title: Elevated ALT and GGT predict all-cause mortality and hepatocellular carcinoma in Taiwanese male: a case-cohort study.
abstract: OBJECTIVE
  Evidence indicates a positive association between liver enzymes and the risk of death in Western countries; however, the evidence in Asian populations is scarce. We investigated the association between liver enzymes and total, cardiovascular (CVD), cancer and hepatocellular carcinoma (HCC) mortality in a cohort of Taiwanese male free of cancer at baseline.
  
  
  METHODS
  From 1996 to 2003, 54,751 Taiwanese male aged 40-80 years without cancer completed a health screening and were followed through 2005 (5.8 ± 2.5 years of follow-up). A random cohort of 3,961 male was selected to compare to 1,864 male who died. We used Cox proportional hazards regression models to assess the risk of all-cause, cardiovascular and cancer mortality associated with alanine aminotransferase (ALT), aspartate aminotransferase (AST) and gamma glutamyl transferase (GGT).
  
  
  RESULTS
  In this population, higher levels of ALT, AST and GGT were significantly associated with all-cause mortality [hazard ratio (HR) 1.2, 1.8 and 1.6 for ALT, AST and GGT, respectively; all p < 0.05], cancer mortality (HR 1.8-2.8) and HCC mortality (HR 5.5-36.1). GGT was significantly associated with CVD mortality (HR 1.2).
  
  
  CONCLUSIONS
  In Taiwanese male free of cancer at baseline, elevations of ALT, AST and GGT were associated with future risk of all-cause death, all cancer and HCC mortality, independent of conventional risk factors, and could be used to identify male who would benefit from HCC screening.
authors.affiliation: Department of Medicine, The Johns Hopkins School of Medicine, 2024 East Monument Street, Suite 2-600, Baltimore, MD, 21287, USA. rhernaez@jhsph.edu.|Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. rhernaez@jhsph.edu.
authors.forename: Ruben
authors.initials: R
authors.lastname: Hernaez
authors.affiliation: Department of Medicine, The Johns Hopkins School of Medicine, 2024 East Monument Street, Suite 2-600, Baltimore, MD, 21287, USA. hcyeh@jhsph.edu.|Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. hcyeh@jhsph.edu.|Welch Center for Prevention, Epidemiology and Clinical Research, The Johns Hopkins University, Baltimore, MD, USA. hcyeh@jhsph.edu.
authors.forename: Hsin-Chieh
authors.initials: HC
authors.lastname: Yeh
authors.affiliation: Department of Medicine, The Johns Hopkins School of Medicine, 2024 East Monument Street, Suite 2-600, Baltimore, MD, 21287, USA. mlazo@jhsph.edu.|Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. mlazo@jhsph.edu.|Welch Center for Prevention, Epidemiology and Clinical Research, The Johns Hopkins University, Baltimore, MD, USA. mlazo@jhsph.edu.
authors.forename: Mariana
authors.initials: M
authors.lastname: Lazo
authors.affiliation: Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. hchung@jhsph.edu.|Department of Medical Research, Mennonite Christian Hospital, Hualian City, Taiwan. hchung@jhsph.edu.
authors.forename: Hui-Ming
authors.initials: HM
authors.lastname: Chung
authors.affiliation: Department of Medicine, The Johns Hopkins School of Medicine, 2024 East Monument Street, Suite 2-600, Baltimore, MD, 21287, USA. jpahamilton@jhmi.edu.
authors.forename: James P
authors.initials: JP
authors.lastname: Hamilton
authors.affiliation: Department of Medicine, The Johns Hopkins School of Medicine, 2024 East Monument Street, Suite 2-600, Baltimore, MD, 21287, USA. akoteish@jhmi.edu.
authors.forename: Ayman
authors.initials: A
authors.lastname: Koteish
authors.affiliation: Department of Medicine, The Johns Hopkins School of Medicine, 2024 East Monument Street, Suite 2-600, Baltimore, MD, 21287, USA. jpotter@jhmi.edu.
authors.forename: James J
authors.initials: JJ
authors.lastname: Potter
authors.affiliation: Department of Medicine, The Johns Hopkins School of Medicine, 2024 East Monument Street, Suite 2-600, Baltimore, MD, 21287, USA. fbrancat@jhmi.edu.|Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. fbrancat@jhmi.edu.|Welch Center for Prevention, Epidemiology and Clinical Research, The Johns Hopkins University, Baltimore, MD, USA. fbrancat@jhmi.edu.
authors.forename: Frederick L
authors.initials: FL
authors.lastname: Brancati
authors.affiliation: Department of Medicine, The Johns Hopkins School of Medicine, 2024 East Monument Street, Suite 2-600, Baltimore, MD, 21287, USA. jmclark@jhmi.edu.|Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. jmclark@jhmi.edu.|Welch Center for Prevention, Epidemiology and Clinical Research, The Johns Hopkins University, Baltimore, MD, USA. jmclark@jhmi.edu.
authors.forename: Jeanne M
authors.initials: JM
authors.lastname: Clark
keywords: Asia; Checkup; Hazard ratio; Longitudinal study; Nonalcoholic fatty liver disease