Clinical Advances in Liver, Pancreas, and Biliary TractTrunk Fat Is Associated With Increased Serum Levels of Alanine Aminotransferase in the United States
Section snippets
Materials and Methods
The National Health and Nutrition Examination Survey (NHANES) is conducted in the United States by the National Center for Health Statistics of the Centers for Disease Control and Prevention and since 1999 has been a continuous annual survey.4 It consists of a cross-sectional interview, examination, and laboratory data collected from a complex multistage, stratified, clustered probability sample representative of the civilian, noninstitutionalized population with oversampling of persons aged 60
Results
Mean (standard deviation) body composition indices for the 5903 men and 5918 women included in the analyses are shown in Table 1 (first row for men and women); ranges and quintile cut points are shown in Table 3, Table 4 (footnote). Fat mass tended to increase in middle age, while lean mass tended to decrease in older age (Table 1). Among men, non-Hispanic blacks had lower fat and lean trunk mass and higher extremity lean mass than either non-Hispanic whites or Mexican Americans (Table 1).
Discussion
The main finding of this large, national, population-based study was a strong association of higher trunk fat mass index (trunk fat mass/height squared) with abnormal ALT activity. This relationship was found among both men and women and was independent of extremity fat, trunk lean, and extremity lean mass, BMI, waist circumference, and of other liver injury risk factors. A measure of insulin resistance attenuated but did not eliminate the relationship among women. In an analysis of an earlier
Acknowledgments
The authors thank Zhongyu Fang for programming support and assistance with creation of tables and Danita Byrd-Holt for consultation on SUDAAN programming using multiply imputed data and the residual method.
Author contributions: CER: study concept and design, statistical analysis and interpretation of data, drafting of manuscript; JEE: study concept and design, statistical analysis and interpretation of data, critical revision of manuscript for important intellectual content.
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This article has an accompanying continuing medical education activity on page e12. Learning Objective: Upon completion of reading this article, successful learners will be able to explain the relationships of body composition measures with elevated ALT activity in the US population.
Conflicts of interest The authors disclose no conflicts.
Funding This work was supported by a contract from the National Institute of Diabetes and Digestive and Kidney Diseases (HHSN267200700001G).