Gastroenterology
Volume 138, Issue 4 , Pages 1346-1356.e3 , April 2010

Trunk Fat Is Associated With Increased Serum Levels of Alanine Aminotransferase in the United States

  • Constance E. Ruhl

      Affiliations

    • Social & Scientific Systems, Inc., Silver Spring, Maryland
    • Corresponding Author InformationReprint requests Address requests for reprints to: Constance E. Ruhl, MD, PhD, Social & Scientific Systems, Inc., 8757 Georgia Avenue, 12th Floor, Silver Spring, MD 20910. fax: 301-628-3201
    • ,
  • James E. Everhart

      Affiliations

    • National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland

Received 10 November 2009 ,Accepted 30 December 2009.

References 

  1. Kral JG, Schaffner F, Pierson RN, et al. Body fat topography as an independent predictor of fatty liver. Metabolism. 1993;42:548–551
  2. Banerji MA, Buckley MC, Chaiken RL, et al. Liver fat, serum triglycerides and visceral adipose tissue in insulin-sensitive and insulin-resistant black men with NIDDM. Int J Obes Relat Metab Disord. 1995;19:846–850
  3. Ruhl CE, Everhart JE. Determinants of the association of overweight with elevated serum alanine aminotransferase activity in the United States. Gastroenterology. 2003;124:71–79
  4. National Center for Health Statistics. National Health and Nutrition Examination Survey (NHANES). http://www.cdc.gov/nchs/nhanes.htm(cited 11 June 2009). Accessed February 3, 2010
  5. National Center for Health Statistics. NHANES 1999-2000 laboratory procedure manual—lab 18 biochemistry profile. http://www.cdc.gov/nchs/data/nhanes/frequency/lab18_met_biochemistry_profile.pdf(cited 4 February 2009). Accessed February 3, 2010
  6. National Center for Health Statistics. NHANES 2001-2002 laboratory procedure manual—lab 18 biochemistry profile. http://www.cdc.gov/nchs/data/nhanes/nhanes_01_02/l18_b_met_biochemistry_profile.pdf(cited 4 February 2009). Accessed February 3, 2010
  7. National Center for Health Statistics. NHANES 2001-2002 laboratory procedure manual - lab 40 ALT. http://www.cdc.gov/nchs/data/nhanes/nhanes_01_02/l40_b_met_alanine_amino_transferase.pdf(cited 4 February 2009). Accessed February 3, 2010
  8. National Center for Health Statistics. NHANES 2003-2004 laboratory procedure manual—lab 40 ALT. http://www.cdc.gov/nchs/data/nhanes/nhanes_03_04/l40_c_met_alanine_amino_transferase.pdf(cited 4 February 2009). Accessed February 3, 2010
  9. National Center for Health Statistics. NHANES 2001-2002 public release data file laboratory 40 - standard biochemistry profile, follicle stimulating hormone, and luteinizing hormone. http://www.cdc.gov/nchs/data/nhanes/nhanes_01_02/l40_b_doc.pdf(cited 4 February 2009). Accessed February 3, 2010
  10. National Center for Health Statistics. National Health and Nutrition Examination Survey: body composition procedures manual. Hyattsville, MD: National Center for Health Statistics.
  11. Flegal KM, Shepherd JA, Looker AC, et al. Comparisons of percentage body fat, body mass index, waist circumference, and waist-stature ratio in adults. Am J Clin Nutr. 2009;89:500–508
  12. Kelly TL, Wilson KE, Heymsfield SB. Dual energy x-ray absorptiometry body composition reference values from NHANES. PLoS One. 2009;4:e7038
  13. National Center for Health Statistics. National Health and Nutrition Examination Survey: technical documentation for the 1999-2004 dual energy X-ray absorptiometry (DXA) multiple imputation data files. http://www.cdc.gov/nchs/data/nhanes/dxa/dxa_techdoc.pdf(cited 22 June 2009). Accessed February 3, 2010
  14. National Center for Health Statistics. National Health and Nutrition Examination Survey anthropometry procedures manual. http://www.cdc.gov/nchs/nhanes/nhanes2003-2004/exam03_04.htm(cited 22 June 2009). Accessed February 3, 2010
  15. Wang J, Rennie KL, Gu W, et al. Independent associations of body-size adjusted fat mass and fat-free mass with the metabolic syndrome in Chinese. Ann Hum Biol. 2009;36:110–121
