Risk of mortality and level of serum alanine aminotransferase among community-dwelling elderly in Israel

Gastric cancer risk in the elderly is associated with omeprazole use and inversely associated with aspirin use

BACKGROUND

The association between long-term omeprazole use and gastric cancer (GC) risk is controversial. The aim of this study was to investigate the incidence of GC in elderly community-dwelling omeprazole chronic users with/without aspirin compared to non-users.

METHODS

The registry of a large health management organization was searched for all community-dwelling members aged ≥65 years from January 2002 to December 2016. Data on demographics, background parameters, and chronic omeprazole and aspirin use (>11 prescriptions/year) were retrieved. Those diagnosed with new-onset GC during the study period (from January 2003) were identified.

RESULTS

Of 51 405 subjects who met the inclusion criteria, 197 were diagnosed with GC during a mean follow-up period of 8.74 ± 4.16 years. This group accounted for 0.7% of PPI chronic users (72/11 008) and 0.3% (125/40 397) of nonusers (P < 0.001). GC risk was directly associated with omeprazole chronic use [hazard ratio (HR) 2.03, 95% confidence interval (CI): 1.51-2.73, P < 0.001] and inversely associated with aspirin chronic use (HR 0.55, 95% CI: 0.40-0.75, P < 0.001). Each year of omeprazole use increased GC risk by 9%, and each year of aspirin use decreased GC risk by 10% among omeprazole chronic users. The lowest rate of GC was found in omeprazole nonusers/ aspirin chronic users, and the highest, in omeprazole chronic users/aspirin nonusers.

CONCLUSION

Higher GC rate was associated with omeprazole chronic use and inversely associated with aspirin chronic use relative to omeprazole nonuse in community-dwelling elderly.

Associations of serum aminotransferase and the risk of all-cause and cause-specific mortality in Chinese type 2 diabetes: a community-based cohort study

OBJECTIVE

Investigating the associations of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) with all-cause, cardiovascular disease (CVD) and cancer mortality in a large cohort of community-dwelling patients with type 2 diabetes mellitus (T2DM).

DESIGN

Community-based prospective cohort study conducted between 2013 and 2014.

SETTING

44 selected townships in Changshu and Huai'an City, Jiangsu province, China.

PARTICIPANTS

20340 participants with T2DM were recruited in Jiangsu province, China.

METHODS

We use Cox proportional hazard models to estimate the HR and 95% CIs of associations of serum ALT and AST levels with all-cause and cause-specific mortality. Restricted cubic splines were used to explore the dose-response relationships between ALT and AST levels with mortality.

RESULTS

ALT and AST levels were inversely associated with CVD mortality, compared with the lowest quintile (Q1), the multivariable HRs of the highest quintile (Q5) was 0.82 (95% CI: 0.66 to 1.01, p for trend=0.022) and 0.78 (95% CI: 0.63 to 0.96, p for trend=0.022), respectively. Furthermore, the HRs for ALT levels in all-cause mortality were 0.90 (95% CI: 0.79 to 1.01, p for trend=0.018), and the HRs for AST levels in cancer mortality were 1.29 (95% CI: 1.02 to 1.63, p for trend=0.023). Stronger inverse effects of ALT and AST levels on all-cause mortality were observed in the older subgroup and in those with dyslipidaemia (all p for interaction <0.05). Further analysis based on gender showed that the associations between serum aminotransferases and the mortality risk were more significant in women and substantially attenuated in men.

CONCLUSION

Our findings suggested patients with T2DM with lower levels of ALT and AST had an increased risk of CVD mortality, which needs confirmation in future clinical trials.

Associations between lead, cadmium, mercury, and arsenic exposure and alanine aminotransferase elevation in the general adult population: an exposure-response analysis

