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Normal alkaline phosphatase levels are dependent on race/ethnicity: NationalGEP Health and Nutrition Examination Survey data
  1. Humberto Gonzalez1,2,
  2. Zaid Imam3,
  3. Robert Wong4,
  4. Jia Li5,
  5. Mei Lu5,
  6. Sheri Trudeau5,
  7. Stuart Gordon1,2,
  8. Mohammad Imam6,
  9. Robert Gish7
  1. 1 Gastroenterology and Hepatology, Henry Ford Health System, Detroit, Michigan, USA
  2. 2 Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan, USA
  3. 3 Internal Medicine, Beaumont Health System, Royal Oak, Michigan, USA
  4. 4 Gastroenterology and Hepatology, Alameda Health System, Oakland, California, USA
  5. 5 Public Health Sciences, Henry Ford Health System, Detroit, Michigan, USA
  6. 6 Gastroenterology, The University of Tennessee Medical Center, Memphis, Tennessee, USA
  7. 7 Gatroenterology and Hepatology, Loma Linda University, Loma Linda, California, USA
  1. Correspondence to Dr Robert Gish; rgish{at}


Objective The range of normal serum alkaline phosphatase is not well defined. We used data from the National Health and Nutrition Examination Survey from 2009 to 2016 to generate normal ranges for a racially diverse sample of healthy adults.

Methods Respondents 18 years or older were included. Conditions known to elevate alkaline phosphatase were cause for exclusion. Alkaline phosphatase was measured using a colorimetric method based on standardised National Health and Nutrition Examination Survey protocols. Because alkaline phosphatase values were not normally distributed, log transformation was used. We calculated upper limits of normal (97.5 percentile), stratified by sex and race/ethnicity, and 90% CIs for the upper limits of normal.

Results 1199 respondents (673 female, 526 male) had body mass index from 18.5 to less than 25. Upper limits of normal were highest among Hispanics (123.2 IU/L (90% CI 110.2 to 136.7) for females; 123.8 IU/L (90% CI 112.0 to 135.1) for males), followed by African Americans (109.9 IU/L (90% CI 97.3 to 122.4) for females; 116.3 IU/L (90% CI 105.0 to 126.1) for males) and whites (97.1 IU/L (90% CI 91.0 to 103.4) for females; 109.6 IU/L (90% CI 102.1 to 116.3) for males). Asian American/Pacific Islander respondents had the lowest results: 93.8 IU/L (90% CI 88.2 to 99.5) for females and 95.3 IU/L (90% CI 88.1 to 102.1) for males.

Conclusions The upper limit of normal alkaline phosphatase varies by race/ethnicity in a large US sample with body mass index of 18.5<25.

  • alkaline phosphatase
  • primary biliary cirrhosis
  • hepatitis B
  • hepatitis C

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  • Presented at Preliminary results for this analysis were presented as a poster at the annual meeting of the American Association for the Study of Liver Diseases (AASLD) 2019, Boston, MA, USA.

  • Contributors Conception and design of the study: HCG, ZI, MI, RGG. Generation, collection, assembly, analysis and/or interpretation of data: HG, ZI, RW, JL, ML, ST, SG, MI, RG. Drafting or revision of the manuscript: HG, ZI, RW, ST, MI. Approval of the final version of the manuscript: HG, ZI, RW, JL, ML, ST, SG, MI, RG.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available. This research study was conducted retrospectively from deidentified National Health and Nutrition Examination Survey (NHANES) data, which is made available for public use.

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