  16. VanItallie TB, Yang MU, Heymsfield SB, et al. Height-normalized indices of the body's fat-free mass and fat mass: potentially useful indicators of nutritional status. Am J Clin Nutr. 1990;52:953–959
  17. Wells JC. A critique of the expression of paediatric body composition data. Arch Dis Child. 2001;85:67–72
  18. Willett W, Stampfer M. Implications of total energy intake for epidemiologic analyses. In:  Willett W editors. Nutritional epidemiology. 2nd ed.. New York: Oxford; 1998;p. 288–291
  19. Breslow NE, Day NE. Statistical methods in cancer research: the design and analysis of cohort studies. In: Lyon, France: International Agency for Research on Cancer; 1987;p. 48–79
  20. National Center for Health Statistics. NHANES analytic guidelines: June 2004 version. http://www.cdc.gov/nchs/data/nhanes/nhanes_general_guidelines_june_04.pdf(cited 14 December 2009). Accessed February 3, 2010
  21. Levey AS, Coresh J, Balk E, et al. National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Ann Intern Med. 2003;139:137–147
  22. Jakobsen MU, Berentzen T, Sorensen TI, et al. Abdominal obesity and fatty liver. Epidemiol Rev. 2007;29:77–87
  23. Sabir N, Sermez Y, Kazil S, et al. Correlation of abdominal fat accumulation and liver steatosis: importance of ultrasonographic and anthropometric measurements. Eur J Ultrasound. 2001;14:121–128
  24. Chalasani N, Deeg MA, Persohn S, et al. Metabolic and anthropometric evaluation of insulin resistance in nondiabetic patients with nonalcoholic steatohepatitis. Am J Gastroenterol. 2003;98:1849–1855
  25. Westerbacka J, Corner A, Tiikkainen M, et al. Women and men have similar amounts of liver and intra-abdominal fat, despite more subcutaneous fat in women: implications for sex differences in markers of cardiovascular risk. Diabetologia. 2004;47:1360–1369
  26. Targher G, Bertolini L, Scala L, et al. Non-alcoholic hepatic steatosis and its relation to increased plasma biomarkers of inflammation and endothelial dysfunction in non-diabetic men (Role of visceral adipose tissue). Diabet Med. 2005;22:1354–1358
  27. Thomas EL, Hamilton G, Patel N, et al. Hepatic triglyceride content and its relation to body adiposity: a magnetic resonance imaging and proton magnetic resonance spectroscopy study. Gut. 2005;54:122–127
  28. Chan DC, Watts GF, Ng TW, et al. Measurement of liver fat by magnetic resonance imaging: Relationships with body fat distribution, insulin sensitivity and plasma lipids in healthy men. Diabetes Obes Metab. 2006;8:698–702
  29. Church TS, Kuk JL, Ross R, et al. Association of cardiorespiratory fitness, body mass index, and waist circumference to nonalcoholic fatty liver disease. Gastroenterology. 2006;130:2023–2030
  30. Eguchi Y, Eguchi T, Mizuta T, et al. Visceral fat accumulation and insulin resistance are important factors in nonalcoholic fatty liver disease. J Gastroenterol. 2006;41:462–469
  31. Liu KH, Chan YL, Chan JC, et al. Mesenteric fat thickness as an independent determinant of fatty liver. Int J Obes (Lond). 2006;30:787–793
  32. Koda M, Kawakami M, Murawaki Y, et al. The impact of visceral fat in nonalcoholic fatty liver disease: cross-sectional and longitudinal studies. J Gastroenterol. 2007;42:897–903
  33. Song HR, Yun KE, Park HS. Relation between alanine aminotransferase concentrations and visceral fat accumulation among nondiabetic overweight Korean women. Am J Clin Nutr. 2008;88:16–21
  34. Park BJ, Kim YJ, Kim DH, et al. Visceral adipose tissue area is an independent risk factor for hepatic steatosis. J Gastroenterol Hepatol. 2008;23:900–907
  35. Seppala-Lindroos A, Vehkavaara S, Hakkinen AM, et al. Fat accumulation in the liver is associated with defects in insulin suppression of glucose production and serum free fatty acids independent of obesity in normal men. J Clin Endocrinol Metab. 2002;87:3023–3028
  36. Holt HB, Wild SH, Wood PJ, et al. Non-esterified fatty acid concentrations are independently associated with hepatic steatosis in obese subjects. Diabetologia. 2006;49:141–148
