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Castells Vilella L, Sánchez-Pintos P, Muñiz Llama JF, Gámez Martínez M, Couce ML, Antón J. Age- and Sex-Dynamic Fluctuations and Reference Intervals for Alkaline Phosphatase Among the Spanish Population. Arch Pathol Lab Med 2025; 149:e19-e25. [PMID: 38797525 DOI: 10.5858/arpa.2023-0335-oa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2024] [Indexed: 05/29/2024]
Abstract
CONTEXT.— Interpretation of alkaline phosphatase (ALP) activity is essential for the diagnosis of certain diseases. ALP changes during life and may vary between different populations. OBJECTIVE.— To establish reference intervals (RIs) and percentile charts for ALP activity in the Spanish population through a multicentric observational study and to compare the RIs to those defined in other countries. DESIGN.— A total of 662 350 ALP measurements from individuals ages 0 to 99 years from 9 Spanish tertiary care centers collected between 2020 and 2022 were analyzed. This study is the largest published on this topic in the literature to date. RESULTS.— Continuous percentile charts for ALP according to sex and age were established which can be used as RIs. Higher levels are reached during the first weeks of life. In puberty, a differential evolution is observed in both sexes, reaching a peak at 10 to 13 years of age in boys and remaining stable in girls at this age. Significant differences were also observed in adults, higher in men between ages 20 and 49 years and between ages 50 and 79 years in women, as reported in some countries. CONCLUSIONS.— ALP activity follows an age- and sex-dependent fluctuation with geographic differences. It is important to have appropriate reference values for each population in order to allow for a correct diagnostic interpretation and early diagnosis of diseases related to ALP abnormalities.
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Affiliation(s)
- Laura Castells Vilella
- From the Department of Pediatrics, Hospital Universitari General de Catalunya, Grupo Quirónsalud, Sant Cugat del Vallès, Barcelona, Spain (Castells Vilella, Muñiz Llama)
| | - Paula Sánchez-Pintos
- the Diagnosis and Treatment Unit of Congenital Metabolic Diseases, Department of Pediatrics, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain (Sánchez-Pintos, Couce)
- IDIS-Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain (Sánchez-Pintos, Couce)
- CIBERER, Instituto Salud Carlos III, Madrid, Spain (Sánchez-Pintos, Couce)
- MetabERN, Udine, Italy (Sánchez-Pintos, Couce)
| | - José Félix Muñiz Llama
- From the Department of Pediatrics, Hospital Universitari General de Catalunya, Grupo Quirónsalud, Sant Cugat del Vallès, Barcelona, Spain (Castells Vilella, Muñiz Llama)
| | - Matías Gámez Martínez
- Quantitative Methods and Socioeconomic Development, Institute for Regional Development, University of Castilla-La Mancha (Gámez Martínez)
| | - María Luz Couce
- the Diagnosis and Treatment Unit of Congenital Metabolic Diseases, Department of Pediatrics, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain (Sánchez-Pintos, Couce)
- IDIS-Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain (Sánchez-Pintos, Couce)
- CIBERER, Instituto Salud Carlos III, Madrid, Spain (Sánchez-Pintos, Couce)
- MetabERN, Udine, Italy (Sánchez-Pintos, Couce)
| | - Jordi Antón
- Pediatric Rheumatology Division, Hospital Sant Joan de Déu, Barcelona, Spain (Antón)
- Immune Deficiency Dysfunction Diseases in Pediatrics (GEMDIP), Institut de Recerca Sant Joan de Déu, Barcelona, Spain (Antón)
- the Department of Surgery and Surgical Specializations at the Facultat de Medicina i Ciències de la Salut, University of Barcelona, Barcelona, Spain (Antón)
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2
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Noah AA, El-Mezayen NS, El-Ganainy SO, Darwish IE, Afify EA. Reversal of fibrosis and portal hypertension by Empagliflozin treatment of CCl 4-induced liver fibrosis: Emphasis on gal-1/NRP-1/TGF-β and gal-1/NRP-1/VEGFR2 pathways. Eur J Pharmacol 2023; 959:176066. [PMID: 37769984 DOI: 10.1016/j.ejphar.2023.176066] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/06/2023] [Accepted: 09/19/2023] [Indexed: 10/03/2023]
Abstract
To date, liver fibrosis has no clinically approved treatment. Empagliflozin (EMPA), a highly selective sodium-glucose-cotransporter-2 (SGLT2) inhibitor, has shown ameliorative potential in liver diseases without revealing its full mechanisms. Neuropilin-1 (NRP-1) is a novel regulator of profibrogenic signaling pathways related to hepatic stellate cells (HSCs) and hepatic sinusoidal endothelial cells (HSECs) that modulates intrahepatic profibrogenic and angiogenic pathways. Herein, EMPA's antifibrotic potentials and effects on galactin-1 (Gal-1)/NRP-1 signaling pathways have been evaluated in an experimental liver fibrosis rat model by testing different EMPA dose regimens. EMPA treatment brought a dose-dependent decrease in Gal-1/NRP-1 hepatic expression. This was coupled with suppression of major HSCs pro-fibrotic pathways; transforming growth factor-β (TGF-β)/TGF-βRI/Smad2 and platelet-derived growth factor-beta (PDGF-β) with a diminution of hepatic Col 1A1 level. In addition, EMPA prompted a protuberant suppression of the angiogenic pathway; vascular endothelial growth factor (VEGF)/VEGF-receptor-2 (VEGFR-2)/SH2-Domain Containing Adaptor Protein-B (Shb), and reversal of altered portal hypertension (PHT) markers; endothelin-1 (ET-1) and endothelial nitric oxide synthase (eNOS). The amelioration of liver fibrosis was coupled with a remarkable improvement in liver aminotransferases and histologic hepatic fibrosis Ishak scores. The highest EMPA dose showed a good safety profile with minimal changes in renal function and glycemic control. Thus, the current study brought about novel findings for a potential liver fibrosis treatment modality via targeting NRP-1 signaling pathways by EMPA.
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Affiliation(s)
- Ashraf A Noah
- Department of Pharmacology and Therapeutics, Faculty of Pharmacy, Pharos University in Alexandria, Alexandria, Egypt; Clinical Research Administration, Alexandria Directorate of Health Affairs, Egyptian Ministry of Health and Population, Alexandria, Egypt
| | - Nesrine S El-Mezayen
- Department of Pharmacology and Therapeutics, Faculty of Pharmacy, Pharos University in Alexandria, Alexandria, Egypt.
| | - Samar O El-Ganainy
- Department of Pharmacology and Therapeutics, Faculty of Pharmacy, Pharos University in Alexandria, Alexandria, Egypt
| | - Inas E Darwish
- Department of Pharmacology and Therapeutics, Faculty of Pharmacy, Pharos University in Alexandria, Alexandria, Egypt; Department of Clinical Pharmacology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Elham A Afify
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Alexandria University, Alexandria, Egypt
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Beykumül A, Ersoy Y, Gülbaş G, Neselioglu S. Can Blood Biomarkers Be Used to Assess Oxidative Stress in COPD Patients After Pulmonary Rehabilitation. Int J Chron Obstruct Pulmon Dis 2023; 18:2179-2186. [PMID: 37818173 PMCID: PMC10561608 DOI: 10.2147/copd.s400415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 08/21/2023] [Indexed: 10/12/2023] Open
Abstract
Purpose To determine the level of oxidative stress in the body due to pulmonary rehabilitation (PR) with thiols and disulfide and to investigate their relationship with indirect markers such as creatine kinase (CK), creatine kinase - MB (CK-MB), and lactate dehydrogenase (LDH), which show cell destruction. Patients and Methods Patients with chronic obstructive pulmonary disease (COPD) are included in inpatient and outpatient care. They were evaluated before and after for PR, and an exercise program was prescribed. In addition, native thiol (NT), total thiol (TT), disulfide (DS), LDH, CK, and CK-MB values were tested. Results The mean age of 21 patients was 63±7.31 years. Eleven of them were outpatients and 10 of them were inpatients. Most of the patients were male (M/F=20/1, 95.2/4.8%). There was a significant difference in pulmonary function tests (PFT), St. George Respiratory Questionnaire (SGRQ), and 1 repetition maximum (1RM) before and after the treatment (p<0.001). There was a correlation between PFT and 1RM upper extremity. While there was no significant difference between thiols and disulfide, according to GOLD scores, there was a significant difference in patients with level 3-MMRC. No correlation was found between LDH, CK, CK-MB, and thiols, DS. ΔCK was found to be associated with ΔDS, and ΔCK-MB with ΔNT, and ΔTT. Conclusion PR contributes to the antioxidant process by improving respiration and reducing oxidative stress. The decrease in LDH, CK with PR, increase in CK-MB, and correlation of CK with thiols and DS gave a different interpretation. In this case, it should be considered that oxidative stress may also be increased in people with high CK values.
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Affiliation(s)
- Ayşegül Beykumül
- Pulmonary Rehabilitation Unit, Turgut Ozal Medical Center, Inonu University, Malatya, Turkey
| | - Yuksel Ersoy
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Gazi Gülbaş
- Department of Chest Diseases, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Salim Neselioglu
- Department of Medical Biochemistry, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
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Haller N, Behringer M, Reichel T, Wahl P, Simon P, Krüger K, Zimmer P, Stöggl T. Blood-Based Biomarkers for Managing Workload in Athletes: Considerations and Recommendations for Evidence-Based Use of Established Biomarkers. Sports Med 2023; 53:1315-1333. [PMID: 37204619 PMCID: PMC10197055 DOI: 10.1007/s40279-023-01836-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2023] [Indexed: 05/20/2023]
Abstract
Blood-based biomarkers can provide an objective individualized measure of training load, recovery, and health status in order to reduce injury risk and maximize performance. Despite enormous potentials, especially owing to currently evolving technology, such as point-of-care testing, and advantages, in terms of objectivity and non-interference with the training process, there are several pitfalls in the use and interpretation of biomarkers. Confounding variables such as preanalytical conditions, inter-individual differences, or an individual chronic workload can lead to variance in resting levels. In addition, statistical considerations such as the detection of meaningful minimal changes are often neglected. The lack of generally applicable and individual reference levels further complicates the interpretation of level changes and thus load management via biomarkers. Here, the potentials and pitfalls of blood-based biomarkers are described, followed by an overview of established biomarkers currently used to support workload management. Creatine kinase is discussed in terms of its evidence for workload management to illustrate the limited applicability of established markers for workload management to date. We conclude with recommendations for best practices in the use and interpretation of biomarkers in a sport-specific context.
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Affiliation(s)
- Nils Haller
- Department of Sports Medicine, Rehabilitation and Disease Prevention, Johannes Gutenberg University of Mainz, Mainz, Germany
- Department of Sport and Exercise Science, University of Salzburg, Schlossallee 49, Salzburg, 5400 Hallein-Rif, Austria
| | - Michael Behringer
- Department of Sports Sciences, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Thomas Reichel
- Department of Exercise Physiology and Sports Therapy, Institute of Sports Science, Justus-Liebig-University Gießen, Gießen, Germany
| | - Patrick Wahl
- Department of Exercise Physiology, German Sport University Cologne, Cologne, Germany
| | - Perikles Simon
- Department of Sports Medicine, Rehabilitation and Disease Prevention, Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Karsten Krüger
- Department of Exercise Physiology and Sports Therapy, Institute of Sports Science, Justus-Liebig-University Gießen, Gießen, Germany
| | - Philipp Zimmer
- Division of Performance and Health (Sports Medicine), Institute for Sport and Sport Science, TU Dortmund University, Dortmund, Germany
| | - Thomas Stöggl
- Department of Sport and Exercise Science, University of Salzburg, Schlossallee 49, Salzburg, 5400 Hallein-Rif, Austria.
- Red Bull Athlete Performance Center, Salzburg, Austria.
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Xu P, He B, Zhou Q, Xu J. Establishment of reference intervals for serum amylase and lipase: a large sample study based on Chinese healthy children. Scand J Clin Lab Invest 2022:1-6. [PMID: 36036831 DOI: 10.1080/00365513.2021.1952485-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 04/28/2021] [Accepted: 07/03/2021] [Indexed: 10/15/2022]
Abstract
This study aimed to establish age- and sex-specific reference intervals for serum amylase and lipase in children by prospective investigation. A total of 6466 healthy Han children of 1 month ∼ <18 years were recruited in communities and schools in five administrative regions of Jilin Province, China. The serum amylase and lipase concentrations were measured on the VITROS 5600 integrated system. The reference intervals were defined by a nonparametric 95% percentile interval. Reference intervals of amylase were divided into four age-specific partitions. It increased rapidly between the ages of 1 month ∼ <1 year and 1 ∼ <5 years, slightly decreased between the ages of 5 ∼ <12 years, and increased slowly between 12 ∼ <18 years. Lipase concentrations showed sex differences after 1-year-old, with reference intervals in males divided into 2 divisions and 3 divisions in females. The lipase concentrations in both males and females showed an upward trend, and the lipase concentrations in females were higher than those in males. This study established reference intervals for amylase and lipase in healthy Chinese children and provided a more accurate explanation for the diagnosis and prognosis of clinical pediatric diseases.
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Affiliation(s)
- Panyang Xu
- Department of Laboratory Medicine, First Hospital of Jilin University, Changchun, China
| | - Bing He
- Department of Laboratory Medicine, First Hospital of Jilin University, Changchun, China
| | - Qi Zhou
- Department of Pediatrics, First Hospital of Jilin University, Changchun, China
| | - Jiancheng Xu
- Department of Laboratory Medicine, First Hospital of Jilin University, Changchun, China
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Martinez-Sanchez L, Cobbaert CM, Noordam R, Brouwer N, Blanco-Grau A, Villena-Ortiz Y, Thelen M, Ferrer-Costa R, Casis E, Rodríguez-Frias F, den Elzen WPJ. Indirect determination of biochemistry reference intervals using outpatient data. PLoS One 2022; 17:e0268522. [PMID: 35588100 PMCID: PMC9119462 DOI: 10.1371/journal.pone.0268522] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 05/02/2022] [Indexed: 12/22/2022] Open
Abstract
The aim of this study was to determine reference intervals in an outpatient population from Vall d'Hebron laboratory using an indirect approach previously described in a Dutch population (NUMBER project). We used anonymized test results from individuals visiting general practitioners and analysed during 2018. Analytical quality was assured by EQA performance, daily average monitoring and by assessing longitudinal accuracy between 2018 and 2020 (using trueness verifiers from Dutch EQA). Per test, outliers by biochemically related tests were excluded, data were transformed to a normal distribution (if necessary) and means and standard deviations were calculated, stratified by age and sex. In addition, the reference limit estimator method was also used to calculate reference intervals using the same dataset. Finally, for standardized tests reference intervals obtained were compared with the published NUMBER results. Reference intervals were calculated using data from 509,408 clinical requests. For biochemical tests following a normal distribution, similar reference intervals were found between Vall d'Hebron and the Dutch study. For creatinine and urea, reference intervals increased with age in both populations. The upper limits of Gamma-glutamyl transferase were markedly higher in the Dutch study compared to Vall d'Hebron results. Creatine kinase and uric acid reference intervals were higher in both populations compared to conventional reference intervals. Medical test results following a normal distribution showed comparable and consistent reference intervals between studies. Therefore a simple indirect method is a feasible and cost-efficient approach for calculating reference intervals. Yet, for generating standardized calculated reference intervals that are traceable to higher order materials and methods, efforts should also focus on test standardization and bias assessment using commutable trueness verifiers.
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Affiliation(s)
- Luisa Martinez-Sanchez
- Clinical Laboratories, Biochemistry Department, Vall d’Hebron University Hospital, Barcelona, Spain
- Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Centre, Leiden, The Netherlands
- Departament de Bioquímica i Biologia Molecular, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Christa M. Cobbaert
- Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Centre, Leiden, The Netherlands
| | - Raymond Noordam
- Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Nannette Brouwer
- Diagnost-IQ, Expert Centre for Clinical Chemistry, Purmerend, The Netherlands
| | - Albert Blanco-Grau
- Clinical Laboratories, Biochemistry Department, Vall d’Hebron University Hospital, Barcelona, Spain
| | - Yolanda Villena-Ortiz
- Clinical Laboratories, Biochemistry Department, Vall d’Hebron University Hospital, Barcelona, Spain
- Departament de Bioquímica i Biologia Molecular, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Marc Thelen
- Laboratory for Clinical Chemistry and Hematology, Amphia, Breda, The Netherlands
- Stichting Kwaliteitsbewaking Medische Laboratoriumdiagnostiek, Nijmegen, The Netherlands
- Department of Laboratory Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Roser Ferrer-Costa
- Clinical Laboratories, Biochemistry Department, Vall d’Hebron University Hospital, Barcelona, Spain
| | - Ernesto Casis
- Clinical Laboratories, Biochemistry Department, Vall d’Hebron University Hospital, Barcelona, Spain
| | - Francisco Rodríguez-Frias
- Clinical Laboratories, Biochemistry Department, Vall d’Hebron University Hospital, Barcelona, Spain
- Departament de Bioquímica i Biologia Molecular, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Wendy P. J. den Elzen
- Clinical Laboratories, Biochemistry Department, Vall d’Hebron University Hospital, Barcelona, Spain
- Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Centre, Leiden, The Netherlands
- Atalmedial Diagnostics Centre, Amsterdam, The Netherlands
- Department of Clinical Chemistry, Amsterdam Public Health research institute, Amsterdam UMC, Amsterdam, The Netherlands
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Lecina M, Castellar C, Pradas F, López-Laval I. 768-km Multi-Stage Ultra-Trail Case Study-Muscle Damage, Biochemical Alterations and Strength Loss on Lower Limbs. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020876. [PMID: 35055697 PMCID: PMC8776162 DOI: 10.3390/ijerph19020876] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/10/2022] [Accepted: 01/10/2022] [Indexed: 01/12/2023]
Abstract
A series of case studies aimed to evaluate muscular fatigue in running a 768-km ultra-trail race in 11 days. Four non-professional athletes (four males) were enrolled. Muscle damage blood biomarkers (creatine kinase (CK), lactodeshydrogenase (LDH), aspartate transaminase (AST) and alanine aminotransferase (ALT) and lower limb strength were evaluated by using Bosco jumps test; squat jump (SJ), countermovement jump (CMJ) and Abalakov jump (ABA) were assessed before (pre), after the race (post) and for two and nine days during the recovery period (rec2 and rec9), respectively. Results showed: pre-post SJ = −28%, CMJ = −36% and ABA = −21%. Values returned to basal during rec9: SJ = −1%, CMJ = −2% or even exceeded pre-values ABA = +3%. On the contrary, muscle damage blood biomarkers values increased at post; CK = +888%, LDH = +172%, AST = +167% and ALT = +159% and the values returned gradually to baseline at rec9 except for AST = +226% and ALT = +103% which remained higher. Nonparametric bivariate Spearman’s test showed strong correlations (Rs ≥ 0.8) between some jumps and muscle damage biomarkers at post (SJ-LDH Rs = 0.80, SJ-AST Rs = 0.8, ABA-LD H Rs = 0.80 and ABA-AST Rs = 0.80), at rec2 (SJ-CK Rs = 0.80 and SJ-ALT Rs = 0.80) and even during rec9 (ABA-CK). Similarly, some parameters such as accumulated elevation and training volume showed a strong correlation with LDH values after finishing the ultra-trail race. The alteration induced by completing an ultra-trail event in the muscle affects lower limb strength and may in some circumstances result in serious medical conditions including post- exertional rhabdomyolysis.
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Affiliation(s)
- Miguel Lecina
- Faculty of Health and Sports Sciences, University of Zaragoza, 22001 Huesca, Spain;
| | - Carlos Castellar
- ENFYRED Research Group, University of Zaragoza, 22001 Huesca, Spain; (C.C.); (F.P.)
| | - Francisco Pradas
- ENFYRED Research Group, University of Zaragoza, 22001 Huesca, Spain; (C.C.); (F.P.)
| | - Isaac López-Laval
- Faculty of Health and Sports Sciences, University of Zaragoza, 22001 Huesca, Spain;
- Movimiento Humano Research Group, University of Zaragoza, 50009 Zaragoza, Spain
- Correspondence:
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Alemam HM, ElJilani MM, Bashein AM. Effect of Intramuscular Injection of Vitamin D on 25-Hydroxyvitamin D Levels, Glycaemic Control, and Liver Enzymes in Libyan Patients with Type 2 Diabetes Mellitus. LIBYAN INTERNATIONAL MEDICAL UNIVERSITY JOURNAL 2022. [DOI: 10.1055/s-0042-1749117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Abstract
Background Vitamin D is a fat-soluble hormone that plays an important role in glycaemic control. In addition, it has a positive effect on improving liver enzyme function.
Aim This study was performed to examine the effect of intramuscular injection of vitamin D on serum 25-hydroxyvitamin D [25(OH)D] levels, glycemic control, and liver enzymes in Libyan patients suffering from type 2 diabetes mellitus (T2DM) with vitamin D deficiency.
Methods and Materials This cross-sectional study enrolled 100 T2DM (50 males and 50 females). Their serum 25(OH)D, fasting blood glucose (FBG), and liver enzymes were measured at the baseline and 12 weeks after treatment with vitamin D (200,000 IU) injection monthly for 3 months. Data analysis involved the estimation of mean ± standard error (SE) and comparison of means between pre and post-treatment values using paired t-test. Independent t-test was used to compare the means between males and females. The level of significance was set at p < 0.05.
Results Females had a lower 25(OH)D blood levels than males at baseline (7.03 ± 0.25 ng/mL versus 7.86 ± 0.26 ng/mL, respectively p < 0.02). 25(OH)D levels in both sexes was increased significantly from 7.45 ± 0.18 ng/mL to 26.69 ± 0.24 ng/mL after 12 weeks of vitamin D injections (p < 0.001), with no significant differences between male and females. FBG levels in both sexes was significantly decreased from 144.68 ± 1.84 mg/dL to 85.96 ± 0.34 mg/dL post treatment (p < 0.001). Alanine aminotransferase (ALT) was increased from 10.24 ± 0.17 U/L at baseline to 20.34 ± 1.15 U/L post treatment (p < 0.001). Similarly, aspartate aminotransferase (AST) was increased from 11.23 ± 0.21 to 20.57 ± 0.22 U/L (p < 0.001), and alkaline phosphatase (ALP) was decreased from 124.95 ± 1.15 U/L to 111.17 ± 1.27 U/L (p < 0.001). There were no significant differences between male and female liver enzymes either pre- or post-vitamin D injections
Conclusion Treatment with vitamin D injection showed a significant increase in 25(OH)D accompanied by decreased FBG and ALP levels and increased ALT and AST levels. Vitamin D levels should be monitored and adjusted in diabetic patients.
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Affiliation(s)
- Hafsa M. Alemam
- Department of Environment, Food, and Biological Applications, Libyan Centre for Biotechnology Research, Tripoli, Libya
| | - Mouna M. ElJilani
- Department of Genetic Engineering, Libyan Centre for Biotechnology Research, Tripoli, Libya
| | - Abdulla M. Bashein
- Department of Biochemistry and Molecular Biology, Faculty of Medicine, University of Tripoli, Tripoli, Libya
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9
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Xu P, He B, Zhou Q, Xu J. Establishment of reference intervals for serum amylase and lipase: a large sample study based on Chinese healthy children. Scandinavian Journal of Clinical and Laboratory Investigation 2021; 81:502-507. [PMID: 34320876 DOI: 10.1080/00365513.2021.1952485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This study aimed to establish age- and sex-specific reference intervals for serum amylase and lipase in children by prospective investigation. A total of 6466 healthy Han children of 1 month ∼ <18 years were recruited in communities and schools in five administrative regions of Jilin Province, China. The serum amylase and lipase concentrations were measured on the VITROS 5600 integrated system. The reference intervals were defined by a nonparametric 95% percentile interval. Reference intervals of amylase were divided into four age-specific partitions. It increased rapidly between the ages of 1 month ∼ <1 year and 1 ∼ <5 years, slightly decreased between the ages of 5 ∼ <12 years, and increased slowly between 12 ∼ <18 years. Lipase concentrations showed sex differences after 1-year-old, with reference intervals in males divided into 2 divisions and 3 divisions in females. The lipase concentrations in both males and females showed an upward trend, and the lipase concentrations in females were higher than those in males. This study established reference intervals for amylase and lipase in healthy Chinese children and provided a more accurate explanation for the diagnosis and prognosis of clinical pediatric diseases.
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Affiliation(s)
- Panyang Xu
- Department of Laboratory Medicine, First Hospital of Jilin University, Changchun, China
| | - Bing He
- Department of Laboratory Medicine, First Hospital of Jilin University, Changchun, China
| | - Qi Zhou
- Department of Pediatrics, First Hospital of Jilin University, Changchun, China
| | - Jiancheng Xu
- Department of Laboratory Medicine, First Hospital of Jilin University, Changchun, China
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10
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Xu P, Zhou Q, Xu J. Reference interval transference of common clinical biomarkers. Scandinavian Journal of Clinical and Laboratory Investigation 2021; 81:264-271. [PMID: 33819111 DOI: 10.1080/00365513.2021.1907858] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Clinical examination has become an important method of disease diagnosis, curative effect evaluation, prognosis judgment and health monitoring, and the biological reference interval is the reference standard to interpret test results and analyses of test information. In clinical tests, the reference interval is often affected by race, sex, age, geographical location and growth and development, so it is very important to establish a suitable reference interval for each laboratory. It is a huge and arduous task for each laboratory to establish its own reference interval. It is unrealistic for different measurement systems to establish reference intervals. According to the C28-A3c guideline from the Clinical and Laboratory Standards Institute (CLSI), clinical laboratories can appropriately transfer the reference intervals provided by other laboratories. This paper reviews whether the biomarkers in multiregional laboratories can transfer reference intervals between different measurement systems to expand the application of reference interval databases and ensure the accuracy and consistency of the test results.
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Affiliation(s)
- Panyang Xu
- Department of Laboratory Medicine, First Hospital of Jilin University, Changchun, China
| | - Qi Zhou
- Department of Pediatrics, First Hospital of Jilin University, Changchun, China
| | - Jiancheng Xu
- Department of Laboratory Medicine, First Hospital of Jilin University, Changchun, China
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Ma C, Xia L, Cheng X, Wu J, Yin Y, Hou L, Li X, Guo X, Lin S, Qiu L. Establishment of variation source and age-related reference interval models for 22 common biochemical analytes in older people using real-world big data mining. Age Ageing 2020; 49:1062-1070. [PMID: 32638996 DOI: 10.1093/ageing/afaa096] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 04/01/2020] [Accepted: 04/05/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND the ageing population has increased in many countries, including China. However, reference intervals (RIs) for older people are rarely established because of difficulties in selecting reference individuals. Here, we aimed to analyse the factors affecting biochemical analytes and establish RI and age-related RI models for biochemical analytes through mining real-world big data. METHODS data for 97,220 individuals downloaded from electronic health records were included. Three derived databases were established. The first database included 97,220 individuals and was used to build age-related RI models after identifying outliers by the Tukey method. The second database consisted of older people and was used to establish variation source models and RIs for biochemical analytes. Differences between older and younger people were compared using the third database. RESULTS sex was the main source of variation of biochemical analytes for older people in the variation source models. The distributions of creatinine and uric acid were significantly different in the RIs of biochemical analytes for older people established according to sex. Age-related RI models for biochemical analytes that were most affected by age were built and visualized, revealing various patterns of changes from the younger to older people. CONCLUSION the study analysed the factors affecting biochemical analytes in older people. Moreover, RI and age-related RI models of biochemical analytes for older people were established to provide important insight into biological processes and to assist clinical use of various biochemical analytes to monitor the status of various diseases for older people.
