title: Elevated alanine aminotransferase activity is not associated with dyslipidemias, but related to insulin resistance and higher disease grades in non-diabetic non-alcoholic fatty liver disease.
abstract: OBJECTIVE
  To explore demographic and metabolic factors associated with increased alanine aminotransferase (ALT) activity in non-diabetic non-alcoholic fatty liver disease (NAFLD) patients.
  
  
  METHODS
  Overall 372 patients who consecutively attended to Gastroenterology Clinic of Baqiyatallah University of Medical Sciences, Tehran, Iran awere diagnosed as NAFLD entered into analysis. Exclusion criteria were having diabetes mellitus and fasting blood glucose over 126 mg/dL, active hepatitis B virus infection, having hepatitis C virus positive serology, and to be under corticosteroid therapy. ALT levels were considered pathologically high when it was over 30 IU/L for men and over 19 IU/L for women.
  
  
  RESULTS
  Bivariate analyses using t test and chi-square test showed that patients with pathologically augmented ALT levels had significantly higher NAFLD grades in their ultrasonographic evaluations (P=0.003). Moreover, these patients represented significantly higher homeostatic model assessment levels (P=0.003), levels of serum insulin (P=0.002), fasting blood glucose (P<0.001), and uric acid (P=0.02). The prevalence of insulin resistance was also higher in patients with increased serum ALT concentrations. Multifactorial logistic regression models showed that ultrasonographic grading of NAFLD (P=0.027) and insulin resistance (P=0.013) were the only variables significantly associated with abnormal ALT levels.
  
  
  CONCLUSIONS
  This study shows that the associations of increased ALT serum levels in NAFLD patients are different from what are supposed before. By excluding diabetic patients from our population, we find that increased ALT levels are not associated with dyslipidemias but are independently associated with insulin resistance and NAFLD grading on ultrasonographic evaluations. Further studies are needed to confirm our results.
authors.affiliation: The Internist Research Center, Tehran, Iran ; Baqiyatallah Research Center for Gastroenterology and Liver Diseases, Baqiyatallah University of Medical Sciences, Tehran, Iran.
authors.forename: Mohammad Ebrahim
authors.initials: ME
authors.lastname: Ghamar-Chehreh
authors.forename: Mohsen
authors.initials: M
authors.lastname: Amini
authors.forename: Hossein
authors.initials: H
authors.lastname: Khedmat
authors.forename: Seyed
authors.initials: S
authors.lastname: Moayed Alavian
authors.forename: Fatemeh
authors.initials: F
authors.lastname: Daraei
authors.forename: Reza
authors.initials: R
authors.lastname: Mohtashami
authors.forename: Reza
authors.initials: R
authors.lastname: Hadi
authors.forename: Bent-Al-Hoda
authors.initials: BA
authors.lastname: Beyram
authors.forename: Saeed
authors.initials: S
authors.lastname: Taheri
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000378:metabolism*; D001786:Blood Glucose; D050171:Dyslipidemias / Q000378:metabolism*; D005260:Female; D006801:Humans; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000000981:diagnostic imaging / Q000378:metabolism* / Q000473:pathology*; D012307:Risk Factors; D014463:Ultrasonography
chemical_list: D001786:Blood Glucose; D000410:Alanine Transaminase
keywords: Alanine aminotransferase; Diabetes mellitus; Dyslipidemia; Fasting blood glucose; Insulin resistance; Metabolic factor; Non-alcoholic fatty liver disease; Serum insulin; Ultrasonographic evaluation