Abstract
The association of metabolic syndrome (MetS) components with elevated serum alanine aminotransferase (ALT) levels, a marker of hepatic injury, may differ between men and women. However, the sex-specific association in a military young population which has a low prevalence of MetS was unclear. We conducted a cross-sectional examination in 6738 men and 766 women, aged 18–50 years, from the cardiorespiratory fitness study in armed forces (CHIEF) in eastern Taiwan. The components of MetS were defined according to the updated International Diabetes Federation (IDF) ethnic criteria for Asians. Elevated ALT levels were defined as ≥40 U/L for both sexes and ≥30 U/L for women alternatively. Multivariate logistic regression analysis was performed to determine the sex-specific association between MetS components and elevated ALT. The prevalence of MetS and elevated ALT in men were 11.9% and 12.7% respectively, and in women were 3.5%, and 3.8% respectively. In men, high-density lipoprotein < 40 mg/dL, blood pressures ≥ 130/85 mmHg, serum triglycerides ≥ 150 mg/dL, and waist size ≥ 90 cm were associated with elevated ALT (odds ratios (OR) and 95% confidence intervals: 1.59 (1.34–1.90), 1.40 (1.19–1.65), 2.00 (1.68–2.39), and 1.68 (1.38–2.04); all p < 0.001); whereas in women, only fasting plasma glucose ≥ 100 mg/dL was associated with elevated ALT ≥ 40 U/L (OR: 7.59 (2.35–24.51), p = 0.001) and ALT ≥ 30 U/L (2.67 (0.89–7.95), p = 0.08). Our findings suggest that the relationship between metabolic abnormalities and elevated ALT may differ by sex, possibly due to the MetS more prevalent in young adult men than in women.
Highlights
Non-alcoholic fatty liver disease (NAFLD), characterized by excessive accumulation of hepatic fat, is defined as the presence of steatosis in more than 5% of hepatocytes [1]
Metabolic syndrome (MetS) is defined as central obesity occurring in parallel with two of the following components: (1) raised levels of blood pressures, triglycerides, and fasting plasma glucose; and (2) reduced high-density lipoprotein concentration based on the International Diabetes
Participants with elevated alanine transaminase (ALT) were relatively older, more likely to be male, and had more prevalent obesity, current cigarette smoking, current alcohol intake, metabolic abnormalities, and an ALT/aspartate transaminase (AST) ratio > 1, an indicator of hepatic injury not caused by alcohol toxicity
Summary
Non-alcoholic fatty liver disease (NAFLD), characterized by excessive accumulation of hepatic fat, is defined as the presence of steatosis in more than 5% of hepatocytes [1]. NAFLD has become a leading etiology of chronic liver disease worldwide [4]. Nonalcoholic steatohepatitis (NASH) is a more aggressive form of NAFLD and covers a wide spectrum of disease severity, including hepatitis, fibrosis, cirrhosis, and hepatocellular carcinoma [5]. NASH commonly coexists with elevated markers of liver injury, serum alanine aminotransferase (ALT), which is closely related to the severity of fat accumulation in the liver and frequently used as a marker of NAFLD in relation to type 2 diabetes mellitus in several epidemiology studies [6,7].
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