Dose-Response Relationship between Alanine Aminotransferase Levels within the Reference Interval and Metabolic Syndrome in Chinese Adults
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Purpose: Elevation in serum alanine aminotransferase (ALT) levels is a biomarker for metabolic syndrome (MS); however, the relationshiphas not been fully investigated within the reference interval of ALT levels. Our objective was to explore the relationship between serum ALT levels within the reference interval and MS in Chinese adults. Materials and Methods: This cross-sectional study included 16028 adults, who attended routine health check-ups at Shengli OilfieldCentral Hospital from January 2006 to March 2012. The reference interval of serum ALT level was defined as less than 40 U/L. Logistic regression models and restricted cubic spline were used to evaluate the association of ALT with MS. Results: The prevalence of MS in the total population was 13.7% (6.4% for females and 18.4% for males). Multiple logistic regressionshowed that ALT levels were positively associated with MS after adjustment for potential confounding factors. The odds ratio of MS in the top quartile was 4.830 [95% confidence interval (CI): 2.980–7.829] in females and 3.168 (95% CI: 2.649–3.790) in males, compared with the ALT levels in the bottom quartile. The restricted cubic spline models revealed a positive non-linear dose-response relationship between ALT levels and the risk of MS in women (p for nonlinearity was 0.0327), but a positive linear dose-response relationship in men (p for nonlinearity was 0.0659). Conclusion: Serum ALT levels within the reference interval are positively associated with MS in a dose-response manner. ElevatedALT levels, even within the reference interval, may reflect early dysmetabolic changes.
Abstract
Purpose: Elevation in serum alanine aminotransferase (ALT) levels is a biomarker for metabolic syndrome (MS); however, the relationshiphas not been fully investigated within the reference interval of ALT levels. Our objective was to explore the relationship between serum ALT levels within the reference interval and MS in Chinese adults. Materials and Methods: This cross-sectional study included 16028 adults, who attended routine health check-ups at Shengli OilfieldCentral Hospital from January 2006 to March 2012. The reference interval of serum ALT level was defined as less than 40 U/L. Logistic regression models and restricted cubic spline were used to evaluate the association of ALT with MS. Results: The prevalence of MS in the total population was 13.7% (6.4% for females and 18.4% for males). Multiple logistic regressionshowed that ALT levels were positively associated with MS after adjustment for potential confounding factors. The odds ratio of MS in the top quartile was 4.830 [95% confidence interval (CI): 2.980–7.829] in females and 3.168 (95% CI: 2.649–3.790) in males, compared with the ALT levels in the bottom quartile. The restricted cubic spline models revealed a positive non-linear dose-response relationship between ALT levels and the risk of MS in women (p for nonlinearity was 0.0327), but a positive linear dose-response relationship in men (p for nonlinearity was 0.0659). Conclusion: Serum ALT levels within the reference interval are positively associated with MS in a dose-response manner. ElevatedALT levels, even within the reference interval, may reflect early dysmetabolic changes.
참고문헌 (35)
- Alberti KG, "Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute;American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity", Circulation, 120, pp.1640~1645 (2009)
- Mottillo S, "The metabolic syndrome and cardiovascular risk a systematic review and meta-analysis", J Am Coll Cardiol, 56, pp.1113~1132 (2010)
- Khang YH, "Risks for cardiovascular disease, stroke, ischaemic heart disease, and diabetes mellitus associated with the metabolic syndrome using the new harmonised definition: findings from nationally representative longitudinal data from an Asian population", Atherosclerosis, 213, pp.579~585 (2010)
- Mozumdar A, "Persistent increase of prevalence of metabolic syndrome among U.S. adults: NHANES III to NHANES 1999-2006", Diabetes Care, 34, pp.216~219 (2011)
- Xi B, "Prevalence of metabolic syndrome and its influencing factors among the Chinese adults: the China Health and Nutrition Survey in 2009", Prev Med, 57, pp.867~871 (2013)
- Owen N, "Too much sitting:the population health science of sedentary behavio", Exerc Sport Sci Rev, 38, pp.105~113 (2010)
