ALD/NAFLD Index (ANI)

Low AST levels are usually not concerning. However, they may indicate Vitamin B6 Deficiency, End-Stage Liver Disease (Cirrhosis), uremia, diabetic ketoacidosis, and pregnancy.

Elevated AST levels are seen in muscle injury (e.g., strenuous exercise, seizures, myopathies, myocardial infarction or heart failure), tissue damage (severe burns, surgery), liver injury (fatty liver, viral or other infections, malignancy), anorexia or rapid weight change (e.g., >5 kg/week), pancreatitis, gallbladder attack and hemolysis (e.g., hemolytic anemia, splenomegaly).

Several drugs can increase AST including: chronic alcohol, NSAIDs, acetaminophen, oral contraceptives, statins, certain antibiotics, corticosteroids, toxins like lead, mercury, and pesticides.

Low ALT levels are associated with low muscle mass (e.g., elderly, frail), Vitamin B6 Deficiency, Chronic Kidney Disease, CVD and cancer mortality in the elderly.

ALT is highly specific to liver injury (Fatty liver, Viral hepatitis, Autoimmune hepatitis, Liver cancer, Alcohol liver damage, Mononucleosis, Hemochromatosis).

Muscle damage – strenuous exercise, trauma, myocardial infarction, congestive heart failure.

Gallstones; Biliary disease; pancreatitis; both obesity and anorexia; rapid weight change; celiac disease; hemolysis.

Many toxins and drugs can increase ALT, but most notable are: Paracetamol, NSAIDs, statins, phenytoin, allopurinol, and antibiotics, especially amoxicillin.

Low MCV indicates microcytic red blood cells, most commonly from iron deficiency.

Other causes: thalassemia, sideroblastic anemia, anemia of chronic disease, vitamin B6 or copper deficiency, lead poisoning.

High MCV indicates macrocytic red blood cells, most commonly from vitamin B12 deficiency (incl. pernicious anemia) or folate deficiency.

Other causes: alcohol use, liver disease, hypothyroidism, hemochromatosis, megaloblastic or myelodysplastic anemia, elevated reticulocytes.