Cadmium, lead, mercury, and arsenic are among the most toxic environmental contaminants. Serum alanine aminotransferase (ALT) is the most common liver biomarker. This analysis aimed to explore the associations between blood cadmium, lead, mercury, urinary total arsenic, and dimethylarsinic acid and ALT elevation in adults. Data were extracted from 5 National Health and Nutrition Examination Survey cycles (NHANES) 2007-2016. Patients with chronic viral hepatitis and excessive alcohol consumption were excluded. ALT elevation was defined according to the 2017 American College of Gastroenterology Clinical Guideline. Logistic models and restricted cubic splines were adopted to assess the exposure-response relationships. Comparing the highest to lowest quintile of exposure, the multivariable-adjusted odds ratios (95% confidence intervals) of ALT elevation were 1.38 (1.07-1.78) for blood lead (P_{for trend} = 0.01), 1.37 (1.16-1.62) for blood mercury (P_{for trend} < 0.01), 0.94 (0.78-1.14) for blood cadmium (P_{for trend} = 0.64), 1.07 (0.79-1.45) for urinary total arsenic (P_{for trend} = 0.81), and 1.25 (0.94-1.66) for urinary dimethylarsinic acid (P_{for trend} = 0.18). The associations between blood lead and mercury and ALT elevation were only observed in women. In addition, the associations between urinary total arsenic [1.53 (1.02-2.29), P_{for trend} = 0.02] and dimethylarsinic acid [2.17 (1.05-4.49), P_{for trend} = 0.02] and ALT elevation were also observed in women. Dose-response analysis showed that there was no safe exposure threshold of blood lead and mercury's toxic effect on ALT elevation, respectively. In conclusion, lead, mercury and arsenic were associated with ALT elevation in adults, and the associations were mainly observed in women.

Association between alanine aminotransferase and all-cause mortality rate: Findings from a study on Japanese community-dwelling individuals

Background

This study examined the relationship between survival prognosis and alanine aminotransferase (ALT), a critical factor contributing to aging‐related health and mortality. The research is based on a follow‐up study with 6‐ and 10‐year intervals.

Methods

The participants included 1,610 males (63 ± 14 years old) and 2,074 females (65 ± 12 years old) who were part of the Nomura cohort study conducted in 2002 (first cohort) and 2014 (second cohort). The multivariable‐adjusted hazard ratios (HRs) of death between the baseline health checkup and the end of the follow‐up periods were estimated using a Cox proportional hazards model, controlling for potential confounding factors.

Results

The follow‐up survey revealed 180 male deaths (11.2% of male participants) and 146 female deaths (7.0% of female participants). The univariate Cox regression analysis showed a significant increase in the HRs of all‐cause mortality with decreasing ALT levels (p < 0.001). Furthermore, compared with individuals with ALT levels of 20–29 IU/L, the multivariable‐adjusted HRs (95% confidence interval) for all‐cause mortality were 2.73 (1.59–4.70) for those with ALT levels <10 IU/L, 1.45 (1.05–2.00) for those with ALT levels of 10–19 IU/L, and 1.63 (1.05–2.53) for those with ALT levels ≥30 IU/L.

Conclusions

Our findings show that abnormally low ALT levels and high within the normal range were related to all‐cause mortality in Japan's community‐dwelling individuals. Especially, ALT activity may be an important biomarker for predicting the long‐term survival of older adults.

High Aspartate Aminotransferase/Alanine Aminotransferase Ratio May Be Associated with All-Cause Mortality in the Elderly: A Retrospective Cohort Study Using Artificial Intelligence and Conventional Analysis

Low serum alanine aminotransferase (ALT) activity and high aspartate aminotransferase (AST)/ALT ratio may be associated with high mortality in the elderly. We aimed to confirm this in an 8-year retrospective cohort study. Clinical data for 5958 people living in a city aged 67−104 years were analyzed for their relationships with all-cause mortality using artificial intelligence (AI) and conventional statistical analysis. In total, 1413 (23.7%) participants died during the study. Auto-AI analysis with five rounds of cross-validation showed that AST/ALT ratio was the third-largest contributor to mortality, following age and sex. Serum albumin concentration and body mass index were the fourth- and fifth-largest contributors. However, when serum ALT and AST were individually considered in the same model, the individual serum ALT and AST activities were the seventh- and tenth-largest contributors. Conventional survival analysis showed that ALT, AST, and AST/ALT ratio as continuous variables were all associated with mortality (adjusted hazard ratios (95% confidence intervals): 0.98 (0.97−0.99), 1.02 (1.02−1.03), and 1.46 (1.32−1.62), respectively; all p < 0.0001). In conclusion, both AI and conventional analysis suggest that of the conventional biochemical markers, high AST/ALT ratio is most closely associated with all-cause mortality in the elderly.

Associations of liver volume and other markers of hepatic steatosis with all-cause mortality in the general population

AIMS

We examined the associations between liver volume and other quantitative and qualitative markers of hepatic steatosis with all-cause mortality in the general population.

METHODS

We included 2769 German middle-aged individuals with a median follow-up of 8.9 years (23,898 person-years). Quantitative markers used were serum liver enzymes and FIB-4 score, while qualitative markers of hepatic steatosis included magnetic resonance imaging (MRI) measurements of liver fat content and total liver volume. Cox proportional hazards models, adjusted for confounding factors, were undertaken to investigate the associations of liver volume and other markers of hepatic steatosis with all-cause mortality.

