title: Association Between Elevated Liver Enzymes and Metabolic Syndrome Among Thai Adults.
abstract: BACKGROUND
  To examine the relation between elevated liver marker concentrations (alanine aminotransferase [ALT], aspartate aminotransferase [AST], and alkaline phosphatase [ALP]) and risk of metabolic syndrome (MetS).
  
  
  METHODS
  This cross-sectional study was comprised of 1,391 Thai participants (451 men and 940 women) receiving annual health check-ups. Multivariable logistic regression procedures were used to estimate odds ratios (OR) and 95% confidence intervals (95%CI) of MetS risk according to quartiles of each liver marker concentration with the lowest quartile specified as the referent group.
  
  
  RESULTS
  Overall, mean concentrations of AST, ALT and ALP increased and mean AST:ALT ratio decreased with increasing presence of metabolic abnormalities (p-value=0.059 for AST in men, all other p-values <0.001). After adjusting for confounders, men with ALT concentrations in the extreme quartiles (>40 units/L), had a 2.77-fold increased risk of MetS (95%CI: 1.18-6.53), as compared with men who had values in the lowest quartile (≤21 units/L). The OR for extreme quartiles of ALP concentrations was 3.72 (95%CI: 1.49-9.29). In women, elevated ALT concentrations were also associated with MetS risk. Those with the highest ALT concentrations (>23 units/L) had a 2.55-fold increased risk of MetS (95%CI: 1.22-5.35) compared to women with concentrations ≤13 units/L.
  
  
  CONCLUSIONS
  These findings add to an emerging body of literature that suggests elevated liver enzymes may be related with MetS risk. However, prospective studies are needed to more fully determine the practical value of elevated liver enzymes as a clinical risk predictor of MetS and related disorders among Thai adults.
authors.affiliation: Department of Epidemiology, Multidisciplinary International Research Training Program, University of Washington School of Public Health and Community Medicine, Seattle, Washington, USA.
authors.forename: Sajithya
authors.initials: S
authors.lastname: Perera
authors.affiliation: Department of Epidemiology, Multidisciplinary International Research Training Program, University of Washington School of Public Health and Community Medicine, Seattle, Washington, USA ; Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
authors.forename: Vitool
authors.initials: V
authors.lastname: Lohsoonthorn
authors.affiliation: Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
authors.forename: Wiroj
authors.initials: W
authors.lastname: Jiamjarasrangsi
authors.affiliation: Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
authors.forename: Somrat
authors.initials: S
authors.lastname: Lertmaharit
authors.affiliation: Department of Epidemiology, Multidisciplinary International Research Training Program, University of Washington School of Public Health and Community Medicine, Seattle, Washington, USA.
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Williams
keywords: Epidemiology; Liver Enzymes; Metabolic Syndrome; Risk Factors