- James PT, "Obesity: the worldwide epidemic", Clin Dermatol, 22, pp.276~280 (2004)
- Schindhelm RK, "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, pp.437~443 (2006)
- Goessling W, "Aminotransferase levels and 20-year risk of metabolic syndrome, diabetes, and cardiovascular disease", Gastroenterology, 135, pp.1935~1944 (2008)
- Janicˇko M, "Redefining the alanine aminotransferase upper limit of normal improves the prediction of metabolic syndrome risk", Eur J Gastroenterol Hepatol, 27, pp.405~411 (2015)
- 김현창, "Normal Serum Aminotransferase Levels and the Metabolic Syndrome: Korean National Health and Nutrition Examination Surveys", Yonsei Medical Journal, 47(4), pp.542~550 (2006), 연세대학교의과대학
- Suh SY, "The association between normal alanine aminotransferase levels and the metabolic syndrome: 2005 Korean National Health and Nutrition Examination Survey", Metabolism, 58, pp.1731~1736 (2009)
- Steinvil A, "The association of higher levels of within-normal-limits liver enzymes and the prevalence of the metabolic syndrome", Cardiovasc Diabetol, 9, pp.30~ (2010)
- Bethel MA, "Metabolic syndrome and alanine aminotransferase:a global perspective from the NAVIGATOR screening population", Diabet Med, 26, pp.1204~1211 (2009)
- Liu Z, "Elevated alanine aminotransferase is strongly associated with incident metabolic syndrome: a meta-analysis of prospective studies", PLoS One, 8, pp.e80596~ (2013)
- WHO, "Guidelines for controlling and monitoring the tobacco epidemic", World Health Organization, ~ (1998)
- Ma G, "The drinking practice of people in China", Acta Nutrimenta Sinica, 27, pp.362~365 (2005)
- Wang X, "Prevalence of the metabolic syndrome among employees in Northeast China", Chin Med J, 128, pp.1989~1993 (2015)
- Desquilbet L, "Dose-response analyses using restricted cubic spline functions in public health research", Stat Med, 29, pp.1037~1057 (2010)
- Polotsky HN, "Metabolic implications of menopause", Semin Reprod Med, 28, pp.426~434 (2010)
- Murphy MJ, "Girls at five are intrinsically more insulin resistant than boys:The Programming Hypotheses Revisited--The EarlyBird Study (EarlyBird 6)", Pediatrics, 113(1 Pt 1), pp.82~86 (2004)
- Ehm MG, "Genomewide search for type 2 diabetes susceptibility genes in four American populations", Am J Hum Genet, 66, pp.1871~1881 (2000)
- Clark JM, "The prevalence and etiology of elevated aminotransferase levels in the United States", Am J Gastroenterol, 98, pp.960~967 (2003)
- Tarantino G, "What about non-alcoholic fatty liver disease as a new criterion to define metabolic syndrome?", World J Gastroenterol, 19, pp.3375~3384 (2013)
- Gariani K, "Non-alcoholic fatty liver disease and insulin resistance: from bench to bedside", Diabetes Metab, 39, pp.16~26 (2013)
- Sookoian S, "Alanine and aspartate aminotransferase and glutamine-cycling pathway: their roles in pathogenesis of metabolic syndrome", World J Gastroenterol, 18, pp.3775~3781 (2012)
- Hanley AJ, "Alanine aminotransferase and directly measured insulin sensitivity in a multiethnic cohort: the Insulin Resistance Atherosclerosis Study", Diabetes Care, 30, pp.1819~1827 (2007)
- Yamada J, "Elevated serum levels of alanine aminotransferase and gamma glutamyltransferase are markers of inflammation and oxidative stress independent of the metabolic syndrome", Atherosclerosis, 189, pp.198~205 (2006)
- 김규남, "Irritable Bowel Syndrome May Be Associated with Elevated Alanine Aminotransferase and Metabolic Syndrome", Yonsei Medical Journal, 57(1), pp.146~152 (2016), 연세대학교의과대학[DOI]
- Harrison SA, "HCV therapy in 2006: down with ALT levels, in with awareness of co-existent metabolic syndrome", J Hepatol, 44, pp.624~626 (2006)
- Wu WC, "Updated thresholds for serum alanine aminotransferase level in a largescale population study composed of 34 346 subjects", Aliment Pharmacol Ther, 36, pp.560~568 (2012)
- Prati D, "Updated definitions of healthy ranges for serum alanine aminotransferase levels", Ann Intern Med, 137, pp.1~10 (2002)
- Kunde SS, "Spectrum of NAFLD and diagnostic implications of the proposed new normal range for serum ALT in obese women", Hepatology, 42, pp.650~656 (2005)
- Wei D, "Association of serum gamma-glutamyl transferase and ferritin with the metabolic syndrome", J Diabetes Res, 2015, pp.741731~ (2015)
- Lu YH, "Comparison of the diagnostic criteria of metabolic syndrome by International Diabetes Federation and that by Chinese Medical Association Diabetes Branch", Zhonghua Yi Xue Za Zhi, 86, pp.386~389 (2006)
