What the AST/ALT ratio shows
AST and ALT are enzymes that leak into the blood when liver cells are damaged. ALT is the more liver-specific of the two; AST also comes from muscle, heart and red blood cells. The ratio between them has been used since the 1950s — it is sometimes called the De Ritis ratio — as a clue to the cause of a raised liver test.
| Ratio | Pattern it is associated with |
|---|---|
| Below 1 | The usual pattern in metabolic (non-alcoholic) fatty liver disease |
| Around 1 or above | Can appear as fibrosis advances, including in fatty liver |
| Above 2 | Classically associated with alcohol-related liver disease |
Important limits
- The ratio is a hint, not a test. Plenty of people break the pattern.
- Both enzymes can be normal in someone who has significant liver disease, so a normal ratio proves nothing.
- Hard exercise, muscle injury and some medicines raise AST without any liver problem at all.
- It cannot distinguish between causes on its own; that takes history, imaging and sometimes further testing.
Before you act on this
FattyFix publishes general health information. It is not medical advice, it is not a diagnosis, and it is not a substitute for talking to a doctor, pharmacist or dietitian who knows your history. Never delay or stop treatment because of something you read here.
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