RESULTS

A larger MRI-assessed liver volume was associated with a nearly three-fold increased risk of all-cause mortality (Hazard Ratio = 3.16; 95% confidence interval 1.88; 5.30), independent of age, sex, body mass index, food frequency score, alcohol consumption and education level. This association was consistent in all subgroups considered (men vs. women; presence or absence of overweight/obesity, metabolic syndrome or diabetes). Higher serum liver enzyme levels and FIB-4 score were also significantly associated with higher all-cause mortality in the total population and in all subgroups. No independent associations were found between other quantitative and qualitative markers of hepatic steatosis and the risk of all-cause mortality.

CONCLUSIONS

We showed for the first time that larger liver volume was associated with a three-fold increase in long-term risk of all-cause mortality. This association remained significant after adjustment for age, sex, alcohol consumption, obesity and other coexisting metabolic disorders.

Associations Between Serum Zinc Levels and Alanine Aminotransferase Elevation in Adults

Recent findings showed that zinc might be linked to alanine aminotransferase (ALT) elevation. This analysis aimed to explore the association between serum zinc levels and ALT elevation in adults. Data on serum zinc and ALT levels from adults aged 20 years and older who participated in the 2011-2016 National Health and Nutrition Examination Surveys were analyzed (N = 4138). Individuals with excessive alcohol consumption and hepatitis B or C infection were excluded. ALT elevation was defined as any value above normal of ALT (> 33 IU/L for males and > 25 IU/L for females). The multivariate logistic model and restricted cubic splines were adopted to assess the non-linear relationship. In a fully adjusted model, the odds ratio and 95% confidence interval of ALT elevation for quartile 4 (Q4) vs. quartile 1 (Q1) of serum zinc levels were 1.68 and 1.29-2.20 (per quartile: 1.20 (1.10-1.31)). In subgroup analysis, the association between serum zinc levels and ALT elevation was found in females (Q4 vs Q1: 1.95 (1.20-3.15)), obese individuals (Q4 vs Q1: 1.80 (1.19-2.74)), and young adults (Q4 vs Q1: 1.72 (1.09-2.72)), while the association was not evident in males, non-obese individuals, and adults older than 50 years old. A linear dose-response relationship between serum zinc levels and ALT elevation was found (P_{for non-linearity} = 0.77). In conclusion, serum zinc was positively associated with ALT elevation in adults, and the association was mainly observed in females, obese individuals, and young adults.

Use of proton pump inhibitors is associated with lower rates of first-time ischemic stroke in community-dwelling elderly

AIM

Data on cardiovascular outcomes in elderly using proton pump inhibitors (PPI) are scant. We aimed to test the association between PPI use and the occurrence of first-time ischemic stroke (FTIS) among elderly.

METHODS

The electronic database of a centrally located district branch of a large health maintenance organization in Israel was retrospectively screened (2002-2016) for community-dwelling individuals (≥65-95 years) for demographics and co-morbidities. Follow-up was until FTIS, death or end of study. Findings were analyzed by PPI use and occurrence of FTIS.

RESULTS

29,639 subjects (without history of stroke and use of antiplatelet aggregation drugs) mean age of 82.2 ± 5.5 years (range: 65-95 years, 38% male) were analyzed: 8,600 (29%) used PPIs. Mean follow up was 10.58 years (SD ± 5.44). Similar total and annual occurrence rates of FTIS were depicted in PPI users and non-users (20.9% vs. 21% and 2% vs. 2.1%, respectively). On a Cox regression analysis, upon adjustment for age, gender and cardiovascular disease related risk factors, PPI use was significantly associated with lower rates of FTIS (HR 0.73, 95% C.I. 0.69-0.77, p < 0.001). The risk for FTIS was significantly lower in subjects using PPI at any dose and for any time period compared to non-users (HR 0.9, 95% C.I. 0.85-0.96 for 7-48 yearly prescriptions and HR 0.51, 95% C.I. 0.46-0.55 for ≥49 yearly prescriptions).

CONCLUSIONS

PPI use was associated with lower rates of FTIS in community-dwelling elders. Prospective large-scale studies are needed to fully elucidate the effect of PPI in this aging population.

