What does it mean to have elevated AST and ALT levels?

Understanding Elevated AST and ALT Levels

Your AST of 46 IU/L and ALT of 60 IU/L represent mild hepatocellular injury, most commonly caused by nonalcoholic fatty liver disease (NAFLD), alcohol consumption, viral hepatitis, or medication-induced liver damage. 1, 2

What These Numbers Mean

Your liver enzyme elevations are classified as mild (less than 5 times the upper limit of normal). 2 The pattern shows:

• ALT is higher than AST (60 vs 46), giving an AST/ALT ratio of approximately 0.77, which is characteristic of NAFLD, viral hepatitis, or drug-induced liver injury rather than alcoholic liver disease. 1, 2, 3

• ALT is the most liver-specific enzyme, as it has minimal presence in other tissues like muscle or heart, making this elevation a reliable indicator of hepatocellular damage. 2, 4

• An AST/ALT ratio less than 1.0 typically rules out advanced alcoholic liver disease and cirrhosis, which usually present with ratios greater than 2.0. 1, 3, 5

Most Common Causes in Your Range

Nonalcoholic fatty liver disease (NAFLD) is the most frequent cause of this pattern, affecting 20-30% of the general population and up to 70% of obese individuals. 1 This condition is associated with:

• Obesity 1
• Diabetes mellitus 1
• Hypertension 1
• Metabolic syndrome 1

Other important causes to consider:

• Alcohol consumption - even moderate amounts can elevate liver enzymes 2, 6
• Medications and supplements - prescription drugs, over-the-counter medications, or herbal products 2, 7
• Viral hepatitis - hepatitis B, C, or E 2, 7
• Non-hepatic causes - muscle injury, thyroid disorders, or strenuous exercise can elevate AST more than ALT 1, 7

What You Should Do Next

Repeat the liver function tests in 2-4 weeks to establish whether this is a persistent problem or a transient elevation. 2 During this time:

• Document your alcohol intake precisely, including frequency and quantity 1, 2
• Review all medications and supplements you're taking, including over-the-counter products 1, 2
• Check for metabolic risk factors - assess your weight, blood sugar, and blood pressure 1, 2

If enzymes remain elevated on repeat testing, obtain:

• Complete liver panel (alkaline phosphatase, bilirubin, albumin, PT/INR) 2
• Viral hepatitis serologies (HBsAg, HBcIgM, HCV antibody) 2
• Thyroid function tests 1, 2
• Creatine kinase to rule out muscle injury 1, 2

Abdominal ultrasound should be performed as first-line imaging if enzymes stay elevated, with 84.8% sensitivity and 93.6% specificity for detecting moderate to severe fatty liver. 1, 2

When to Seek Urgent Evaluation

Immediate medical attention is needed if:

• ALT rises above 240 IU/L (5× upper limit of normal) 2
• You develop symptoms like jaundice, severe fatigue, right upper abdominal pain, nausea, or vomiting 1
• Bilirubin becomes elevated (≥2× upper limit of normal) 1

Important Pitfalls to Avoid

Don't assume this is benign without investigation - while mild elevations are common, they can represent early stages of significant liver disease that requires intervention. 2, 6

Don't overlook non-hepatic causes - AST can be elevated from heart or muscle problems, so if both enzymes are elevated, checking creatine kinase helps distinguish liver from muscle injury. 1, 7, 4

Consider hepatology referral if liver enzymes remain elevated for 6 months or more despite addressing reversible causes like alcohol, medications, or weight loss. 2, 6