Association of cardiometabolic risk factors and hepatic enzymes in a national sample of Iranian children and adolescents: the CASPIAN-III study

Sulfated Polysaccharide from Caulerpa racemosa Attenuates the Obesity-Induced Cardiometabolic Syndrome via Regulating the PRMT1-DDAH-ADMA with mTOR-SIRT1-AMPK Pathways and Gut Microbiota Modulation

Our investigation intended to analyze the effects of sulfated polysaccharides from Caulerpa racemosa (SPCr) in attenuating obesity-induced cardiometabolic syndrome via regulating the protein arginine N-methyltransferase 1-asymmetric dimethylarginine-dimethylarginine dimethylamino-hydrolase (PRMT1-DDAH-ADMA) with the mammalian target of rapamycin-Sirtuin 1-5' AMP-activated protein kinase (mTOR-SIRT1-AMPK) pathways and gut microbiota modulation. This is a follow-up study that used SPs from previous in vitro studies, consisting of 2,3-di-O-methyl-1,4,5-tri-O-acetylarabinitol, 2,3,4,6-tetra-O-methyl-D-mannopyranose, and type B ulvanobiuronicacid 3-sulfate. A total of forty rats were randomly divided into four treatment groups: Group A received a standard diet; Group B was provided with a diet enriched in cholesterol and fat (CFED); and Groups C and D were given the CFED along with ad libitum water, and daily oral supplementation of 65 or 130 mg/kg of body weight (BW) of SPCr, respectively. Group D showed the lowest low-density lipoprotein, triglyceride, total cholesterol, and blood glucose levels, and the highest HDL level compared to the other groups in this study. These results in the group fed high-dose SPCr demonstrated a significant effect compared to the group fed low-dose SPCr (p < 0.0001), as well as in total cholesterol and blood glucose (p < 0.05). Supplementation with SPCr was also observed to have an upregulation effect on peroxisome proliferator-activated receptor gamma coactivator (PGC)-1alpha, interleukin 10, Sirtuin 1, DDAH-II, superoxide dismutase (SOD) cardio, and AMPK, which was also followed by a downregulation of PRMT-1, TNF-α, 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor, and mTOR. Interestingly, gut microbiota modulation was also observed; feeding the rats with a cholesterol-enriched diet shifted the gut microbiota composition toward the Firmicutes level, lowered the Bacteroidetes level, and increased the Firmicutes level. A dose of 130 mg/kg BW of SPCr is the recommended dose, and investigation still needs to be continued in clinical trials with humans to see its efficacy at an advanced level.

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

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.

Metabolic risk associated with liver enzymes, uric acid, and hemoglobin in adolescents

BACKGROUND

The associations of renal, hepatic, and hematologic markers with metabolic risk (MR) have already been shown in adolescents. However, it is still controversial which marker best predicts metabolic changes in youth. The aim of this study was to verify the association of MR with alanine aminotransferase (ALT), aspartate aminotransferase (AST), uric acid, and hemoglobin (Hb) in adolescents.

METHODS

We evaluated 1713 Brazilian adolescents aged 10 to 17 years. MR was calculated using a continuous metabolic risk score, including the sum of Z-scores of waist circumference, systolic blood pressure, fasting glucose, high-density lipoproteins, triglycerides, and cardiorespiratory fitness. Cutoff points were set for MR prediction for five metabolic components (ALT, AST, AST/ALT ratio, uric acid, and Hb).

RESULTS

MR was strongly associated with increased uric acid (odds ratio [OR]: 2.50; 95% confidence interval [CI]: 1.74-3.59), ALT (OR: 2.64; 95% CI: 1.63-4.27), and AST levels (OR: 2.53; 95% CI: 1.24-5.18). Uric acid was shown to be the best predictor for MR (sensitivity: 55.79%; specificity: 61.35%; area under the curve: 0.616).

CONCLUSION

Elevated hepatic, renal, and hematological markers were associated with MR in adolescents, especially ALT, AST, and uric acid levels.

IMPACT

Elevated hepatic, renal, and hematological markers were associated with metabolic risk in adolescents, especially ALT, AST, and uric acid levels. It is still controversial which marker best predicts metabolic changes in adolescents. In addition, association of Hb with metabolic risk is under-studied in this population. It is important to further investigate the relationship between elevated Hb and hepatic markers, since there are key aspects not addressed yet. Our results highlight the importance of creating public health policies aimed to child and adolescent population, to prevention of metabolic disorders from an early age.

