ASAT / ALAT ratio
Stomach and gut healthAlso known as: AST/ALT ratio, De Ritis ratio, GOT/GPT, De-Ritis-Quotient
This ratio compares two liver enzymes to give insight into liver health.
Reference range
Source: Ahead Health benchmark
Reference ranges may vary between labs and assays. Always interpret results with your healthcare provider.
Why this matters
The ratio can indicate the type of liver stress. A lower ratio may point to fatty liver, while a higher ratio can suggest alcohol-related liver changes or more advanced liver problems. Monitoring it helps guide lifestyle or treatment decisions to protect liver health.
How this connects to other biomarkers
- An ASAT/ALAT ratio > 2 with elevated transaminases is classically associated with alcohol-related liver disease, while a ratio < 1 suggests viral hepatitis or non-alcoholic fatty liver disease (NAFLD/MASLD).
- In established cirrhosis from any cause, the ratio often rises above 1.5 due to disproportionate Aspartat-Aminotransferase (ASAT) elevation.
- A ratio > 1 with normal or only mildly elevated Alanine Aminotransferase (ALAT) and elevated Total Creatine Kinase (CK) suggests muscle (rather than liver) is the source of the AST.
How often should I test ASAT / ALAT ratio?
Most adults benefit from yearly reassessment of the ASAT/ALAT ratio as part of a liver panel.
At baseline / for screening: Once every 12 months from age 30 as part of a comprehensive panel. More frequently, every 3 to 6 months, if you have known liver disease, regular alcohol intake, fatty liver (MASLD), or take hepatotoxic medication.
When monitoring an intervention or change: Retest 3 to 6 months after a sustained lifestyle change for fatty liver, such as meaningful weight loss (5 to 10 percent of body weight), reducing alcohol, improving sleep, or shifting toward a Mediterranean-style diet. Retest 4 to 6 weeks after starting a hepatotoxic medication (statin, methotrexate, isoniazid, certain antifungals) to confirm tolerance. If a result was meaningfully elevated, your clinician guides the follow-up.
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