title: Dose-Response Relationship between Alanine Aminotransferase Levels within the Reference Interval and Metabolic Syndrome in Chinese Adults.
abstract: OBJECTIVE
  Elevation in serum alanine aminotransferase (ALT) levels is a biomarker for metabolic syndrome (MS); however, the relationship has not been fully investigated within the reference interval of ALT levels. Our objective was to explore the relationship between serum ALT levels within the reference interval and MS in Chinese adults.
  
  
  METHODS
  This cross-sectional study included 16028 adults, who attended routine health check-ups at Shengli Oilfield Central Hospital from January 2006 to March 2012. The reference interval of serum ALT level was defined as less than 40 U/L. Logistic regression models and restricted cubic spline were used to evaluate the association of ALT with MS.
  
  
  RESULTS
  The prevalence of MS in the total population was 13.7% (6.4% for females and 18.4% for males). Multiple logistic regression showed that ALT levels were positively associated with MS after adjustment for potential confounding factors. The odds ratio of MS in the top quartile was 4.830 [95% confidence interval (CI): 2.980-7.829] in females and 3.168 (95% CI: 2.649-3.790) in males, compared with the ALT levels in the bottom quartile. The restricted cubic spline models revealed a positive non-linear dose-response relationship between ALT levels and the risk of MS in women (p for nonlinearity was 0.0327), but a positive linear dose-response relationship in men (p for nonlinearity was 0.0659).
  
  
  CONCLUSIONS
  Serum ALT levels within the reference interval are positively associated with MS in a dose-response manner. Elevated ALT levels, even within the reference interval, may reflect early dysmetabolic changes.
authors.affiliation: Department of Epidemiology, School of Public Health, Shandong University, Jinan, China.
authors.forename: Peipei
authors.initials: P
authors.lastname: Wu
authors.affiliation: Department of Prevention and Health Care, Dongying Shengli Oilfield Central Hospital, Dongying, China.
authors.forename: Qicai
authors.initials: Q
authors.lastname: Chen
authors.affiliation: Department of Nutrition and Food Safety, Zhejiang Center for Disease Control and Prevention, Hangzhou, China.
authors.forename: Lili
authors.initials: L
authors.lastname: Chen
authors.affiliation: Tianjin Entry-Exit Inspection and Quarantine Bureau, Tianjin, China.
authors.forename: Pengpeng
authors.initials: P
authors.lastname: Zhang
authors.affiliation: Department of Epidemiology, School of Public Health, Shandong University, Jinan, China.
authors.forename: Juan
authors.initials: J
authors.lastname: Xiao
authors.affiliation: Department of Medical Records and Statistics, Zhejiang Hospital, Hangzhou, China.
authors.forename: Xiaoxiao
authors.initials: X
authors.lastname: Chen
authors.affiliation: Department of Epidemiology, School of Public Health, Shandong University, Jinan, China.
authors.forename: Meng
authors.initials: M
authors.lastname: Liu
authors.affiliation: Department of Epidemiology, School of Public Health, Shandong University, Jinan, China. wshm@sdu.edu.cn.
authors.forename: Shumei
authors.initials: S
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood*; D044466:Asian People; D015415:Biomarkers / Q000097:blood; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D024821:Metabolic Syndrome / Q000201:enzymology* / Q000453:epidemiology; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D012016:Reference Values
chemical_list: D015415:Biomarkers; D000410:Alanine Transaminase
keywords: Alanine aminotransferase; metabolic syndrome; restricted cubic spline