The client is vegetarian, normal weight, elevated total cholesterol, HDL, and LDL. Decreased Triglycerides and an elevated AST:ALT ratio
Biliary insufficiency can be associated with this pattern. However, further investigation is warranted including assessing medical history and current symptoms, as well as determining trends and patterns using past labs.
Besides elevations in AST:ALT ratio and total and LDL cholesterol, biliary insufficiency may be characterized by increased total bilirubin, GGT, alkaline phosphatase, and LDH so these labs should be evaluated as well. Family history and medication use should also be evaluated, especially in the event of genetic hyperlipidemia.
The elevated AST:ALT Ratio (DeRitis Ratio) may be of concern and warrants further investigation. Please read our article on the DeRitis ratio in the ODX Blog. Biliary obstruction may cause an AST:ALT ratio of greater than 1.5 which suggests intrahepatic cholestasis is possible. An AST:ALT ratio of less than 1.5 would suggest extrahepatic obstruction (Hall 2012).
The labs listed also yield an elevated non-HDL cholesterol of 211, and an elevated cholesterol:HDL ratio of 3.89. Therefore, further evaluation of hyperlipidemia and cardiovascular risk factors and biomarkers would be prudent including LDL and HDL subfractionation, hs-CRP, homocysteine, fibrinogen, fasting glucose and insulin, etc. It is noted in this case that, the triglyceride:HDL ratio was optimal at 0.86 whereas an elevated ratio of 4 or above may be associated with nonalcoholic fatty liver disease (Yi 2017).
A baseline assessment of thyroid function would be prudent to rule out hypothyroidism as a cause of elevated cholesterol, as well as an assessment of steroid hormones including vitamin D.
References
Hall P, Cash J. What is the real function of the liver 'function' tests? Ulster Med J. 2012 Jan;81(1):30-6. [R]
Yi, M et al. “Increased prevalence and risk of non-alcoholic fatty liver disease in overweight and obese patients with Type 2 diabetes in South China.” Diabetic medicine : a journal of the British Diabetic Association vol. 34,4 (2017): 505-513. doi:10.1111/dme.13174 [R]