Chulalongkorn Medical Journal


Background : It still remains unclear whether the currently used normal rangefor serum alanine aminotransferase (ALT) levels really reflects ahealthy liver.Objective : To determine the thresholds for healthy ALT values or the normalvalue for Thai subjects with the low risk of liver diseases whoparticipate in the annual physical checkup at King ChulalongkornMemorial Hospital (KCMH).Materials and Methods : We retrospectively reviewed the medical records of annualhealth examination, including questionnaires conducted atKCMH, Thailand from January to December 2006. A group ofthe low risk of liver diseases was selected by excluding patientswho showed any abnormalities of the risk factors that weresignificantly associated with the serum ALT level, includinghepatitis B, hepatitis C, alcohol consumption, diabetes,hyperlipidemia and obesity.Results : The mean age of the 1,879 enrolled subjects was 41.7 ±10.1years, and 81.7% of them were female. The upper limit range ofthe ALT level of the group of subjects with the low risk ofliver diseases (i.e. 95th percentile) was 33.6 IU/L for males and32 IU/L for females. The upper thresholds of AST and ALT valueof the subjects with the metabolic syndrome (METS) werestatistically significantly higher than those in subjects withoutMETS (AST 57.4 vs. 30IU/L and ALT 87.3 vs. 31.6 IU/L).Conclusion : The ALT threshold of the group of Thai subjects with the low riskof liver diseases was clearly lower than the previously acceptedthreshold (<40IU/L). Metabolic syndrome significantly affectsthe ALT threshold level.


Faculty of Medicine, Chulalongkorn University

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