title: Revising the upper limit of normal for levels of serum alanine aminotransferase in a Middle Eastern population with normal liver histology.
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.
  
  
  OBJECTIVE
  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/m(2) for men and 24.7 ± 3.25 kg/m(2) 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.
authors.affiliation: 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. walhamoudi@gmail.com
authors.forename: Waleed
authors.initials: W
authors.lastname: Al-hamoudi
authors.forename: Safiyya
authors.initials: S
authors.lastname: Ali
authors.forename: Bassem
authors.initials: B
authors.lastname: Hegab
authors.forename: Hussien
authors.initials: H
authors.lastname: Elsiesy
authors.forename: Almoutaz
authors.initials: A
authors.lastname: Hashim
authors.forename: Mohammed
authors.initials: M
authors.lastname: Al-Sofayan
authors.forename: Hatem
authors.initials: H
authors.lastname: Khalaf
authors.forename: Hamad
authors.initials: H
authors.lastname: Al-Bahili
authors.forename: Nasser
authors.initials: N
authors.lastname: Al-Masri
authors.forename: Mohammed
authors.initials: M
authors.lastname: Al-Sebayel
authors.forename: Dieter
authors.initials: D
authors.lastname: Broering
authors.forename: Ayman
authors.initials: A
authors.lastname: Abdo
authors.forename: Saleh
authors.initials: S
authors.lastname: Alqahtani
authors.forename: Faisal
authors.initials: F
authors.lastname: Abaalkhail
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000378:metabolism*; D005260:Female; D006801:Humans; D008099:Liver / Q000201:enzymology* / Q000378:metabolism; D008297:Male; D012529:Saudi Arabia; D014019:Tissue Donors; D055815:Young Adult
chemical_list: D000410:Alanine Transaminase
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