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Affiliation(s)
- Chaochao Ma
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing 100730, China
| | - Liangyu Xia
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing 100730, China
| | - Xinqi Cheng
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing 100730, China
| | - Jie Wu
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing 100730, China
| | - Yicong Yin
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing 100730, China
| | - Lian Hou
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing 100730, China
| | - Xiaoqi Li
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing 100730, China
| | - Xiuzhi Guo
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing 100730, China
| | - Songbai Lin
- Department of Health Care, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Ling Qiu
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing 100730, China
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12
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Gonzalez H, Imam Z, Wong R, Li J, Lu M, Trudeau S, Gordon S, Imam M, Gish R. Normal alkaline phosphatase levels are dependent on race/ethnicity: NationalGEP Health and Nutrition Examination Survey data. BMJ Open Gastroenterol 2020; 7:e000502. [PMID: 33055108 PMCID: PMC7559036 DOI: 10.1136/bmjgast-2020-000502] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 09/03/2020] [Accepted: 09/17/2020] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE The range of normal serum alkaline phosphatase is not well defined. We used data from the National Health and Nutrition Examination Survey from 2009 to 2016 to generate normal ranges for a racially diverse sample of healthy adults. METHODS Respondents 18 years or older were included. Conditions known to elevate alkaline phosphatase were cause for exclusion. Alkaline phosphatase was measured using a colorimetric method based on standardised National Health and Nutrition Examination Survey protocols. Because alkaline phosphatase values were not normally distributed, log transformation was used. We calculated upper limits of normal (97.5 percentile), stratified by sex and race/ethnicity, and 90% CIs for the upper limits of normal. RESULTS 1199 respondents (673 female, 526 male) had body mass index from 18.5 to less than 25. Upper limits of normal were highest among Hispanics (123.2 IU/L (90% CI 110.2 to 136.7) for females; 123.8 IU/L (90% CI 112.0 to 135.1) for males), followed by African Americans (109.9 IU/L (90% CI 97.3 to 122.4) for females; 116.3 IU/L (90% CI 105.0 to 126.1) for males) and whites (97.1 IU/L (90% CI 91.0 to 103.4) for females; 109.6 IU/L (90% CI 102.1 to 116.3) for males). Asian American/Pacific Islander respondents had the lowest results: 93.8 IU/L (90% CI 88.2 to 99.5) for females and 95.3 IU/L (90% CI 88.1 to 102.1) for males. CONCLUSIONS The upper limit of normal alkaline phosphatase varies by race/ethnicity in a large US sample with body mass index of 18.5<25.
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Affiliation(s)
- Humberto Gonzalez
- Gastroenterology and Hepatology, Henry Ford Health System, Detroit, Michigan, USA
- Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Zaid Imam
- Internal Medicine, Beaumont Health System, Royal Oak, Michigan, USA
| | - Robert Wong
- Gastroenterology and Hepatology, Alameda Health System, Oakland, California, USA
| | - Jia Li
- Public Health Sciences, Henry Ford Health System, Detroit, Michigan, USA
| | - Mei Lu
- Public Health Sciences, Henry Ford Health System, Detroit, Michigan, USA
| | - Sheri Trudeau
- Public Health Sciences, Henry Ford Health System, Detroit, Michigan, USA
| | - Stuart Gordon
- Gastroenterology and Hepatology, Henry Ford Health System, Detroit, Michigan, USA
- Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Mohammad Imam
- Gastroenterology, The University of Tennessee Medical Center, Memphis, Tennessee, USA
| | - Robert Gish
- Gatroenterology and Hepatology, Loma Linda University, Loma Linda, California, USA
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13
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Stucchi L, Valli C, Stancari G, Zucca E, Ferrucci F. Creatine-kinase reference intervals at rest and after maximal exercise in Standardbred racehorses. COMPARATIVE EXERCISE PHYSIOLOGY 2019. [DOI: 10.3920/cep190020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Due to the high variability of data drawn from the literature, aim of the study was to evaluate the effects of exercise on creatine-kinase (CK) serum activity and to determine CK reference intervals (RIs) at rest and post-exercise in healthy Standardbred racehorses. Data concerning history, physical examination, laboratory evaluation and ECG were collected retrospectively from a population of 258 Standardbred racehorses in training that underwent an incremental-maximal treadmill exercise. Those subjects with alterations potentially influencing CK serum activity were excluded. Finally, a reference sample of 194 horses was selected. Blood samples were collected 1 hour before exercise and 6 hour post-exercise and analysed with a spectrophotometric method. Values were compared by Wilcoxon test for paired samples. The effect of age and sex was evaluated by Kruskal-Wallis and Dunn post-test. Statistical significance was set at P<0.05. RIs were determined following Clinical and Laboratory Standard Institute guidelines (CLSI), approved by the American Society for Veterinary Clinical Pathology. Using a macroinstruction set for Microsoft Excel (RefValAdv), RIs were determined with a non-parametric method. A significant increase (P<0.0001) in CK activity post-exercise was observed. Partition by sex and age did not show any statistical difference, either at rest or post-exercise. In RIs determination no outliers were identified. RIs ranged from 25 to 394 U/l at rest and from 44 to 735 U/l post-exercise. To our knowledge, this is the first study considering CK post-exercise RIs in racehorses using CLSI’s guidelines and specific CK-related exclusion criteria. These RIs could be useful to discriminate between physiological and pathological CK post-exercise increase.
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Affiliation(s)
- L. Stucchi
- Equine Sports Medicine Lab (ESM-Lab), Department of Health, Animal Science and Food Safety (VESPA), Università degli Studi di Milano, Via Celoria 10, 20133 Milano, Italy
| | - C. Valli
- Equine practitioner, Cassago Brianza (LC), Italy
| | - G. Stancari
- Equine Sports Medicine Lab (ESM-Lab), Department of Health, Animal Science and Food Safety (VESPA), Università degli Studi di Milano, Via Celoria 10, 20133 Milano, Italy
| | - E. Zucca
- Equine Sports Medicine Lab (ESM-Lab), Department of Health, Animal Science and Food Safety (VESPA), Università degli Studi di Milano, Via Celoria 10, 20133 Milano, Italy
| | - F. Ferrucci
- Equine Sports Medicine Lab (ESM-Lab), Department of Health, Animal Science and Food Safety (VESPA), Università degli Studi di Milano, Via Celoria 10, 20133 Milano, Italy
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14
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Johansen MB, Christensen PA. A simple transformation independent method for outlier definition. Clin Chem Lab Med 2019; 56:1524-1532. [PMID: 29634477 DOI: 10.1515/cclm-2018-0025] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 02/22/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Definition and elimination of outliers is a key element for medical laboratories establishing or verifying reference intervals (RIs). Especially as inclusion of just a few outlying observations may seriously affect the determination of the reference limits. Many methods have been developed for definition of outliers. Several of these methods are developed for the normal distribution and often data require transformation before outlier elimination. METHODS We have developed a non-parametric transformation independent outlier definition. The new method relies on drawing reproducible histograms. This is done by using defined bin sizes above and below the median. The method is compared to the method recommended by CLSI/IFCC, which uses Box-Cox transformation (BCT) and Tukey's fences for outlier definition. The comparison is done on eight simulated distributions and an indirect clinical datasets. RESULTS The comparison on simulated distributions shows that without outliers added the recommended method in general defines fewer outliers. However, when outliers are added on one side the proposed method often produces better results. With outliers on both sides the methods are equally good. Furthermore, it is found that the presence of outliers affects the BCT, and subsequently affects the determined limits of current recommended methods. This is especially seen in skewed distributions. The proposed outlier definition reproduced current RI limits on clinical data containing outliers. CONCLUSIONS We find our simple transformation independent outlier detection method as good as or better than the currently recommended methods.
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Affiliation(s)
| | - Peter Astrup Christensen
- Department of Clinical Biochemistry, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark, Phone: +45 97649000
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15
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Molino Lova R, Vassalle C, Masini E, Del Ry S, Cabiati M, Pasquini G, Macchi C. Relationship between inflammatory parameters and cardiovascular and lifestyle factors in the Mugello study oldest old. Biomark Med 2018; 12:1115-1124. [PMID: 30203672 DOI: 10.2217/bmm-2017-0441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM To explore possible inter-relationships of various biomarkers of inflammation and lifestyle and other cardiovascular risk factors (age, gender, smoking history, hypertension, Type 2 diabetes, dyslipidemia, alteration of circadian rhythms, body mass index, calf circumference, thigh circumference, abdominal circumference) in the Mugello study oldest old. METHODS In 399 noninstitutionalized nonagenarians (291 women), whole blood cells, mean platelet volume, C-reactive protein, uric acid, gamma-glutamyl transferase were assessed. RESULTS Aging resulted as the only independent determinant for uric acid (<0.05), and abdominal circumference for C-reactive protein. Female gender (<0.01), and thigh circumference (<0.05) remained as determinants for mean platelet volume, age (<0.01), and male gender (<0.01) for gamma-glutamyl transferase, and Type 2 diabetes (≤0.01) and alteration of circadian rhythms (<0.05) for whole blood cells. CONCLUSION Several inflammatory parameters remain associated with adverse lifestyle and cardiovascular risk factors even among nonagenarians.
