What does a decrease in Aspartate Aminotransferase (AST) from 35 to 24 and Alanine Aminotransferase (ALT) from 71 to 55 indicate for my liver health?

Improving Liver Enzymes: This is Reassuring and Expected

Your liver enzymes are moving in the right direction—this decrease from AST 35→24 and ALT 71→55 indicates improvement in liver health and is not concerning. This pattern suggests your liver is recovering from whatever was causing the initial elevation.

Why This is Reassuring

• ALT is the most liver-specific enzyme, and your ALT has decreased by 23% (from 71 to 55 IU/L), indicating reduced hepatocellular injury 1
• Your AST has normalized completely, dropping from 35 to 24 IU/L, which is well within the normal range for both men (29-33 IU/L) and women (19-25 IU/L) 1, 2
• The AST/ALT ratio remains <1 (0.44), which is characteristic of improving nonalcoholic fatty liver disease (NAFLD) or resolving medication-induced liver injury, rather than worsening liver disease 3, 4

What These Numbers Mean

• Your initial ALT of 71 IU/L represented mild elevation (<5× upper limit of normal), most commonly caused by NAFLD, medication effects, or viral hepatitis 1, 3
• The downward trend indicates successful treatment or resolution of the underlying cause, whether through lifestyle modifications, medication discontinuation, or natural recovery 1
• Normal AST with mildly elevated ALT is highly specific for hepatocellular improvement rather than cholestatic disease or advanced fibrosis 3

Recommended Next Steps

• Repeat liver enzymes in 4-6 weeks to confirm continued improvement and ensure ALT continues trending toward normal 1, 3
• If ALT normalizes (<30 IU/L for men, <19 IU/L for women), no further immediate testing is needed 1, 2
• If ALT remains elevated but stable at current levels, continue monitoring every 4-8 weeks until normalized 1
• Only if ALT increases to >2× baseline (>142 IU/L) or >3× upper limit of normal would more urgent evaluation be warranted 1

Continue Current Management

• If you made lifestyle changes (weight loss, exercise, dietary modifications), continue these as they are clearly working 1, 3
• If you discontinued a medication, this confirms it was likely the cause and should remain discontinued 1, 3
• If you reduced alcohol consumption, maintain abstinence or reduced intake 5, 1

When to Worry (You're Not There)

• ALT increasing to >300 IU/L or doubling from current level would require urgent evaluation 1
• Development of jaundice, abdominal pain, or confusion would warrant immediate medical attention 1
• ALT remaining elevated >6 months despite continued improvement would warrant hepatology referral 1, 3

Your current trajectory shows healing, not harm. The key is confirming this trend continues with follow-up testing in 4-6 weeks.