Liver and pancreas · Blood

ALAT

A liver enzyme that leaks into the blood when liver cells are damaged; the first test when a liver disorder is suspected.

At a glance

Measured in blood
In 15 test panels
No special preparation

Explanation

ALAT: what is measured?

ALAT (alanine aminotransferase) is an enzyme found mainly in liver cells, where it helps with the metabolism of proteins. Normally there is little ALAT in the blood. If liver cells are damaged, for example by fat, alcohol, a virus or medicines, ALAT leaks into the blood and the value rises. This often happens before there are any symptoms. According to the Dutch GP guideline (NHG), ALAT is the first and most specific blood test for damage to liver cells.

What can it detect?

Damage to liver cells, whatever the cause (fatty liver, alcohol, viral hepatitis, medicines)
Chronic liver inflammation due to hepatitis B or C, even without symptoms
Monitoring of the liver with medicines or substances that can strain the liver, such as anabolic steroids

Result

What does the result mean?

ALAT too high

A slightly raised ALAT in someone without symptoms is common and is usually not a serious liver disease. The most common cause is fatty liver due to overweight, diabetes or alcohol. Heavy exercise or strength training in the days before the sample collection, medicines (including high-dose paracetamol, statins, antibiotics), anabolic steroids and herbal preparations can also raise the value temporarily. A strongly raised value, more than ten times the upper limit, fits acute liver inflammation, usually due to a virus, and needs further testing straight away. Symptoms that may go with liver damage: tiredness, pain in the upper right abdomen, dark urine, yellow skin or yellow whites of the eyes.

ALAT too low

A low ALAT has no meaning; the value can be very low in healthy people. Only with severe malnutrition or a vitamin B6 deficiency is the value sometimes somewhat lower than expected, but ALAT is not used for that.

After an abnormal result

With a slightly to moderately raised ALAT without a clear cause, the GP repeats the test after about 4 weeks, usually with the advice not to drink alcohol during that period and after checking medicines and supplements. If the value stays raised, testing for hepatitis B and C and iron overload follows, and usually an ultrasound of the liver. With a value of more than ten times the upper limit or with jaundice, further testing or referral to a gastroenterologist follows straight away.

Reliability

How reliable is the test?

ALAT is sensitive to damage to liver cells but says nothing about the cause; further testing is needed for that. A normal ALAT does not completely rule out liver disease: in liver cirrhosis (scarred liver), a blocked bile duct and some chronic infections, the value can be normal. The Dutch GP guideline (NHG) only attaches meaning to a rise that is present on repeated testing; a single slightly raised value is often temporary.

What can affect the result?

Heavy exercise or strength training in the 2 to 3 days before the sample collection can raise ALAT, usually together with ASAT and creatine kinase.
Alcohol in the days before the sample collection, medicines (including paracetamol, statins, anti-epileptic drugs, antibiotics), anabolic steroids and supplements can raise the value.
Reference values differ per laboratory and are higher for men than for women; a higher body weight gives a higher ALAT on average.

Who it is for

Who is the test useful for?

Useful for

Useful with symptoms that fit a liver disorder (tiredness with pain in the upper right abdomen, jaundice, dark urine), with overweight or diabetes and a suspected fatty liver, with long-term heavy alcohol use, when using medicines or anabolic steroids that strain the liver, and with an increased risk of hepatitis B or C. Also suitable for monitoring a previously abnormal value. In healthy adults without risk factors, a chance finding of a slightly raised value is often temporary or harmless and mainly leads to extra testing.

How common is it?

A slightly raised ALAT is regularly found in adults who have blood tests without symptoms. Fatty liver is by far the most common cause and, according to the Dutch GP guideline (NHG), occurs in about 1 in 4 adults, and much more often in people with overweight or diabetes. In the Netherlands, about 40,000 people have chronic hepatitis B and about 25,000 have chronic hepatitis C, often without knowing it.

NHG guideline on viral hepatitis and other liver disorders; RIVM

Drawbacks and risks

A slightly raised ALAT is often temporary (sport, alcohol, medicines); without a repeat measurement, this can cause unnecessary worry and unnecessary follow-up testing.
A normal value can give false reassurance in advanced liver damage, where ALAT can fall again.

Get tested

ALAT: test panels

ALAT is part of these test panels. You order online and have your blood drawn at a collection point or collect the sample at home.

Blood draw
ALAT (alanine aminotransferase)
ALT; liver-specific enzyme.
€ 8,00
Blood draw
Bodybuilder Test
Panel for strength and muscle development; hormones, liver, and muscles.
€ 134,00
Blood draw
General Health Checkup
With this General Health Check-up, you gain detailed insight into your overall health and well-being.
€ 125,00
Fingerstick
ALT (alanine aminotransferase)
ALT; liver-specific enzyme.
€ 8,00
Blood draw
InsideTracker
InsideTracker Blood Analysis: analyze 48 biomarkers for complete health optimization and personalized recommendations.
€ 335,00
Blood draw
Testosterone Replacement Therapy (TRT)
Testosterone, LH, FSH, Oestradiol, Prolactin, liver function, and blood values. For men with low testosterone or TRT monitoring.
€ 175,00
Blood draw
Hormone Recovery (After Steroids)
Testosterone, free testosterone, SHBG, LH, FSH, estradiol, TSH, liver function, and lipid profile. For recovery after anabolic steroid use.
€ 325,00
Blood draw
Endurance Sports
Complete blood count, iron status (ferritin, transferrin), kidney function, liver function, testosterone, and hs-CRP. For athletes and endurance sport participants.
€ 203,00
Blood draw
General Blood Test (Basic)
Hemoglobin, MCV, TSH, fT4, eGFR, creatinine, ALT, AST, sodium, and potassium. General health check of kidney, liver, and thyroid.
€ 125,00

How reliable is the test?

ALAT