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Liver

AST and alcohol: what the ratio with ALT says

In liver cells, AST sits mainly in the mitochondria, the small power plants inside the cell, according to the NVKC. AST is an enzyme that helps cells turn one substance into another, and it also occurs in heart and skeletal muscle.

When liver or muscle cells are damaged, AST enters the blood, and with more serious liver damage it becomes higher than ALT according to the NVKC. Only a blood test establishes how much AST the blood holds.

Star-SHL, Unilabs, Certe and Diagnostiek voor U set the upper limit at 35 U/l (units per litre) in adult men and at 31 U/l in adult women. According to a 2017 review, an AST of 2 times ALT or more should make a doctor strongly suspect liver damage from alcohol.

Doctor's Assessment Included

AST is an enzyme from liver and muscle cells that enters the blood when those cells are damaged. Star-SHL, Unilabs, Certe and Diagnostiek voor U use the same upper limit for adults: 35 U/l for men and 31 U/l for women.

  • With mild liver damage ALT is higher than AST according to the NVKC; with more serious damage to the liver cells AST is higher.
  • Haemolysis, the bursting of red blood cells, gives a falsely raised result according to Star-SHL, because the AST concentration in a red blood cell is about 10 times higher than in serum.
  • According to the NVKC, AST is usually measured together with ALT, alkaline phosphatase and bilirubin.

Reference Ranges

See the value that applies to you:

Choose male or female — this range differs by sex.

Enter your age — this range changes with age.

This range also depends on context such as cycle phase or sample material; the highlighted rows apply to your group.

Your reference range
u/l
14 53 u/l
Reference ranges by group, in u/l
Male · 1–5 years 24–53 u/l
24 53
Male · 6–12 years 19–42 u/l
19 42
Male · 13–18 years 14–39 u/l
14 39
Male · 19 years and older 14–43 u/l
14 43
14 53 u/l

Source: NVKC Reference population: Dutch general-practice population (NUMBER, n = 7,574,327)

Reference ranges may vary between laboratories. When you order a test, a BIG-registered doctor assesses your personal results in context. For treatment decisions, discuss your results with your GP.

Check your own value

AST (Aspartate Aminotransferase): what Dutch laboratories use

Reference ranges by group, in u/l
Star-shl · Male 0–35 U/l
0 35
Unilabs · Male · 19 years and older 0–35 U/l
0 35
Certe · Male · 18 years and older · a limit, not a range < 35 U/L
35
Diagnostiek voor U · Male · a limit, not a range < 35 U/L
35
0 38.5 u/l

Source: Star-shl

Source: Unilabs

Source: Certe

Source: Diagnostiek voor U

Each value as the laboratory itself publishes it, retrieved in 2026.

AST (Aspartate Aminotransferase): what this test measures

The AST test measures the amount of aspartate aminotransferase in the blood in units per litre (U/l), and the value is usually read next to ALT. The ratio between AST and ALT gives information about how serious a liver abnormality is, according to the NVKC.

A 2018 British guideline calls ALT the more liver-specific value, but AST possibly the more sensitive sign of liver damage in alcohol-related liver disease.

AST (Aspartate Aminotransferase): why this value matters

In liver damage from alcohol, AST rises more than ALT according to a 2017 review, and that review gives two explanations for it. According to that review, most people with chronic alcohol misuse have a shortage of pyridoxal 5′-phosphate, a form of vitamin B6 needed to make ALT and AST, and that shortage slows the making of ALT more than that of AST.

In addition, according to the same review, alcohol itself stimulates the making and release of AST from the mitochondria, which raises the AST/ALT ratio.

AST (Aspartate Aminotransferase): how the blood test works

Referral
No GP referral needed. After the order we arrange the referral through ZorgDomein, within one business day; orders after 17:00 or at the weekend start on the next business day. ZorgDomein emails a barcode, and that barcode is what the draw site needs.
The draw
A blood draw from a vein in the arm, at a partner laboratory's draw site. No home kit, no finger prick.
Which test
Complete Metabolic Panel · €149,-
Where
650+ draw sites run by independent laboratories across the Netherlands. Draw sites

AST (Aspartate Aminotransferase): how to prepare

  1. No hard training beforehand

    Required

    No heavy training, long endurance sessions or anything that leaves you out of breath in the 48 hours before the draw. Normal walking is fine.

  • Water is always fine. Drink as usual beforehand, it makes the draw easier.
  • Take your usual medication, unless your own doctor told you otherwise.

AST (Aspartate Aminotransferase): when is testing worthwhile?

