Biomarkers · Liver & Nutritional
Alkaline Phosphatase (ALP)
Lower values carry lower risk. In NHANES 1999–2018 with linked mortality to 2019, each standard deviation is associated with a hazard ratio of 1.25. Reproduces in NHANES
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 SD1.2595% CI 1.23–1.28 · 43,812 adults, 5,900 deaths
Published hazard ratio1.38top vs bottom third (95% CI 1.25–1.52) · Systematic Review & Meta-analysis (24 Prospective Cohorts)
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 | 41.0 | 54.0 | 65.0 | 79.0 | 108 | 2,700 | 2017-2018 |
| All | 40-59 | 45.0 | 60.0 | 73.0 | 89.0 | 122 | 2,650 | 2017-2018 |
| All | 60+ | 48.0 | 65.0 | 79.0 | 97.0 | 135 | 2,800 | 2017-2018 |
| All | all | 44.0 | 59.0 | 72.0 | 88.0 | 122 | 8,150 | 2017-2018 |
| Men | all | 44.0 | 58.0 | 71.0 | 86.0 | 118 | 3,950 | 2017-2018 |
| Women | all | 43.0 | 59.0 | 73.0 | 90.0 | 126 | 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 |
|---|---|---|---|---|
| clinical | Biliary ductal obstruction, choledocholithiasis, or primary sclerosing cholangitis | +200% to +800% elevation (>250 U/L) | clinical guideline | Hirschfield GM, et al. Lancet. 2013;381:1579-1588. |
| clinical | Active Paget's disease of bone or osteolytic bone metastases | +300% to +1200% elevation | clinical guideline | Ralston SH, et al. J Bone Miner Res. 2019;34:579-604. |
| nutraceutical | Optimization of Vitamin D and dietary Calcium homeostasis | -15% to -25% reduction in secondary hyperparathyroid ALP elevations | meta-analysis | Holick MF. N Engl J Med. 2007;357:266-281. |
| pharmacologic | Ursodeoxycholic acid (UDCA 13-15 mg/kg/day) in cholestatic liver diseases | -35% to -65% reduction | rct | Poupon RE, et al. N Engl J Med. 1994;330:1342-1347. |
| pharmacologic | Antiresorptive bisphosphonates (Alendronate / Zoledronic acid) in bone turnover / Paget's disease | -40% to -75% reduction to normal baseline | rct | Reid IR, et al. N Engl J Med. 2005;353:898-908. |
Sources
- Hazard curve: J Clin Endocrinol Metab 2015; 100:1517
- 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.