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Abstract

The objective of this study was to characterize the prevalence of asymptomatic liver transminase (LT) abnormalities in a healthy, low-risk adult population and identify associated risk factors. We reviewed 2340 completed medical records of participants in our Executive Health Program, which provided screening medical evaluations for executives. LT (alanine aminotransferase and aspartate aminotransferase) were considered abnormal if they above normal range for our laboratory. Subjects were excluded if they had a history of viral hepatitis, nonviral liver disease, or an identifiable cause of LT elevation. Of the 2340 subjects 2294 met inclusion criteria and all had AST recorded, but only 1309 had ALT recorded. In all, 341 subjects (14.9%) were found to have abnormal LT and in those who had less than 3 drinks per day, 13.9% had elevated LT and 3.6% had LT twice the upper limit of normal. Of the 1309 subjects in whom both AST and ALT were measured, 20.8% had abnormal LT and 6.3% had LT twice the upper limit of normal. On univariate analysis age < 60 (P = 0.005), male sex (P < 0.0001), body mass index > or = 30 (P < 0.0001), cholesterol > or = 200 mg/dl (P = 0.018), and triglycerides > or = 200 mg/dl (P < 0.0001) were associated with abnormal LT; all these variables except cholesterol were significant by logistic regression analysis. The odds ratio of abnormal LT and LT 2 times normal was 1.79 (CI 1.20-2.68) and 2.50 (CI 1.04-6), respectively, in subjects with one risk factor, and 2.80 (CI 1.07-7.34) and 4.73 (CI 0.91-24.5), respectively, in subjects with four risk factors. In conclusion, there is a high prevalence of LT abnormalities in this healthy population. Subjects with multiple risk factors should be considered for screening.

Alanine Aminotransferase Decreases with Age: The Rancho Bernardo Study

“…Even after multivariate adjustments for factors previously found in other studies to be associated with differing ALT levels (sex [2], [4], [7], [8], [11]; alcohol use [7]; components of the metabolic syndrome [4]–[11]: BMI, waist-hip ratio, diabetes, fasting glucose, total cholesterol to HDL ratio, triglycerides), for surrogate markers of adiposity (leptin [4], IL-6 [27], [28], adiponectin [29], [30], ghrelin [31], [32]), and for other markers of liver function (bilirubin, GGT, albumin), the association of rising age with decreasing ALT remained significant (p<0.0001, Table 2). Correspondingly, the extreme values of ALT (95 th percentile cutoff points for upper limit of ALT, Figures 1 and 2) as well as the prevalence of elevated ALT (p<0.0001, Figure 3) both decreased with rising age as well.…”

“…A study of serum ALT concentrations in healthy Iranian blood donors also concluded that ALT did not correlate with age [15]. However, a few studies published since that time have reported that the prevalence of elevated (abnormal) ALT decreases with age [4], [6], [7], [8], [10], [11]. Some have found this association to be true in men, but not in women [3], [5], [16].…”

Nonalcoholic fatty liver disease (NAFLD) in the Veterans Administration population: development and validation of an algorithm for NAFLD using automated data

“…Our gold standard definition for verifying NAFLD derived from chart review was elevated liver enzymes ( i.e ., ALT >40IU/ml for males and ALT>31IU/ml for females 7,8 ) and no other documented liver diseases (HCV, HBV, alcoholic liver disease, and other less common etiologies of chronic liver disease) in the presence of either: (1) a histological diagnosis of NAFLD, (2) radiological NAFLD features such as fatty liver, increased or heterogeneous echogenicity, or (3) patients not meeting criteria #1 or #2 but had features of metabolic syndrome defined as two or more of the following: BMI > 25, hypertension defined by systolic blood pressure ≥130 mmHg or diastolic blood pressure ≥ 85 mmHg; high density lipoprotein (HDL) < 40g/dl; triglycerides >150mg/dl; or presence of diabetes (hemoglobin A1c (HbA1c) >7.0). For each measurement, if there were multiple values we used the value that was closest to the date of the first elevated ALT.…”

Serum Levels of Alanine Aminotransferase Decrease With Age in Longitudinal Analysis

“…A study in healthy Iranian blood donors found no correlation between ALT and age (15), but others have reported that the prevalence of elevated ALT decreases with increasing age. (4,6–8,10,11,16) Most of these studies were performed using retrospective chart reviews of patients who had laboratory tests for medical reasons, in self-selected populations (such as blood donors), or in Asian populations, whose liver function may differ compared to Western populations.…”