Abstract
Background/Objectives:
Obesity has been identified as an important factor of elevated alanine aminotransferase (ALT), a surrogate of non-alcoholic fatty liver disease. We investigated the relationship between obesity and elevated ALT in the general Korean population.
Subjects/Methods:
The study sample was comprised of 3098 Korean adults who had participated in the 2005 Korean National Health and Nutrition Examination Survey. Obesity was assessed using body mass index (BMI). Overweight (23⩽BMI<25) and obese (BMI⩾25) were defined by the International Obesity Task Force for Asian adults. ALT was measured by enzymatic methods. Elevated ALT was defined as an enzyme activity >40 IU/l for men and >31 IU/l for women.
Results:
Among participants, 246 (12.7%) men and 86 (7.4%) women displayed elevated ALT. BMI was significantly higher in men and women with elevated ALT than those with normal ALT (P<0.0001). The unadjusted odds ratio (OR) for elevated ALT increased according to the degree of BMI in men (OR: 1.9, 95% confidence interval (CI): 1.25–2.93 in overweight vs OR: 5.01, 95% CI: 3.49–7.21 in obese; P<0.0001) and women (OR: 2.44, 95% CI: 1.24–4.82 vs OR: 3.94, 95% CI: 2.18–7.13; P<0.0001). This trend did not differ after adjustment for putative risk factors including alcohol intake in men (OR: 1.56 vs OR: 3.47, P<0.0001) and women (OR: 1.55 vs OR: 3.10, P=0.0015).
Conclusion:
BMI is implicated as a strong risk factor of elevated ALT in non-diabetic Korean adults.
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References
Adams LA, Knuiman MW, Divitini ML, Olynyk JK (2008). Body mass index is a stronger predictor of alanine aminotransaminase levels than alcohol consumption. J Gastroenterol Hepatol 23, 1089–1093.
Alberti KG, Zimmet P, Shaw J (2005). The metabolic syndrome—a new worldwide definition. Lancet 366, 1059–1062.
Bizzaro N, Tremolada F, Casarin C, Bonetti P, Noventa F, Diodati G et al. (1992). Serum alanine aminotransferase levels among volunteer blood donors: effect of sex, alcohol intake and obesity. Ital J Gastroenterol 24, 237–241.
Chang Y, Ryu S, Sung E, Jang Y (2007). Higher concentrations of alanine aminotransferase within the reference interval predict nonalcoholic fatty liver disease. Clin Chem 53, 686–692.
Chen CH, Huang MH, Yang JC, Nien CK, Yang CC, Yeh YH et al. (2006). Prevalence and risk factors of nonalcoholic fatty liver disease in an adult population of Taiwan: metabolic significance of nonalcoholic fatty liver disease in nonobese adults. J Clin Gastroenterol 40, 745–752.
Chen CH, Huang MH, Yang JC, Nien CK, Yang CC, Yeh YH et al. (2007). Prevalence and etiology of elevated serum alanine aminotransferase level in an adult population in Taiwan. J Gastroenterol Hepatol 22, 1482–1489.
Clark JM, Brancati FL, Diehl AM (2002). Nonalcoholic fatty liver disease. Gastroenterology 122, 1649–1657.
Clark JM, Brancati FL, Diehl AM (2003). The prevalence and etiology of elevated aminotransferase levels in the United States. Am J Gastroenterol 98, 960–967.
Daniel S, Ben-Menachem T, Vasudevan G, Ma CK, Blumenkehl M (1999). Prospective evaluation of unexplained chronic liver transaminase abnormalities in asymptomatic and symptomatic patients. Am J Gastroenterol 94, 3010–3014.
Flegal KM, Carroll MD, Ogden CL, Johnson CL (2002). Prevalence and trends in obesity among US adults, 1999–2000. JAMA 288, 1723–1727.
Hanley AJ, Williams K, Festa A, Wagenknecht LE, D’Agostino Jr RB, Haffner SM (2005). Liver markers and development of the metabolic syndrome: the insulin resistance atherosclerosis study. Diabetes 54, 3140–3147.
Hultcrantz R, Glaumann H, Lindberg G, Nilsson LH (1986). Liver investigation in 149 asymptomatic patients with moderately elevated activities of serum aminotransferases. Scand J Gastroenterol 21, 109–113.
Ioannou GN, Boyko EJ, Lee SP (2006). The prevalence and predictors of elevated serum aminotransferase activity in the United States in 1999–2002. Am J Gastroenterol 101, 76–82.
Kim IK, Kim J, Kang JH, Song J (2008). Serum leptin as a predictor of fatty liver in 7-year-old Korean children. Ann Nutr Metab 53, 109–116.
Ko TC, Chan J, Chan A, Wong P, Hui S, Chow F et al. (2007). Doubling over ten years of central obesity in Hong Kong Chinese working men. Chin Med J (Engl) 120, 1151–1154.
Kwon JH, Bae SH (2008). Current status and clinical course of hepatitis C virus in Korea. Korean J Gastroenterol 51, 360–367.
