title: Serum alkaline phosphatase, a risk factor for non-alcoholic fatty liver, but only for women in their 30s and 40s: evidence from a large cohort study.
abstract: BACKGROUND
  Several risk factors are able to predict non-alcoholic fatty liver (NAFL) development, but the predictive value of serum alkaline phosphatase (ALP) remains uncertain. Our aim is to investigate the association between serum ALP levels and NAFL.
  
  
  METHODS
  21,331 NAFL-free subjects were included. Sex-specific ALP quartiles (Q1 to Q4) were defined. With Q1 used as reference, hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated across each quartile.
  
  
  RESULTS
  After adjusting for confounding variables, values in Q2, Q3 and Q4 had HRs (95%CIs) of 1.16 (0.94-1.43), 1.38 (1.13-1.69), 1.51 (1.24-1.83) in females and 0.99 (0.90-1.09), 1.04 (0.95-1.14), 0.96 (0.87-1.05) in males, respectively. A subgroup analysis of age factors in females, from Q2 to Q4, adjusted HRs (95%CIs) were 1.31 (0.81-1.99), 1.86 (1.23-2.81), 2.44 (1.60-3.71) in their 30 s, 1.13 (0.83-1.54), 1.17 (0.85-1.62), 1.65 (1.22-2.25) in their 40 s, and 0.95 (0.51-1.78), 0.91 (0.52-1.62), 0.89 (0.53-1.52) in their 50 s.
  
  
  CONCLUSIONS
  Higher serum ALP levels are considered a significant predictor for NAFL development in females aged 30 to 50.
authors.affiliation: a Department of Hepatology, Liver Research Center , the First Affiliated Hospital of Wenzhou Medical University , Wenzhou , China.|b School of the First Clinical Medical Sciences , Wenzhou Medical University , Wenzhou , China.
authors.forename: Yu-Jie
authors.initials: YJ
authors.lastname: Zhou
authors.affiliation: c Department of Cardiology , Zhejiang Provincial People's Hospital , Hangzhou , China.
authors.forename: Hai
authors.initials: H
authors.lastname: Zou
authors.affiliation: a Department of Hepatology, Liver Research Center , the First Affiliated Hospital of Wenzhou Medical University , Wenzhou , China.|b School of the First Clinical Medical Sciences , Wenzhou Medical University , Wenzhou , China.
authors.forename: Ji-Na
authors.initials: JN
authors.lastname: Zheng
authors.affiliation: a Department of Hepatology, Liver Research Center , the First Affiliated Hospital of Wenzhou Medical University , Wenzhou , China.|d School of the Second Clinical Medical Sciences , Wenzhou Medical University , Wenzhou , China.
authors.forename: Tian-Tian
authors.initials: TT
authors.lastname: Zou
authors.affiliation: e Department of Surgery, Oncology and Gastroenterology , University of Padua , Padua , Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Vitale
authors.affiliation: f Institute of Internal Medicine , Catholic University of Rome , Rome , Italy.|g Gastroenterology Area, Fondazione Policlinico Gemelli , Rome , Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Miele
authors.affiliation: h Department of Anesthesiology , Critical Care, Emergency Medicine and Pain Therapy, Ziekenhuis Oost-Limburg , Genk , Belgium.
authors.forename: Sven
authors.initials: S
authors.lastname: Van Poucke
authors.affiliation: i Department of Endocrinology , the First Affiliated Hospital of Wenzhou Medical University , Wenzhou , China.
authors.forename: Wen-Yue
authors.initials: WY
authors.lastname: Liu
authors.affiliation: j Department of Food Science & Nutrition , Zhejiang University , Hangzhou , China.
authors.forename: Shengrong
authors.initials: S
authors.lastname: Shen
authors.affiliation: k Wenzhou Medical Center, Wenzhou People's Hospital , Wenzhou , China.
authors.forename: Dong-Chu
authors.initials: DC
authors.lastname: Zhang
authors.affiliation: a Department of Hepatology, Liver Research Center , the First Affiliated Hospital of Wenzhou Medical University , Wenzhou , China.|l Institute of Hepatology , Wenzhou Medical University , Wenzhou , China.
authors.forename: Ke-Qing
authors.initials: KQ
authors.lastname: Shi
authors.affiliation: a Department of Hepatology, Liver Research Center , the First Affiliated Hospital of Wenzhou Medical University , Wenzhou , China.|l Institute of Hepatology , Wenzhou Medical University , Wenzhou , China.
authors.forename: Ming-Hua
authors.initials: MH
authors.lastname: Zheng
mesh_terms: D000328:Adult; D000367:Age Factors; D000469:Alkaline Phosphatase / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D002681:China / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D012737:Sex Factors; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; D000469:Alkaline Phosphatase
keywords: Non-alcoholic fatty liver; age factors; alkaline phosphatase; risk factor; sex factors