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Affiliation(s)
| | | | | | - Silvia Del Ry
- Italian National Research Council, Istituto di Fisiologia Clinica, Pisa, Italy
| | - Manuela Cabiati
- Italian National Research Council, Istituto di Fisiologia Clinica, Pisa, Italy
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16
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Kristiansen S, Friis-Hansen L, Antonio Juel Jensen C, Ingemann Hansen S. Verification study on the NORIP LDH reference intervals with a proposed new upper reference limit. Scand J Clin Lab Invest 2018; 78:421-427. [DOI: 10.1080/00365513.2018.1481223] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Søren Kristiansen
- Department of Clinical Biochemistry, Copenhagen University Hospital of Nordsjælland, Denmark
| | - Lennart Friis-Hansen
- Department of Clinical Biochemistry, Copenhagen University Hospital of Nordsjælland, Denmark
| | | | - Steen Ingemann Hansen
- Department of Clinical Biochemistry, Copenhagen University Hospital of Nordsjælland, Denmark
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17
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Özçürümez MK, Haeckel R. Biological variables influencing the estimation of reference limits. Scandinavian Journal of Clinical and Laboratory Investigation 2018; 78:337-345. [PMID: 29764232 DOI: 10.1080/00365513.2018.1471617] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Reference limits (RLs) are required to evaluate laboratory results for medical decisions. The establishment of RL depends on the pre-analytical and the analytical conditions. Furthermore, biological characteristics of the sub-population chosen to provide the reference samples may influence the RL. The most important biological preconditions are gender, age, chronobiological influences, posture, regional and ethnic effects. The influence of these components varies and is often neglected. Therefore, a list of biological variables is collected from the literature and their influence on the estimation of RL is discussed. Biological preconditions must be specified if RL are reported as well for directly as for indirectly estimated RL. The influence of biological variables is especially important if RL established by direct methods are compared with those derived from indirect techniques. Even if these factors are not incorporated into the estimation of RL, their understanding can assist the interpretation of laboratory results of an individual.
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Affiliation(s)
- Mustafa K Özçürümez
- a IMD-Oderland GmbH , Frankfurt (Oder) , Germany.,b Institut für Klinische Chemie Medizinische Fakultät Mannheim der Universität Heidelberg , Mannheim , Germany
| | - Rainer Haeckel
- c Bremer Zentrum für Laboratoriumsmedizin Klinikum Bremen Mitte , Bremen , Germany
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18
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Jeon JS, Oh JJ, Kwak HC, Yun HY, Kim HC, Kim YM, Oh SJ, Kim SK. Age-Related Changes in Sulfur Amino Acid Metabolism in Male C57BL/6 Mice. Biomol Ther (Seoul) 2018; 26:167-174. [PMID: 28605831 PMCID: PMC5839495 DOI: 10.4062/biomolther.2017.054] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 03/30/2017] [Accepted: 03/30/2017] [Indexed: 11/05/2022] Open
Abstract
Alterations in sulfur amino acid metabolism are associated with an increased risk of a number of common late-life diseases, which raises the possibility that metabolism of sulfur amino acids may change with age. The present study was conducted to understand the age-related changes in hepatic metabolism of sulfur amino acids in 2-, 6-, 18- and 30-month-old male C57BL/6 mice. For this purpose, metabolite profiling of sulfur amino acids from methionine to taurine or glutathione (GSH) was performed. The levels of sulfur amino acids and their metabolites were not significantly different among 2-, 6- and 18-month-old mice, except for plasma GSH and hepatic homocysteine. Plasma total GSH and hepatic total homocysteine levels were significantly higher in 2-month-old mice than those in the other age groups. In contrast, 30-month-old mice exhibited increased hepatic methionine and cysteine, compared with all other groups, but decreased hepatic S-adenosylmethionine (SAM), S-adenosylhomocysteine and homocysteine, relative to 2-month-old mice. No differences in hepatic reduced GSH, GSH disulfide, or taurine were observed. The hepatic changes in homocysteine and cysteine may be attributed to upregulation of cystathionine β-synthase and down-regulation of γ-glutamylcysteine ligase in the aged mice. The elevation of hepatic cysteine levels may be involved in the maintenance of hepatic GSH levels. The opposite changes of methionine and SAM suggest that the regulatory role of SAM in hepatic sulfur amino acid metabolism may be impaired in 30-month-old mice.
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Affiliation(s)
- Jang Su Jeon
- College of Pharmacy, Chungnam National University, Daejeon 34134, Republic of Korea
| | - Jeong-Ja Oh
- College of Pharmacy, Chungnam National University, Daejeon 34134, Republic of Korea
| | - Hui Chan Kwak
- College of Pharmacy, Chungnam National University, Daejeon 34134, Republic of Korea
| | - Hwi-Yeol Yun
- College of Pharmacy, Chungnam National University, Daejeon 34134, Republic of Korea
| | - Hyoung Chin Kim
- Bio-Evaluation Center, KRIBB, Ochang 28116, Republic of Korea
| | - Young-Mi Kim
- College of Pharmacy, Hanyang University, Ansan 15588, Republic of Korea
| | - Soo Jin Oh
- Bio-Evaluation Center, KRIBB, Ochang 28116, Republic of Korea.,New Drug Development Center, ASAN Institute for Life Science, Asan Medical Center, Seoul 05505, Republic of Korea
| | - Sang Kyum Kim
- College of Pharmacy, Chungnam National University, Daejeon 34134, Republic of Korea
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19
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Nazari M, Azarbayjani MA, Azizbeigi K. Effect of Exercise Order of Resistance Training on Strength Performance and Indices of Muscle Damage in Young Active Girls. Asian J Sports Med 2016; 7:e30599. [PMID: 27826394 PMCID: PMC5097860 DOI: 10.5812/asjsm.30599] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 08/19/2015] [Accepted: 12/10/2015] [Indexed: 11/30/2022] Open
Abstract
Background Exercise order is one of the key variables in designing resistance training (RT) that may affect physiological and functional muscle characteristics. Objectives The purpose of this research was to examine the effect of exercise order of RT on muscle strength, lactate dehydrogenase (LDH) and creatine kinase (CK) enzymes as indices of muscle damage in active young girls. Patients and Methods For this purpose, 24 active girls aged 20 - 30 years voluntarily participated in six weeks RT. The subjects were randomly assigned into three groups of large to small muscle group (SLM, n = 8), large to small group (LSM, n = 8) and control group (Co, n = 8). The RT performed in bench press, lat pull down, triceps with machine and biceps with barbell. Before and after RT, blood sample was collected to measure the level of LDH and CK enzymes activity. Results The result of analysis indicated that RT significantly increased the level of LDH enzymes in all three groups (P < 0.05). In addition, the result showed that six weeks of RT did not cause any significant change in CK (P > 0.05). However, there is no significant difference between SLM, LSM and control in CK and LDH after six weeks RT. Conclusions Both RT methods cause the same improvement on muscle strength and performance. Also muscle damage indices did not show sensitivity to the exercise order. Therefore, resistance training may be designed regardless of effect of exercise order on muscle damage.
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Affiliation(s)
- Maydeye Nazari
- Department of Physical Education and Sports Sciences, Taft Branch, Islamic Azad University, Taft, IR Iran
| | - Mohammad Ali Azarbayjani
- Department of Exercise Physiology, Faculty of Physical Education and Sports Science, Tehran Central Branch, Islamic Azad University, Tehran, IR Iran
- Corresponding author: Mohammad Ali Azarbayjani, Department of Exercise Physiology, Faculty of Physical Education and Sports Science, Tehran Central Branch, Islamic Azad University, Iranzamin St, Shahrake Gharb Sq, Tehran, IR Iran. Tel: +98-9123172908, E-mail:
| | - Kamal Azizbeigi
- Department of Physical Education and Sports Sciences, Sanandaj Branch, Islamic Azad University, Sanandaj, IR Iran
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20
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Galvan E, Walker DK, Simbo SY, Dalton R, Levers K, O'Connor A, Goodenough C, Barringer ND, Greenwood M, Rasmussen C, Smith SB, Riechman SE, Fluckey JD, Murano PS, Earnest CP, Kreider RB. Acute and chronic safety and efficacy of dose dependent creatine nitrate supplementation and exercise performance. J Int Soc Sports Nutr 2016; 13:12. [PMID: 27034623 PMCID: PMC4815124 DOI: 10.1186/s12970-016-0124-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 03/23/2016] [Indexed: 02/07/2023] Open
Abstract
Background Creatine monohydrate (CrM) and nitrate are popular supplements for improving exercise performance; yet have not been investigated in combination. We performed two studies to determine the safety and exercise performance-characteristics of creatine nitrate (CrN) supplementation. Methods Study 1 participants (N = 13) ingested 1.5 g CrN (CrN-Low), 3 g CrN (CrN-High), 5 g CrM or a placebo in a randomized, crossover study (7d washout) to determine supplement safety (hepatorenal and muscle enzymes, heart rate, blood pressure and side effects) measured at time-0 (unsupplemented), 30-min, and then hourly for 5-h post-ingestion. Study 2 participants (N = 48) received the same CrN treatments vs. 3 g CrM in a randomized, double-blind, 28d trial inclusive of a 7-d interim testing period and loading sequence (4 servings/d). Day-7 and d-28 measured Tendo™ bench press performance, Wingate testing and a 6x6-s bicycle ergometer sprint. Data were analyzed using a GLM and results are reported as mean ± SD or mean change ± 95 % CI. Results In both studies we observed several significant, yet stochastic changes in blood markers that were not indicative of potential harm or consistent for any treatment group. Equally, all treatment groups reported a similar number of minimal side effects. In Study 2, there was a significant increase in plasma nitrates for both CrN groups by d-7, subsequently abating by d-28. Muscle creatine increased significantly by d-7 in the CrM and CrN-High groups, but then decreased by d-28 for CrN-High. By d-28, there were significant increases in bench press lifting volume (kg) for all groups (PLA, 126.6, 95 % CI 26.3, 226.8; CrM, 194.1, 95 % CI 89.0, 299.2; CrN-Low, 118.3, 95 % CI 26.1, 210.5; CrN-High, 267.2, 95 % CI 175.0, 359.4, kg). Only the CrN-High group was significantly greater than PLA (p < 0.05). Similar findings were observed for bench press peak power (PLA, 59.0, 95 % CI 4.5, 113.4; CrM, 68.6, 95 % CI 11.4, 125.8; CrN-Low, 40.9, 95 % CI −9.2, 91.0; CrN-High, 60.9, 95 % CI 10.8, 111.1, W) and average power. Conclusions Creatine nitrate delivered at 3 g was well-tolerated, demonstrated similar performance benefits to 3 g CrM, in addition, within the confines of this study, there were no safety concerns.