Excessive alcohol use is among the NVKC's causes of liver conditions, and AST is requested on suspicion of liver damage according to the NVKC. According to Thuisarts, the GP has liver tests done among other things when someone has been drinking too much alcohol for a while.

AST (Aspartate Aminotransferase): symptoms of a high or low value

Low Levels

A low AST in adult men does not count as an abnormality at Star-SHL, Unilabs, Certe and Diagnostiek voor U, because the adult lower limit there is 0 U/l or absent.

High Levels

In alcoholic hepatitis, AST is usually only moderately raised according to a 2017 review: AST then seldom exceeds 8 to 10 times the upper limit, and ALT seldom 5 times. In severe acute alcoholic hepatitis, bilirubin can rise considerably according to that review.

When AST is higher than ALT, that also fits damage to heart or skeletal muscle according to the NVKC, so a high ratio does not point to alcohol alone.

AST (Aspartate Aminotransferase): causes of a low or high value

What lowers the value

  • Pregnancy

    ASAT can be lower during pregnancy.

What raises the value

  • Liver inflammation (hepatitis)

    In liver inflammation, whether caused by a virus or not, ASAT can stay raised for months.

  • Heavy drinking

    Alcohol can damage the liver, after which ASAT leaks from liver cells into the blood.

  • Medicines

    Some medicines can damage the liver and so raise ASAT.

  • Muscle damage

    ASAT is also found in heart and skeletal muscle; in muscle damage ASAT is higher than ALAT.

  • Burst red blood cells in the tube

    A red blood cell holds about 10 times as much ASAT as serum, so blood damaged in the tube gives a falsely high result.

AST (Aspartate Aminotransferase): lifestyle and this value

With a raised AST from alcohol, Thuisarts advises stopping drinking for a while; after a few weeks the GP can then check whether the liver tests have improved. According to a 2017 review, other conditions that damage the liver can also play a part in liver damage from alcohol, such as chronic hepatitis B or C, obesity and diabetes.

AST (Aspartate Aminotransferase): frequently asked questions

What does gamma-GT add to AST with alcohol?

Together with an AST/ALT ratio above 2, a gamma-GT above 2 times the normal value strongly points to liver damage from alcohol according to a 2017 review. Gamma-GT alone is a sensitive but non-specific measure of liver damage according to that review, which cannot show liver damage from alcohol on its own.

Why is a CK test better for muscle damage than AST?

According to the NVKC, creatine kinase (CK) points to muscle damage more specifically than AST, which is why doctors hardly use AST for muscle damage.

AST (Aspartate Aminotransferase): sources

  1. den Elzen WPJ, Brouwer N, Thelen MH, Le Cessie S, Haagen I-A, Cobbaert CM. NUMBER: standardized reference intervals in the Netherlands using a 'big data' approach. Clin Chem Lab Med 2018;57(1):42-56. (retrieved 2026) doi.org
  2. Star-shl, Labbepalingen (referentiewaarden per bepaling), star-shl.nl, geraadpleegd 2026-10-01 (retrieved 2026) star-shl.nl
  3. Unilabs, Bepalingenklapper (referentiewaarden per bepaling), bepalingenklapper.nl, geraadpleegd 2026-10-01 (retrieved 2026) bepalingenklapper.nl
  4. Certe, Bepalingenwijzer (referentiewaarden per bepaling), bepalingenwijzer.certe.nl, geraadpleegd 2026-10-01 (retrieved 2026) bepalingenwijzer.certe.nl
  5. Diagnostiek voor U, eLabgids (Referentiewaarden DvU), diagnostiek.getincontrol.eu, geraadpleegd 2026-10-01 (retrieved 2026) diagnostiek.getincontrol.eu
  6. NVKC, Alles over testen: ASAT, allesovertesten.nl, geraadpleegd 2026-10-03 (retrieved 2026) allesovertesten.nl

Test Products

This marker is included in the following test panels.

Heart and blood vessels

Complete Metabolic Panel

Comprehensive metabolic panel: electrolytes, kidney, liver, glucose, HbA1c, and protein.

HbA1c (Glycated Hemoglobin) ALT (Alanine Aminotransferase) Calcium ALP (Alkaline Phosphatase) AST (Aspartate Aminotransferase) Bilirubin (Total) Urea (BUN) Creatinine eGFR (Estimated Glomerular Filtration Rate) Glucose (Fasting) Bicarbonate Chloride Sodium Potassium Albumin Total Protein Bilirubin (Direct) Bilirubin (Indirect)
€149,-

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Medical policy
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AST (Aspartate Aminotransferase)

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