients with fatty liver than the old ALT ranges.
What are the implications of the study?
Laboratories should consider revising the upper limits of normal for ALT to improve the accuracy of this test in identifying patients with liver disease.
Related articles in Annals:
This article has been cited by other articles:
|
|
 |
|
  N. A. Singh and N. Reau Management of hepatitis B virus J. Antimicrob. Chemother., August 1, 2008; 62(2): 224 - 228. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Arora and G. Triadafilopoulos Drawing Conclusions about Short-Term Variability in Liver Function Test Results Ann Intern Med, July 15, 2008; 149(2): 144 - 144. [Full Text] [PDF]
|
|
|
|
|
|
A. Colli and D. Prati Drawing Conclusions about Short-Term Variability in Liver Function Test Results Ann Intern Med, July 15, 2008; 149(2): 145 - 145. [Full Text] [PDF]
|
|
|
|
|
|
M. Lazo, E. Selvin, and J. M. Clark Drawing Conclusions about Short-Term Variability in Liver Function Test Results Ann Intern Med, July 15, 2008; 149(2): 145 - 146. [Full Text] [PDF]
|
|
|
|
 |
|
 E. Denney-Wilson, L. L. Hardy, T. Dobbins, A. D. Okely, and L. A. Baur Body Mass Index, Waist Circumference, and Chronic Disease Risk Factors in Australian Adolescents Arch Pediatr Adolesc Med, June 1, 2008; 162(6): 566 - 573. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. S. Ford, M. B. Schulze, M. M. Bergmann, C. Thamer, H.-G. Joost, and H. Boeing Liver Enzymes and Incident Diabetes: Findings from the European Prospective Investigation Into Cancer and Nutrition (EPIC)-Potsdam Study Diabetes Care, June 1, 2008; 31(6): 1138 - 1143. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S Kechagias, A Ernersson, O Dahlqvist, P Lundberg, T Lindstrom, F H Nystrom, and for the Fast Food Study Group Fast-food-based hyper-alimentation can induce rapid and profound elevation of serum alanine aminotransferase in healthy subjects Gut, May 1, 2008; 57(5): 649 - 654. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. A. Neuschwander-Tetri, A. Unalp, M. H. Creer, and for the Nonalcoholic Steatohepatitis Clinical Rese Influence of Local Reference Populations on Upper Limits of Normal for Serum Alanine Aminotransferase Levels Arch Intern Med, March 24, 2008; 168(6): 663 - 666. [Full Text] [PDF]
|
|
|
|
|
|
M. Lazo, E. Selvin, and J. M. Clark Brief Communication: Clinical Implications of Short-Term Variability in Liver Function Test Results Ann Intern Med, March 4, 2008; 148(5): 348 - 352. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Musso, R. Gambino, S. Bo, B. Uberti, G. Biroli, G. Pagano, and M. Cassader Should Nonalcoholic Fatty Liver Disease Be Included in the Definition of Metabolic Syndrome?: A cross-sectional comparison with Adult Treatment Panel III criteria in nonobese nondiabetic subjects Diabetes Care, March 1, 2008; 31(3): 562 - 568. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A Fraser, S Ebrahim, G Davey Smith, and D A Lawlor The associations between height components (leg and trunk length) and adult levels of liver enzymes J. Epidemiol. Community Health, January 1, 2008; 62(1): 48 - 53. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. Bugeac, A. Pacht, H. Mandel, T. Iancu, A. Tamir, I. Srugo, and R. Shaoul The significance of isolated elevation of serum aminotransferases in infants and young children Arch. Dis. Child., December 1, 2007; 92(12): 1109 - 1112. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Musso, R. Gambino, F. De Michieli, G. Biroli, A. Premoli, G. Pagano, S. Bo, M. Durazzo, and M. Cassader Nitrosative stress predicts the presence and severity of nonalcoholic fatty liver at different stages of the development of insulin resistance and metabolic syndrome: possible role of vitamin A intake Am. J. Clinical Nutrition, September 1, 2007; 86(3): 661 - 671. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. K. Schindhelm, R. J. Heine, and M. Diamant Prevalence of Nonalcoholic Fatty Liver Disease and Its Association With Cardiovascular Disease Among Type 2 Diabetic Patients: Response to Targher et al. Diabetes Care, September 1, 2007; 30(9): e94 - e94. [Full Text] [PDF]
|
|
|
|
 |
|
 A. Kotronen, J. Westerbacka, R. Bergholm, K. H. Pietilainen, and H. Yki-Jarvinen Liver Fat in the Metabolic Syndrome J. Clin. Endocrinol. Metab., September 1, 2007; 92(9): 3490 - 3497. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. C. Sung, M. C. Ryan, B. S. Kim, Y. K. Cho, B. I. Kim, and G. M. Reaven Relationships Between Estimates of Adiposity, Insulin Resistance, and Nonalcoholic Fatty Liver Disease in a Large Group of Nondiabetic Korean Adults Diabetes Care, August 1, 2007; 30(8): 2113 - 2118. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. Degertekin and A. S.F. Lok When to Start and Stop Hepatitis B Treatment: Can One Set of Criteria Apply to All Patients Regardless of Age at Infection? Ann Intern Med, July 3, 2007; 147(1): 62 - 64. [Full Text] [PDF]
|
|
|
|
|
|
T. Kumada, H. Toyoda, S. Kiriyama, Y. Sone, M. Tanikawa, Y. Hisanaga, A. Kanamori, J. Kondo, T. Yamauchi, and S. Nakano Relation between incidence of hepatic carcinogenesis and integration value of alanine aminotransferase in patients with hepatitis C virus infection Gut, May 1, 2007; 56(5): 738 - 739. [Full Text] [PDF]