Association of Alanine Aminotransferase With Different Metabolic Phenotypes of Obesity in Children and Adolescents: The CASPIAN-V Study

Aim: To determine the association of alanine aminotransferase with different metabolic phenotypes of obesity in a nationally- representative sample of Iranian children and adolescents. Methods: This national study was conducted in the framework of the fifth survey of a national surveillance program entitled Childhood and Adolescence Surveillance and Prevention of Adult Non-communicable Disease study. Participants consisted of 4,200 subjects aged 7-18 years, who were recruited by multistage random cluster sampling from 30 provinces in Iran. They were categorized to normal weight and obese groups and in each group those with and without MetS components. Results: Overall, 3,843 of participants completed the survey (response rate: 91.5%). Their mean (SD) age was 12.58 (3.15) years; 52.6% were boys, and 72.7% lived in urban areas. Mean of alanine aminotransferase (ALT) in subjects with abdominal obesity and general obesity was 8.81 (95% CI: 7.99-9.62) (IU/L) and 8.87 (95% CI: 7.28-10.46) (IU/L), respectively. According to the adjusted model, one unit increment in ALT increased odds of being metabolically non-healthy obese (MNHO) by 2% compared to metabolically healthy non-obese (MHNO) [adj.OR (95% CI): 1.02 (1.01-1.04)]. Also, subjects in the third and fourth quartiles of serum ALT had significantly greater odds of being MNHO than those in its first quartile [Q3/Q1: adj. OR (95% CI): 3.85 (1.70-8.71); Q4/Q1: Adj. OR (95% CI): 3.63 (1.51-8.73)]. Conclusion: This large population-based study revealed significant associations between metabolic phenotypes of obesity and ALT level.

Aminotransferase Ratio Is a Useful Index for Hepatosteatosis in Children and Adolescents: A Cross-Sectional Observational Study

Nonalcoholic fatty liver disease (NAFLD) and childhood obesity are emerging global health issues. The aim of this study was to identify a simple predictor of NAFLD in children and adolescents. This community-based study was conducted from December 2012 to September 2013 in Taiwan and included 1,222 children between 10 and 19 years of age. After excluding alcohol consumption and hepatic-related lesions, NAFLD was diagnosed according to sonographic criteria. Potential confounding factors (including age, gender, and anthropometric and laboratory data) were tested by logistic regression analysis. The cutoff value was determined using receiver operating characteristic (ROC) curve analysis. In addition to older age, heavier weight, and wider waist, subjects with NAFLD had significantly higher blood pressure, lipid disturbances, and alanine aminotransferase/aspartate aminotransferase (ALT/AST) ratios. The correlation between NAFLD and ALT/AST ratio remained significant even after adjusting for confounders (adjusted odds ratio [OR], 2.19; 95% confidence interval [CI], 1.24-3.87; p = .007). The risk score of having a fatty liver, based on ALT/AST ratio, was greater than 0.981 according to ROC curve analysis (sensitivity, 60.5%; specificity, 80.3%; area under the curve, 0.756; CI, 0.71-0.80; p < .001). Therefore, ALT/AST ratio may represent a powerful index of hepatosteatosis in children and adolescents.

The Relationship Between Aspartate Aminotransferase To Alanine Aminotransferase Ratio And Metabolic Syndrome In Adolescents In Northeast China

AIM

To investigate the relationship of the aspartate aminotransferase to alanine aminotransferase ratio (AST/ALT) and metabolic syndrome (MetS) in adolescents in northeast China.

METHODS

A stratified cluster random sample of 935 students 11-16 years of age in a city in the northeast of China were enrolled in 2010-2011. Participants were given a physical examination and a laboratory evaluation, and 93 participants were followed-up after 5 years.

RESULTS

AST/ALT was negatively correlated with waist circumference (WC), waist-to-hip ratio, body mass index (BMI), diastolic blood pressure, triglycerides, low-density lipoprotein, uric acid, fasting insulin, and insulin resistance. It was positively correlated with high-density lipoprotein. Multivariate logistic regression showed that the risk of MetS was 6.02 times greater in adolescents with the lowest, compared with the highest, AST/ALT. Central obesity was the MetS component most closely associated with low AST/ALT [odds ratio (OR) =5.13, 95% CI: 2.83, 9.28]. Five years later, baseline AST/ALT was negatively correlated with WC (r=-0.21, P=0.046), BMI (r=-0.29, P=0.005) and fasting plasma glucose (r=-0.25, P=0.017).

