title: Liver enzymes and clustering cardiometabolic risk factors in European adolescents: the HELENA study.
abstract: OBJECTIVE
  This study aimed to explore the associations of liver biomarkers with cardiometabolic risk factors and their clustering, and to provide reference values (percentiles) and cut-off points for liver biomarkers associated with high cardiometabolic risk in European adolescents.
  
  
  METHODS
  Alanine aminotransferase (ALT), gamma-glutamyltransferase (GGT), aspartate aminotransferase to ALT ratio (AST/ALT), waist circumference, blood pressure, triglycerides, high-density lipoprotein cholesterol and insulin were measured in 1084 adolescents. We computed a continuous cardiometabolic risk score and defined the high cardiometabolic risk.
  
  
  RESULTS
  Higher ALT and GGT and lower AST/ALT were associated with adiposity and with the number of adverse cardiometabolic risk factors (Ps < 0.05). Higher GGT and lower AST/ALT were associated with higher cardiometabolic risk score (Ps < 0.001) in males and females, and ALT only in males (Ps < 0.001). Gender- and age-specific percentiles for liver biomarkers were provided. Receiver operating characteristic analyses showed a significant discriminatory accuracy of AST/ALT in identifying the low/high cardiometabolic risk (Ps < 0.01) and thresholds were provided.
  
  
  CONCLUSIONS
  Higher GGT and lower AST/ALT are associated with higher cardiometabolic risk factors and their clustering in male and female European adolescents, whereas the associations of ALT were gender dependent. Our results suggest the usefulness of AST/ALT as a screening test in the assessment of adolescents with high cardiometabolic risk and provide gender- and age-specific thresholds that might be of clinical interest.
authors.affiliation: Department of Nutrition and Food Science, University of the Basque Country, UPV/EHU, Vitoria, Spain.
authors.forename: I
authors.initials: I
authors.lastname: Labayen
authors.affiliation: PROFITH 'PROmoting FITness and Health through Physical Activity' Research Group, Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Granada, Spain.|Department of Biosciences and Nutrition at NOVUM, Unit for Preventive Nutrition, Karolinska Institutet, Huddinge, Sweden.
authors.forename: J R
authors.initials: JR
authors.lastname: Ruiz
authors.affiliation: PROFITH 'PROmoting FITness and Health through Physical Activity' Research Group, Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Granada, Spain.|Department of Biosciences and Nutrition at NOVUM, Unit for Preventive Nutrition, Karolinska Institutet, Huddinge, Sweden.
authors.forename: F B
authors.initials: FB
authors.lastname: Ortega
authors.affiliation: Georgia Prevention Institute, Medical College of Georgia, Georgia Regents University, Augusta, GA, USA.
authors.forename: C L
authors.initials: CL
authors.lastname: Davis
authors.affiliation: Department of Pediatrics, Faculty of Medicine, University of Zaragoza, Health Research Institute of Aragon (IIS Aragón), Aragon, Spain.
authors.forename: G
authors.initials: G
authors.lastname: Rodríguez
authors.affiliation: Department of Health and Human Performance, Faculty of Physical Activity and Sport Sciences-INEF, Universidad Politécnica de Madrid, Madrid, Spain.
authors.forename: M
authors.initials: M
authors.lastname: González-Gross
authors.affiliation: Department of Health and Human Performance, Faculty of Physical Activity and Sport Sciences-INEF, Universidad Politécnica de Madrid, Madrid, Spain.|Department of Nutrition and Food Science, University of Bonn, Bonn, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Breidenassel
authors.affiliation: INSERM, U744, Institut Pasteur de Lille, UDSL, Lille, France.
authors.forename: J
authors.initials: J
authors.lastname: Dallongeville
authors.affiliation: Immunonutrition Research Group, Department of Metabolism and Nutrition, Spanish Council for Scientific Research (CSIC), Madrid, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Marcos
authors.affiliation: Division of Nutrition and Metabolism, Department of Pediatrics, Medical University of Vienna, Vienna, Austria.
authors.forename: K
authors.initials: K
authors.lastname: Widhalm
authors.affiliation: University of Crete School of Medicine, Greece.
authors.forename: A
authors.initials: A
authors.lastname: Kafatos
authors.affiliation: Department of Pediatrics, University of Pecs, Pecs, Hungary.
authors.forename: D
authors.initials: D
authors.lastname: Molnar
authors.affiliation: Department of Public Health, School of Medicine, Ghent University, Ghent, Belgium.
authors.forename: S
authors.initials: S
authors.lastname: DeHenauw
authors.affiliation: Inserm U995, Pediatric Department, Lille University Hospital and University Lille 2, France.
authors.forename: F
authors.initials: F
authors.lastname: Gottrand
authors.affiliation: Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain.|Department of Preventive Medicine, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: L A
authors.initials: LA
authors.lastname: Moreno
mesh_terms: D050154:Adiposity; D000293:Adolescent; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure; D005060:Europe; D005260:Female; D006801:Humans; D007328:Insulin / Q000097:blood; D008075:Lipoproteins, HDL / Q000097:blood; D008099:Liver / Q000201:enzymology*; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood* / Q000453:epidemiology / Q000209:etiology; D063766:Pediatric Obesity / Q000097:blood* / Q000150:complications / Q000453:epidemiology; D012016:Reference Values; D012307:Risk Factors; D014280:Triglycerides / Q000097:blood; D055105:Waist Circumference; D044465:White People; D005723:gamma-Glutamyltransferase / Q000097:blood
chemical_list: D015415:Biomarkers; D007328:Insulin; D008075:Lipoproteins, HDL; D014280:Triglycerides; D005723:gamma-Glutamyltransferase; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase
keywords: Liver; adolescents; cardiometabolic risk factors; obesity