Biomarkers · Liver & Nutritional
Alanine Aminotransferase (ALT)
U-shaped: both low and high values carry risk. In NHANES 1999–2018 with linked mortality to 2019, each standard deviation is associated with a hazard ratio of 0.90. U-shaped: slope not comparable
NHANES, our fit with 95% CIPublished curve
Hazard ratios relative to each curve's own reference value, so the two curves need not cross 1 at the same point. The dotted vertical line marks the NHANES median.
NHANES hazard per SD0.9095% CI 0.87–0.93 · 48,280 adults, 7,007 deaths
Published hazard ratio1.26top vs bottom quarter (95% CI 1.12–1.42) · Pooled Prospective Cohorts Meta-Analysis
Where people sit
Population percentiles (U/L) by sex and age band. Cycle or source as recorded in the catalogue.
| Sex | Age | 5th | 25th | Median | 75th | 95th | n | Cycle / source |
|---|---|---|---|---|---|---|---|---|
| All | 20-39 | 10.0 | 14.0 | 19.0 | 28.0 | 56.0 | 2,700 | 2017-2018 |
| All | 40-59 | 11.0 | 16.0 | 22.0 | 31.0 | 61.0 | 2,650 | 2017-2018 |
| All | 60+ | 10.0 | 14.0 | 18.0 | 25.0 | 48.0 | 2,800 | 2017-2018 |
| All | all | 10.0 | 15.0 | 20.0 | 28.0 | 55.0 | 8,150 | 2017-2018 |
| Men | all | 13.0 | 18.0 | 24.0 | 34.0 | 67.0 | 3,950 | 2017-2018 |
| Women | all | 9.00 | 13.0 | 17.0 | 24.0 | 44.0 | 4,200 | 2017-2018 |
What studies found when this marker was changed
Effects on the biomarker reported in the cited studies. They describe what happened in those populations, not a recommendation for anyone. See all catalogued interventions.
| Type | Intervention | Reported effect | Evidence | Source |
|---|---|---|---|---|
| diet | Weight loss (5-10% body weight) and avoidance of ultra-processed foods/fructose | Reduces elevated ALT by 40-60% into normal range (<25 U/L) | RCT | Kunutsor SK, et al. Liver enzymes and risk of all-cause and cardiovascular morta… |
| diet | Weight loss (7-10% body weight) and fructose restriction | -30% to -60% reduction (drop to normal range) | rct | Vilar-Gomez E, et al. Gastroenterology. 2015;149:367-378. |
| diet | Daily filtered black coffee consumption (2-3 cups/day) | -15% to -25% reduction | meta-analysis | Kennedy OJ, et al. Aliment Pharmacol Ther. 2016;43:562-574. |
| diet | Excessive acute or chronic ethanol consumption | +100% to +400% elevation | clinical guideline | European Association for the Study of the Liver. J Hepatol. 2018;69:154-181. |
| pharmacologic | Pioglitazone or GLP-1 RA therapy in MASLD/NASH | -35% to -55% reduction | rct | Sanyal AJ, et al. N Engl J Med. 2010;362:1675-1685. |
| pharmacologic | Acetaminophen overdose or hepatotoxic drug-induced liver injury (DILI) | +500% to +5000% acute elevation (>1000 U/L) | clinical guideline | Chalasani NP, et al. Am J Gastroenterol. 2021;116:878-898. |
Sources
- Hazard curve: Recalculated from mortality_association (HR=1.26 quartile_extreme); per-SD log(HR)=0.1803.
- Kunutsor SK, et al. Liver enzymes and risk of all-cause and cardiovascular mortality: a systematic review and meta-analysis of prospective cohort studies. Eur J Epidemiol. 2014;29(5):309-324.
- Empirical curve: our Cox model with age and sex, NHANES 1999–2018 with linked mortality to 2019.
Map Alanine Aminotransferase (ALT) against another biomarker.