Low Activities of Aspartate and Alanine Aminotransferase: Their Significance in Alcoholic Liver Disease

Two widely used and well-established enzyme tests used to detect diseases of the liver, heart, skeletal muscle, brain, and kidney are elevations in the activity of serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT). We hypothesized that the frequency of low ALT would greatly exceed the frequency of low AST in a population with a high prevalence of alcoholic liver disease. During 1 year, the frequency of low AST and ALT activity (<10 U/L) was found to be 0.17% (27/16,067) and 4.1% (472/11,582), a 24-fold difference, in 26 and 261 individual patients, respectively. Patients with alcoholic liver disease and low ALT were 10 times the number of those with alcoholic liver disease and low AST, which may reflect the low hepatic and serum ALT activity seen in these patients, as well as the widespread distribution of AST in tissues.