Upper Limit of Normal for Serum Alanine Transaminase in Healthy Population
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Dear Editor, we read the recent publication on “Upper Limit of Normal for Serum Alanine Transaminase (ALT)” with a great interest. Mohen et al.  reported that “The mean ALT in men and women were 21.87 ± 2.9 (97.5th percentile 28 U/L) and 19.35 ± 3.3 (97.5th percentile 24 U/L) respectively.” and concluded that “There is a need to re-consider ALT levels in our population for better detection of individuals at risk for liver disease .” We would like to share ideas and experience on this topic. First, the healthy population in this study might not a disease free population. The statistical confirmation for the normal distribution of the ALT results is required for setting any normal reference value. In our experience from Thailand, where there is a high rate of silent hepatitis virus infection, the reference value derived from the study of healthy people, without screening for hepatitis B carrier, is high . If the reference value is intended for using for detection of individual risk for liver disease, exclusion of the case with underlying silent hepatitis carrier status is needed.
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