title: The independent effects of cigarette smoking, alcohol consumption, and serum aspartate aminotransferase on the alanine aminotransferase ratio in korean men for the risk for esophageal cancer.
abstract: OBJECTIVE
  The goal of this study is to assess the interactions among alcohol consumption, cigarette smoking, and aspartate aminotransferase (AST) / alanine aminotransferase (ALT) ratios on esophageal cancer.
  
  
  METHODS
  Alcohol and the risk of incidence and death from esophageal cancer were examined in a 14-year prospective cohort study of 782,632 Korean men, 30 to 93 years of age, who received health insurance from the National Health Insurance Corporation and had a medical evaluation from 1992 to 1995.
  
  
  RESULTS
  Smoking, alcohol intake, and AST/ALT ratios were associated with the increased risk of esophageal cancer in a dose-dependent manner independent of each other. Smoking was associated with an increased risk of incidence [Hazard ratio (HR) = 2.2, 95% CI = 1.8 to 2.5] and mortality (HR = 2.5, 2.0 to 3.1). Combined HR of incidence for alcohol consumption (> 25 g/day) and smoking was 4.5 (3.8-5.5); for alcohol (> 25 g/day) and the AST/ALT ratio (>or= 2.0), it was 5.8 (4.6-7.2); for smoking and the AST/ALT ratio (>or= 2.0), it was 6.3 (5.1-7.5). Similar results were seen for mortality from esophageal cancer. Subjects who drank >or= 25 g/day with an AST/ALT ratio >or= 2 had a higher risk of esophageal cancer incidence (HR = 6.5, 4.8 to 8.7) compared with those who drank >or= 25 g/day with an AST/ALT ratio < 2 (HR = 2.2, 1.9 to 2.6).
  
  
  CONCLUSIONS
  Alcohol, smoking, and the AST/ALT ratio are independently associated with increased risk of esophageal cancer but did not interact synergistically. The combination of the AST/ALT ratio with a questionnaire for alcohol consumption may increase the effectiveness for determining the risk of esophageal cancer.
authors.affiliation: Department of Epidemiology and Health Promotion, Institute for Health Promotion, Graduate School of Public Health, Yonsei University, 250 Seongsan-ro, Seodaemun-gu, Seoul 120-752, Korea.
authors.forename: Heejin
authors.initials: H
authors.lastname: Kimm
authors.forename: Sangwon
authors.initials: S
authors.lastname: Kim
authors.forename: Sun Ha
authors.initials: SH
authors.lastname: Jee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000410:Alanine Transaminase / Q000097:blood*; D000428:Alcohol Drinking / Q000009:adverse effects*; D044466:Asian People; D001219:Aspartate Aminotransferases / Q000097:blood*; D004938:Esophageal Neoplasms / Q000201:enzymology* / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D007723:Korea / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*
chemical_list: D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase