AST/ALT ratio: what your result means.

Ratio of liver enzymes AST to ALT; helps distinguish liver disease patterns. AST/ALT ratio is measured by blood test as part of the Metabolic panel in the HodieLabs Health Blueprint.

Why AST/ALT ratio matters

De Ritis ratio >2 with AST >2× normal is highly suggestive of alcoholic hepatitis. In non-alcoholic liver disease, the ratio typically stays <1 until cirrhosis develops.

Associated risks when out of range: Ratio >2 suggests alcoholic liver disease. Ratio <1 is typical of NAFLD/NASH. Rising ratio with normal transaminases may indicate early fibrosis progression.

Evidence basis

The HodieLabs Evidence-Based Clinical Library classifies AST/ALT ratio as an strong evidence-tier biomarker. Its reference ranges come from a published authority standard rather than from observational optimisation targets. The standard used here is De Ritis ratio hepatology consensus; AST/ALT 0.8–1.3 normal in healthy adults. Ratio <0.8 may indicate NAFLD, >2.0 suggests advanced fibrosis or alcoholic liver disease. Best interpreted alongside absolute ALT, AST, and GGT values. Where relevant clinical outcomes are noted on this page, they reflect the guideline literature referenced below.

Evidence-based reference ranges

The HodieLabs Evidence-Based Clinical Library interprets AST/ALT ratio against published clinical authority standards, never arbitrary "optimal" ranges. Measured in ratio:

Clinical interpretation

• De Ritis ratio >2 with AST >2× normal is highly suggestive of alcoholic hepatitis.
• In non-alcoholic liver disease, the ratio typically stays <1 until cirrhosis develops.
• A rising AST/ALT ratio over time can signal progression from NAFLD to fibrosis.

What improves it: the evidence-based levers

• Calculate from existing AST and ALT results, no additional test needed
• Ratio >1 warrants further liver investigation (FibroScan, ultrasound)

Recommended testing frequency: Annual, as part of a comprehensive panel. Single markers are always interpreted in context.

How AST/ALT ratio testing works at HodieLabs

AST/ALT ratio is measured in every Health Blueprint at our Melbourne Preventative Health & Longevity Clinic, interpreted by a doctor against the guideline-cited ranges above and tracked over time through your HodieLabs membership.

References

1. De Ritis ratio hepatology consensus; AST/ALT 0.8–1.3 normal in healthy adults. Ratio <0.8 may indicate NAFLD, >2.0 suggests advanced fibrosis or alcoholic liver disease. Best interpreted alongside absolute ALT, AST, and GGT values.

This page is general information from the HodieLabs Evidence-Based Clinical Library, not medical advice. Speak with your GP about what testing and care is appropriate for you.