Differences among patients with and without nonalcoholic fatty liver disease having elevated alanine aminotransferase levels at various stages of metabolic syndrome

Masahiro Sogabe; Toshiya Okahisa; Takeshi Kurihara; Masanori Takehara; Kaizo Kagemoto; Jun Okazaki; Yoshifumi Kida; Akihiro Hirao; Hironori Tanaka; Tetsu Tomonari; Tatsuya Taniguchi; Koichi Okamoto; Masahiko Nakasono; Tetsuji Takayama

doi:10.1371/journal.pone.0238388

Differences among patients with and without nonalcoholic fatty liver disease having elevated alanine aminotransferase levels at various stages of metabolic syndrome

PLoS One. 2020 Aug 31;15(8):e0238388. doi: 10.1371/journal.pone.0238388. eCollection 2020.

Authors

Affiliations

¹ Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan.
² Department of Internal Medicine, Shikoku Central Hospital of the Mutual aid Association of Public School Teachers, Shikokuchuo, Japan.
³ Department of Internal Medicine, Tsurugi Municipal Handa Hospital, Tsurugi, Japan.

Abstract

Background: The prevalence of nonalcoholic fatty liver disease (NAFLD) in the non-obese population has increased and NAFLD is not always recognized in individuals with metabolic syndrome (MS). The risk of cirrhosis is higher in patients having NAFLD with elevated alanine aminotransferase (ALT) levels than in those having NAFLD with normal ALT levels.

Objective: To measure the differences in clinical factors associated with NAFLD having elevation of ALT among subjects with Non-MS, Pre-MS, and MS, and to measure differences in metabolites between MS subjects with and without NAFLD having elevation of ALT.

Methods: Among 7,054 persons undergoing health check-ups, we included 3,025 subjects who met the selection criteria. We measured differences in clinical factors for NAFLD having elevation of ALT among subjects with Non-MS, Pre-MS, and MS, and compared metabolites between subjects with and without NAFLD having elevation of ALT in 32 subjects with MS.

Results: The prevalence of NAFLD and NAFLD having elevation of ALT was significantly progressively greater in subjects with Non-MS, Pre-MS, and MS (p <0.001, respectively). In the Non-MS group, there were significant differences between subjects with and without NAFLD having elevation of ALT with respect to body mass index (BMI), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol, hemoglobin A1c, uric acid, aspartate aminotransferase (AST); In the Pre-MS group, there were significant differences in BMI, hypertension, AST, and gamma-glutamyl transpeptidase (GGT); In the MS group, there were significant differences in HDL-C, impaired glucose tolerance, AST, and GGT. There were significant differences in levels of metabolites of nicotinamide, inosine, and acetyl-L-carnitine between MS subjects with and without NAFLD having elevation of ALT (all p <0.05).

Conclusions: Although NAFLD having elevation of ALT is important for development of NAFLD, differences in factors associated with NAFLD having elevation of ALT at various stages of MS should be considered. Additionally, several metabolites may play roles in the identification of risk for NAFLD in individuals with MS.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Alanine Transaminase / metabolism*
Aspartate Aminotransferases / metabolism
Body Mass Index
Cholesterol, HDL / metabolism
Cholesterol, LDL / metabolism
Cross-Sectional Studies
Female
Glycated Hemoglobin / metabolism
Humans
Liver / metabolism
Male
Metabolic Syndrome / metabolism*
Middle Aged
Non-alcoholic Fatty Liver Disease / metabolism*
Risk Factors
Uric Acid / metabolism
gamma-Glutamyltransferase / metabolism

Substances

Cholesterol, HDL
Cholesterol, LDL
Glycated Hemoglobin A
Uric Acid
gamma-Glutamyltransferase
Aspartate Aminotransferases
Alanine Transaminase

Grants and funding

This work was supported by Grants-in-Aid for Scientific Research (KAKENHI) (C) to M.S. (no. 16K09057) from the Japan Society for the Promotion of Science (JSPS) and the funders had no role in this manuscript.