Trends in Serum AST-to-ALT Ratio Among U.S. Adults: Analysis of the U.S. National Health and Nutrition Examination Survey

Abstract

Background:

Using nationally representative data, we examined the age-, sex-, and ethnic-specific variation in the ratio of serum aspartate aminotransferase and alanine aminotransferase (AST-to-ALT ratio or AAR) of U.S. adults (20+ years). Understanding these subgroup differences in AAR will provide insight into population patterns of these ratios, which provide a basis for normative comparisons for the application of personalized diagnostic information to patients in the clinical setting.

Methods:

Data for this analysis are based on continuous cycles (1999–2016) of the National Health and Nutrition Examination Survey (NHANES).

Results:

Within the complete sample (n = 13,731), mean AST and ALT values were similar (∼25 U/L), with higher absolute values, but lower AAR, in males compared with females. From 1999–2000 to 2015–2016 there were consistent sex, age, and ethnic differences in the AAR. Specifically, the AAR for individuals 65+ years was markedly higher in all survey years, with subtle ethnic variation [Mexican Americans (0.95–1.04) Other Hispanic (1.0–1.09), Non-Hispanic White (1.05–1.11), Non-Hispanic Black (1.12–1.22), and Other Ethnicity (1.01–1.17)]. Sex-specific analysis reveals that the lower AAR observed among Mexican Americans is almost entirely accounted for by the markedly lower AAR in men.

Conclusion:

Future work is necessary to understand these subgroup variations in longer term studies with incident disease.