CONCLUSION

In adolescents, AST/ALT was significantly associated with MetS and its components and predicted overweight/obesity in adulthood.

Ideal cardiovascular health associated with fatty liver: Results from a multi-ethnic survey

BACKGROUND AND AIMS

Little is known about the role of liver enzymes as predictors of non-liver-related morbidity and mortality. The ideal cardiovascular health (CVH) score proposed by the American Heart Association (AHA) can be used to predict mortality and morbidity. We investigated the association of the CVH score with liver enzymes and the risk of non-alcoholic fatty liver disease (NAFLD) among US adults.

METHODS

By using the National Health and Nutrition Examination Survey database (cross-sectional), the CVH score was calculated as meeting ideal levels of the following components: 4 behaviors (smoking, body mass index, physical activity and diet adherence) and 3 factors (total cholesterol, blood pressure and fasting glucose).

RESULTS

Individuals with a higher CVH score ("better CVH") had a more favorable profile of liver biomarkers. Adjusted (for age, gender, race, poverty to income ratio, education, marital status and alcohol intake) linear regression indicated significant and negative associations between liver biomarkers and CVH score: (β = -0.069, p < 0.001) for alanine aminotransferase, (β = -0.095, p < 0.001), aspartate aminotransferase, (β = -0.067, p < 0.001), alkaline phosphatase and (β = -0.125, p < 0.001) and fatty liver index. In the logistic regression, with the same confounders, individuals with a higher CVH score had 12% less likelihood of NAFLD compared with those with a lower score. Furthermore, each CVH metric separately was inversely linked to the risk of NAFLD.

CONCLUSIONS

For the first time among US adults, our findings shed light on the role CVH on liver biomarkers.

Association of alanine aminotransferase concentration with cardiometabolic risk factors in children and adolescents: the CASPIAN-V cross-sectional study

BACKGROUND

It has been suggested that the levels of some liver enzymes, and especially alanine aminotransferase (ALT), might be correlatable with cardiometabolic risk factors. We investigated the relationship between ALT concentration and cardiometabolic risk factors among children and adolescents.

DESIGN AND SETTING

This nationwide study in Iran was conducted within the framework of the fifth survey of a national surveillance program known as the Childhood and Adolescence Surveillance and PreventIon of Adult Non-communicable disease study (CASPIAN-V).

METHODS

The participants comprised 4200 students aged 7-18 years, who were recruited through multi-stage random cluster sampling in 30 provinces in Iran. Physical examinations and laboratory tests were conducted in accordance with standard protocols.

RESULTS

Overall, 3843 students (participation rate: 91.5%) completed the survey. Mean ALT levels were significantly higher in individuals with dyslipidemia, in terms of elevated total cholesterol (TC) or LDL-cholesterol or triglycerides (TG), excess weight and dyslipidemia. Some cardiometabolic risk factors were associated with higher levels of ALT, with the following odds ratio (OR) and 95% confidence interval (CI):metabolic syndrome (OR: 1.013; 95% CI: 1.001-1.025); elevated TC (OR: 1.060; 95% CI: 1.039-1.081), elevated LDL (OR: 1.031; 95% CI: 1.016-1.046), elevated TG (OR: 1.056; 95% CI: 1.040-1.072) and dyslipidemia (OR: 1.051; 95% CI: 1.034-1.068).

CONCLUSION

This large population-based study revealed that some cardiometabolic risk factors were significantly associated with ALT levels. These findings suggest that an association with fatty liver is an underlying mechanism for development of cardiometabolic risk factors.

Positive Effect of Fermented Camel Milk on Liver Enzymes of Adolescents with Metabolic Syndrome: a Double Blind, Randomized, Cross-over Trial

Background:

Metabolic syndrome (MetS) has several health consequences. Liver enzymes elevation is among them.

Aim:

This study aimed to assess the effects of fermented Camel milk (FCM), as a functional food and dairy, on some features of MetS in adolescents including liver enzymes status, serum lipids and anthropometric measures.

