title: Association of cardiometabolic risk factors and hepatic enzymes in a national sample of Iranian children and adolescents: the CASPIAN-III study.
abstract: OBJECTIVE
  Elevated liver enzymes including alanine aminotransferase (ALT) and aspartate aminotransferase (AST) may be associated with metabolic syndrome (MetS) and cardiovascular disease. We investigated the association of cardiometabolic risk factors and liver enzymes in a nationally representative sample of Iranian children and adolescents.
  
  
  METHODS
  The national study was conducted in the framework of the third survey of Childhood and Adolescence Surveillance and PreventIon of Adult Non-communicable Disease study. Subjects were 3948 students (1942 girls, 67.55% urban, mean age 14.7 ± 2.4 years) who were recruited by multistage random cluster sampling from 27 provincial counties in Iran. Physical examination and laboratory tests were conducted under standard protocols.
  
  
  RESULTS
  Participants with elevated serum ALT had higher levels of almost all cardiometabolic risk factors than other participants; this difference was not significant for fasting blood glucose, total cholesterol, and diastolic blood pressure in both sexes, as well as low-density lipoprotein cholesterol in girls. Participants with generalized and abdominal obesity, MetS, elevated blood pressure, triglycerides, and total cholesterol had increased risk for elevated ALT; this risk remained significant after adjusting for sex and age. Low high-density lipoprotein cholesterol was found as a predictor for both elevated ALT (odds ratio 2.182, 95% confidence interval 1.533-3.105) and AST (odds ratio 2.022, 95% confidence interval 1.438-2.844) even after adjusting for all potential confounders. General (B 0.158, SE 0.030) and abdominal obesity (B 0.058, SE 0.029), MetS (B 0.231, SE 0.048), and triglycerides (B 0.094, SE 0.030) were associated with ALT:AST ratio after adjusting for all potential confounders (P < 0.001).
  
  
  CONCLUSIONS
  We documented strong relations of elevated ALT, AST levels, and ALT:AST ratio with most cardiometabolic risk factors. This relation was independent of anthropometric indexes. Liver enzymes can be considered as a cardiometabolic risk factor from childhood, and as an additional component of the MetS.
authors.affiliation: *Department of Food and Nutrition Policy and Planning Research, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran †Department of Public Health, Alborz University of Medical Sciences, Karaj ‡Pediatrics Department, Child Growth and Development Research Center, and Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan §Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran ¶Department of Pediatrics, Ahvaz Jundishapur University of Medical Sciences, Ahvaz #Department of Medical Emergencies, Qom University of Medical Sciences, Qom **Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Fatemeh
authors.initials: F
authors.lastname: Mohammadi
authors.forename: Mostafa
authors.initials: M
authors.lastname: Qorbani
authors.forename: Roya
authors.initials: R
authors.lastname: Kelishadi
authors.forename: Fereshteh
authors.initials: F
authors.lastname: Baygi
authors.forename: Gelayol
authors.initials: G
authors.lastname: Ardalan
authors.forename: Mahnaz
authors.initials: M
authors.lastname: Taslimi
authors.forename: Minoosadat
authors.initials: M
authors.lastname: Mahmoudarabi
authors.forename: Mohammad-Esmaeil
authors.initials: ME
authors.lastname: Motlagh
authors.forename: Hamid
authors.initials: H
authors.lastname: Asayesh
authors.forename: Bagher
authors.initials: B
authors.lastname: Larijani
authors.forename: Ramin
authors.initials: R
authors.lastname: Heshmat
mesh_terms: D000293:Adolescent; D000410:Alanine Transaminase / Q000097:blood*; D001219:Aspartate Aminotransferases / Q000097:blood*; D002318:Cardiovascular Diseases / Q000097:blood / Q000453:epidemiology*; D002648:Child; D008078:Cholesterol, LDL / Q000097:blood; D005260:Female; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000453:epidemiology; D007492:Iran / Q000453:epidemiology; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood / Q000453:epidemiology*; D056128:Obesity, Abdominal / Q000097:blood / Q000453:epidemiology; D012307:Risk Factors; D014280:Triglycerides / Q000097:blood
chemical_list: D008078:Cholesterol, LDL; D014280:Triglycerides; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase