Indian Journal of Clinical Biochemistry

, Volume 33, Issue 2, pp 241–241 | Cite as

Upper Limit of Normal for Serum Alanine Transaminase in Healthy Population

  • Beuy Joob
  • Viroj Wiwanitkit
Letter to the Editor

Dear Editor, we read the recent publication on “Upper Limit of Normal for Serum Alanine Transaminase (ALT)” with a great interest. Mohen et al. [1] 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 [1].” 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 [2]. 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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Conflict of interest



  1. 1.
    Mohan P, Sundar V, Bhaskar E, Anthony S. Estimation of upper limit of normal for serum alanine transaminase in healthy South Indian population. Indian J Clin Biochem. 2017;32:337–42.CrossRefPubMedGoogle Scholar
  2. 2.
    Wiwanitkit V, Tangdhanakanond K. Clinical chemistry laboratory references parameters. Chula Med J. 2003;47:97–100.Google Scholar

Copyright information

© Association of Clinical Biochemists of India 2017

Authors and Affiliations

  1. 1.Sanitation 1 Medical Academic CenterBangkokThailand
  2. 2.Hainan Medical UniversityHaikouChina
  3. 3.Dr. DY Patil UniversityPuneIndia

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