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Affiliation(s)
- Elfego Galvan
- Department of Health and Kinesiology, Exercise and Sport Nutrition Laboratory, Texas A&M University, College Station, TX 77843-4243 USA
| | - Dillon K Walker
- Department of Health and Kinesiology, Center for Translational Research in Aging and Longevity, Texas A&M University, College Station, TX 77843-4243 USA
| | - Sunday Y Simbo
- Department of Health and Kinesiology, Center for Translational Research in Aging and Longevity, Texas A&M University, College Station, TX 77843-4243 USA
| | - Ryan Dalton
- Department of Health and Kinesiology, Exercise and Sport Nutrition Laboratory, Texas A&M University, College Station, TX 77843-4243 USA
| | - Kyle Levers
- Department of Health and Kinesiology, Exercise and Sport Nutrition Laboratory, Texas A&M University, College Station, TX 77843-4243 USA
| | - Abigail O'Connor
- Department of Health and Kinesiology, Exercise and Sport Nutrition Laboratory, Texas A&M University, College Station, TX 77843-4243 USA
| | - Chelsea Goodenough
- Department of Health and Kinesiology, Exercise and Sport Nutrition Laboratory, Texas A&M University, College Station, TX 77843-4243 USA
| | - Nicholas D Barringer
- United States Military-Baylor University Graduate Program in Nutrition, Joint Base, San Antonio, TX 78234 USA
| | - Mike Greenwood
- Department of Health and Kinesiology, Exercise and Sport Nutrition Laboratory, Texas A&M University, College Station, TX 77843-4243 USA
| | - Christopher Rasmussen
- Department of Health and Kinesiology, Exercise and Sport Nutrition Laboratory, Texas A&M University, College Station, TX 77843-4243 USA
| | - Stephen B Smith
- Department of Animal Science, Texas A&M University, College Station, TX 77843-4243 USA
| | - Steven E Riechman
- Department of Health and Kinesiology, Human Countermeasures Laboratory, Texas A&M University, College Station, TX 77843-4243 USA
| | - James D Fluckey
- Department of Health and Kinesiology, Muscle Biology Laboratory, Texas A&M University, College Station, TX 77843-4243 USA
| | - Peter S Murano
- Department of Nutrition and Food Science, Texas A&M University, College Station, TX 77843-4243 USA
| | | | - Richard B Kreider
- Department of Health and Kinesiology, Exercise and Sport Nutrition Laboratory, Texas A&M University, College Station, TX 77843-4243 USA
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Kwon SY, Na YA. Relations between Normal Serum Gamma-glutamyltransferase and Risk Factors of Coronary Heart Diseases according to Age and Gender. KOREAN JOURNAL OF CLINICAL LABORATORY SCIENCE 2016. [DOI: 10.15324/kjcls.2016.48.1.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Se Young Kwon
- Department of Biomedical Laboratory Science, Daegu Health College, Daegu 41453, Korea
| | - Young Ak Na
- Department of Biomedical Laboratory Science, Daegu Health College, Daegu 41453, Korea
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22
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Adeli K, Higgins V, Nieuwesteeg M, Raizman JE, Chen Y, Wong SL, Blais D. Biochemical Marker Reference Values across Pediatric, Adult, and Geriatric Ages: Establishment of Robust Pediatric and Adult Reference Intervals on the Basis of the Canadian Health Measures Survey. Clin Chem 2015; 61:1049-62. [DOI: 10.1373/clinchem.2015.240515] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 05/05/2015] [Indexed: 11/06/2022]
Abstract
Abstract
BACKGROUND
Biological covariates such as age and sex can markedly influence biochemical marker reference values, but no comprehensive study has examined such changes across pediatric, adult, and geriatric ages. The Canadian Health Measures Survey (CHMS) collected comprehensive nationwide health information and blood samples from children and adults in the household population and, in collaboration with the Canadian Laboratory Initiative on Pediatric Reference Intervals (CALIPER), examined biological changes in biochemical markers from pediatric to geriatric age, establishing a comprehensive reference interval database for routine disease biomarkers.
METHODS
The CHMS collected health information, physical measurements, and biosamples (blood and urine) from approximately 12 000 Canadians aged 3–79 years and measured 24 biochemical markers with the Ortho Vitros 5600 FS analyzer or a manual microplate. By use of CLSI C28-A3 guidelines, we determined age- and sex-specific reference intervals, including corresponding 90% CIs, on the basis of specific exclusion criteria.
RESULTS
Biochemical marker reference values exhibited dynamic changes from pediatric to geriatric age. Most biochemical markers required some combination of age and/or sex partitioning. Two or more age partitions were required for all analytes except bicarbonate, which remained constant throughout life. Additional sex partitioning was required for most biomarkers, except bicarbonate, total cholesterol, total protein, urine iodine, and potassium.
CONCLUSIONS
Understanding the fluctuations in biochemical markers over a wide age range provides important insight into biological processes and facilitates clinical application of biochemical markers to monitor manifestation of various disease states. The CHMS-CALIPER collaboration addresses this important evidence gap and allows the establishment of robust pediatric and adult reference intervals.
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Affiliation(s)
- Khosrow Adeli
- CALIPER Program, Pediatric Laboratory Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Victoria Higgins
- CALIPER Program, Pediatric Laboratory Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Michelle Nieuwesteeg
- CALIPER Program, Pediatric Laboratory Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Joshua E Raizman
- CALIPER Program, Pediatric Laboratory Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Yunqi Chen
- CALIPER Program, Pediatric Laboratory Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Suzy L Wong
- Health Analysis Division, Statistics Canada, Ottawa, ON, Canada
| | - David Blais
- Health Statistics Division, Statistics Canada, Ottawa, ON, Canada
- Current affiliation: Section Head, Laboratory Services, Health Canada, Ottawa, ON, Canada
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Shin EH, Caterson EJ, Jackson WM, Nesti LJ. Quality of healing: defining, quantifying, and enhancing skeletal muscle healing. Wound Repair Regen 2015; 22 Suppl 1:18-24. [PMID: 24813360 DOI: 10.1111/wrr.12163] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 01/24/2014] [Indexed: 12/12/2022]
Abstract
Skeletal muscle injury is common in everyday physical activity and athletics, as well as in orthopedic trauma and disease. The overall functional disability resulting from muscle injury is directly related to the intrinsic healing properties of muscle and extrinsic treatment options designed to maximize repair and/or regeneration of muscle tissue all while minimizing pathologic healing pathways. It is important to understand the injury and repair pathways in order to improve the speed and quality of recovery. Recent military conflicts in Iraq and Afghanistan have highlighted the importance of successfully addressing muscular injury and showed the need for novel treatment options that will maximize functional regeneration of the damaged tissue. These severe, wartime injuries, when juxtaposed to peacetime, sports-related injuries, provide us with interesting case examples of the two extreme forms of muscular damage. Comparing and contrasting the differences in these healing pathways will likely provide helpful cues that will help physicians recapitulate the near complete repair and regeneration in less traumatic injuries in addition to more severe cases.
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Affiliation(s)
- Emily H Shin
- Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland; Clinical and Experimental Orthopaedics group, National Institutes of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland
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A systematic review of the prevalence of mildly abnormal liver function tests and associated health outcomes. Eur J Gastroenterol Hepatol 2015; 27:1-7. [PMID: 25380394 DOI: 10.1097/meg.0000000000000233] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Liver function tests (LFTs) are commonly performed to investigate asymptomatic individuals or those with nonspecific symptoms. Understanding the prevalence of mildly abnormal LFTs in the general population and the prevalence of liver disease following abnormal LFTs has important implications for the planning of care pathways and the provision of healthcare services. A systematic review of the literature on the prevalence of abnormal LFTs in the general population and their respective health outcomes was conducted. A total of 37 studies reporting data on the prevalence of abnormal LFTs (published between 2000 and 2014) were identified from online database searches or were manually selected from article bibliographies. The prevalence of mildly abnormal LFTs, with one or more abnormal constituents in the LFT, was high at 10-21.7%. The prevalence of severe liver disease within cohorts with abnormal LFTs is relatively low (<5%), and a large proportion of abnormal LFTs remains unexplained. Among individuals with unexplained abnormal LFTs, risk factors include obesity and insulin resistance. Common aetiologies for abnormal LFTs were non-alcohol-related fatty liver disease (NAFLD), followed by alcohol use and viral infections. In addition, normal LFTs do not rule out liver disease. The prevalence of abnormal LFTs depends on the definition and population but is likely to be between 10 and 20% in the general population. Abnormal LFTs are associated with a range of health outcomes but are not necessarily strongly diagnostic of severe liver pathology. Important areas of future research include further studies on the prevalence and predictive ability of LFTs in large, population-representative samples.
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Danielsson J, Kangastupa P, Laatikainen T, Aalto M, Niemelä O. Impacts of common factors of life style on serum liver enzymes. World J Gastroenterol 2014; 20:11743-11752. [PMID: 25206278 PMCID: PMC4155364 DOI: 10.3748/wjg.v20.i33.11743] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 05/19/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the impacts of gender, age and factors of life style (alcohol, overweight, coffee and smoking) on serum liver enzymes.
