Low alanine aminotransferase levels predict low muscle strength in older patients with diabetes: A nationwide cross‐sectional study in Korea

Abstract

Aim Low alanine aminotransferase (ALT) level is associated with frailty in the older adult population. We investigated the usefulness of ALT in predicting low muscle strength among older patients with diabetes. Methods We included 550 men aged ≥50 years and 525 postmenopausal women. All participants had diabetes, and data were based on the 2014–2016 Korea National Health and Nutrition Examination Survey. Participants with ALT levels confounded by hepatic causes or who had a cerebrovascular accident were excluded. The accompanying metabolic disorders and the associated parameters were evaluated. Low muscle strength was defined as handgrip strength below the Korean‐specific cut‐off value. Results In men and women, when ALT level was divided into quartiles (Q1–Q4), a positive correlation between ALT and body mass index, triglycerides, fasting plasma glucose, glycated hemoglobin levels and handgrip strength was observed, whereas a negative correlation was observed with age and duration of diabetes (P < 0.05, all). After adjusting for age, sex, protein intake, aerobic exercise, body mass index, duration of diabetes, glycated hemoglobin and triglycerides, the lower ALT quartiles ([Q1 and Q2) showed a higher risk for low muscle strength compared with Q4 (OR 2.123 and 2.437; P = 0.060 and 0.029). The cut‐off ALT level for low muscle strength was 18.5 IU/L. Conclusion Older patients with diabetes with ALT levels below low‐to‐normal should not be considered metabolically healthy. Clinicians should pay special attention to the risk of low muscle strength in individuals with ALT levels of ≤18.5 IU/L, independent of any associated metabolic disorders. Geriatr Gerontol Int 2020; 20: 271–276.

Impact of postoperative bile leakage on long‐term outcome in patients following liver resection for hepatocellular carcinoma

“…ALT levels can be increased by release from adipocytes in obese patients. Conversely, the amount of ALT released from the skeletal muscle decreases in patients with sarcopenia 26 . In this study, these factors may not have made ALT as a risk factor for bile leakage in HCC patients.…”

“…Conversely, the amount of ALT released from the skeletal muscle decreases in patients with sarcopenia. 26 In this study, these factors may not have made ALT as a risk factor for bile leakage in HCC patients. Liver resection with broad exposure of the hilar Glissonean sheath is considered as a high-risk procedure 27 that may lead to bile leakage.…”

Association of low alanine aminotransferase values with extubation failure in adult critically ill patients: A retrospective cohort study

“…(13,16) It was recently shown that low ALT levels are associated with reduced muscle strength, adverse outcomes in the general population of hospitalized patients, patients with chronic obstructive pulmonary disease exacerbation, and rehabilitation program participants. (12,15,16,32) To the best of our knowledge, this is the rst study to assess the correlation between low ALT and extubation failure.…”

Low ALT Levels Associated with Poor Outcomes in 8700 Hospitalized Heart Failure Patients

“…Serum ALT is a readily available, inexpensive, and routine biochemical assay used in clinical practice. A large number of studies have established the association between low ALT levels and sarcopenia and frailty in both middle-aged [ 22 ] and elderly patients [ 16 , 37 ] and in a myriad of clinical contexts [ 18 , 19 ]. A prospective study of 179 patients in an internal ward found that low ALT blood activity and high Frail questionnaire score correlated with increased mortality and with each other [ 17 ].…”

“…Nevertheless, when the liver parenchyma is intact, ALT blood levels (demonstrated as catalytic activity) are a good marker for the whole-body skeletal muscle mass [ 14 , 15 ]. Utilizing the aforementioned, a large body of evidence accumulated in the past years, marking lower ALT values as a reliable marker for sarcopenia and frailty, in large, heterogeneous patient populations [ 16 , 17 , 18 , 19 ]. Characterizing sarcopenia and frailty status in patients with HF may provide clinicians with an indicator for gauging disease severity, prognosis, and disease progression or reversal.…”