Upper limit of normal for alanine aminotransferase: Quo vadis?
Several studies suggest that a substantial number of patients with normal serum alanine aminotransferase (ALT) levels, defined by current thresholds, have ongoing hepatic necro-inflammation and fibrosis, and are at risk of liver disease progression. A major problem lies in the definition of normalit...
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| Published in | Clinica chimica acta Vol. 422; pp. 29 - 39 |
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| Main Authors | , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Netherlands
Elsevier B.V
25.06.2013
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| Online Access | Get full text |
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| Abstract | Several studies suggest that a substantial number of patients with normal serum alanine aminotransferase (ALT) levels, defined by current thresholds, have ongoing hepatic necro-inflammation and fibrosis, and are at risk of liver disease progression. A major problem lies in the definition of normality. The current upper limit of normal (ULN) for ALT was established in the 1980s when reference populations were likely to include many persons with hepatitis C virus infection and nonalcoholic fatty liver disease. Because ALT may be influenced, not only by liver disease, but also by other medical conditions, changing lifestyle factors and demographic determinants, the current ALT ULN threshold has recently been challenged. This review not only highlights current evidence on why and how ALT ULN should be redefined, but also discusses the current concerns about updating the ULN threshold for ALT.
•Why upper limit of normal (ULN) for alanine aminotransferase (ALT) should be redefined?•How a well-defined healthy group is generated for ALT ULN?•Factors modulating ALT activity•Skepticism concerning the need to update the current ALT ULN |
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| AbstractList | Several studies suggest that a substantial number of patients with normal serum alanine aminotransferase (ALT) levels, defined by current thresholds, have ongoing hepatic necro-inflammation and fibrosis, and are at risk of liver disease progression. A major problem lies in the definition of normality. The current upper limit of normal (ULN) for ALT was established in the 1980s when reference populations were likely to include many persons with hepatitis C virus infection and nonalcoholic fatty liver disease. Because ALT may be influenced, not only by liver disease, but also by other medical conditions, changing lifestyle factors and demographic determinants, the current ALT ULN threshold has recently been challenged. This review not only highlights current evidence on why and how ALT ULN should be redefined, but also discusses the current concerns about updating the ULN threshold for ALT.
•Why upper limit of normal (ULN) for alanine aminotransferase (ALT) should be redefined?•How a well-defined healthy group is generated for ALT ULN?•Factors modulating ALT activity•Skepticism concerning the need to update the current ALT ULN Several studies suggest that a substantial number of patients with normal serum alanine aminotransferase (ALT) levels, defined by current thresholds, have ongoing hepatic necro-inflammation and fibrosis, and are at risk of liver disease progression. A major problem lies in the definition of normality. The current upper limit of normal (ULN) for ALT was established in the 1980s when reference populations were likely to include many persons with hepatitis C virus infection and nonalcoholic fatty liver disease. Because ALT may be influenced, not only by liver disease, but also by other medical conditions, changing lifestyle factors and demographic determinants, the current ALT ULN threshold has recently been challenged. This review not only highlights current evidence on why and how ALT ULN should be redefined, but also discusses the current concerns about updating the ULN threshold for ALT. |
| Author | Chiesa, C. Romaggioli, S. Bonci, E. Anania, C. Ferraro, F. Pacifico, L. |
| Author_xml | – sequence: 1 givenname: L. surname: Pacifico fullname: Pacifico, L. organization: Department of Pediatrics and Child Neuropsychiatry, Sapienza University of Rome, Italy – sequence: 2 givenname: F. surname: Ferraro fullname: Ferraro, F. organization: Department of Pediatrics and Child Neuropsychiatry, Sapienza University of Rome, Italy – sequence: 3 givenname: E. surname: Bonci fullname: Bonci, E. organization: Department of Experimental Medicine, Sapienza University of Rome, Italy – sequence: 4 givenname: C. surname: Anania fullname: Anania, C. organization: Department of Pediatrics and Child Neuropsychiatry, Sapienza University of Rome, Italy – sequence: 5 givenname: S. surname: Romaggioli fullname: Romaggioli, S. organization: Department of Pediatrics and Child Neuropsychiatry, Sapienza University of Rome, Italy – sequence: 6 givenname: C. surname: Chiesa fullname: Chiesa, C. email: claudio.chiesa@ift.cnr.it organization: Institute of Translational Pharmacology, National Research Council, Rome, Italy |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/23566931$$D View this record in MEDLINE/PubMed |
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| Keywords | Obesity Hepatitis Alanine aminotransferase Aspartate aminotransferase Nonalcoholic fatty liver disease Upper limit of normal |
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| SubjectTerms | Alanine aminotransferase Alanine Transaminase - blood Alanine Transaminase - genetics Alanine Transaminase - metabolism Aspartate aminotransferase Hepatitis Humans Nonalcoholic fatty liver disease Obesity Reference Values Upper limit of normal |
| Title | Upper limit of normal for alanine aminotransferase: Quo vadis? |
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