METHODS: Serum alanine aminotransferase (ALT) and gamma-glutamyltransferase (GGT) were measured from 6269 apparently healthy individuals (2851 men, 3418 women, mean age 45 ± 12 years, range 25-74 years) in a national cross-sectional health survey. All subjects underwent detailed clinical examinations and interviews including the amount and pattern of alcohol use, coffee consumption and smoking habits.
RESULTS: In this population with a mean ± SD alcohol consumption of 65 ± 105 g/wk and body mass index (BMI) of 26.1 ± 4.3 kg/m2, both ALT and GGT were significantly influenced by alcohol use (P < 0.001) and BMI (P < 0.001), whereas smoking increased only GGT (P < 0.001). A significant effect of age on ALT was seen in men (P < 0.001) whereas not in women. Significant two-factor interactions of alcohol use in men were observed with age (ALT: P < 0.01; GGT: P < 0.001) and BMI (GGT: P < 0.05). For ALT, a significant interaction also occurred between BMI and age (P < 0.005). In contrast, women showed significant interactions of alcohol use with BMI (GGT: P < 0.05), smoking (GGT: P < 0.001), and coffee consumption (GGT: P < 0.001).
CONCLUSION: Life-style associated changes in liver enzymes may reflect health risks, which should be considered in the definition of normal limits for liver enzymes.
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Koumakis E, Souberbielle JC, Payet J, Sarfati E, Borderie D, Kahan A, Cormier C. Individual site-specific bone mineral density gain in normocalcemic primary hyperparathyroidism. Osteoporos Int 2014; 25:1963-8. [PMID: 24676846 DOI: 10.1007/s00198-014-2689-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2013] [Accepted: 03/12/2014] [Indexed: 12/12/2022]
Abstract
UNLABELLED In this study, we show that successful parathyroidectomy is followed at 1 year by a significant individual bone mineral density (BMD) gain in nearly half of normocalcemic PHPT patients with reduced bone mass. Alkaline phosphatase levels above median were identified as an independent predictor of individual BMD gain in normocalcemic PHPT patients. INTRODUCTION The aims of this study were to assess bone mineral density (BMD) gains after parathyroidectomy (PTX) in normocalcemic primary hyperparathyroidism (PHPT) at the individual level and to identify predictors of BMD gain after PTX in this context. METHODS Longitudinal cohort study of 55 PHPT patients referred for low bone mass and mild abnormalities of calcium/phosphorus metabolism, and successfully treated by PTX. BMD gain at 1 year was considered significant if ≥0.030 g/cm(2) at one site or more, without any equivalent BMD loss at another site. A logistic regression analysis was performed to identify predictive factors of individual BMD gain. RESULTS Among the 55 PHPT patients included, 29 patients with hypercalcemia, 36 patients with normocalcemic PHPT, defined by normal pre-PTX serum total (albumin-corrected) calcium (tCa), including 15 patients with normal ionized calcium (iCa), were identified. At 1 year of PTX, an individual BMD gain was observed in 73.7 % of hypercalcemic, 44.4 % of normocalcemic, and 46 % of PHPT patients with both normal tCa and iCa. Site-specific BMD gains were most important at the spine and hip in all subgroups including patients with normal iCa. Alkaline phosphatase activity above median, which reflects high bone turnover, was predictive of individual BMD gain, both in the overall cohort (OR = 4.9, 95 % CI 1.3-18.9), and in the normocalcemic group: OR = 8.4, 95 % CI 1.4-56.6. CONCLUSIONS Successful PTX is followed at 1 year by a significant individual BMD gain in nearly half of normocalcemic PHPT patients with osteoporosis. ALP levels above median could contribute to the therapeutic decision in this context.
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Affiliation(s)
- E Koumakis
- Department of Rheumatology A, Cochin Hospital, APHP, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France,
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Yamamoto Y, Hosogaya S, Osawa S, Ichihara K, Onuma T, Saito A, Banba K, Araki H, Nagamine Y, Shinohara K, Okada G, Matsumoto H, Oguri T, Gonaikawa S, Iwagami M. Nationwide multicenter study aimed at the establishment of common reference intervals for standardized clinical laboratory tests in Japan. Clin Chem Lab Med 2014; 51:1663-72. [PMID: 23612542 DOI: 10.1515/cclm-2012-0413] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Accepted: 02/05/2013] [Indexed: 11/15/2022]
Abstract
BACKGROUND The Japanese Association of Medical Technologists (JAMT) sought to establish common reference intervals (RIs) applicable nationwide in Japan for 27 serum constituent analytes for which certified reference materials are available and nine analytes frequently measured in routine tests. More than 100 laboratories certified for metrological traceability collaborated in the recruitment, sampling, and measurement of analytes for the establishment of RIs. No previous attempt has been made to establish RIs by such a large number of laboratories. The allowable limits of trueness and intermediate precision based on the JAMT criteria were applied to the reference values measured by these laboratories, and measured values within the allowance limits were used to establish RIs. METHODS Reference individuals included 5748 healthy volunteers aged 18-65 years who were engaged in medical care-related work based on the CLSI guidelines. After secondary exclusion of individuals in whom abnormal values were detected in basic routine test items and adjustment for the distribution of age and gender, 3371 reference individuals were chosen in the parametric determination of RIs. Employing the three-level nested ANOVA, between-laboratory, -region, -sex, and -age variations were evaluated. RESULTS No significant difference was noted in between-region variations in any item. Results of ANOVA revealed between-sex and -age variations in 14 and 15 analytes, respectively. Based on these results of variation, RIs were established with and without partition by sex. CONCLUSIONS Since no between-region variation was detected in reference values among accuracy-certified core laboratories, RIs applicable nationwide were established.
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Affiliation(s)
- Yoshikazu Yamamoto
- Department of Clinical Laboratory Science, Tenri Health Care University Division, 80-1, Bessho, Tennri, Nara 632-0018, Japan.
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The genetic architecture of liver enzyme levels: GGT, ALT and AST. Behav Genet 2013; 43:329-39. [PMID: 23580007 DOI: 10.1007/s10519-013-9593-y] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Accepted: 04/04/2013] [Indexed: 12/20/2022]
Abstract
High levels of liver enzymes GGT, ALT and AST are predictive of disease and all-cause mortality and can reflect liver injury, fatty liver and/or oxidative stress. Variation in GGT, ALT and AST levels is heritable. Moderation of the heritability of these liver enzymes by age and sex has not often been explored, and it is not clear to what extent non-additive genetic and shared environmental factors may play a role. To examine the genetic architecture of GGT, ALT and AST, plasma levels were assessed in a large sample of twins, their siblings, parents and spouses (N = 8,371; age range 18-90). For GGT and ALT, but not for AST, genetic structural equation modeling showed evidence for quantitative sex differences in the genetic architecture. There was no evidence for qualitative sex differences, i.e. the same genes were expressed in males and females. Both additive and non-additive genetic factors were important for GGT in females (total heritability h(2) 60 %) and AST in both sexes (total h(2) 43 %). The heritability of GGT in males and ALT for both sexes was due to additive effects only (GGT males 30 %; ALT males 40 %, females 22 %). Evidence emerged for shared environmental factors influencing GGT in the male offspring generation (variance explained 28 %). Thus, the same genes influence liver enzyme levels across sex and age, but their relative contribution to the variation in GGT and ALT differs in males and females and for GGT across age. Given adequate sample sizes these results suggest that genome-wide association studies may result in the detection of new susceptibility loci for liver enzyme levels when pooling results over sex and age.
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Viitasalo A, Laaksonen DE, Lindi V, Eloranta AM, Jääskeläinen J, Tompuri T, Väisänen S, Lakka HM, Lakka TA. Clustering of Metabolic Risk Factors Is Associated with High-Normal Levels of Liver Enzymes Among 6- to 8-Year-Old Children: The PANIC Study. Metab Syndr Relat Disord 2012; 10:337-43. [DOI: 10.1089/met.2012.0015] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Affiliation(s)
- Anna Viitasalo
- Department of Physiology, Institute of Biomedicine, University of Eastern Finland, Kuopio Campus, Kuopio, Finland
| | - David E. Laaksonen
- Department of Physiology, Institute of Biomedicine, University of Eastern Finland, Kuopio Campus, Kuopio, Finland
- Department of Internal Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Virpi Lindi
- Department of Physiology, Institute of Biomedicine, University of Eastern Finland, Kuopio Campus, Kuopio, Finland
| | - Aino-Maija Eloranta
- Department of Physiology, Institute of Biomedicine, University of Eastern Finland, Kuopio Campus, Kuopio, Finland
- Department of Public Health, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | | | - Tuomo Tompuri
- Department of Physiology, Institute of Biomedicine, University of Eastern Finland, Kuopio Campus, Kuopio, Finland
- Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Sari Väisänen
- Department of Clinical Chemistry, Kuopio University Hospital, Kuopio, Finland
| | - Hanna-Maaria Lakka
- Department of Physiology, Institute of Biomedicine, University of Eastern Finland, Kuopio Campus, Kuopio, Finland
- Department of Public Health, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Timo A. Lakka
- Department of Physiology, Institute of Biomedicine, University of Eastern Finland, Kuopio Campus, Kuopio, Finland
- Kuopio Research Institute of Exercise Medicine, Kuopio, Finland
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Hu Y, Snitker S, Ryan KA, Yang R, Mitchell BD, Shuldiner AR, Zhu D, Gong DW. Serum alanine aminotransferase is correlated with hematocrit in healthy human subjects. Scandinavian Journal of Clinical and Laboratory Investigation 2012; 72:258-64. [PMID: 22486855 DOI: 10.3109/00365513.2012.660536] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Serum alanine aminotransferase (ALT) activity is a widely-used surrogate marker for liver injury. However, mild elevation of serum ALT is frequently observed in apparently healthy individuals, making it sometimes challenging to interpret whether this laboratory abnormality is medically benign or serious. To obtain a better understanding of the factors influencing ALT levels, we examined the relation between ALT and a number of anthropometric and biochemistry measurements in humans. METHODS We assessed the associations of ALT with hematocrit (HCT) in 1,200 apparently healthy adults from an Amish population. Multivariate analyses were carried out to determine whether observed associations were independent of other factors known to modulate ALT and HCT, including body mass index (BMI) and sex. The correlation detected in the Amish was then replicated in an independent population sample (N = 9,842) from the National Health and Nutrition Examination Survey (NHANES) III. RESULTS ALT levels were positively correlated with HCT (r = 0.33, p < 0.0001) in both Amish and NHANES III. The magnitude of association was unchanged after adjustment for BMI, but was reduced by age/sex adjustment to r = 0.18 (p < 0.0001) and r = 0.17 (p < 0.0001) in the Amish and NHANES populations, respectively. HCT accounts for about 3% of the population variation in ALT, which is smaller than the contributions of gender and BMI, but larger than individual blood pressure and cholesterol components. CONCLUSIONS We observed a correlation between ALT and HCT, suggesting that HCT may be a newly identified modulator of ALT in humans.
