Association of alanine aminotransferase concentration with cardiometabolic risk factors in children and adolescents
the CASPIAN-V cross-sectional study
Keywords:
Alanine aminotransferase, Risk factors, ChildAbstract
BACKGROUND: It has been suggested that the levels of some liver enzymes, and especially alanine ami- notransferase (ALT), might be correlatable with cardiometabolic risk factors. We investigated the relation- ship between ALT concentration and cardiometabolic risk factors among children and adolescents. DESIGN AND SETTING: This nationwide study in Iran was conducted within the framework of the fifth survey of a national surveillance program known as the Childhood and Adolescence Surveillance and PreventIon of Adult Non-communicable disease study (CASPIAN-V). METHODS: The participants comprised 4200 students aged 7-18 years, who were recruited through multi-stage random cluster sampling in 30 provinces in Iran. Physical examinations and laboratory tests were conducted in accordance with standard protocols. RESULTS: Overall, 3843 students (participation rate: 91.5%) completed the survey. Mean ALT levels were significantly higher in individuals with dyslipidemia, in terms of elevated total cholesterol (TC) or LDL-cho- lesterol or triglycerides (TG), excess weight and dyslipidemia. Some cardiometabolic risk factors were asso- ciated with higher levels of ALT, with the following odds ratio (OR) and 95% confidence interval (CI): meta- bolic syndrome (OR: 1.013; 95% CI: 1.001-1.025); elevated TC (OR: 1.060; 95% CI: 1.039-1.081), elevated LDL (OR: 1.031; 95% CI: 1.016-1.046), elevated TG (OR: 1.056; 95% CI: 1.040-1.072) and dyslipidemia (OR: 1.051; 95% CI: 1.034-1.068). CONCLUSION: This large population-based study revealed that some cardiometabolic risk factors were significantly associated with ALT levels. These findings suggest that an association with fatty liver is an underlying mechanism for development of cardiometabolic risk factors.
Downloads
References
Ghouri N, Preiss D, Sattar N. Liver enzymes, nonalcoholic fatty liver disease, and incident cardiovascular disease: a narrative review and clinical perspective of prospective data. Hepatology. 2010;52(3):1156-61. PMID: 20658466; doi: 10.1002/hep.23789.
Wong VW, Wong GL, Yip GW, et al. Coronary artery disease and cardiovascular outcomes in patients with non-alcoholic fatty liver disease. Gut. 2011;60(12):1721-7. PMID: 21602530; doi: 10.1136/gut.2011.242016.
Chang Y, Ryu S, Sung E, Jang Y. Higher concentrations of alanine aminotransferase within the reference interval predict nonalcoholic fatty liver disease. Clin Chem. 2007;53(4):686-92. PMID: 17272484; doi: 10.1373/clinchem.2006.081257.
Song HR, Yun KE, Park HS. Relation between alanine aminotransferase concentrations and visceral fat accumulation among nondiabetic overweight Korean women. Am J Clin Nutr. 2008;88(1):16-21. PMID: 18614719; doi: 10.1093/ajcn/88.1.16.
Goessling W, Massaro JM, Vasan RS, et al. Aminotransferase levels and 20-year risk of metabolic syndrome, diabetes, and cardiovascular disease. Gastroenterology. 2008;135(6):1935-44, 1944 e1. PMID: 19010326; doi: 10.1053/j.gastro.2008.09.018.
Porter SA, Pedley A, Massaro JM, et al. Aminotransferase levels are associated with cardiometabolic risk above and beyond visceral fat and insulin resistance: the Framingham Heart Study. Arterioscler Thromb Vasc Biol. 2013;33(1):139-46. PMID: 23162012; doi: 10.1161/ATVBAHA.112.300075.
Musso G, Gambino R, Bo S, et al. Should nonalcoholic fatty liver disease be included in the definition of metabolic syndrome? A cross-sectional comparison with Adult Treatment Panel III criteria in nonobese nondiabetic subjects. Diabetes Care. 2008;31(3):562-8. PMID: 18056890; doi: 10.2337/dc07-1526.
Lee Y, Han KD, Jung JJ, et al. Upper Normal Alanine Aminotransferase Range and Insulin Resistance in Korean Adolescents: Korean National Health and Nutrition Examination Survey, 2009-2010. Dig Dis Sci. 2016;61(6):1700-6. PMID: 26703124; doi: 10.1007/s10620-015-4009-x.
