title: Association of elevated alanine aminotransferase with BMI and diabetes in older veteran outpatients.
abstract: OBJECTIVE
  We determined age-stratified associations of elevated alanine aminotransferase (ALAT), as a likely indicator of non-alcoholic steatonecrosis (NASH), with body mass index (BMI) and diabetes among older male, veteran outpatients.
  
  
  METHODS
  Administrative files at three, urban Veteran Administration Healthcare Systems were surveyed. 47.916 male outpatients, mean age 69.2 years, without ICD-9CM documented liver diseases or alcohol- or drug-abuse, had the highest of one or more ALAT results analyzed. Logistic regression determined age-stratified predictors of elevated ALAT among groups <50 ("younger-aged"), 50-70 ("middle-aged") and >70 ("older-aged"). BMI, diabetes and "statin" use were predictors.
  
  
  RESULTS
  1272 (2.7%) patients had their highest ALAT greater than the upper limit of normal (mean=98.4U/L). 4.9% of all diabetics and 15.2, 6.1 and 3.4% of the "younger-aged", middle-aged" and "older-aged" diabetics, respectively, had elevated ALATs. BMI values from 25 to <30 and 30 to 45, compared with those from >20 to <25, predicted elevated ALAT in the two younger groups. In contrast, among "older-aged" patients, diabetes independently predicted elevated ALAT, whereas BMI did not.
  
  
  CONCLUSIONS
  The cross-sectional findings support previous epidemiologic data associating ALAT elevations with obesity and diabetes, and provide new evidence that in elderly male patients, ALAT elevations, absent other known liver diseases, may selectively associate with diabetes.
authors.affiliation: Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Cooperative Studies Program, Veterans Affairs Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA 02130, USA. john.hermos@va.gov
authors.forename: John A
authors.initials: JA
authors.lastname: Hermos
authors.forename: Seth A
authors.initials: SA
authors.lastname: Cohen
authors.forename: Robert
authors.initials: R
authors.lastname: Hall
authors.forename: David R
authors.initials: DR
authors.lastname: Gagnon
authors.forename: Mary T
authors.initials: MT
authors.lastname: Brophy
authors.forename: Louis D
authors.initials: LD
authors.lastname: Fiore
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000410:Alanine Transaminase / Q000097:blood*; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000453:epidemiology; D005234:Fatty Liver / Q000097:blood* / Q000453:epidemiology; D006801:Humans; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood* / Q000453:epidemiology; D008875:Middle Aged; D009765:Obesity / Q000097:blood* / Q000453:epidemiology; D010045:Outpatients / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D012307:Risk Factors; D014728:Veterans / Q000706:statistics & numerical data
chemical_list: D000410:Alanine Transaminase