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Alanine Aminotransferase and 20-Year Risk of Major Chronic Diseases and Death in a Healthy Cohort Aged 30 to 49 Years

Authors Jensen MD, Lauritzen T, Vilstrup H, Jepsen P

Received 6 December 2019

Accepted for publication 25 February 2020

Published 31 March 2020 Volume 2020:12 Pages 345—351


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Professor Irene Petersen

Morten Daniel Jensen,1 Torsten Lauritzen,2 Hendrik Vilstrup,1 Peter Jepsen1,3

1Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark; 2Department of Public Health, Research Group for General Practice, University of Aarhus, Aarhus, Denmark; 3Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark

Correspondence: Morten Daniel Jensen
Department of Hepatology and Gastroenterology, Aarhus University Hospital, Entrance C, Plan 1, Intersection C116, Palle Juul-Jensens Boulevard 99, Aarhus N 8200, Denmark
Tel +45 27 59 75 49

Purpose: Alanine aminotransferase is the most frequently used marker of liver cell injury. We examined the association between alanine aminotransferase levels and long-term absolute risks of morbidity and mortality in healthy Danish people aged 30– 49 years.
Patients and Methods: We divided 671 healthy participants from the Ebeltoft Health Promotion Project into four categories based on their baseline alanine aminotransferase values: low (≤ 10U/l), medium-low (men: 11– 34U/l, women: 11– 22U/l), medium-high (men: 35– 69U/l, women: 23– 44U/l) and high (men: ≥ 70U/l, women: ≥ 45U/l), and followed them through Danish healthcare registries for up to 20 years. We examined mortality and absolute risks of liver disease, overall cancer, ischemic heart disease, and diabetes.
Results: The risk of any cancer was highest for participants with “low alanine aminotransferase” or “high alanine aminotransferase” (20-year risk: 17.2% [95% confidence interval (CI): 6.3– 32.7%] and 18.2% [95% CI: 5.7– 36.3%], respectively). The risk of diabetes was highest for participants with “medium-high alanine aminotransferase” or “high alanine aminotransferase” (20-year risk: 12.1% [95% CI: 7.3– 18.3%] and 9.1% [95% CI: 1.6– 25.1%], respectively). Participants with “high alanine aminotransferase” had the highest 20-year risk of liver disease (20-year risk: 13.6% [95% CI: 3.4– 30.9%], while it was 1.0% or less in the other groups). The chance of being alive after 20 years without having been diagnosed with liver disease, cancer, ischemic heart disease, or diabetes was lowest in the “high alanine aminotransferase” group (50% [95% CI: 28– 68%]) and 72– 79% in the other groups.
Conclusion: Our findings suggest that persons with high or abnormally low alanine aminotransferase measurements are at increased long-term risk of several chronic diseases.

Keywords: ALT, mortality, morbidity, cohort study

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