BACKGROUND/Aim: The upper limits of normal (ULN) for alanine aminotransferase (ALT) levels was established several decades ago at 40 IU/L, regardless of sex or body mass index (BMI)

the ULN for ALT has been recommended to be lowered to ≤30U/L in men and ≤19U/L in women. Aim: to evaluate the ALT concentrations in a healthy Middle-Eastern population with biopsy-proven normal liver tissue and document if BMI or Gender had an impact on that level

Methods: ALT values were calculated from 175 consecutive Saudi potential living liver donors who underwent a liver biopsy as part of a stepwise pretransplant workup.

Results:. Of the 175 potential liver donors who underwent liver biopsy, 65 (37%) donors were classified as having greater than 5% steatosis. The remaining 110 (63%) study subjects were classified as having normal liver histology The mean age of the 110 potential donors with normal liver histology was 27±6.2 years for men and 38.6±7.1 years for women. The mean ALT concentration w as 12.9U/L±4.5 in women and 19.7U/L±6.9 in men .The mean body mass index (BMI) levels were 23.0±3.5 kg/m2 for men and 24.7±3.25 kg/m2 for women, and the ALT levels were higher in male patients (22.6U/L±9 vs. 16.4U/L±8, p-value=0.003). Multivariate linear regression showed that BMI and sex were independent variables that were positively associated with the levels of ALT (p< 0.0001).

Conclusion: The ULN for ALT levels in Middle-Eastern populations should be lowered, including separate values for males and females. BMI and sex (male gender) were positively correlated with ALT levels. BMI and sex were independent variables that were positively associated with the levels of ALT.

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