The Clinical Significance of Slightly to Moderately Increased Liver Transaminase Values in Asymptomatic Patients

Mathiesen, Ulrik; Franzén, LE; Frydén, Aril; Foberg, U; Bodemar, Göran

doi:10.1080/00365529950172880

Cited by 119 publications

(8 citation statements)

References 8 publications

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“…There is of course a possibility that the frequency of NAFLD could be higher if patients had been biopsied. In a previous study by Mathiesen et al, it was also conducted in Sweden the prevalence of steatosis was 40% among subjects who underwent liver biopsy due to asymptomatic slightly-moderately elevated LFTs of all causes [25]. More newer sensitive non-invasive techniques like magnetic resonance spectroscopy have come to clinical usage after this study is designed, which could strengthen the results it had been used.…”

Section: Discussionmentioning

confidence: 82%

Insulin resistance with impaired fasting glucose increases the risk of NAFLD

Önnerhag¹,

Nilsson²,

Lindgren³

2013

OJGas

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Background: Our aim was to investigate the frequency of elevated liver enzymes and NAFLD in patients with known insulin resistance during 15 years of follow-up. Methods: Subjects with insulin resistance were identified from a population-based prospective cohort study in Sweden, Malm? Diet and Cancer Study, conducted in 1991-1996. Inall, 285 non-diabetic subjects with insulin resistance established by HOMA-IR (homeostasis model assessment) were invited to do the liver function testing and if elevated, they should be further assessed by radiological examination of the liver, anthropometric measures and blood testing. Results: 165 subjects (57.9%) agreed to do the liver function testing. Of these, 25 subjects (15%) had elevated liver enzymes. After exclusion of other diseases, 5 of the remaining 21 subjects (23.8%) had radiological signs of steatosis. Liver steatosis significantly correlated with ALT (alanine aminotransferase) (p = 0.04), HOMA-IR (p = 0.00) and the metabolic syndrome (p = 0.03). 80% of the subjects with NAFLD had either developed type 2 diabetes mellitus or had impaired fasting glucose and 80% fulfilled the WHO-criteria for the metabolic syndrome, which were of significant differences to the group without NAFLD. Conclusion: The risk of developing elevated liver enzymes and NAFLD at long-term follow-up in insulin resistant subjects is not insignificant, but mainly associated with the simultaneous development of impaired fasting glucose, established diabetes mellitus and/ or the metabolic syndrome.

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Section: Discussionmentioning

confidence: 82%

Insulin resistance with impaired fasting glucose increases the risk of NAFLD

Önnerhag¹,

Nilsson²,

Lindgren³

2013

OJGas

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“…However, this normal range was calculated from a supposedly healthy reference population, which probably included people with mild to moderate chronic liver disease. Several previous studies have demonstrated that serum aminotransferase level, even within the normal range, may be associated with morbidity and mortality 15-17,22,29,47. The progressive linear association between serum aminotransferase level and the metabolic syndrome suggests that people with high normal aminotransferase levels may need further investigation for the presence of fatty liver disease.…”

Section: Discussionmentioning

confidence: 99%

Normal Serum Aminotransferase Levels and the Metabolic Syndrome: Korean National Health and Nutrition Examination Surveys

et al. 2006

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Increasing evidence suggests an association between elevated serum aminotransferase level and the metabolic syndrome. However, the significance of relatively low levels of aminotransferase in relation to the metabolic syndrome has not been fully investigated in the general population. We investigated the association between serum amiontransferase level and the metabolic syndrome using data from a nationwide survey in Korea. We measured serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels and metabolic conditions among 9771 participants aged 20 or more in the 1998 and 2001 Korean National Health and Nutrition Examination Surveys. Metabolic syndrome was defined according to NCEP-ATP III criteria with a modified waist circumference cutoff (men > 90 cm; women > 80 cm). Serum aminotransferase level, even within normal range, was associated with the metabolic syndrome independent of age, body mass index, waist circumference, smoking, and alcohol intake. Compared with the lowest level (< 20 IU/L), the adjusted odds ratios (95% CI) for an AST level of 20-29, 30-39, 40-49 and ≥ 50 IU/L were 1.10 (0.85-1.42), 1.37 (1.02-1.83), 1.62 (1.08-2.43), and 2.25 (1.47-3.44) in men, and 1.18 (0.99-1.41), 1.43 (1.29-1.83), 1.71 (1.09-2.68), and 2.14 (1.20-3.80) in women, respectively. Corresponding odds ratios for ALT levels were 1.27 (0.99-1.63), 1.69 (1.28-2.23), 2.17 (1.58-2.99), and 2.65 (1.96-3.58) in men, and 1.44 (1.22-1.70), 1.65 (1.26-2.15), 2.94 (1.93-4.47), and 2.25 (1.54-3.30) in women, respectively. In conclusion, elevated serum aminotransferase levels, even in the normal to near normal range, are associated with features of the metabolic syndrome.

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“…These definitions did not consider that metabolic covariates caused liver injury with slight-to-moderate ALT elevation 3, 106. Because of the increasing prevalence of patients with metabolic disorders, the clinical significance of ALT values have been recognized.…”

Section: Several Concerns That Clinicians Should Raisementioning

confidence: 99%

Alanine Aminotransferase-Old Biomarker and New Concept: A Review

et al. 2014

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Measurement of serum alanine aminotransferase (ALT) is a common, readily available, and inexpensive laboratory assay in clinical practice. ALT activity is not only measured to detect liver disease, but also to monitor overall health. ALT activity is influenced by various factors, including viral hepatitis, alcohol consumption, and medication. Recently, the impact of metabolic abnormalities on ALT variation has raised concern due to the worldwide obesity epidemic. The normal ranges for ALT have been updated and validated considering the metabolic covariates in the various ethnic districts. The interaction between metabolic and demographic factors on ALT variation has also been discussed in previous studies. In addition, an extremely low ALT value might reflect the process of aging, and frailty in older adults has been raised as another clinically significant feature of this enzyme, to be followed with additional epidemiologic investigation. Timely updated, comprehensive, and systematic introduction of ALT activity is necessary to aid clinicians make better use of this enzyme.

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The Clinical Significance of Slightly to Moderately Increased Liver Transaminase Values in Asymptomatic Patients

Abstract: Most transaminitis patients had steatosis, and some had defined diseases including chronic hepatitis C. Chronic hepatitis of unknown etiology was found in a substantial proportion (24%) of a population living in an area with a low burden of hepatic viruses and genetic disorders.

Cited by 119 publications

References 8 publications

Insulin resistance with impaired fasting glucose increases the risk of NAFLD

Insulin resistance with impaired fasting glucose increases the risk of NAFLD

Normal Serum Aminotransferase Levels and the Metabolic Syndrome: Korean National Health and Nutrition Examination Surveys

Alanine Aminotransferase-Old Biomarker and New Concept: A Review

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