US EPA

7757318 

Journal Article 

Serum activity of alanine aminotransferase (ALT) as an indicator of health and disease 

Kim, WR; Flamm, SL; Di Bisceglie, AM; Bodenheimer, HC 

2008 

Yes 

Hepatology
ISSN: 0270-9139
EISSN: 1527-3350 

47 

4 

1363-1370 

English 

18366115 

10.1002/hep.22109 

WOS:000254637100028 

Physicians caring for patients with liver disease, predominantly hepatologists and gastroenterologists, have long been aware that measurements of liver enzyme activities (serum aminotransferases, including ALT [alanine aminotransferase] and AST [asparate amniotransferase]) are critical in the diagnosis and assessment of liver disease. These enzymes were formerly referred to as SGPT and SGOT, respectively. The serum ALT activity (hereafter termed ALT) has been regarded as a reliable and sensitive marker of liver disease. ALT may also be a good indicator of overall health, particularly in the context of obesity, the metabolic syndrome, and presence of cardiovascular disease, as many patients affected by these conditions also are at risk of having non-alcoholic fatty liver disease.

Despite all these considerations, abnormal ALT activity is often ignored or minimized by practitioners as most patients are asymptomatic. Minor elevations are often construed to be clinically insignificant, in part because of lack of a longitudinal perspective about the impact of abnormal ALT on long-term outcome such as end-stage liver disease or premature mortality. This document summarizes the position of the American Association for the Study of Liver Disease regarding ALT and includes review of its physiology, its distribution in health and disease, and its role as a screening and diagnostic test and clinical tool. Specifically, the significance of ALT measurements for determining general health, liver health and liver disease is addressed. The purpose of this document is to reinforce that the significance and etiology of a persistently elevated ALT must be evaluated regardless of the degree of elevation and to examine ALT as a population screening tool for early detection of liver disease.