A recent study (S Bussler et al. Hepatology 2018; 1319-1330) provides reference age-related reference values for ALT, AST, and GGT for children from 11 months of age through 16 years. This study from Leipzig used the LIFE Child prospective longitudinal population-based cohort with 3,131 cases (normal weight).
- Figure 2 provides age- and sex-related percentiles for ALT. At all ages and in both genders, the 90% cutoff was ~30 IU (or less).
- Figure 3 provides age- and sex-related percentiles for AST. There was a negative sloping curve with both genders, such that the 90% cutoff was ~60 IU at ~1 yr and ~40 IU at ~13 yr. Females tended to have modestly higher values.
- Figure 4 provides age- and sex-related percentiles for GGT. At all ages and in both genders, the 90% cutoff was ~25 IU. Males tended to have modestly higher values.
These values overall are similar to previous studies. From NASPGHAN NAFLD Guidelines: For ALT: “In the United States, sex-specific biologically based cutoffs have been determined from nationally representative data and have been validated in a fairly diverse cohort. These cutoffs are 22 mg/dL for girls and 26 mg/dL for boys. A Canadian study found the upper limit of normal for ALT to be 30 mg/dL in children 1 to 12 years of age, and 24 mg/dL in those between 13 and 19 years”
Related blog post: Pediatric NAFLD Guidelines 2017