Mahady SE, Gale J, Macaskill P, Craig JC, George J. Prevalence of elevated alanine transaminase in Australia and its relationship to metabolic risk factors: A cross-sectional study of 9,447 people. J Gastroenterol Hepatol. 2017;32(1):169-76. PMID: 27144984; doi: 10.1111/jgh.13434.
Radmard AR, Rahmanian MS, Abrishami A, et al. Assessment of Abdominal Fat Distribution in Non-Alcoholic Fatty Liver Disease by Magnetic Resonance Imaging: a Population-based Study. Arch Iran Med. 2016;19(10):693-9. PMID: 27743433; doi: 0161910/AIM.005.
Pimenta NM, Cortez-Pinto H, Melo X, et al. Waist-to-height ratio is independently related to whole and central body fat, regardless of the waist circumference measurement protocol, in non-alcoholic fatty liver disease patients. J Hum Nutr Diet. 2017;30(2):185-92. PMID: 27600326; doi: 10.1111/jhn.12410.
Kim HC, Choi KS, Jang YH, Shin HW, Kim DJ. Normal serum aminotransferase levels and the metabolic syndrome: Korean National Health and Nutrition Examination Surveys. Yonsei Med J. 2006;47(4):542-50. PMID: 16941745; doi: 10.3349/ymj.2006.47.4.542.
Chen S, Guo X, Zhang X, et al. Association between elevated serum alanine aminotransferase and cardiometabolic risk factors in rural Chinese population: a cross-sectional study. BMC Cardiovasc Disord. 2015;15:65. PMID: 26160405; doi: 10.1186/s12872-015-0060-y.
Fraser A, Longnecker MP, Lawlor DA. Prevalence of elevated alanine aminotransferase among US adolescents and associated factors: NHANES 1999-2004. Gastroenterology. 2007;133(6):1814-20. PMID: 18054554; doi: 10.1053/j.gastro.2007.08.077.
Fraser A, Harris R, Sattar N, Ebrahim S, Smith GD, Lawlor DA. Gamma-glutamyltransferase is associated with incident vascular events independently of alcohol intake: analysis of the British Women’s Heart and Health Study and Meta-Analysis. Arterioscler Thromb Vasc Biol. 2007;27(12):2729-35. PMID: 17932318; doi: 10.1161/ATVBAHA.107.152298.
Bhatia LS, Curzen NP, Calder PC, Byrne CD. Non-alcoholic fatty liver disease: a new and important cardiovascular risk factor? Eur Heart J. 2012;33(10):1190-200. PMID: 22408036; doi: 10.1093/eurheartj/ehr453.
Motlagh M, Ziaodini H, Qorbani M, et al. Methodology and early findings of the fifth survey of childhood and adolescence surveillance and prevention of adult noncommunicable disease: The CASPIAN-V study. Int J Prev Med 2017;8:4. PMID: 28217266; doi: 10.4103/2008-7802.198915.
Kelishadi R, Majdzadeh R, Motlagh ME, et al. Development and evaluation of a questionnaire for assessment of determinants of weight disorders among children and adolescents: the Caspian-IV study. Int J Prev Med. 2012;3(10):699-705. PMID: 23112896.
WHO Expert Committee on Physical Status. Physical Status: the use and interpretation of anthropometry Geneva: World Health Organization; 1995. ISBN-13: 978-9241208543; ISBN-10: 9241208546.
WHO Multicentre Growth Reference Study Group. WHO Child Growth Standards based on length/height, weight and age. Acta Paediatr Suppl. 2006;450:76-85. PMID: 16817681.
Knowles KM, Paiva LL, Sanchez SE, et al. Waist circumference, body mass index, and other measures of adiposity in predicting cardiovascular disease risk factors among Peruvian adults. Int J Hypertens. 2011;2011:931402. PMID: 21331161; doi: 10.4061/2011/931402.
National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics. 2004;114(2 Suppl 4th Report):555-76. PMID: 15286277.
McNamara JR, Schaefer EJ. Automated enzymatic standardized lipid analyses for plasma and lipoprotein fractions. Clin Chim Acta. 1987;166(1):1-8. PMID: 3608193.
Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem. 1972;18(6):499-502. PMID: 4337382.
Li C, Ford ES, Mokdad AH, Cook S. Recent trends in waist circumference and waist-height ratio among US children and adolescents. Pediatrics. 2006;118(5):e1390-8. PMID: 17079540; doi: 10.1542/peds.2006-1062.
Grundy SM, Cleeman JI, Daniels SR, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation. 2005;112(17):2735-52. PMID: 16157765; doi: 10.1161/CIRCULATIONAHA.105.169404.
