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Revising the Upper Limit of Normal for Levels of Serum Alanine Aminotransferase in a Middle Eastern Population with Normal Liver Histology

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Abstract

Background

Recently, the upper limits of normal (ULN) for alanine-aminotransferase (ALT) has been recommended to be lowered to ≤30 U/l in men and ≤19 U/l in women.

Aim

To evaluate the ALT concentrations in a healthy Middle Eastern population with biopsy-proven normal liver tissue.

Methods

ALT values were calculated from 175 consecutive Saudi potential living liver donors who underwent a liver biopsy as part of a stepwise pretransplant workup.

Results

The mean age of the 110 potential donors with normal liver histology was 27 ± 6.2 years for men and 38.6 ± 7.1 years for women. The mean body mass index (BMI) levels were 23.0 ± 3.5 kg/m2 for men and 24.7 ± 3.25 kg/m2 for women, and the ALT levels were higher in male patients (22.6 ± 9 vs. 16.4 U/l ± 8, p value = 0.003). Multivariate linear regression showed that BMI and sex were independent variables that were positively associated with the levels of ALT (p < 0.0001). Moreover, when we analyzed donors according to the Prati criteria, 63 (36.0 %) of the individuals were classified into this subgroup. The mean ALT concentration was 12.9 U/l ± 4.5 in women and 19.7 U/l ± 6.9 in men, and these values were significantly lower than those obtained from subjects who did not fit the Prati criteria (19.4 U/l ± 1.8, p = 0.04 for women and 29.0 U/l ± 12.1, p = <0.0001 for men). Thus, we calculated healthy ALT values of 33 IU/l for men and 22 IU/l for women.

Conclusions

The ULN for ALT levels in Middle Eastern populations should be lowered, including separate values for males and females. Furthermore, metabolic parameters were shown to have a significant effect on ALT levels.

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Authors and Affiliations

  1. Department of Medicine, Gastroenterology and Hepatology Unit (59) and Liver Research Center, College of Medicine, King Saud University, PO Box 2925, Riyadh, 11461, Saudi Arabia

    Waleed Al-hamoudi, Safiyya Ali & Ayman Abdo

  2. Department of Liver Transplantation and Hepatobiliary Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia

    Waleed Al-hamoudi, Bassem Hegab, Hussien Elsiesy, Almoutaz Hashim, Mohammed Al-Sofayan, Hatem Khalaf, Hamad Al-Bahili, Nasser Al-Masri, Mohammed Al-Sebayel, Dieter Broering, Saleh Alqahtani & Faisal Abaalkhail

  3. Department of Hepato-Biliary-Pancreatic Surgery and Liver Transplantation, National Liver institute, University of Menoufiya, Menoufiya, 32714, Egypt

    Bassem Hegab

Authors
  1. Waleed Al-hamoudi
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  2. Safiyya Ali
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  3. Bassem Hegab
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  4. Hussien Elsiesy
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  5. Almoutaz Hashim
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  6. Mohammed Al-Sofayan
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  7. Hatem Khalaf
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  8. Hamad Al-Bahili
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  9. Nasser Al-Masri
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  10. Mohammed Al-Sebayel
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  11. Dieter Broering
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  12. Ayman Abdo
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  13. Saleh Alqahtani
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  14. Faisal Abaalkhail
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Corresponding author

Correspondence to Waleed Al-hamoudi.

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Al-hamoudi, W., Ali, S., Hegab, B. 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 58, 2369–2375 (2013). https://doi.org/10.1007/s10620-013-2659-0

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  • DOI: https://doi.org/10.1007/s10620-013-2659-0

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