Associations of Coffee Consumption with the Circulating Level of Alanine Aminotransferase and Aspartate Aminotransferase. A Meta-Analysis of Observational Studies

Background: The associations of coffee consumption with the circulating level of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) remains controversial. We conducted a meta-analysis of observational studies to sum up the existing evidence about this matter.Methods: A comprehensive literature-search up to January 2020, using PubMed, Embase and Web of Science databases, was conducted to identify the relevant observational studies that examined the associations of coffee consumption with the circulating level of ALT and AST. The standard mean difference (SMD) for the level of ALT and AST, odds ratio (OR) for the elevated ALT and AST and their corresponding 95% CIs for the highest versus lowest categories of coffee intake were determined.Results: A total of 19 observational studies, which involved 222,067 individuals, were included in this meta-analysis. The combined SMD suggested that coffee consumption was associated with a lower level of ALT (SMD = -0.14, 95% CI: -0.22 to -0.06; p = 0.001) and AST (SMD = -0.17, 95% CI: -0.20 to -0.13; p < 0.001), respectively. Meanwhile, the overall multivariable adjusted OR showed that coffee consumption was inversely associated with the elevated ALT (OR = 0.69, 95% CI: 0.60 to 0.79; p < 0.001) and AST (OR = 0.62, 95% CI: 0.48 to 0.81; p < 0.001), respectively.Conclusion: The results of this meta-analysis suggest that coffee consumption is inversely associated with the circulating level of ALT and AST, and elevated ALT and AST. More randomized controlled trials are needed to elaborate the concerned issues.

Association of low alanine aminotransferase with loss of independence or death: A 5-year population-based cohort study

BACKGROUND AND AIM

Alanine aminotransferase (ALT) is an important enzyme for amino acid metabolism and gluconeogenesis, and low ALT is an indicator of vitamin B6 deficiency. However, it is unknown whether individuals with low ALT are likely to develop loss of independence (LOI) or death. We investigated the association of low ALT with LOI or death in the elderly.

METHODS

Between 2008 and 2010, 2,484 elderly individuals (≥ 65 years old) without functional dependency from the Locomotive Syndrome and Health Outcomes in the Aizu Cohort Study were enrolled. Based on baseline ALT values, the participants were divided into the following groups: ALT < 10 (n = 73), 10-20 (n = 1,372), 20-30 (reference, n = 734), 30-40 (n = 201), and ≥ 40 (n = 104) U/L groups. LOI was defined as requiring complete support for basic activities of daily living, which is care levels 3-5 in Japanese long-term care insurance certifications. The hazard ratios of LOI or death were estimated by Cox proportional hazard models adjusted for potential confounders.

RESULTS

During the median follow-up period of 5.75 (interquartile range 4.85-5.83) years, LOI or death occurred in 195 participants (7.85%). Compared with ALT 20-30 U/L, low ALT was associated with LOI or death (multivariable adjusted hazard ratios [95% confidence intervals]: 3.02 [1.57-5.81] and 1.55 [1.07-2.24] in ALT < 10 and 10-20 U/L groups, respectively), while high ALT was not (1.29 [0.72-2.31] and 1.49 [0.68-3.25] in ALT 30-40 and ≥ 40 U/L groups, respectively).

CONCLUSIONS

Clinicians should be aware of not only high ALT, indicating liver injury, but also low ALT associated with LOI or death.

Lowering the upper limit of serum alanine aminotransferase levels may reveal significant liver disease in the elderly

This study sought to determine the prevalence of significant liver disease in those subjects with serum alanine aminotransferase levels in the range between the current and the newly suggested upper limit of normal (termed the delta range). The files of the previous study subjects (who underwent at least one alanine aminotransferase measurement in 2002 and followed to 2012) were reviewed for a diagnosis of chronic liver disease; aspartate aminotransferase/platelet ratio index, FIB-4 and alanine aminotransferase/aspartate aminotransferase ratio were used to evaluate liver fibrosis. The prevalence of significant liver disease, by diagnoses and fibrosis scores was compared between subjects with alanine aminotransferase levels in the delta range (men, 42-45 IU/L; women, 26-34 IU/L) and in the newly suggested normal range (men, 15-42 IU/L; women, 10-26 IU/L). The cohort included 49,634 subjects (41% male, mean age 83±6 years) of whom 2022 were diagnosed with chronic liver disease including 366 with cirrhosis. Compared to subjects with alanine aminotransferase levels in the newly suggested normal range, subjects with alanine aminotransferase levels in the delta range had a significantly higher rate of chronic liver disease (men, 15.3% vs. 4.9%; women, 7.8% vs. 3.3%) and of cirrhosis specifically (men, 4.2% vs. 0.9%; women, 1.5% vs. 0.4%) and also had higher mean fibrosis scores (P <0.001 for all). Lowering the current upper limit of normal of serum alanine aminotransferase may help to identify elderly patients at risk of significant liver disease.