The ALT/AST ratio compares two liver enzymes to add context to liver health.
The ALT/AST ratio is a calculated value, not a separate blood test. It is ALT divided by AST, two liver enzymes. It is the inverse of the more common De Ritis (AST/ALT) ratio.
A higher ALT/AST ratio (ALT relatively higher than AST) is more typical of non-alcoholic fatty liver and mild liver irritation. A lower ratio (AST relatively higher) can point to alcohol-related liver disease or more advanced scarring. The ratio is a pattern clue and is always read alongside the actual enzyme values.
Aniva reads your result against research-backed ranges, not just the lab's wide normal. The reference shown below is specific to this biomarker.
These are interpretive guides, not strict lab ranges. Thresholds for the ALT/AST direction are not tightly standardised, so it is usually read as the inverse of the De Ritis ratio.
| Pattern | Interpretation |
|---|---|
| ALT/AST above ~1 (AST/ALT below 1) | Often non-alcoholic fatty liver or mild injury |
| ALT/AST below ~1 (AST/ALT above 1) | Possible alcohol-related disease or fibrosis |
| ALT/AST below ~0.5 (AST/ALT above 2) | Strongly suggestive of alcohol-related liver disease |
Anything affecting ALT or AST affects the ratio: recent alcohol, muscle injury or strenuous exercise (raises AST), some medicines, and vitamin B6 status. Both enzymes can be normal even with significant liver disease.
Best read with its components, ALT and AST, plus GGT and a full liver panel.
What does my ALT/AST ratio mean? A higher ratio means ALT is higher than AST; a lower ratio means AST is higher. Your clinician will interpret it with your other results.
Do I need to fast for this test? No. Fasting is not required for the ALT/AST ratio.
What can affect my result? Alcohol, hard workouts, muscle injury, medicines, supplements, pregnancy, and recent illness can change ALT or AST and shift the ratio.
How often should I test this? If abnormal, your clinician may repeat it in weeks to months, or sooner if symptoms change.
How long do results take? Results are usually ready in about 7 days.
What should I discuss with my clinician? Ask how the ratio compares with ALT, AST, GGT, and your history, and whether any follow-up tests or lifestyle changes are wise.
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