P305 Low ALT is more Common in Patients with IBD than Healthy Controls and is Associated with Active Disease

Shafrir, A.(1,2,3);Katz, L.(1,2);Zinger, A.(1,2);Safadi, R.(1,2);Kaliski, I.(1,2);

(1)Hadassah Medical Center, Department of Gastroenterology and Hepatology, Jerusalem, Israel;(2)Hebrew University of Jerusalem, Faculty of Medicine, Jerusalem, Israel;(3)Meuhedet Health Maintenace Organization, Jerusalem District, Tel Aviv, Israel;


Sarcopenia is underdiagnosed in patients with Inflammatory bowel disease (IBD). Studies have shown that low alanine transaminase (ALT) levels are associated with sarcopenia. We evaluated the association of low ALT levels with the IBD diagnosis and activity. 


Data of patients from state mandatory health maintenance organization in Israel was collected. Electronic medical records within the past two years included diagnosis, medications, blood and stool tests. Based on ICD9 coding, patients diagnosed with Ulcerative Colitis (UC) or Crohn's disease (CD) were compared to healthy control group. Patients with ICD9 diagnosis of chronic liver disease, cirrhosis, and age <18 were not included. Serum ALT lower than 15 was considered low.


Our cohort consisted of 348,454 patients, of them, 1780 patients with CD and 916 with UC. Mean ALT was lower among patients with IBD than healthy controls (22.71 vs. 24.04, p-value<0.001).  In multivariate logistic regression, controlling for age, sex, BMI, and smoking status, IBD was associated with low ALT levels (OR – 1.25 95% CI 1.12-1.39, p-value<0.001)

Of the CD patients, 392 (27.96%) were in the low ALT group. Patients in the low ALT group were younger (38.85 vs. 42.38 p- value<0.001), were less likely to be male (33.9% vs. 54.7%), had lower BMI (23.94 vs. 26.29 p – value<0.001). Fecal Calprotectin and CRP was higher in the low ALT group (601.25 vs. 282.33 p-value<0.001, 12.94 vs. 7.35 p value<0.001 respectively) while serum albumin was lower (4.12 vs. 4.28 p-value<0.001).

Among patients with UC, 204 (30.13%), had low ALT. Patients in the low ALT group were slightly younger (46.92 vs. 49.65 p-value=0.06), less likely to be male 22.5% vs. 52% p-value<0.001), had lower BMI (25 vs. 26.37 p-value=0.004). Patients with low ALT had higher CRP levels (12.92 vs. 6 p-value<0.001) and non-significantly higher fecal calprotectin levels (779.52 vs. 498.18 p-value 0.16). Serum albumin was lower in the low ALT group (4.04 vs. 4.26 p value<0.001)

In multivariate linear regression models, controlling for age, gender IBD subtype, and smoking status, low ALT was associated with elevated fecal calprotectin and CRP and lower albumin levels  (p-value<0.001).


Patients with IBD have lower ALT levels than the general population. Among patients with IBD, low ALT is associated with active disease. Further studies are warranted to strengthen the association of low ALT with sarcopenia among patients with IBD.