Document Type : Short Communication
Authors
- Sodaif Darvish Moghadam 1
- Mohammad Javad Zahedi 2
- Mohammad Mahdi Hayatbakhsh Abbasi 3
- Ali Akbar Haghdoost 4
- Mahdieh Khalily Zade 5
- Mehdi Khaleghinia 6
- Azam Dehghani 7
- Sara Shafieipour 8
1 Professor of Gastroenterology and Hepatology, Gastroenterology and Hepatology Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran
2 Professor of Gastroenterology and Hepatology, Physiology Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
3 Professor of Internal Medicine, Gastroenterology and Hepatology Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran
4 Professor of Epidemiology, Research Center for Modeling in Health, Kerman University of Medical Sciences, Kerman, Iran
5 Infectious Disease Specialist, Clinical Research Development Unit, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran
6 Infectious Disease Specialist, Samen Hepatitis Clinic, Kerman University of Medical Sciences, Kerman, Iran
7 MSc of Biostatistics, Clinical Research Development Unit, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran
8 Assistant Professor of Gastroenterology and Hepatology, Gastroenterology and Hepatology Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran
Abstract
Background: Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) are two accessible indices for liver evaluation. Upper limit of normal (ULN) of these tests are important for starting further investigations for persons with high values. In recent years, cut off points for ULN of these tests have been disputed. This study aimed to determine the ULN of ALT and AST in a population-based study.
Methods: This cross-sectional study was performed on a randomized clustered sample of people of Kerman city. Demographic, anthropometric, and laboratory data were collected and analyzed. After excluding the recognized risk factors for liver function tests in another group (group 2), data were analyzed in this subgroup.
Results:Of 2748 subjects included in this study, 1172 (42.4%) were men, with an age range of 15-85 years. The mean (± SE), median, mode, and 95th percentile were 23.74 ± 0.18, 22, 19, and 37 for AST and 22.37 ± 0.27, 18, 15, and 46 for ALT, respectively. The levels of AST and ALT were higher in men and middle age group (p <0.0001). Similar results were obtained for gender but the association of AST and ALT with age was disappeared in another group.
Conclusion: According to the results of the present study, it is recommended to measure the ULN of AST and ALT periodically in different regions concerning age and gender.
Keywords
- Piton A, Poynard T, Imbert-Bismut F, Khalil L, Delattre J, Pelissier E, et al. Factors associated with serum alanine transaminase activity in healthy subjects: consequences for the definition of normal values, for selection of blood donors, and for patients with chronic hepatitis C. MULTIVIRC Group. Hepatology 1998;27(5):1213-9.
- Kariv R, Leshno M, Beth-Or A, Strul H, Blendis L, Kokia E, et al. Re-evaluation of serum alanine aminotransferase upper normal limit and its modulating factors in a large-scale population study. Liver Int 2006;26(4):445-50.
- Lee JK, Shim JH, Lee HC, Lee SH, Kim KM, Lim YS, et al. Estimation of the healthy upper limits for serum alanine aminotransferase in Asian populations with normal liver histology. Hepatology 2010;51(5):1577-83.
- Volzke H, Alte D, Ittermann T, Schmidt CO, Rettig R, Mayerle J, et al. Subjects with sonographical hepatic steatosis should be excluded from studies to establish upper reference levels of serum transaminases. Liver Int 2011;31(7):985-93.
- Zheng MH, Shi KQ, Fan YC, Liu WY, Lin XF, Li LF, et al. Upper limits of normal for serum alanine aminotransferase levels in Chinese Han population. PloS one 2012; 7(9):e43736.
- Wu WC, Wu CY, Wang YJ, Hung HH, Yang HI, Kao WY, et al. Updated thresholds for serum alanine aminotransferase level in a large-scale population study composed of 34 346 subjects. Aliment Pharmacol Ther. 2012;36(6):560-8.
- Prati D, Taioli E, Zanella A, Della Torre E, Butelli S, Del Vecchio E, et al. Updated definitions of healthy ranges for serum alanine aminotransferase levels. Ann Intern Med 2002; 137(1):1-10.
- Kim CW, Chang Y, Sung E, Shin H, Ryu S. Serum ferritin levels predict incident non-alcoholic fatty liver disease in healthy Korean men. Metabolism 2012; 61(8):1182-8.
- Elinav E, Ben-Dov IZ, Ackerman E, Kiderman A, Glikberg F, Shapira Y, et al. Correlation between serum alanine aminotransferase activity and age: an inverted U curve pattern. Am J Gastroenterol. 2005; 100(10):2201-4.
- Grossi E, Colombo R, Cavuto S, Franzini C. Age and gender relationships of serum alanine aminotransferase values in healthy subjects. The Am J Gastroenterol 2006; 101(7):1675-6.
- Kang HS, Um SH, Seo YS, An H, Lee KG, Hyun JJ, et al. Healthy range for serum ALT and the clinical significance of "unhealthy" normal ALT levels in the Korean population. J Gastroenterol Hepatol 2011; 26(2):292-9.
- Kabir A, Pourshams A, Khoshnia M, Malekzadeh F. Normal limit for serum alanine aminotransferase level and distribution of metabolic factors in old population of kalaleh, iran. Hepat Mon 2013; 13(10):e10640.
- Poustchi H, George J, Esmaili S, Esna-Ashari F, Ardalan G, Sepanlou SG, et al. Gender differences in healthy ranges for serum alanine aminotransferase levels in adolescence. PloS one 2011; 6(6):e21178.
- Sull JW, Yun JE, Lee S-Y, Ohrr H, Jee SH, Guallar E, et al. Body mass index and serum aminotransferase levels in Korean men and women. J cli gastroenterol 2009;43(9):869-75.
- Al-hamoudi W, Ali S, Hegab B, Elsiesy H, Hashim A, Al-Sofayan M, et al. Revising the upper limit of normal for levels of serum alanine aminotransferase in a Middle Eastern population with normal liver histology. Dig Dis Sci 2013; 58(8):2369-75.
- Dong MH, Bettencourt R, Barrett-Connor E, Loomba R. Alanine aminotransferase decreases with age: the Rancho Bernardo Study. PloS one 2010; 5(12):e14254.
- Jamali R, Pourshams A, Amini S, Deyhim M-R, Rezvan H, Malekzadeh R. The upper normal limit of serum alanine aminotransferase in Golestan Province, northeast Iran. Arch Iran Med 2008; 11(6):602-7.
- Ruhl CE, Everhart JE. Upper limits of normal for alanine aminotransferase activity in the United States population. Hepatology 2012; 55(2):447-54.
- Tanaka K, Hyogo H, Ono M, Takahashi H, Kitajima Y, Ono N, et al. Upper limit of normal serum alanine aminotransferase levels in Japanese subjects. Hepatol Res 2014: 44(12):1196-207.
- Pacifico L, Ferraro F, Bonci E, Anania C, Romaggioli S, Chiesa C. Upper limit of normal for alanine aminotransferase: Quo vadis? Cli Chim Acta 2013; 422:29-39.
)