Liver
ALT / AST Ratio (De Ritis)
What This Marker Tells Us
Compares two liver enzymes with different locations within cells, revealing the type and severity of liver damage and helping distinguish between various causes of liver injury.
Why It Matters
Identifies whether liver damage is primarily from alcohol, fatty liver disease, viral hepatitis, or other causes. AST exists in liver, heart, muscle, and other tissues, while ALT is more liver-specific. When liver cells are damaged, both enzymes leak into blood, but the ratio between them creates a signature pattern for different conditions. Early detection of liver dysfunction prevents progression to cirrhosis, liver failure, and metabolic disease.
How to Interpret Your Trends
Ratios below 1.0 typically indicate non-alcoholic fatty liver disease, viral hepatitis, or drug-induced liver injury where ALT rises more than AST. Typical ratios (0.8-1.0) suggest healthy liver function. Ratios above 2.0 signal alcoholic liver disease, cirrhosis, or severe liver damage where AST predominates. Very high ratios indicate advanced fibrosis or muscle damage contributing to elevated AST.
What Influences This Marker
Alcohol consumption dramatically elevates AST relative to ALT. Non-alcoholic fatty liver disease from metabolic syndrome, obesity, and insulin resistance raises ALT more. Intense exercise, muscle injury, and rhabdomyolysis increase AST. Medications, supplements, viral infections, and autoimmune conditions affect both enzymes. Weight loss, reduced alcohol intake, and improved metabolic health normalize the ratio.
How Your Team Uses It
Your team uses this ratio to identify liver injury patterns, guide alcohol and supplement recommendations, and monitor metabolic interventions. Rising ratios prompt investigation of alcohol use, fatty liver progression, or medication effects. It informs lifestyle modifications for liver health optimization.
Related Signals We Also Review
ALT, AST, GGT, alkaline phosphatase, bilirubin, albumin, platelet count, and metabolic markers complete the liver health assessment.