AST/ALT

The De Ritis ratio helps distinguish causes of liver injury. ALT is largely liver-specific; AST is found in liver and skeletal muscle. Ratios above 2 suggest alcoholic liver disease; below 1 suggests non-alcoholic fatty liver disease.

Ratios above 2 typically reflect alcohol-related disease, advanced cirrhosis, ischaemic hepatitis, or muscle breakdown (rhabdomyolysis, myocardial infarction). Ratios below 0.8 reflect NAFLD/NASH, drug-induced hepatotoxicity, or early viral hepatitis.

Elevated liver enzymes are largely asymptomatic until advanced disease. Fatigue, right upper quadrant discomfort, jaundice, and dark urine signal significant hepatic dysfunction.

Cruciferous vegetables support hepatic detoxification. Coffee (2–3 cups/day) robustly reduces liver enzymes. Antioxidant-rich foods (blueberries, green tea) reduce hepatic oxidative stress.

Alcohol is the primary dietary driver of elevated ratios. High-fructose foods promote hepatic fat deposition. Paracetamol overuse is a leading cause of drug-induced liver injury.