ALT Trends through Childhood and Adolescence Associated with Hepatic Steatosis at 24 Years: A Population-Based UK Cohort Study

Relationship between triglyceride-glucose index and aminotransferase among Royal Thai Army personnel 2017-2021: a serial cross-sectional study

BACKGROUND

Insulin resistance (IR) is a major pathogenesis of nonalcoholic fatty liver disease (NAFLD). The triglyceride-glucose (TyG) index has recently gained popularity to assess IR and NAFLD due to its simplicity and low cost. The aim of the current study was to evaluate the relationship between the TyG index and aminotransferase.

METHODS

A serial cross-sectional study was conducted among 232,235 Royal Thai Army (RTA) personnel aged 35-60 years from 2017-2021. Elevated aminotransferase was defined as ≥ 40 U/L and ≥ 35 U/L among males and females, respectively. A linear regression analysis between the TyG index and log-transformed aminotransferase was performed. High- and low-TyG index groups were divided according to Youden's index cut point for predicting elevated aminotransferase. Multivariable logistic analysis was also utilized to investigate the association between the TyG index and elevated aminotransferase.

RESULTS

The TyG index revealed a dose‒response relationship with log-transformed aminotransferase in both sexes and all age groups. The TyG index was positively associated with the prevalence of elevated aminotransferases. In comparison with the first TyG quartile (< 8.37), participants in the fourth quartile (> 9.23) had a higher chance for elevated ALT (AOR: 2.81, 95% CI: 2.71-2.90 for males and AOR: 4.01, 95% CI: 3.50-4.60 for females, P < 0.001 for both). In the fourth TyG quartile, the prevalence of elevated ALT was 47.8% and 40.2% in the participants aged 35-44 and male participants, respectively.

CONCLUSION

A high TyG index is a novel risk factor for elevated aminotransferase among RTA personnel. Those with a high TyG index should be screened for elevated aminotransferase, particularly males aged 35-44 years.

Updated reference ranges for aminotransferase levels of Korean children and young adolescents based on the risk factors for metabolic syndrome

We investigated the reference values of liver enzymes based on cardiometabolic risks among children and adolescents using the Korea National Health and Nutrition Examination Survey. A total of 8091 subjects aged 10-18 years were included from the data from 2007-2017. Overall, aspartate aminotransferase (AST), alanine aminotransferase (ALT), and the AST/ALT ratio varied with sex and age. AST levels tended to decrease with age, but ALT levels had a U-shaped curve, which resulted in a gradual increase in the AST/ALT ratio after age 13. The prevalence of MetS was strongly associated with elevated AST or ALT and a decreased AST/ALT ratio. The prevalence ratios of the development of MetS were also elevated in groups with high levels of AST and ALT and a low AST/ALT ratio. Particularly in the combined ALT and AST/ALT analyses, borderline-high levels also showed a high prevalence ratio of MetS. Liver enzymes were also involved in the increase in the adjusted mean values for each risk factor for MetS. Here, we provided updated reference values for liver enzymes based on the analysis between population-based data and cardiometabolic risk factors; AST, ALT and the AST/ALT ratio might be useful in the early diagnosis and treatment of MetS.

Associations of maternal diet and nutritional status with offspring hepatic steatosis in the Avon longitudinal study of parents and children

BACKGROUND

Priming for cardiometabolic diseases, including non-alcoholic fatty liver disease (NAFLD), is hypothesized to begin in utero. The primary objective of this study is to determine whether there is an association between maternal nutritional status and offspring NAFLD.

METHODS

Data come from the Avon Longitudinal Study of Parents and Children (ALSPAC) in the UK. The analytic sample included 3353 participants who had maternal information on pre-pregnancy BMI, gestational weight gain, diabetes, and free sugar intake as percent of total energy and were assessed for mild-severe hepatic steatosis at 24 years by transient elastography (controlled attenuation parameter score ≥ 248 dB/m). Multiple logistic regression was used to evaluate the association between maternal factors and offspring hepatic steatosis at 24 years.

RESULTS

In confounder-adjusted models the independent associations for each maternal factor with mild to severe vs low hepatic steatosis at 24 years were: pre-pregnancy overweight (OR: 1.84, 95%CL: 1.43-2.38) or obesity (OR: 2.73, 95%CL: 1.84-4.03), more than recommended gestational weight gain (OR: 1.30, 95%CL: 1.04-1.64), diabetes (OR: 1.39, 95%CI: 0.87, 2.21), and high free sugar intake during pregnancy (OR: 1.04, 95% CI: 0.82, 1.33). These associations were largely mediated by BMI at 24 years, but not by birthweight or breastfeeding.

CONCLUSIONS

Our results suggest that maternal nutritional status is associated with the development of NAFLD in their adult offspring, although the relationship is largely mediated by offspring BMI in adulthood.

Decreased Muscle-to-Fat Mass Ratio Is Associated with Low Muscular Fitness and High Alanine Aminotransferase in Children and Adolescent Boys in Organized Sports Clubs

Decreased muscle-to-fat mass ratio (MFR) is associated with pediatric nonalcoholic fatty liver disease (NAFLD) and may reduce muscular fitness. Regular exercise in sports clubs has not led to reductions in obesity in children and adolescents; they may have decreased MFR. Decreased MFR could cause reduced muscular fitness, which may put them at risk for NAFLD development. We investigated whether MFR is related to muscular fitness and serum alanine aminotransferase (ALT), to determine whether MFR could be used to screen for NAFLD in children and adolescent boys belonging to sports clubs. Altogether, 113 participants (aged 7–17 years) who underwent body composition, laboratory, and muscular fitness measurements during a medical checkup were divided into tertiles according to their MFR. Lower extremity muscular fitness values were significantly decreased in the lowest MFR tertile (p < 0.001); conversely, serum ALT levels were significantly increased (p < 0.01). Decreased MFR significantly increased the risk of elevated ALT, which requires screening for NAFLD, after adjusting for age, obesity, muscular fitness parameters, and metabolic risk factors (odds ratio = 8.53, 95% confidence interval = 1.60–45.6, p = 0.012). Physical fitness and body composition assessments, focusing on MFR, can be useful in improving performance and screening for NAFLD in children and adolescents exercising in sports clubs.