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The Motivation for Alcohol Reward: Predictors of Progressive-Ratio Intravenous Alcohol Self-Administration in Humans
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The ALT upper reference interval debate: Blame it on the alcohol.

Michael A Vera1, Christopher D Koch1, AnnMarie Liapakis2

  • 1Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT, USA.

Clinica Chimica Acta; International Journal of Clinical Chemistry
|January 1, 2022
PubMed
Summary

Alanine aminotransferase (ALT) upper reference limits (URL) vary due to alcohol consumption. This study found that alcohol-restricted adults had lower ALT URL, suggesting alcohol intake influences these reference ranges.

Keywords:
ALTAlcoholLiver functionNon-alcoholic fatty liver diseaseNon-alcoholic steatohepatitisReference intervals

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Area of Science:

  • Clinical Biochemistry
  • Laboratory Medicine
  • Gastroenterology

Background:

  • Clinical guidelines for alanine aminotransferase (ALT) upper reference limits (URL) differ, causing debate among experts.
  • The American College of Gastroenterology (ACG) proposed lower ALT URL, while laboratory experts suggested higher values.

Purpose of the Study:

  • To investigate the impact of alcohol consumption on ALT URL variability.
  • To reconcile discrepancies in established ALT URL by analyzing population data.

Main Methods:

  • Analyzed ALT data from 7379 outpatients (aged ≥13 years, BMI 19-25), excluding those with suspected liver disease.
  • Stratified participants into pediatric, alcohol-restricted adult, and age-grouped adult cohorts with alcohol access.
  • Utilized Roche Cobas 8000 for ALT measurements, traceable to IFCC-reference measurement procedures.

Main Results:

  • Pediatric ALT URL aligned with CALIPER findings, while alcohol-restricted adults showed URL closer to ACG recommendations.
  • Significant increases in ALT URL were observed in men and women across all adult age groups with alcohol access.

Conclusions:

  • Variable inclusion of alcohol consumers in population studies contributes to discrepancies in ALT URL.
  • Alcohol consumption is a significant factor influencing ALT URL, necessitating consideration in guideline development.