Mohammadi Fatemeh, Qorbani Mostafa, Kelishadi Roya, Baygi Fereshteh, Ardalan Gelayol, Taslimi Mahnaz, Mahmoudarabi Minoosadat, Motlagh Mohammad-Esmaeil, Asayesh Hamid, Larijani Bagher, Heshmat Ramin
*Department of Food and Nutrition Policy and Planning Research, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran †Department of Public Health, Alborz University of Medical Sciences, Karaj ‡Pediatrics Department, Child Growth and Development Research Center, and Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan §Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran ¶Department of Pediatrics, Ahvaz Jundishapur University of Medical Sciences, Ahvaz #Department of Medical Emergencies, Qom University of Medical Sciences, Qom **Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
J Pediatr Gastroenterol Nutr. 2014 Apr;58(4):463-8. doi: 10.1097/MPG.0000000000000246.
Elevated liver enzymes including alanine aminotransferase (ALT) and aspartate aminotransferase (AST) may be associated with metabolic syndrome (MetS) and cardiovascular disease. We investigated the association of cardiometabolic risk factors and liver enzymes in a nationally representative sample of Iranian children and adolescents.
The national study was conducted in the framework of the third survey of Childhood and Adolescence Surveillance and PreventIon of Adult Non-communicable Disease study. Subjects were 3948 students (1942 girls, 67.55% urban, mean age 14.7 ± 2.4 years) who were recruited by multistage random cluster sampling from 27 provincial counties in Iran. Physical examination and laboratory tests were conducted under standard protocols.
Participants with elevated serum ALT had higher levels of almost all cardiometabolic risk factors than other participants; this difference was not significant for fasting blood glucose, total cholesterol, and diastolic blood pressure in both sexes, as well as low-density lipoprotein cholesterol in girls. Participants with generalized and abdominal obesity, MetS, elevated blood pressure, triglycerides, and total cholesterol had increased risk for elevated ALT; this risk remained significant after adjusting for sex and age. Low high-density lipoprotein cholesterol was found as a predictor for both elevated ALT (odds ratio 2.182, 95% confidence interval 1.533-3.105) and AST (odds ratio 2.022, 95% confidence interval 1.438-2.844) even after adjusting for all potential confounders. General (B 0.158, SE 0.030) and abdominal obesity (B 0.058, SE 0.029), MetS (B 0.231, SE 0.048), and triglycerides (B 0.094, SE 0.030) were associated with ALT:AST ratio after adjusting for all potential confounders (P < 0.001).
We documented strong relations of elevated ALT, AST levels, and ALT:AST ratio with most cardiometabolic risk factors. This relation was independent of anthropometric indexes. Liver enzymes can be considered as a cardiometabolic risk factor from childhood, and as an additional component of the MetS.
包括丙氨酸氨基转移酶（ALT）和天冬氨酸氨基转移酶（AST）在内的肝酶升高可能与代谢综合征（MetS）及心血管疾病有关。我们在一个具有全国代表性的伊朗儿童和青少年样本中调查了心脏代谢危险因素与肝酶之间的关联。
这项全国性研究是在儿童和青少年监测及成人非传染性疾病预防研究的第三次调查框架内进行的。研究对象为3948名学生（1942名女孩，67.55%来自城市，平均年龄14.7±2.4岁），他们通过多阶段随机整群抽样从伊朗的27个省级县招募而来。体格检查和实验室检测按照标准方案进行。
血清ALT升高的参与者几乎所有心脏代谢危险因素水平均高于其他参与者；在男女两性的空腹血糖、总胆固醇和舒张压以及女孩的低密度脂蛋白胆固醇方面，这种差异不显著。患有全身性肥胖和腹型肥胖、MetS、血压升高、甘油三酯升高和总胆固醇升高的参与者ALT升高的风险增加；在对性别和年龄进行调整后，这种风险仍然显著。即使在对所有潜在混杂因素进行调整后，低高密度脂蛋白胆固醇仍被发现是ALT升高（比值比2.182，95%置信区间1.533 - 3.105）和AST升高（比值比2.022，95%置信区间1.438 - 2.844）的一个预测因素。在对所有潜在混杂因素进行调整后，全身性肥胖（B 0.158，标准误0.030）、腹型肥胖（B 0.058，标准误0.029）、MetS（B 0.231，标准误0.048）和甘油三酯（B
0.094，标准误0.030）与ALT:AST比值相关（P < 0.001）。
我们记录了ALT、AST水平及ALT:AST比值与大多数心脏代谢危险因素之间的密切关系。这种关系独立于人体测量指标。肝酶可从儿童期起就被视为一种心脏代谢危险因素，并且是MetS的一个额外组成部分。
