Lower alanine aminotransferase levels are associated with increased all-cause and cardiovascular mortality in nonalcoholic fatty liver patients

Table 3 Association of alanine aminotransferase level, cardiovascular disease, cancer-related and others-related mortality stratified by the presence/absence of nonalcoholic fatty liver disease

	Total population		No NAFLD		NAFLD
	HR (95%CI)	P value	HR (95%CI)	P value	HR (95%CI)	P value
ALT level
Cardiovascular
< 0.5 ULN	1		1		1
0.5-1 ULN	0.74 (0.65-0.85)	< 0.001	0.82 (0.68-0.97)	0.022	0.66 (0.52-0.82)	< 0.001
1-2 ULN	0.63 (0.50-0.79)	< 0.001	0.78 (0.56-1.09)	0.149	0.55 (0.39-0.78)	< 0.001
≥ 2 ULN	0.63 (0.35-1.12)	0.113	0.70 (0.26-1.86)	0.469	0.68 (0.31-1.50)	0.342
Cancer
< 0.5 ULN	1		1		1
0.5-1 ULN	0.74 (0.64-0.86)	< 0.001	0.70 (0.58-0.84)	< 0.001	0.85 (0.66-1.11)	0.230
1-2 ULN	0.67 (0.52-0.86)	0.002	0.61 (0.42-0.88)	0.009	0.77 (0.54-1.12)	0.171
≥ 2 ULN	1.11 (0.67-1.86)	0.682	0.86 (0.35-2.11)	0.738	1.39 (0.70-2.75)	0.346
Others
< 0.5 ULN	1		1		1
0.5-1 ULN	0.89 (0.80-0.99)	0.029	0.92 (0.81-1.05)	0.227	0.80 (0.67-0.95)	0.011
1-2 ULN	0.98 (0.83-1.16)	0.809	1.25 (0.98-1.60)	0.074	0.73 (0.57-0.93)	0.012
≥ 2 ULN	0.75 (0.51-1.09)	0.131	0.69 (0.33-1.45)	0.331	0.53 (0.32-0.89)	0.015

The multivariate model was adjusted for age, sex, race/ethnicity, body mass index, waist circumference, aspartate aminotransferase, albumin, triglyceride, total cholesterol, high-density lipoprotein cholesterol, smoking status, diabetes, hypertension, and sedentary lifestyle. Others: Chronic lower respiratory diseases, accidents (unintentional injuries), cerebrovascular diseases, Alzheimer’s diseases, diabetes mellitus, influenza and pneumonia, nephritis, nephrotic syndrome and nephrosis and all other causes (residual). CI: Confidence interval; HR: Hazard ratio; ULN: Upper limits of normal; ALT: Alanine aminotransferase; NAFLD: Nonalcoholic fatty liver disease.