Which liver enzyme is primarily elevated in alcoholic liver disease?

In alcoholic liver disease, aspartate aminotransferase (AST) is typically elevated and is often more significantly elevated than alanine aminotransferase (ALT). This is due to the effect of alcohol on liver cells, where AST is released into the bloodstream as a result of liver damage.

The AST to ALT ratio is particularly indicative of alcoholic liver disease; a ratio greater than 2:1 is commonly associated with this condition. This contrasts with non-alcoholic liver diseases, where ALT is usually more elevated compared to AST.

While gamma-glutamyl transferase (GGT) may also be elevated in cases of alcohol consumption and liver injury, it is not as specific for alcohol-related liver disease as the AST elevation. Alkaline phosphatase (ALP) is typically associated with conditions affecting bile flow rather than direct liver cell damage. Therefore, the elevation of AST is a key biochemical marker in the diagnosis and management of alcoholic liver disease.