Methods:

Overweight/obese adolescents with MetS were randomly assigned to FCM 250 cc per day for 8 weeks, a 4-week washout, and then to diluted Cow’s yogurt (DCY) 250 cc per day for 8 weeks, or the reverse sequence. Anthropometric measures, liver enzymes and serum lipids were measured just before and after each one of the four periods. A three-day food record and physical activity questionnaire were completed before each period. Statistical analyses were done using Minitab and SPSS soft-wares considering the significance level of 0.05.

Results:

Twenty-four participants with a mean age (SD) of 13.77 (1.87) years (range: 10.45-16.25) (58% girls) completed the study. It resulted significant mean reduction of aspartate aminotransferase (AST) (-3.75 U/L [95% CI: -7.06; -0.43]; p=0.042) and alanine aminotransferase (ALT) (-2.54 U/L [95% CI: -3.33; -2.24], and p=0.006) and AST/ALT ratio (-0.16 U/L [95% CI: -0.28; -0.05]; p= 0.029) by FCM consumption in comparison to DCY. Non-significant favorable effects on anthropometric measures and serum lipids were seen as well.

Conclusion:

According to the observed favorable effects of fermented camel milk on liver enzymes, its consumption may be considered as a functional food supplement in related circumstances.

Ideal cardiovascular health and liver enzyme levels in European adolescents; the HELENA study

There is an increasing interest for the role of liver enzymes as predictors of non-liver-related morbidity and mortality. The American Heart Association (AHA) described the ideal cardiovascular health concept as a score of seven cardiovascular health behaviors and factors that can be used to monitor and predict ideal cardiovascular health over time. This study aimed to examine the association of the ideal cardiovascular health (ICH), as defined by the AHA, with liver enzyme levels in European adolescents. A total of 637 adolescents (54.6% females), aged 14.6 ± 1.2 years from nine European countries participated in this cross-sectional study. Blood levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma-glutamyltransferase were measured and the AST/ALT ratio calculated. Ideal cardiovascular health was defined as meeting ideal levels of the following components: four behaviors (smoking, body mass index, physical activity, and diet) and three factors (total cholesterol, blood pressure, and glucose). A higher number of ideal cardiovascular health behaviors, factors, and ideal cardiovascular health index were associated with lower ALT (P < 0.05, P < 0.001, and P < 0.001, respectively) and gamma-glutamyltransferase (P < 0.001, P < 0.01, and P < 0.001, respectively) levels. Similarly, a higher number of ideal cardiovascular health behaviors (P < 0.01), factors (P < 0.01), and ideal cardiovascular health index (P < 0.001) were associated with a higher aspartate aminotransferase to alanine aminotransferase ratio. These findings reinforce the usefulness of the ICH index as an instrument to identify target individuals and promote cardiovascular health in adolescents, and it also extends these observations to the liver manifestation of the metabolic syndrome.

Relationship between parental hypertension and cardiometabolic risk factors in adolescents

This study aimed to investigate the relationship between parental hypertension and cardiometabolic risk factors in adolescents. The authors analyzed data of 554 adolescents aged 13 to 19 years from the Korean National Health and Nutrition Examination Survey 2013. The associations between parental hypertension and cardiometabolic abnormalities in adolescents were evaluated through multivariate logistic regression. Parental hypertension was noted in 16.2% of participants. The adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for overweight (OR, 2.08; 95% CI, 1.01-4.28) and obesity (OR, 2.11; 95% CI, 1.09-4.07) were significantly higher in participants with parental hypertension. The adjusted ORs for abdominal obesity (OR, 2.36; 95% CI, 1.01-5.56), high blood pressure (OR, 3.05; 95% CI, 1.19-7.78), and elevated alanine transaminase defined as >35 IU/L (OR, 2.86; 95% CI, 1.03-7.95) were significantly higher in participants with parental hypertension. Prevention of cardiometabolic risk factors should be reinforced in the offspring of hypertensive parents.

Endothelial dysfunction biomarker, endothelial cell-specific molecule-1, and pediatric metabolic syndrome

BACKGROUND

The aim of this study was to compare serum endothelial cell-specific molecule-1 (endocan) in pediatric patients with metabolic syndrome (MetS) and in healthy children, and to determine whether it can be used as an indicator of endothelium damage-induced complications in pediatric MetS patients.

METHODS

The study included 30 patients, aged 6-16 years, who were diagnosed with MetS. Another 30 children with no diseases were recruited as healthy controls. Endocan concentration was measured using enzyme-linked immunosorbent assay.

