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- Title
Upper limit of normal ALT levels in health and metabolic diseases: Pooled analysis of 423,355 individuals with bootstrap modelling.
- Authors
Tan, Eunice X.; Huang, Daniel Q.; Yee, Natasha Tang Sook; Wan, Zi Hui; Nerurkar, Sanjna N.; Kai, Justin Chua Ying; Goh, Kang Shiong; Ng, Cheng Han; Muthiah, Mark; Zhou, Yu; Woodward, Amanda; Le, Michael H.; Yeo, Yee Hui; Barnett, Scott; Cheung, Ramsey; Nguyen, Mindie H.
- Abstract
Summary: Introduction: Given the global rise in obesity‐related metabolic diseases, the upper limit of normal (ULN) alanine aminotransferase (ALT) in individuals with and without metabolic diseases may have changed. We performed a meta‐analysis combined with bootstrap modelling to estimate the ALT ULN levels for individuals with and without metabolic diseases. Methods and Results: Two separate searches of the PubMed, Embase and Cochrane databases were performed, one to identify healthy individuals which yielded 12 articles (349,367 individuals); another to include those with potential metabolic diseases but without known liver disease which yielded 35 articles (232,388 individuals). We estimated the mean ALT using a random‐effects mixed model and the ULN level (95th‐percentile value) via a bootstrap model with 10,000 resamples. In individuals without metabolic diseases and known liver disease, the ALT ULN levels were 32 U/L overall; 36 U/L in males and 28 U/L in females. In analyses that included individuals with metabolic diseases, the ALT ULN levels were 40 U/L among the overweight/obese (29 U/L if normal weight) and 36 U/L among those with type 2 diabetes mellitus (T2DM) (33 U/L if no T2DM). On meta‐regression of study‐level factors, body mass index (coefficient 1.49, 95% CI 0.11–2.86, p = 0.03), high‐density lipoprotein (coefficient −0.47, 95% CI −0.85‐(−0.08), p = 0.02) and triglycerides (coefficient 0.19, 95% CI 0.12–0.25, p < 0.0001) correlated with ALT. Conclusion: We provide expected ranges of ALT ULN levels for individuals without known liver disease without metabolic diseases and those with or without T2DM and/or are normal weight or overweight/obese. These data may have implications for clinical care and screening.
- Subjects
METABOLIC disorders; TYPE 2 diabetes; BODY mass index; HIGH density lipoproteins; ALANINE aminotransferase
- Publication
Alimentary Pharmacology & Therapeutics, 2024, Vol 59, Issue 8, p984
- ISSN
0269-2813
- Publication type
Article
- DOI
10.1111/apt.17914