  37. Nielsen S, Guo Z, Johnson CM, et al. Splanchnic lipolysis in human obesity. J Clin Invest. 2004;113:1582–1588
  38. Meek SE, Nair KS, Jensen MD. Insulin regulation of regional free fatty acid metabolism. Diabetes. 1999;48:10–14
  39. Williams MJ, Hunter GR, Kekes-Szabo T, et al. Regional fat distribution in women and risk of cardiovascular disease. Am J Clin Nutr. 1997;65:855–860
  40. Paradisi G, Smith L, Burtner C, et al. Dual energy x-ray absorptiometry assessment of fat mass distribution and its association with the insulin resistance syndrome. Diabetes Care. 1999;22:1310–1317
  41. Van Pelt RE, Evans EM, Schechtman KB, et al. Contributions of total and regional fat mass to risk for cardiovascular disease in older women. Am J Physiol Endocrinol Metab. 2002;282:E1023–E1028
  42. Tanko LB, Bagger YZ, Alexandersen P, et al. Peripheral adiposity exhibits an independent dominant antiatherogenic effect in elderly women. Circulation. 2003;107:1626–1631
  43. Snijder MB, Dekker JM, Visser M, et al. Trunk fat and leg fat have independent and opposite associations with fasting and postload glucose levels: the Hoorn study. Diabetes Care. 2004;27:372–377
  44. Snijder MB, Visser M, Dekker JM, et al. Low subcutaneous thigh fat is a risk factor for unfavourable glucose and lipid levels, independently of high abdominal fat (The Health ABC Study). Diabetologia. 2005;48:301–308
  45. Van Pelt RE, Jankowski CM, Gozansky WS, et al. Lower-body adiposity and metabolic protection in postmenopausal women. J Clin Endocrinol Metab. 2005;90:4573–4578
  46. Vega GL, Adams-Huet B, Peshock R, et al. Influence of body fat content and distribution on variation in metabolic risk. J Clin Endocrinol Metab. 2006;91:4459–4466
  47. Hara M, Saikawa T, Kurokawa M, et al. Leg fat percentage correlates negatively with coronary atherosclerosis. Circ J. 2004;68:1173–1178
  48. Snijder MB, Henry RM, Visser M, et al. Regional body composition as a determinant of arterial stiffness in the elderly: The Hoorn Study. J Hypertens. 2004;22:2339–2347
  49. Ferreira I, Snijder MB, Twisk JW, et al. Central fat mass versus peripheral fat and lean mass: opposite (adverse versus favorable) associations with arterial stiffness? (The Amsterdam Growth and Health Longitudinal Study). J Clin Endocrinol Metab. 2004;89:2632–2639
  50. Marceau P, Biron S, Hould FS, et al. Liver pathology and the metabolic syndrome X in severe obesity. J Clin Endocrinol Metab. 1999;84:1513–1517
  51. Knobler H, Schattner A, Zhornicki T, et al. Fatty liver—an additional and treatable feature of the insulin resistance syndrome. QJM. 1999;92:73–79
  52. Marchesini G, Brizi M, Bianchi G, et al. Nonalcoholic fatty liver disease: a feature of the metabolic syndrome. Diabetes. 2001;50:1844–1850
  53. Perlemuter G, Naveau S, Belle-Croix F, et al. Independent and opposite associations of trunk fat and leg fat with liver enzyme levels. Liver Int. 2008;28:1381–1388
  54. Jun DW, Han JH, Kim SH, et al. Association between low thigh fat and non-alcoholic fatty liver disease. J Gastroenterol Hepatol. 2008;23:888–893
  55. Rebuffe-Scrive M, Enk L, Crona N, et al. Fat cell metabolism in different regions in women (Effect of menstrual cycle, pregnancy, and lactation). J Clin Invest. 1985;75:1973–1976
  56. Bos G, Snijder MB, Nijpels G, et al. Opposite contributions of trunk and leg fat mass with plasma lipase activities: the Hoorn study. Obes Res. 2005;13:1817–1823
  57. Ruhl CE, Everhart JE. Relation of elevated serum alanine aminotransferase activity with iron and antioxidant levels in the United States. Gastroenterology. 2003;124:1821–1829
  58. Ruhl CE, Everhart JE. Coffee and caffeine consumption reduce the risk of elevated serum alanine aminotransferase activity in the United States. Gastroenterology. 2005;128:24–32

 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).

PII: S0016-5085(10)00005-3

doi: 10.1053/j.gastro.2009.12.053

Gastroenterology
Volume 138, Issue 4 , Pages 1346-1356.e3 , April 2010

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