title: Persistent alanine aminotransferase elevation among the general Iranian population: prevalence and causes.
abstract: OBJECTIVE
  To determine the prevalence and causes of persistently elevated alanine aminotransferase (ALT) levels among the general population in northern Iran.
  
  
  METHODS
  A total of 2292 (1376 female, aged 18-75 year), were selected by systematic clustered random sampling from the cities and villages of Gonbad and Kalaleh in Golestan Province and invited to participate in the study. A comprehensive history regarding alcohol drinking and medication was taken. Body mass index (BMI), viral markers and ALT levels were measured. If ALT level was > or = 40 U/L, it was rechecked twice within 6 mo. Those with > or = 2 times elevation of ALT were considered as having persistently elevated ALT level. Non-alcoholic fatty liver disease (NAFLD) was diagnosed based on evidence of fatty liver upon sonography and excluding other etiology.
  
  
  RESULTS
  A total of 2049 (1351 female) patients participated in the study, 162 (7.9%) had elevated ALT level at the first measurement. Persistently elevated ALT level was detected in 64 (3.1%) participants, with 51 (79.6%) with no obvious etiology, six (9.3%) with Hepatitis B, four (6.2%) with Hepatitis C virus (HCV) infection and three (4.6%) with alcoholic hepatitis. The prevalence of NAFLD and alcoholic hepatitis was 2.04% (42 patients) and 0.1% (three), respectively. There was correlation between NAFLD and male gender, overweight, diabetes and living in an urban area [odds ratio = 3.03 (95% CI: 1.6-5.72), 4.21 (95% CI: 1.83-9.68), 2.86 (95% CI: 1.05-7.79) and 2.04 (95% CI: 1.00-4.16) respectively].
  
  
  CONCLUSIONS
  NAFLD is the most common cause of persistently elevated serum ALT level among the general population of Iran.
authors.affiliation: Digestive Disease Research Center, Medical Sciences/University of Tehran, Shariati Hospital, North Kargar Avenue, Tehran 14117, Iran.
authors.forename: Raika
authors.initials: R
authors.lastname: Jamali
authors.forename: Mahmoodreza
authors.initials: M
authors.lastname: Khonsari
authors.forename: Shahin
authors.initials: S
authors.lastname: Merat
authors.forename: Masoud
authors.initials: M
authors.lastname: Khoshnia
authors.forename: Elham
authors.initials: E
authors.lastname: Jafari
authors.forename: Alireza
authors.initials: A
authors.lastname: Bahram Kalhori
authors.forename: Hassan
authors.initials: H
authors.lastname: Abolghasemi
authors.forename: Sedighe
authors.initials: S
authors.lastname: Amini
authors.forename: Mahtab
authors.initials: M
authors.lastname: Maghsoudlu
authors.forename: Mohammad-Reza
authors.initials: MR
authors.lastname: Deyhim
authors.forename: Houri
authors.initials: H
authors.lastname: Rezvan
authors.forename: Akram
authors.initials: A
authors.lastname: Pourshams
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D005234:Fatty Liver / Q000097:blood* / Q000453:epidemiology / Q000208:ethnology*; D005260:Female; D006509:Hepatitis B / Q000097:blood / Q000453:epidemiology / Q000208:ethnology; D006526:Hepatitis C / Q000097:blood / Q000453:epidemiology / Q000208:ethnology; D006801:Humans; D007492:Iran / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence
chemical_list: D015415:Biomarkers; D000410:Alanine Transaminase