Is elevated ALT associated with lifestyle risk factors? A population-based survey

Pargol Balali; Maryam Nasserinejad; Sina Azadnajafabad; Naser Ahmadi; Farnaz Delavari; Laleh Rashidian; Erfan Ghasemi; Arezou Dilmaghani-Marand; Sahar Mohammadi Fateh; Narges Ebrahimi; Ameneh Kazemi; Arefeh Alipour Derouei; Shirin Djalalinia; Negar Rezaei; Alireza Delavari

doi:10.1007/s40200-022-01137-6

Is elevated ALT associated with lifestyle risk factors? A population-based survey

J Diabetes Metab Disord. 2022 Oct 12;21(2):1743-1751. doi: 10.1007/s40200-022-01137-6. eCollection 2022 Dec.

Authors

Pargol Balali^{1

2}, Maryam Nasserinejad¹, Sina Azadnajafabad¹, Naser Ahmadi¹, Farnaz Delavari², Laleh Rashidian², Erfan Ghasemi¹, Arezou Dilmaghani-Marand¹, Sahar Mohammadi Fateh^{1

3}, Narges Ebrahimi¹, Ameneh Kazemi¹, Arefeh Alipour Derouei¹, Shirin Djalalinia⁴, Negar Rezaei^{1

3}, Alireza Delavari⁵

Affiliations

¹ Non-Communicable Diseases Research Center,, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
² Tehran University of Medical Sciences, Tehran, Iran.
³ Endocrinology and Metabolism Research Center, Exndocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
⁴ Deputy of Research and Technology, Ministry of Health and Medical Education, Tehran, Iran.
⁵ Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran.

Abstract

Purpose: Given the high prevalence of non-alcoholic fatty liver disease (NAFLD) and the role of Alanine aminotransferase (ALT) in diagnosing liver injury along with the increasing prevalence of lifestyle risk factors, we aimed to evaluate the association between serum ALT level and lifestyle risk factors in a population-based survey.

Methods: This was a population-based study conducted in rural and urban areas of Iran in 2016. Cluster sampling method was applied to enroll a total of 31,050 participants aged ≥ 18. Demographic data, anthropometric measures, and laboratory samples were gathered. Multivariate logistic regression analyses were performed using three different cut-off levels for elevated ALT to assess the relationship between elevated ALT and lifestyle risk factors.

Results: The prevalence of elevated ALT was significantly higher in men with elevated body mass index (BMI), waist-to-hip ratio (WTH), hip circumference, and salt consumption, likewise, in women with higher BMI and WTH. In the multivariate logistic model adjusted for age and sex, high WTH (adjusted odds ratio: 1.73; 95% CI 1.52-1.96), BMI > 25 (1.51; 95% CI 1.29-1.76), hip circumference (1.26; 95% CI 1-1.58), and current smoking (0.67; 95% CI 0.56-0.8) were associated with elevated ALT levels using American cut-off (ALT > 33U/L for male and ALT > 25U/L for female). Only physical measurements (BMI, WTH) but not lifestyle risk factors were related to the increased ALT regardless of the selected cut-offs.

Conclusion: As elevated ALT was associated with several lifestyle risk factors, stewardship programs should be established to modify lifestyle risk factors, such as abdominal obesity and physical inactivity.

Supplementary information: The online version contains supplementary material available at 10.1007/s40200-022-01137-6.

Keywords: Alanine aminotransferase; Fatty liver; Lifestyle risk factors; Non-communicable disease; Population-based survey.

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