Alanine Aminotransferase Decreases with Age: The Rancho Bernardo Study

Dong, Mamie H.; Bettencourt, Ricki; Barrett‐Connor, Elizabeth; Loomba, Rohit

doi:10.1371/journal.pone.0014254

Cited by 76 publications

(75 citation statements)

References 47 publications

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“…As a covariate influencing ALT activity, the association between age and ALT activity has been described in previous studies 11-13. The impact of age on ALT fluctuation is not only present based on quantitative discrimination, but also on the diagnostic value in predicting all-cause and disease-specific mortality.…”

Section: Several Concerns That Clinicians Should Raisementioning

confidence: 85%

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Alanine Aminotransferase-Old Biomarker and New Concept: A Review

et al. 2014

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Measurement of serum alanine aminotransferase (ALT) is a common, readily available, and inexpensive laboratory assay in clinical practice. ALT activity is not only measured to detect liver disease, but also to monitor overall health. ALT activity is influenced by various factors, including viral hepatitis, alcohol consumption, and medication. Recently, the impact of metabolic abnormalities on ALT variation has raised concern due to the worldwide obesity epidemic. The normal ranges for ALT have been updated and validated considering the metabolic covariates in the various ethnic districts. The interaction between metabolic and demographic factors on ALT variation has also been discussed in previous studies. In addition, an extremely low ALT value might reflect the process of aging, and frailty in older adults has been raised as another clinically significant feature of this enzyme, to be followed with additional epidemiologic investigation. Timely updated, comprehensive, and systematic introduction of ALT activity is necessary to aid clinicians make better use of this enzyme.

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Section: Several Concerns That Clinicians Should Raisementioning

confidence: 85%

“…Specifically, age has been shown to be associated with the ALT level in prior cross-sectional and prospective studies 11-13. Elinav et al 12 reported an inverted curve with peak ALT levels at 40-55 years in a group of Israeli participants.…”

Section: Demographic Characteristics Influence the Serum Alt Levelmentioning

confidence: 96%

Alanine Aminotransferase-Old Biomarker and New Concept: A Review

et al. 2014

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“…(17) In our previous cross-sectional analysis of the Rancho Bernardo Cohort (community dwelling participants residing in Southern California), we showed that older age was associated with decreased ALT, independent of sex, alcohol use, metabolic covariates, and surrogate markers of liver function. (18) All of the prior studies, however, were cross-sectional, with the potential for survivor bias. Thus, the question still remained whether a given individual’s ALT decreases with age.…”

Section: Introductionmentioning

confidence: 99%

Serum Levels of Alanine Aminotransferase Decrease With Age in Longitudinal Analysis

Dong¹,

Bettencourt²,

Brenner³

et al. 2012

Clinical Gastroenterology and Hepatology

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Background & Aims An increased level of alanine aminotransferase (ALT) is a marker of liver injury. The mean ALT level has been reported to decrease with age; we performed a longitudinal analysis to determine whether serum levels of ALT changes with age among community-dwelling, older adults in the US. Methods We analyzed clinical data from 2 cohorts of individuals who participated in the Rancho Bernardo Study, in Southern CA. The first cohort comprised 1073 community-dwelling participants (59% women); clinical data was collected from 1984 to 1987 and 1992 to 1997. The second cohort comprised 416 participants (64% women); data was collected from 1984 to 1987, 1992 to 1997, and 1997 to 1999. Demographic, metabolic covariates, ALT, bilirubin, and albumin were measured. Changes in individual ALT over time were examined in unadjusted and multivariable-adjusted linear and logistic regression analyses. Results At the baseline visit, the patients’ mean age was 65.7 years and body mass index was 24.9 kg/m2. In cohort 1, the mean levels of ALT decreased with age by 10% (from 21 to 19 IU/L) between the time periods of 1984–1987 and 1992–1997 (P<.0001). In cohort 2, they decreased by 20% (from 20 to 16 IU/L) between the time periods of 1984–1987 and 1997–1999 (P<.0001). Categorically-defined increases in ALT also decreased with age (P<.0001). Results remained consistent in sex-specific analyses and after adjusting for metabolic syndrome components, alcohol use, bilirubin, and serum levels of albumin (P<.0001). Conclusions In a longitudinal analysis, we observed that levels of ALT decrease with age, independent of sex, metabolic factors, alcohol use, and results from commonly used liver function tests (bilirubin and albumin). When interpreting serum levels of ALT, physicians should consider patients’ age especially in elderly.

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“…Studies have shown that various clinic-demographic factors, such as gender and age, body fat -its distribution pattern and serum lipid levels might interfere with the liver enzymes level in the general population [3,4].…”

Section: Introductionmentioning

confidence: 99%

Hepatic Enzyme’s Reference Intervals and Their Modulating Factors in Western Indian Population

Maksane¹,

Dandekar²,

Shukla

et al. 2015

Ind J Clin Biochem

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The reference intervals (RIs) of serum aminotransferases and Gamma-glutamyl transferase (GGT) have been established many years ago. Recent RIs are not available. The prospective study was conducted to re-evaluate the RIs of liver enzymes and the effect of demographic and anthropometric variables on them in western Indian population. A total of 1059 blood donors comprised the study population. Anthropometry and serum liver enzymes levels were measured. Subjects were categorized into normal weight and overweight by using body mass index (BMI) and waist circumference (WC). For RI determination, non-parametric methodology recommended by IFCC/CLSI was adopted. Mann-Whitney test and Spearman's rank correlation were used for statistical analysis. Upper limit of normal reference value of liver enzymes were lower in female compared to male. (ALT-23.55 F vs 36.00 M, GGT-34.58 F vs 36.20 M) When RI of liver enzymes were calculated according to body mass index, the upper limit of normal of ALT and GGT were higher in overweight group compared to normal weight group. (ALT-38.00 vs 27.00 IU/L and GGT-37.59 vs 35.26 IU/L). In both male and female, liver enzymes correlated significantly with age. WC and BMI were positively correlated with AST, ALT and GGT in both subgroups and the correlation was stronger in male. Demographic factors should be considered for making liver enzyme tests more clinically relevant. Gender based partitioning should be adopted for serum alanine aminotransferase (ALT) and GGT reference values for Western Indian population.

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Alanine Aminotransferase Decreases with Age: The Rancho Bernardo Study

Cited by 76 publications

References 47 publications

Alanine Aminotransferase-Old Biomarker and New Concept: A Review

Alanine Aminotransferase-Old Biomarker and New Concept: A Review

Serum Levels of Alanine Aminotransferase Decrease With Age in Longitudinal Analysis

Hepatic Enzyme’s Reference Intervals and Their Modulating Factors in Western Indian Population

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