title: Synergistic association between alcohol intake and body mass index with serum alanine and aspartate aminotransferase levels in older adults: the Rancho Bernardo Study.
abstract: BACKGROUND
  The association between body-mass-index (BMI), alcohol consumption and their joint effect in increasing the risk of elevated serum alanine (ALT) and aspartate (AST) is unclear in older community-dwelling adults.
  
  
  OBJECTIVE
  To determine the association between alcohol, BMI, and their combined effect with serum ALT and AST in older community-dwelling adults in the United States.
  
  
  METHODS
  A cross-sectional, population-based study in participants (n = 2364) from the Rancho Bernardo Study (54% women; mean age: 70 years, BMI: 25 kg/m(2), alcohol users: 63%) who attended a research visit in 1984-87. BMI was recorded by a trained nurse and alcohol use ascertained by a validated questionnaire. Odds-ratio (OR) and 95% confidence intervals (CI) of elevated serum ALT and AST (defined as > or =30 U/L in men and > or =19 U/L in women) were calculated for alcohol and BMI separately and their joint exposure using logistic regression models.
  
  
  RESULTS
  In multivariate logistic regression models adjusted for age, alcohol use, total cholesterol, serum triglycerides, fasting plasma glucose, systolic blood pressure, and diabetes mellitus, obesity independently increased the odds of elevated ALT in this cohort of older men and women by 3.0 (95% CI, 1.7-5.3) and 1.8 (95% CI, 1.1-2.7) respectively. Joint effects of consuming >3 alcoholic drinks/day and obesity raised the odds of elevated ALT by 8.9 (95% CI, 2.4-33.1) and AST by 21-fold (95% CI, 2.6-170.1), demonstrating synergism. Obese participants had higher odds of elevated ALT even at 0 < or = 1 drink/day.
  
  
  CONCLUSIONS
  In older men and women, the combination of obesity with alcohol is synergistic in increasing the risk of liver injury.
authors.affiliation: Division of Gastroenterology, Department of Medicine, University of California, San Diego, La Jolla, CA 92093, USA. roloomba@ucsd.edu
authors.forename: R
authors.initials: R
authors.lastname: Loomba
authors.forename: R
authors.initials: R
authors.lastname: Bettencourt
authors.forename: E
authors.initials: E
authors.lastname: Barrett-Connor
mesh_terms: D000368:Aged; D000410:Alanine Transaminase / Q000097:blood*; D000428:Alcohol Drinking / Q000097:blood* / Q000453:epidemiology; D001219:Aspartate Aminotransferases / Q000097:blood*; D015992:Body Mass Index; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008107:Liver Diseases / Q000097:blood* / Q000453:epidemiology / Q000209:etiology; D008297:Male; D015999:Multivariate Analysis; D009765:Obesity / Q000097:blood* / Q000150:complications / Q000453:epidemiology; D016017:Odds Ratio; D015995:Prevalence; D012307:Risk Factors; D011795:Surveys and Questionnaires
chemical_list: D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase