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Background and aims:The prevalence of cognitive impairment is increasing, especially in South Korea and South America. It is hypothesized that the alanine transaminase-to-aspartate aminotransferase ratio (ALT/AST), a marker of liver function, may influence cognitive function. However, as of now, there is no consensus on the clinical evidence supporting the link between ALT/AST ratio and cognitive impairment. Methods: Data from two cycles (2011-2014) of the National Health and Nutrition Examination Survey (NHANES) were utilized to investigate the correlation between serum ALP levels and cognitive impairment. Cognitive function was assessed through three tests: the Consortium to Establish a Registry for Alzheimer's Disease (CERAD), Animal Fluency (AF), and Digit Symbol Substitution Test (DSST) scores. The inflection point for cognitive impairment was defined as CERAD < 5, AF < 14, and DSST < 34. Weighted multiple logistic regression models were applied to explore the relationship between ALT/AST ratio and cognitive impairment. Generalized additive models (GAM) and a smooth curve fit (penalty spline method) were employed to examine potential nonlinear associations. Subgroup analyses and interaction tests were also carried out. Results: The study enrolled a total of 2765 adults aged 60 years and older. Our findings revealed a significant correlation between ALT/AST levels and a reduced likelihood of cognitive impairment in the CERAD test results [fully adjusted odds ratio (OR) = 0.53, 95% confidence interval (CI): 0.34-0.83]. Specifically, in the highest quartile (Q4) of CERAD scores, this association remained significant [fully adjusted Q4: OR = 0.67, 95% CI: 0.50-0.88], with a trend significance (p = 0.012). A notable association was observed between ALT/AST levels and a decreased probability of cognitive impairment in the DSST test outcomes [fully adjusted OR = 0.46, 95% CI: 0.28-0.77]. Particularly, in Q3 [fully adjusted OR = 0.69, 95% CI: 0.50-0.94] and Q4 [fully adjusted OR = 0.60, 95% CI: 0.44-0.82], displaying a significant trend across quartiles (p = 0.004). The generalized additive models (GAM) and smooth curve analyses revealed a nonlinear relationship between serum ALT/AST levels and cognitive impairment. Additionally, inflection points for ALT/AST were determined as 1.29 (CERAD test), 0.63 (AF test), and 0.87 (DSST test), respectively. Significant interactions were noted between ALT/AST and cognitive impairment concerning the CERAD test, taking into account race, education, and alcohol (P < 0.05). Moreover, significant interactions were observed between ALT/AST and cognitive impairment in connection with the CERAD test, considering age, race, alcohol, and hypertension (P < 0.05). Lastly, significant interactions were identified between ALT/AST and cognitive impairment associated with the CERAD test, accounting for alcohol, vigorous work activity, high cholesterol, and hypertension (P < 0.05). Conclusions: In conclusion, our study unveils a non-linear relationship and a threshold effect between serum ALT/AST levels and cognitive impairment. Validating these results necessitates large-scale prospective clinical trials utilizing rigorous methodologies and comprehensive datasets.
Background and aims:The prevalence of cognitive impairment is increasing, especially in South Korea and South America. It is hypothesized that the alanine transaminase-to-aspartate aminotransferase ratio (ALT/AST), a marker of liver function, may influence cognitive function. However, as of now, there is no consensus on the clinical evidence supporting the link between ALT/AST ratio and cognitive impairment. Methods: Data from two cycles (2011-2014) of the National Health and Nutrition Examination Survey (NHANES) were utilized to investigate the correlation between serum ALP levels and cognitive impairment. Cognitive function was assessed through three tests: the Consortium to Establish a Registry for Alzheimer's Disease (CERAD), Animal Fluency (AF), and Digit Symbol Substitution Test (DSST) scores. The inflection point for cognitive impairment was defined as CERAD < 5, AF < 14, and DSST < 34. Weighted multiple logistic regression models were applied to explore the relationship between ALT/AST ratio and cognitive impairment. Generalized additive models (GAM) and a smooth curve fit (penalty spline method) were employed to examine potential nonlinear associations. Subgroup analyses and interaction tests were also carried out. Results: The study enrolled a total of 2765 adults aged 60 years and older. Our findings revealed a significant correlation between ALT/AST levels and a reduced likelihood of cognitive impairment in the CERAD test results [fully adjusted odds ratio (OR) = 0.53, 95% confidence interval (CI): 0.34-0.83]. Specifically, in the highest quartile (Q4) of CERAD scores, this association remained significant [fully adjusted Q4: OR = 0.67, 95% CI: 0.50-0.88], with a trend significance (p = 0.012). A notable association was observed between ALT/AST levels and a decreased probability of cognitive impairment in the DSST test outcomes [fully adjusted OR = 0.46, 95% CI: 0.28-0.77]. Particularly, in Q3 [fully adjusted OR = 0.69, 95% CI: 0.50-0.94] and Q4 [fully adjusted OR = 0.60, 95% CI: 0.44-0.82], displaying a significant trend across quartiles (p = 0.004). The generalized additive models (GAM) and smooth curve analyses revealed a nonlinear relationship between serum ALT/AST levels and cognitive impairment. Additionally, inflection points for ALT/AST were determined as 1.29 (CERAD test), 0.63 (AF test), and 0.87 (DSST test), respectively. Significant interactions were noted between ALT/AST and cognitive impairment concerning the CERAD test, taking into account race, education, and alcohol (P < 0.05). Moreover, significant interactions were observed between ALT/AST and cognitive impairment in connection with the CERAD test, considering age, race, alcohol, and hypertension (P < 0.05). Lastly, significant interactions were identified between ALT/AST and cognitive impairment associated with the CERAD test, accounting for alcohol, vigorous work activity, high cholesterol, and hypertension (P < 0.05). Conclusions: In conclusion, our study unveils a non-linear relationship and a threshold effect between serum ALT/AST levels and cognitive impairment. Validating these results necessitates large-scale prospective clinical trials utilizing rigorous methodologies and comprehensive datasets.
Background: No effective drugs currently exist to cure Alzheimer’s disease (AD) due to its complexity and the lack of understanding of the involved molecular signaling and pathways. The relationship between liver health and AD is now widely recognized. Still, molecular links and shared pathways between the liver and brain remain unclear, making the liver-brain axis in AD therapies a new area for exploration. However, bibliometric studies on this topic are lacking. Objective: This study aims to review the liver-brain axis in AD and identify future research hotspots and trends through bibliometric analysis. Methods: Articles and reviews related to AD and liver and its related diseases were searched in the Web of Science Core Collection (WoSCC) database up to 2024. Data were processed and visually analyzed using VOSviewer, CiteSpace, and Pajek. Results: We collected 1,777 articles on AD and liver and its related diseases from 2,517 institutions across 80 countries. Keyword cluster analysis identified 11 clusters, with ‘insulin resistance,’ ‘amyloid-beta,’ ‘apolipoprotein-E,’ ‘oxidative stress,’ and ‘inflammation’ appearing most frequently, and exhibiting strong total link strength. These results indicate that these topics have been the primary focus of research on the liver-brain axis in AD. Conclusions: This study is the first to comprehensively analyze the liver-brain axis in AD using bibliometric methods. The research results identify recent research frontiers and hotspots, aiding scholars in gaining a deeper understanding of the correlation between AD and the liver.
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