RESULTS

Endocan was increased almost threefold in the MetS group compared with the healthy group. Systolic arterial tension and diastolic arterial tension, serum triglyceride, total cholesterol, and low-density lipoprotein cholesterol were higher, and high-density lipoprotein cholesterol was lower, in the MetS children than in the healthy group. Fasting blood glucose (FBG), hemoglobin A1c (HBA1C), and homeostasis model assessment insulin resistance (HOMA-IR) were also significantly increased in the children with MetS compared with the healthy group.

CONCLUSIONS

Serum endocan level in pediatric MetS patients could be an important indicator of cardiovascular risk in adulthood.

Association of hypertriglyceridemic-waist phenotype with liver enzymes and cardiometabolic risk factors in adolescents: the CASPIAN-III study

OBJECTIVE

This study aims to investigate the role of metabolic syndrome (MetS) and the hypertriglyceridemic-waist (HW) phenotype in determining cardiometabolic risk factors and elevated liver enzymes in a national sample of Iranian pediatric population.

METHOD

This nationwide study was conducted in the framework of the third survey of a surveillance program. Students, aged 10-18 years, were recruited from 27 provinces in Iran. The prevalence of cardiometabolic risk factors was compared in students with and without HW and MetS. The association of HW with different cardiometabolic risk factors was determined.

RESULTS

The mean age of studied population was 14.73±2.41 years. Prevalence of HW and MetS was 3.3% and 4%, respectively. Sixty-nine (71.1%) participants with HW had MetS. The prevalence of obesity, elevated systolic blood pressure, hypercholesterolemia, and elevated alanine aminotransaminase (ALT) was significantly higher in subjects with HW phenotype and MetS than in their peers (p<0.05). A significant association was observed between HW and elevated levels of cholesterol and ALT, as well as between obesity and low HDL-C (p<0.05).

CONCLUSIONS

The current findings serve as complementary evidence to previous studies, which have been mainly conducted among adults, suggesting that the HW phenotype is associated with cardiometabolic risk factors, especially with elevated cholesterol and ALT. The authors propose that, in primary care settings and in large epidemiological studies, the measurement of all MetS components can be replaced by studying HW as a screening tool for identifying children at high risk for cardiometabolic disorders.

Acarbose versus trans-chalcone: comparing the effect of two glycosidase inhibitors on obese mice

OBJECTIVE

Acarbose and trans-chalcone are glucosidase inhibitors whose beneficial effects have been demonstrated in diabetes. The present study aimed at investigating their potential effects in obesity.

MATERIALS AND METHODS

NMRI male mice (n = 48) were subjected to a high fat diet for four weeks, which induced an initial state of obesity. One control group was given normal rodent diet. Obese animals were then switched to normal rodent diet, and divided to four groups (n = 12 in each): untreated, sham (receiving grape seed oil), and experimental groups receiving acarbose and trans-chalcone (12 mg/kg) during eight weeks. Body weight, blood glucose and other biochemical parameters including triglycerides (TG), cholesterol, HDL, AST, and ALT were measured, as well as leptin, adiponectin, TNF-α, and total antioxidant capacity (TAC). Histological studies were performed on adipose cells and liver tissue samples.

RESULTS

All factors were affected in a positive manner by acarbose, save for body weight, blood sugar and leptin levels, on which acarbose effects, although observable, were not statistically significant. Grape seed oil, used as a solvent for trans-chalcone was found to possess significant effect on TG and TAC, and had beneficial effects on other factors including liver enzymes and cholesterol. Trans-chalcone effects were significant on HDL, leptin and ALT. All compounds seemed to be able to affect fat deposition in liver tissue, and decrease the size of adipose tissue cells to some extent.

CONCLUSION

In conclusion, the tested compounds were able to affect lipid accumulation in tissues and influence adipokines, which may result in an enhanced state with regard to inflammation and oxidative stress.

Liver enzymes and clustering cardiometabolic risk factors in European adolescents: the HELENA study

OBJECTIVES

This study aimed to explore the associations of liver biomarkers with cardiometabolic risk factors and their clustering, and to provide reference values (percentiles) and cut-off points for liver biomarkers associated with high cardiometabolic risk in European adolescents.

