A/G Ratio: Albumin to Globulin Balance and What It Says About Liver and Immune Health
Overview
The A/G ratio is the albumin to globulin ratio, a simple way to look at the balance between two major protein groups in your blood. Albumin is mainly made by the liver and reflects nutrition and liver function, while globulins include many immune related proteins. In this glossary you will see what the A/G ratio actually measures, how it fits together with Albumin, Globulin, and liver enzymes like ALT, how to think about lower or higher ratios, what can nudge this balance over time, and when it is worth walking your result through with a clinician
What the A/G ratio is and why it matters
Your blood proteins are broadly split into two groups:
Albumin - the most abundant protein, mainly made by the liver, helping with fluid balance and carrying hormones, drugs, and nutrients
Globulins - a group that includes many antibodies and other immune and transport proteins
The A/G ratio is calculated by dividing albumin by globulin.
A higher ratio usually means relatively more albumin compared with globulins
A lower ratio usually means relatively more globulins or less albumin
The ratio on its own does not give a diagnosis, but it can point toward patterns in liver function, nutrition, and immune activity when you view it alongside other tests.
What your A/G ratio result can tell you
Your A/G ratio can help answer questions like:
Is my liver likely making enough albumin
Could chronic inflammation or immune activation be increasing globulin proteins
Does the pattern fit with other liver tests and my symptoms
A low A/G ratio can show up when albumin is low, globulins are high, or both. This may happen with chronic liver disease, chronic inflammation, some immune conditions, or protein loss in the gut or kidneys. A higher than usual A/G ratio can appear when globulin levels are low or albumin is relatively higher, which is less common but still worth context.
The ratio is most helpful when viewed together with albumin, globulin, liver enzymes, and kidney markers rather than alone.
How to read high and low A/G ratios
It is often more intuitive to think about what is driving the ratio rather than just the number.
When the A/G ratio is low
A low A/G ratio means there is relatively less albumin compared with globulins. This can happen when:
Albumin is low because the liver is not making enough, intake or absorption of protein is poor, or protein is being lost through kidneys or gut
Globulin proteins are higher due to chronic inflammation, infection, or certain immune or blood conditions
Both albumin is down and globulins are up at the same time
People with a low A/G ratio may have other lab changes, such as abnormal liver enzymes, signs of inflammation, or protein in the urine, depending on the cause. Symptoms might include fatigue, swelling in legs or abdomen, or other signs that match liver, kidney, or immune issues rather than the ratio itself.
When the A/G ratio is high
A higher than usual A/G ratio is less common, but can be seen when:
Globulin levels are relatively low
Albumin is on the higher side within the normal range and globulins are toward the lower end
This pattern can show up with some inherited or acquired immune protein deficiencies, or simply as a normal variant in some people. As with a low ratio, the meaning depends heavily on the rest of the labs and the clinical picture.
What can affect your A/G ratio
The A/G ratio shifts with changes in both albumin and globulin. Things that commonly influence it include:
Liver function and protein production
The liver makes albumin, so chronic liver disease, advanced scarring, or severe acute liver injury can lower albumin and reduce the A/G ratio.Inflammation and immune activity
Many globulin proteins are antibodies or immune related. Chronic infections, autoimmune diseases, and other inflammatory states can increase globulins and lower the ratio even if albumin is stable.Nutrition and absorption
Severe undernutrition, low protein intake, or conditions that reduce protein absorption in the gut can lower albumin over time, which may lower the A/G ratio.Kidney and gut protein loss
When kidneys leak protein into urine or the gut loses protein, albumin can drop, again shifting the ratio downward.Hydration and fluid shifts
Dehydration or fluid overload can slightly change albumin and globulin concentrations and therefore the ratio, although these effects are usually smaller than those from liver or immune changes.
Because both sides of the ratio can move, trends over time and the rest of the metabolic and protein panel are usually more informative than a single number.
When to talk to a clinician about A/G ratio
You should review your A/G ratio with a clinician when:
The ratio is clearly outside the reference range and stays that way on repeat testing
You also have abnormal albumin, globulin, or liver enzyme results
You have symptoms such as swelling, unexplained fatigue, weight changes, abdominal discomfort, or frequent infections
You have known liver, kidney, or autoimmune conditions and want to understand whether this pattern reflects disease activity
A clinician can place your A/G ratio alongside albumin, globulin, liver enzymes, kidney markers, inflammatory tests, and your symptom story. From there they can help decide whether the pattern most likely reflects liver function, immune activity, protein loss, nutrition issues, or something that needs more targeted work up.
A/G ratio in one view
The A/G ratio is a simple way to look at the balance between albumin and globulin proteins in your blood and offers a quiet window into liver function, nutrition, and immune activity. A lower ratio usually means less albumin, more globulins, or both, while a higher ratio points toward relatively more albumin or fewer globulins. On its own it is not diagnostic, but together with albumin, globulin, liver enzymes, kidney markers, and your symptoms it becomes a useful guide for spotting when protein balance and liver or immune health deserve a closer look with a clinician.
