Alanine aminotransferase and gamma‐glutamyl transferase have different dose‐response relationships with risk of mortality by age

Oh, Chang‐Mo; Won, Young‐Joo; Cho, Hyunsoon; Lee, Jong Keun; Park, Boyoung; Jun, Jae Kwan; Koh, Dong-Hee; Ki, Moran; Jung, Kyu-Won; Oh, In‐Hwan

doi:10.1111/liv.12879

Cited by 32 publications

(49 citation statements)

References 28 publications

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“…The participants were divided into the following groups at baseline: ALT < 10, ALT 10–20, ALT 20–30, ALT 30–40, and ALT ≥ 40 U/L groups. The ALT 20–30 U/L group was defined as the reference group because it was expected to have the lowest mortality based on a previous study …”

Section: Methodsmentioning

confidence: 99%

“…The ALT 20-30 U/L group was defined as the reference group because it was expected to have the lowest mortality based on a previous study. 8 Loss of independence and death. Loss of independence was defined as receiving care levels 3 to 5 in the LTCI certification status, which is the condition requiring complete support for activities of basic daily living.…”

Section: Methodsmentioning

confidence: 99%

“…6,7 The prevalence of low ALT (< 10 U/L) was reported as 8.6%. 8 The possible causes of low ALT are ALT gene mutation, uremia, and malnutrition, including vitamin B6 deficiency. [9][10][11] Although there has been much discussion regarding the upper limit of ALT, 12 low levels of ALT have not been emphasized.…”

Section: Introductionmentioning

confidence: 99%

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

Yamazaki

Kamitani

Matsui

et al. 2019

J of Gastro and Hepatol

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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.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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

Yamazaki

Kamitani

Matsui

et al. 2019

J of Gastro and Hepatol

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“…This biannual regular checkup includes anthropometric measurements, blood pressure, social habits, physical activity, and laboratory tests with overnight fasting. All biochemical samples are collected and measured as previously described 25 . Past medical history, alcohol consumption, smoking history, and exercise habits are collected by standardized self-reporting questionnaires.…”

Section: Study Population This Longitudinal Cohort Study Utilized Damentioning

confidence: 99%

Gamma glutamyltransferase and risk of dementia in prediabetes and diabetes

Han

Lee

Han

et al. 2020

Sci Rep

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Diabetes is associated with cognitive impairment and greater risk for dementia, but the role of gammaglutamyltransferase (γ-GT) in dementia has not been elucidated. We determined incident dementia including Alzheimer's disease and vascular dementia, analyzing data from participants aged 40 years or older in the National Health Insurance Database, collected by the National Health Insurance Service in Korea, from January 2009 to December 2015. During a median follow-up of 7.6 years, 272,657 participants were diagnosed as having dementia. Higher serum γ-GT was associated with increased risk of dementia (HR = 1.22, 95% CI = 1.20-1.24), and had a strong positive association with early onset dementia (HR = 1.32, 95% CI = 1.24-1.40). An additive impact of higher γ-GT on dementia was observed regardless of glycemic status, and prevalent diabetes with the highest γ-GT quartile had a 1.8-fold increased dementia risk (HR = 1.82, 95% CI = 1.78-1.85). This effect of γ-GT concentration in diabetes was more prominent in individuals with vascular dementia (HR = 1.94, 95% CI = 1.84-2.04). In subgroup analysis, young age, male sex, and relatively healthy subjects with a higher γ-GT quartile had more increased dementia risk. In conclusion, γ-GT concentration as well as glycemic status could be a future risk factor for dementia in the general population.Over the past few decades, population aging has produced increased cases of dementia. Dementia is the leading cause of chronic disability in elderly individuals 1,2 . The worldwide prevalence of dementia was approximately 35.6 million in 2010, and the number of individuals living with dementia is expected to double every 20 years 3 . In addition, early onset dementia (EOD) can lead to significant socioeconomic burden and impaired quality of life in the younger population 4,5 , Along with genetic risk factors, inflammatory pathways and vascular factors have been implicated in the development of dementia. It is reported that chronic systemic inflammation could lead to cognitive dysfunction and substantially increase the risk of cognitive impairment 6 . Among chronic inflammatory diseases, diabetes is thought to play an important role in cognitive dysfunction 7 . Atherosclerosis is not only implicated in vascular dementia (VaD), but is also an independent risk factor for Alzheimer's disease (AD), which suggests its importance in dementia regardless of subtype 8 .Gamma-glutamyltransferase (γ-GT) is known as a marker of hepatobiliary disease 9 . γ-GT is a highly sensitive enzyme whose level may be elevated in liver disease such as non-alcoholic fatty liver disease (NAFLD). Recent studies demonstrate the possible role of γ-GT in systemic diseases; large population-based studies show the association between γ-GT and vascular disease 10,11 . Furthermore, correlations between γ-GT in inflammation 12 , and oxidation 13 have been demonstrated. In this context, it is plausible that elevated γ-GT in liver disease shares some common mechanisms in dementia. We hypothesized that γ-GT may be independ...

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“…The four studies to date which have examined the association of serum liver enzyme levels with all‐cause mortality in participants without hepatitis virus infection reported a consistent positive association of GGT and an inconsistent association of ALT . Only one of these studies included the association of AST with all‐cause mortality .…”

Section: Introductionmentioning

confidence: 99%

Association between serum liver enzymes and all‐cause mortality: The Japan Public Health Center‐based Prospective Study

Yuwaki

Shimazu²,

Yamagiwa³

et al. 2019

Liver International

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Background & Aims:The association of serum liver enzyme levels with all-cause mortality in individuals without hepatitis B virus or hepatitis C virus infection is inconsistent. We aimed to investigate all-cause and non-liver disease mortality according to levels of serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), and gamma-glutamyltransferase (GGT) stratified by hepatitis virus infection status in a Japanese cohort. Methods: Participants were 7243 men and 13 513 women aged 40-69 years at the baseline survey in 1993-1994. Multivariate-adjusted hazard ratios of death from the baseline health check-up to December 2012 were calculated with a Cox proportional hazards model controlling for potential confounding factors.Results: During follow-up, 2235 deaths in men and 1901 deaths in women were identified. All serum liver enzymes were associated with all-cause mortality in each sex and hepatitis virus infection status. In participants without infection, those with more than twice the upper level of normal (ULN), which was defined as 30 IU/L for AST and ALT and 50 IU/L for GGT, had a higher risk of non-liver disease mortality compared to those below the ULN (HR 1.69; 95% confidence interval 1.13-2.53, 1.49; 1.02-2.18, 1.39; 1.11-1.73, 1.72; 1.08-2.74 and 1.72; 1.10-2.69 for AST, ALT, and GGT in men and AST and GGT in women, respectively), except for ALT in women. Conclusions:In participants without hepatitis virus infection, serum liver enzyme levels were positively associated with all-cause mortality. Similar associations were also found for non-liver disease mortality. K E Y W O R D Shepatitis viruses, mortality, prospective studies, transferase

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Alanine aminotransferase and gamma‐glutamyl transferase have different dose‐response relationships with risk of mortality by age

Cited by 32 publications

References 28 publications

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

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

Gamma glutamyltransferase and risk of dementia in prediabetes and diabetes

Association between serum liver enzymes and all‐cause mortality: The Japan Public Health Center‐based Prospective Study

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