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

Abstract

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

Abbreviations

ALT, Alanine aminotransferase; ICD, International Classification of Diseases; CI, Confidence interval.

Data Sharing Statement

Data are available upon reasonable request.

Ethics and Consent Statement

This project, where data from an ethical committee-approved project is linked to data from Danish healthcare registries, does not require a new approval from an ethics committee, according to Danish law.

Disclosure

The abstract of this paper was presented at the “The International Liver Congress 2019” as a poster presentation with interim findings. The poster’s abstract was published in “Poster Presentations” in “Journal of Hepatology”: https://doi.org/10.1016/S0618-8278(19)30648-6.

The authors report no conflicts of interest in this work.