title: Metabolic markers and ALT cutoff level for diagnosing nonalcoholic fatty liver disease: a community-based cross-sectional study.
abstract: BACKGROUND
  Untreated nonalcoholic fatty liver disease (NAFLD) may progress to liver cirrhosis or failure and is associated with the development of hepatocellular carcinoma, diabetes, and cardiovascular disease. It is therefore essential to diagnose and treat NAFLD at an early stage. To assist in this effort, this retrospective study explored the risk factors for NAFLD, and derived new surrogates, a revised alanine aminotransferase (ALT) cutoff level and a novel NAFLD index, to identify previously undiagnosed cases of NAFLD.
  
  
  METHODS
  Using a community-based, cross-sectional design, the records of 6,370 Japanese subjects who had undergone at least 1 annual health check-up were reviewed for the identification of subjects meeting the diagnostic criteria for NAFLD and the variables associated with NAFLD for the estimation of ideal ALT cutoff levels.
  
  
  RESULTS
  The results of multivariate analysis of the 1,346 subjects who met the diagnostic criteria for NAFLD confirmed that metabolic disease markers and a novel NAFLD index, using the variables derived from multivariate analysis, were also markers of NAFLD. The ALT cutoff levels for NAFLD diagnosis were estimated at 25 U/L for males and 17 U/L for females.
  
  
  CONCLUSIONS
  ALT level and the novel NAFLD index were confirmed to be surrogate markers for NAFLD in addition to metabolic disease markers. The ALT cutoff level used in NAFLD diagnosis should be revised downward to identify subjects at risk of NAFLD to prevent NAFLD progression and the development of associated diseases.
authors.affiliation: Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon, Ehime, 791-0295, Japan.
authors.forename: Teruki
authors.initials: T
authors.lastname: Miyake
authors.forename: Teru
authors.initials: T
authors.lastname: Kumagi
authors.forename: Masashi
authors.initials: M
authors.lastname: Hirooka
authors.forename: Mitsuhito
authors.initials: M
authors.lastname: Koizumi
authors.forename: Shinya
authors.initials: S
authors.lastname: Furukawa
authors.forename: Teruhisa
authors.initials: T
authors.lastname: Ueda
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Tokumoto
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Ikeda
authors.forename: Masanori
authors.initials: M
authors.lastname: Abe
authors.forename: Kohichiro
authors.initials: K
authors.lastname: Kitai
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Hiasa
authors.forename: Bunzo
authors.initials: B
authors.lastname: Matsuura
authors.forename: Morikazu
authors.initials: M
authors.lastname: Onji
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000410:Alanine Transaminase / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D004796:Clinical Enzyme Tests / Q000379:methods; D003153:Community Health Services; D003430:Cross-Sectional Studies; D042241:Early Diagnosis; D005234:Fatty Liver / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease; D012307:Risk Factors; D012720:Severity of Illness Index; D055815:Young Adult
chemical_list: D015415:Biomarkers; D000410:Alanine Transaminase