{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T02:27:15Z","timestamp":1790908035422,"version":"4.1.0"},"reference-count":35,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2024,2,19]],"date-time":"2024-02-19T00:00:00Z","timestamp":1708300800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Aliment Pharmacol Ther"],"published-print":{"date-parts":[[2024,4]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Given the global rise in obesity\u2010related metabolic diseases, the upper limit of normal (ULN) alanine aminotransferase (ALT) in individuals with and without metabolic diseases may have changed. We performed a meta\u2010analysis combined with bootstrap modelling to estimate the ALT ULN levels for individuals with and without metabolic diseases.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods and Results<\/jats:title><jats:p>Two separate searches of the PubMed, Embase and Cochrane databases were performed, one to identify healthy individuals which yielded 12 articles (349,367 individuals); another to include those with potential metabolic diseases but without known liver disease which yielded 35 articles (232,388 individuals). We estimated the mean ALT using a random\u2010effects mixed model and the ULN level (95th\u2010percentile value) via a bootstrap model with 10,000 resamples. In individuals without metabolic diseases and known liver disease, the ALT ULN levels were 32\u2009U\/L overall; 36\u2009U\/L in males and 28\u2009U\/L in females. In analyses that included individuals with metabolic diseases, the ALT ULN levels were 40\u2009U\/L among the overweight\/obese (29\u2009U\/L if normal weight) and 36\u2009U\/L among those with type 2 diabetes mellitus (T2DM) (33\u2009U\/L if no T2DM). On meta\u2010regression of study\u2010level factors, body mass index (coefficient 1.49, 95% CI 0.11\u20132.86, <jats:italic>p<\/jats:italic>\u2009=\u20090.03), high\u2010density lipoprotein (coefficient \u22120.47, 95% CI \u22120.85\u2010(\u22120.08), <jats:italic>p<\/jats:italic>\u2009=\u20090.02) and triglycerides (coefficient 0.19, 95% CI 0.12\u20130.25, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.0001) correlated with ALT.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>We provide expected ranges of ALT ULN levels for individuals without known liver disease without metabolic diseases and those with or without T2DM and\/or are normal weight or overweight\/obese. These data may have implications for clinical care and screening.<\/jats:p><\/jats:sec>","DOI":"10.1111\/apt.17914","type":"journal-article","created":{"date-parts":[[2024,2,19]],"date-time":"2024-02-19T12:58:54Z","timestamp":1708347534000},"page":"984-992","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Upper limit of normal <scp>ALT<\/scp> levels in health and metabolic diseases: Pooled analysis of 423,355 individuals with bootstrap modelling"],"prefix":"10.1111","volume":"59","author":[{"given":"Eunice X.","family":"Tan","sequence":"first","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Medicine National University Hospital  Singapore Singapore"},{"name":"Department of Medicine, Yong Loo Lin School of Medicine National University of Singapore  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5165-5061","authenticated-orcid":false,"given":"Daniel Q.","family":"Huang","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Medicine National University Hospital  Singapore Singapore"},{"name":"Department of Medicine, Yong Loo Lin School of Medicine National University of Singapore  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natasha Tang Sook","family":"Yee","sequence":"additional","affiliation":[{"name":"Department of Medicine, Yong Loo Lin School of Medicine National University of Singapore  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zi Hui","family":"Wan","sequence":"additional","affiliation":[{"name":"Department of Medicine, Yong Loo Lin School of Medicine National University of Singapore  Singapore 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