|
|
|
|
|
|
G. Targher, L. Bertolini, R. Padovani, S. Rodella, R. Tessari, L. Zenari, C. Day, and G. Arcaro Prevalence of Nonalcoholic Fatty Liver Disease and Its Association With Cardiovascular Disease Among Type 2 Diabetic Patients Diabetes Care, May 1, 2007; 30(5): 1212 - 1218. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. C. Ryan, F. Abbasi, C. Lamendola, S. Carter, and T. L. McLaughlin Serum Alanine Aminotransferase Levels Decrease Further With Carbohydrate Than Fat Restriction in Insulin-Resistant Adults Diabetes Care, May 1, 2007; 30(5): 1075 - 1080. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Y. Chang, S. Ryu, E. Sung, and Y. Jang Higher Concentrations of Alanine Aminotransferase within the Reference Interval Predict Nonalcoholic Fatty Liver Disease Clin. Chem., April 1, 2007; 53(4): 686 - 692. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. S. Burgert, S. E. Taksali, J. Dziura, T. R. Goodman, C. W. Yeckel, X. Papademetris, R. T. Constable, R. Weiss, W. V. Tamborlane, M. Savoye, et al. Alanine Aminotransferase Levels and Fatty Liver in Childhood Obesity: Associations with Insulin Resistance, Adiponectin, and Visceral Fat J. Clin. Endocrinol. Metab., November 1, 2006; 91(11): 4287 - 4294. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. J. Saukkonen, D. L. Cohn, R. M. Jasmer, S. Schenker, J. A. Jereb, C. M. Nolan, C. A. Peloquin, F. M. Gordin, D. Nunes, D. B. Strader, et al. An Official ATS Statement: Hepatotoxicity of Antituberculosis Therapy. Am. J. Respir. Crit. Care Med., October 15, 2006; 174(8): 935 - 952. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. J. Jenkins, A. R Josse, R. Labelle, A. Marchie, L. S. Augustin, and C. W. Kendall Nonalcoholic fatty liver, nonalcoholic steatohepatitis, ectopic fat, and the glycemic index Am. J. Clinical Nutrition, July 1, 2006; 84(1): 3 - 4. [Full Text] [PDF]
|
|
|
|
|
|
T. L. Setji, N. D. Holland, L. L. Sanders, K. C. Pereira, A. M. Diehl, and A. J. Brown Nonalcoholic Steatohepatitis and Nonalcoholic Fatty Liver Disease in Young Women with Polycystic Ovary Syndrome J. Clin. Endocrinol. Metab., May 1, 2006; 91(5): 1741 - 1747. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Marsh Making Therapeutic Decisions in Adults with Aplastic Anemia Hematology, January 1, 2006; 2006(1): 78 - 85. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. J.G. Hanley, K. Williams, A. Festa, L. E. Wagenknecht, R. B. D'Agostino Jr, and S. M. Haffner Liver Markers and Development of the Metabolic Syndrome: The Insulin Resistance Atherosclerosis Study Diabetes, November 1, 2005; 54(11): 3140 - 3147. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. S. Szczepaniak, P. Nurenberg, D. Leonard, J. D. Browning, J. S. Reingold, S. Grundy, H. H. Hobbs, and R. L. Dobbins Magnetic resonance spectroscopy to measure hepatic triglyceride content: prevalence of hepatic steatosis in the general population Am J Physiol Endocrinol Metab, February 1, 2005; 288(2): E462 - E468. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Kerner, O. Avizohar, R. Sella, P. Bartha, O. Zinder, W. Markiewicz, Y. Levy, G. J. Brook, and D. Aronson Association Between Elevated Liver Enzymes and C-Reactive Protein: Possible Hepatic Contribution to Systemic Inflammation in the Metabolic Syndrome Arterioscler. Thromb. Vasc. Biol., January 1, 2005; 25(1): 193 - 197. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 V. Cameron, K. A. Musana, S. H. Yale, and A. S. Abdulkarim Sensitivity and Specificity of Tests of Liver Injury Clin. Med. Res., November 1, 2004; 2(4): 205 - 205. [Full Text] [PDF]
|
|
|
|
 |
|
 H. C. Kim, C. M. Nam, S. H. Jee, K. H. Han, D. K. Oh, and I. Suh Normal serum aminotransferase concentration and risk of mortality from liver diseases: prospective cohort study BMJ, April 24, 2004; 328(7446): 983. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Roderick Liver function tests: defining what's normal BMJ, April 24, 2004; 328(7446): 987 - 987. [Full Text] [PDF]
|
|
|
|
|
|
R. L. Koretz Update in Gastroenterology Ann Intern Med, September 2, 2003; 139(5_Part_1): 352 - 358. [Full Text] [PDF]
|
|
|
|
 |
|
 M.A. Pappolla, T.K. Bryant-Thomas, D. Herbert, J. Pacheco, M. Fabra Garcia, M. Manjon, X. Girones, T.L. Henry, E. Matsubara, D. Zambon, et al. Mild hypercholesterolemia is an early risk factor for the development of Alzheimer amyloid pathology Neurology, July 22, 2003; 61(2): 199 - 205. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. R. Senior Healthy Ranges for Alanine Aminotransferase Levels Ann Intern Med, January 21, 2003; 138(2): 156 - 156. [Full Text] [PDF]
|
|
|
|
|
|
F. G. De Rosa, S. Bonora, and G. Di Perri Healthy Ranges for Alanine Aminotransferase Levels Ann Intern Med, January 21, 2003; 138(2): 156 - 157. [Full Text] [PDF]
|
|
|
|
|
|
M. M. Kaplan Alanine Aminotransferase Levels: What's Normal? Ann Intern Med, July 2, 2002; 137(1): 49 - 51. [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Article