METHODS

Alanine aminotransferase (ALT), gamma-glutamyltransferase (GGT), aspartate aminotransferase to ALT ratio (AST/ALT), waist circumference, blood pressure, triglycerides, high-density lipoprotein cholesterol and insulin were measured in 1084 adolescents. We computed a continuous cardiometabolic risk score and defined the high cardiometabolic risk.

RESULTS

Higher ALT and GGT and lower AST/ALT were associated with adiposity and with the number of adverse cardiometabolic risk factors (Ps < 0.05). Higher GGT and lower AST/ALT were associated with higher cardiometabolic risk score (Ps < 0.001) in males and females, and ALT only in males (Ps < 0.001). Gender- and age-specific percentiles for liver biomarkers were provided. Receiver operating characteristic analyses showed a significant discriminatory accuracy of AST/ALT in identifying the low/high cardiometabolic risk (Ps < 0.01) and thresholds were provided.

CONCLUSIONS

Higher GGT and lower AST/ALT are associated with higher cardiometabolic risk factors and their clustering in male and female European adolescents, whereas the associations of ALT were gender dependent. Our results suggest the usefulness of AST/ALT as a screening test in the assessment of adolescents with high cardiometabolic risk and provide gender- and age-specific thresholds that might be of clinical interest.

Serum aminotransferase ratio is independently correlated with hepatosteatosis in patients with HCV: a cross-sectional observational study

OBJECTIVES

The incidence of non-alcoholic fatty liver disease (NAFLD) is significant in hepatitis C virus (HCV) carriers due to multiple mechanisms, and this worsens the progression of chronic liver diseases, such as cirrhosis and hepatocellular carcinoma, and death. The purpose of this study was to examine whether the alanine aminotransferase/aspartate aminotransferase (ALT/AST) ratio correlates with the status of hepatosteatosis.

DESIGN

A cross-sectional observational study.

SETTING

Community-based annual examination in northern Taiwan.

PARTICIPANTS

A total of 1354 participants (age 20 years or over) were enrolled after excluding participants with HCV seronegative, laboratory or questionnaires loss, moderate alcohol consumption, liver cirrhosis, tumours and postlobectomy.

OUTCOME MEASURES

Fatty liver was diagnosed according to echogenic findings. NAFLD included grades 1-3 fatty liver and high-degree NAFLD defined grades 2-3 fatty liver.

RESULTS

580 males and 774 females with a mean age of 47.2 (SD=16.1) years were cross-sectionally studied. The participants with NAFLD have significantly higher levels of ALT/AST ratio, fasting glucose, triglyceride and systolic/diastolic blood pressure than non-NAFLD participants. The association between NAFLD and ALT/AST was significant even when adjusting for the metabolic syndrome (aOR 1.90; 95% CI 1.37 to 2.65; p<0.001). In patients with a high degree of NAFLD, the ALT/AST ratio was still a significant predictor for hepatosteatosis (aOR 2.44; 95% CI 1.58 to 3.77; p<0.001).

CONCLUSIONS

The ALT/AST ratio could be a strong risk of hepatosteatosis in patients with chronic HCV infection.

Association of serum concentrations of magnesium and some trace elements with cardiometabolic risk factors and liver enzymes in adolescents: the CASPIAN-III Study

This study aims to investigate the association of serum concentrations of magnesium (Mg), selenium (Se), chromium (Cr), and copper (Cu) with cardiometabolic risk factors and liver functions in Iranian children and adolescents. This case-control study was conducted under a national surveillance program. It comprised 320 students, aged 10-18 years, in two groups of equal number with or without metabolic syndrome (MetS). Serum concentrations of Mg and abovementioned trace elements were measured by atomic absorption spectrophotometry. Median regression analysis and different models of logistic regression were used to determine the associations of these elements with cardiometabolic risk factors. In the MetS group, the median of Mg, Se, Cr, and Cu was lower or equal to controls. Mg had significant inverse association with some MetS components; however, the corresponding figure was stronger for the simultaneous association of Mg, Se, Cr, and Cu with MetS components. The binary logistic regression revealed that Mg was a significant protective factor against MetS (P = 0.0001). Likewise, by considering the simultaneous association of Mg, Se, Cr, and Cu with MetS, Se was a significant protective factor against MetS. The corresponding figures were not significant for Cr and Cu. Se and Cu had significant inverse association with liver enzymes. The protective role of Mg and Se against MetS and liver enzymes, as well as the associations of these elements with some cardiometabolic risk factors and liver enzymes in the pediatric age group should be considered in future preventive and interventional studies.