Lee DH, Ha MH, Christiani DC (2001). Body weight, alcohol consumption and liver enzyme activity—a 4-year follow-up study. Int J Epidemiol 30, 766–770.
Nakamura K, Motohashi Y, Kikuchi S, Tanaka M, Nakano S (1998). Liver transferase activity in healthy Japanese employees aged 18–39 years. Ind Health 36, 218–222.
Nakamura S (1980). Alcohol, liver function tests, and high density lipoprotein cholesterol in university students. Tohoku J Exp Med 132, 241–242.
NCEP (2001). Executive Summary of the Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 285, 2486–2497.
Pan WH, Lee MS, Chuang SY, Lin YC, Fu ML (2008). Obesity pandemic, correlated factors and guidelines to define, screen and manage obesity in Taiwan. Obes Rev 9 (Suppl 1), 22–31.
Pendino GM, Mariano A, Surace P, Caserta CA, Fiorillo MT, Amante A et al. (2005). Prevalence and etiology of altered liver tests: a population-based survey in a Mediterranean town. Hepatology 41, 1151–1159.
Ratziu V, Giral P, Charlotte F, Bruckert E, Thibault V, Theodorou I et al. (2000). Liver fibrosis in overweight patients. Gastroenterology 118, 1117–1123.
Robinson D, Whitehead TP (1989). Effect of body mass and other factors on serum liver enzyme levels in men attending for well population screening. Ann Clin Biochem 26 (Part 5), 393–400.
Ruhl CE, Everhart JE (2003). Determinants of the association of overweight with elevated serum alanine aminotransferase activity in the United States. Gastroenterology 124, 71–79.
Ruhl CE, Everhart JE (2005). Joint effects of body weight and alcohol on elevated serum alanine aminotransferase in the United States population. Clin Gastroenterol Hepatol 3, 1260–1268.
Saito T, Misawa K, Kawata S (2007). 1. Fatty liver and non-alcoholic steatohepatitis. Intern Med 46, 101–103.
Salvaggio A, Periti M, Miano L, Tavanelli M, Marzorati D (1991). Body mass index and liver enzyme activity in serum. Clin Chem 37, 720–723.
Schindhelm RK, Diamant M, Dekker JM, Tushuizen ME, Teerlink T, Heine RJ (2006). Alanine aminotransferase as a marker of non-alcoholic fatty liver disease in relation to type 2 diabetes mellitus and cardiovascular disease. Diabetes Metab Res Rev 22, 437–443.
Skelly MM, James PD, Ryder SD (2001). Findings on liver biopsy to investigate abnormal liver function tests in the absence of diagnostic serology. J Hepatol 35, 195–199.
Song HR, Yun KE, Park HS (2008). Relation between alanine aminotransferase concentrations and visceral fat accumulation among nondiabetic overweight Korean women. Am J Clin Nutr 88, 16–21.
Stranges S, Dorn JM, Muti P, Freudenheim JL, Farinaro E, Russell M et al. (2004). Body fat distribution, relative weight, and liver enzyme levels: a population-based study. Hepatology 39, 754–763.
Sung KC, Ryan MC, Kim BS, Cho YK, Kim BI, Reaven GM (2007). Relationships between estimates of adiposity, insulin resistance, and nonalcoholic fatty liver disease in a large group of nondiabetic Korean adults. Diabetes Care 30, 2113–2118.
Teli MR, James OF, Burt AD, Bennett MK, Day CP (1995). The natural history of nonalcoholic fatty liver: a follow-up study. Hepatology 22, 1714–1719.
The American Society of Hypertension (1992). Recommendations for routine blood pressure measurement by indirect cuff sphygmomanometry. American Society of Hypertension. Am J Hypertens 5, 207–209.
Thorburn AW (2005). Prevalence of obesity in Australia. Obes Rev 6, 187–189.
Van Helden J, Denoyel G, Karwowska S, Reamer R, Schmalz J, Wright T et al. (2004). Performance of hepatitis B assays on the Bayer ADVIA Centaur Immunoassay System. Clin Lab 50, 63–73.
Wannamethee SG, Shaper AG, Lennon L, Whincup PH (2005). Hepatic enzymes, the metabolic syndrome, and the risk of type 2 diabetes in older men. Diabetes Care 28, 2913–2918.
World Health Organization (2000). The Asia-Pacific Perspective: Redefining Obesity and Its Treatment. IOTF, Health Communications Australia Pty Ltd.: Brisbane.
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This research was supported by grant from Dong-il Culture Scholarship Foundation in 2009.
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Contributors: JK contributed to analysis and interpretation of data and manuscript preparation, and IJ is responsible for all the process of this study.
Author contributions: JK contributed to analysis and interpretation of data and manuscript preparation, and IJ is responsible for all the process of this study.
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Kim, J., Jo, I. Relationship between body mass index and alanine aminotransferase concentration in non-diabetic Korean adults. Eur J Clin Nutr 64, 169–175 (2010). https://doi.org/10.1038/ejcn.2009.131
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DOI: https://doi.org/10.1038/ejcn.2009.131
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