title: Redefining the alanine aminotransferase upper limit of normal improves the prediction of metabolic syndrome risk.
abstract: BACKGROUND
  Multiple studies have recently proposed the lowering of upper limit of normal (ULN) for alanine aminotransferase (ALT) to improve the diagnostic sensitivity for viral hepatitides and metabolic syndrome (MS). We have tried to validate some of the proposed ULNs in the diagnosis of MS.
  
  
  METHODS
  We used data from the HepaMeta Study conducted in 2011 in Slovakia, which explored the prevalence of MS in eastern Slovakia. Patients were tested for the criteria of MS and ALT. Different, previously published, ALT cutoffs were then used to calculate odds' ratios, sensitivity, specificity, and accuracy of MS and its components.
  
  
  RESULTS
  Manufacturers' recommended ULN used in our institution (0.8 µkat/l, 47 U/l for men and 0.6 µkat/l, 35 U/l for women) failed to predict any significant risk of MS. Lowered cutoff (72% of the original ULN) identified the patients with the highest age-adjusted probability of MS (odds ratio 3.194, 95% confidence interval 1.398-7.295). ALT was significantly associated with elevated levels of triacylglycerols, hyperglycemia, and obesity.
  
  
  CONCLUSIONS
  In patients with MS, one must consider liver involvement if the patient has ALT levels in the upper third of the reference range. There is the need for discussion about the feasibility of lower ALT ULN in clinical practice.
authors: aFirst Department of Internal Medicine Departments of bPublic Health cMedical Biochemistry dInfectious Diseases, Pavol Jozef Šafárik University in Košice, Košice eDepartment of Internal Medicine, Poprad Hospital, Poprad, Slovakia.
authors: Martin
authors: M
authors: Janičko
authors: Eduard
authors: E
authors: Veselíny
authors: Radoslav
authors: R
authors: Orenčák
authors: Rastislav
authors: R
authors: Husťak
authors: Ján
authors: J
authors: Fedačko
authors: Sylvia
authors: S
authors: Dražilová
authors: Andrea
authors: A
authors: Madarasová-Gecková
authors: Mária
authors: M
authors: Mareková
authors: Daniel
authors: D
authors: Pella
authors: Pavol
authors: P
authors: Kristián
authors: Marek
authors: M
authors: Rác
authors: Peter
authors: P
authors: Jarčuška
mesh_terms: D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood / Q000175:diagnosis* / Q000201:enzymology; D008875:Middle Aged; D016017:Odds Ratio; D012015:Reference Standards; D018570:Risk Assessment; D012680:Sensitivity and Specificity
chemical_list: D015415:Biomarkers; D000410:Alanine Transaminase