Association between alanine aminotransferase within the normal range and all-cause and cause-specific mortality: A nationwide cohort study

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.

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.

Serum alanine aminotransferase activity and risk factors for cardiovascular disease in a Caucasian population: the Tromsø study

Background

High and low levels of serum alanine aminotransferase (ALT) are both associated with cardiovascular diseases (CVD) risks especially in elderly, but the mechanisms are less known. This study investigated associations between ALT and CVD risk factors including effects of sex and age in a Caucasian population.

Methods

Cross-sectional data were analysed sex-stratified in 2555 men (mean age 60.4 years) and 2858 women (mean age 60.0 years) from the population study Tromsø 6. Associations were assessed by variance analysis and multivariable logistic regression of odds to have abnormal ALT. Risk factors included body mass index (BMI), waist-to-hip-ratio, blood pressure, lipids, glucose, glycated haemoglobin and high-sensitive C-reactive protein (CRP).

Results

Abnormal elevated ALT was detected in 113 men (4.4%) and 188 women (6.6%). Most CVD risk factors associated positively with ALT in both sexes except systolic blood pressure and CRP (women only), while ALT was positively associated with age in men when adjusted for CVD risk factors, P < 0.001. BMI predicted ALT in men (OR 0.94; 95% CI 0.88–1.00, P = 0.047) and women (OR 0.90; 95% CI 0.86–0.95, P < 0.001). A linear inversed association between age and ALT in men and a non-linear inversed U-trend in women with maximum level between 60 and 64 years were found.

Conclusion

This study confirms a positive relationship between ALT and CVD risk factors, particularly BMI. Age is not a major confounder in the ALT-CVD relationship, but separate sex-analyses is recommended in such studies.