An overview on the successes, challenges and future perspective of a national school-based surveillance program: the CASPIAN study

The Childhood and Adolescence Surveillance and PreventIon of Adult Non-communicable disease (CASPIAN) study is implemented in the Islamic Republic of Iran from 2003. The aim of this national school- based surveillance program was to provide accurate data of regular surveys of this program to be reviewing methodology, protocols, data collection and questionnaires of these surveys. Information was obtained from articles and books were published from CASPIAN studies. The CASPIAN studies were repeated every two years, with blood sampling for biochemical factors every four years. Methods and questionnaires of all surveys were similar at their core level and some optional factors added in different surveys. The results of CASPIAN studies represent the public health of Iranian children and adolescents that are useful for policy makers and based on them, intervention programs can set in national and sub-national level.

Association of serum lead and mercury level with cardiometabolic risk factors and liver enzymes in a nationally representative sample of adolescents: the CASPIAN-III study

This study aims to determine the difference of serum Pb and Hg levels in adolescents with or without metabolic syndrome (MetS) and the association of serum levels of these heavy metals with cardiometabolic risk factors and liver enzymes in Iranian adolescents. The study population consisted of 320 adolescents (160 with MetS and 160 healthy controls). The relationship between serum heavy metals and cardiometabolic risk factors was assessed by linear regression. The odds ratios (OR) of having metabolic syndrome across Pb and Hg quartiles were determined by multiple logistic regression analysis. The mean (SD) of Pb and Hg concentrations were higher in adolescents with MetS than in those without it (0.83 (0.27) and 0.17 (0.01) vs. 0.65 (0.15) and 0.10 (0.08) μg/L, P = 0.01 and 0.0001, respectively). Increase in serum Pb and Hg was associated with increase in some cardiometabolic risk factors. Among boys and girls, diastolic blood pressure (DBP), fasting blood glucose, total cholesterol (TC), triglycerides (TG), and alanine aminotransaminase increased significantly across quartiles of serum Pb. Among girls, SBP, DBP, TC, and TG had a significant increase across Hg quartiles. The corresponding figure among boys was significant for SBP, DBP, and TG. Higher quartiles of Pb increased the risk of having MetS (OR 95 % CI 3.10, 2.25-4.27), the corresponding figure was 2.03, 1.75-3.16, across Hg quartiles. Our study showed significant associations between serum Pb and Hg levels with cardiometabolic risk factors in adolescents. In future surveys, the role of potential confounders should be considered more extensively. The clinical significance of these findings needs to be confirmed in longitudinal studies. By considering the origins of chronic diseases from early life, controlling environmental pollutants should be considered as a health priority for primordial or primary prevention of noncommunicable diseases.

Association between psychosocial distress with cardio metabolic risk factors and liver enzymes in a nationally-representative sample of Iranian children and adolescents: the CASPIAN-III study

Background

The present study was designed to evaluate association of psychosocial distress with cardio metabolic risk factors and liver enzymes in Iranian children and adolescents.

Method

This nationwide study was conducted as the third survey of the school-based surveillance system that was conducted among 5593 school students, 10–18 years in Iran. High triglyceride (TG), high fasting blood sugar (FBS), high total cholesterol (TC), high low-density lipoprotein cholesterol (LDL-C), low high-density lipoprotein cholesterol (HDL-C), hypertension (HTN), generalized obesity and abdominal obesity were considered as cardio metabolic risk factors and alanine transaminase (ALT) and aspartate aminotransferase (AST) were considered as liver enzymes. Data were analyzed using multiple logistic regression (MLR) analysis.

Result

Psychosocial distress was detected in2027 (71.2%) of boys and 1759 (63.3%) of girls. Among boys, the mean of LDL, AST and DBP were higher and the mean FBS and HDL were lowering those with psychiatric distress than their other counterparts. Girls with psychosocial distress had significantly higher mean of HDL and FBS than those without psychiatric distress. Psychosocial distress significantly increased the odds of high LDL (OR = 2.36, 95%CI 1.53, 3.64), high FBS (OR = 1.23, 95%CI 1.02, 1.49) and low HDL (OR = 1.65, 95%CI 1.41, 1.95).

Conclusion

Psychosocial distress in adolescents is associated with increased risk of some cardio metabolic risk factors.