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Affiliation(s)
- Yun Hu
- Division of Endocrinology, Diabetes and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA
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Tynjälä J, Kangastupa P, Laatikainen T, Aalto M, Niemelä O. Effect of age and gender on the relationship between alcohol consumption and serum GGT: time to recalibrate goals for normal ranges. Alcohol Alcohol 2012; 47:558-62. [PMID: 22753786 DOI: 10.1093/alcalc/ags072] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
AIMS While serum gamma-glutamyltransferase (GGT) enzyme activity is a well established biomarker of excessive alcohol consumption and liver dysfunction, recent studies have also implicated it as a predictor of morbidity due to extrahepatic causes. Therefore, further information on the associations between ethanol intake and GGT activities in apparently healthy individuals appears warranted. METHODS Data on alcohol consumption and serum GGT activities were collected from 18,899 individuals (8807 men, 10,092 women), mean age 48 years and range 25-74 years, who participated in a national cross-sectional health survey. Alcohol use was assessed by detailed questionnaires and the study population was subsequently divided into subgroups according to age and gender. Body mass index and smoking were used as covariates in all analyses. RESULTS In men over 40 years, a reported regular consumption of 8 standard ethanol doses ('dose' = 12 g ethanol) or more per week was found to lead to a significant elevation in serum GGT activities, whereas those below 40 showed first significant changes not until the reported ethanol intake exceeded 14 doses per week. For women, the corresponding threshold levels were four and seven standard ethanol doses, respectively. CONCLUSION The data pertaining to the present population sample indicate that rather low levels of reported regular ethanol consumption lead to elevated levels of GGT and that age over 40 markedly enhances the impact of alcohol consumption on GGT activity. The present findings should form the basis for defining safe levels of ethanol consumption and in recalibrating goals for normal limits in the clinical use of GGT measurements.
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Affiliation(s)
- Joanna Tynjälä
- Department of Laboratory Medicine and Medical Research Unit, Seinäjoki Central Hospital, University of Tampere, Seinäjoki FIN-60220, Finland
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Variation of serum creatine kinase (CK) levels and prevalence of persistent hyperCKemia in a Norwegian normal population. The Tromsø Study. Neuromuscul Disord 2011; 21:494-500. [PMID: 21592795 DOI: 10.1016/j.nmd.2011.04.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Revised: 04/01/2011] [Accepted: 04/08/2011] [Indexed: 11/19/2022]
Abstract
In this cross-sectional study we assessed the prevalence of hyperCKemia, defined as persistent CK values ≥210 U/L in women, ≥400 U/L in men <50 years and ≥280 U/L in men ≥50 years (reference values according to the Nordic Reference Interval Project). Blood samples were obtained from 12,828 participants in the 6th survey of The Tromsø Study. We identified 686 (5.3%) individuals with incidentally elevated CK. After a standardized control test, 169 persons (1.3%) had persistent hyperCKemia, i.e. 69.9% normalization. Use of statins or other causes of hyperCKemia were detected in 78 individuals (46.2%), giving a prevalence of "idiopathic hyperCKemia" of 0.71%. CK variation was highest in younger men and in females between 60 and 69 years. This study has identified persistent hyperCKemia in 1.3% of the normal population, and demonstrates the importance of performing controlled CK analyses, also in those with identified risk factors.
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Madden MC, Byrnes WC, Lebin JA, Batliner ME, Allen DL. Plasma matrix metalloproteinase-9 response to eccentric exercise of the elbow flexors. Eur J Appl Physiol 2011; 111:1795-805. [DOI: 10.1007/s00421-010-1806-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2010] [Accepted: 12/23/2010] [Indexed: 12/31/2022]
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Ceriotti F, Henny J, Queraltó J, Ziyu S, Özarda Y, Chen B, Boyd JC, Panteghini M. Common reference intervals for aspartate aminotransferase (AST), alanine aminotransferase (ALT) and γ-glutamyl transferase (GGT) in serum: results from an IFCC multicenter study. Clin Chem Lab Med 2010; 48:1593-601. [PMID: 21034260 DOI: 10.1515/cclm.2010.315] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Aspartate aminotransferase (AST), alanine aminotransferase (ALT) and γ-glutamyl transferase (GGT) measurements are important for the assessment of liver damage. The aim of this study was to define the reference intervals (RIs) for these enzymes in adults, paying attention to standardization of the methods used and careful selection of the reference population. METHODS AST, ALT and GGT were measured with commercial analytical systems standardized to the IFCC-recommended reference measurement systems. Three centers (two in Italy and one in China) measured their own freshly collected samples; one of these centers also measured frozen samples from the Nordic Countries RI Project and from a Turkish center. RIs were generated using non-parametric techniques from the results of 765 individuals (411 females and 354 males, 18-85 years old) selected on the basis of the results of other laboratory tests and a specific questionnaire. RESULTS AST results from the four regions (Milan, Beijing, Bursa and Nordic Countries) were statistically different, but these differences were too small to be clinically relevant. Likewise, differences between the upper reference limits for genders was only 1.7 U/L (0.03 μkat/L), allowing a single RI of 11-34 U/L (0.18-0.57 μkat/L) to be defined. Interregional differences were not statistically significant for ALT, but partitioning was required due to significant gender differences. RIs for ALT were 8-41 U/L (0.13-0.68 μkat/L) for females and 9-59 U/L (0.15-0.99 μkat/L) for males, respectively. The upper reference limits for GGT from the Nordic Country population were higher than those from the other three regions and results from this group were excluded from final calculations. The GGT RIs were 6-40 U/L (0.11-0.66 μkat/L) for females and 12-68 U/L (0.20- 1.13 μkat/L) for males, respectively. CONCLUSIONS For AST and ALT, the implementation of common RIs appears to be possible, because no differences between regions were observed. However, a common RI for GGT that is applicable worldwide appears unlikely due to differences among populations.
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Affiliation(s)
- Ferruccio Ceriotti
- Diagnostica e Ricerca S. Raffaele, Istituto Scientifico Universitario S. Raffaele, Milano, Italy.
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Machado CN, Gevaerd MDS, Goldfeder RT, Carvalho TD. Efeito do exercício nas concentrações séricas de creatina cinase em triatletas de ultradistância. REV BRAS MED ESPORTE 2010. [DOI: 10.1590/s1517-86922010000500012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
O triatlo é um esporte de destaque e ampla participação mundial. Incorpora três diferentes modalidades de endurance - natação, ciclismo e corrida - dentro de um único evento. Há uma variedade de distâncias sobre as quais os eventos de triatlo são realizados, sendo a prova de ultradistância (ironman) a mais extensa. Autores diversos já relataram a ocorrência de lesões após esforço intenso, seja diretamente, através de alterações histológicas no sarcômero, ou indiretamente, pela quantificação da concentração de proteínas musculares específicas (biomarcadoras de lesão) no plasma. Entre esses marcadores de lesão muscular destacam-se a mioglobina e a creatina cinase. Efetivamente, a creatina cinase é o indicador bioquímico mais utilizado na literatura como indicador da ocorrência de lesão muscular. Dentro desse contexto justifica-se o objetivo do presente trabalho que visa verificar o efeito do exercício nas concentrações séricas de creatina cinase em triatletas de ultradistância frente a um período de competição. Para tanto, foram avaliados os dados das concentrações séricas de CK de 10 atletas que participaram da prova do Ironman Brasil de 2007. As análises sanguíneas foram realizadas em cinco períodos distintos: 19 dias antes da prova do ironman (CK1), 48 horas antes da prova (CK2), imediatamente após (CK3), cinco dias após (CK4) e 12 dias depois da prova (CK5). Os resultados apontaram aumento significativo nas concentrações de CK nos períodos 3 e 4 em relação aos demais períodos avaliados. Estas alterações evidenciam a influência do exercício exaustivo sobre as concentrações de CK, revelando a possibilidade de desenvolvimento de lesões musculares durante essa competição. Este fato reforça a importância do monitoramento de biomarcadores, como a CK, que permite a treinadores e atletas ajustarem suas cargas de treinamento para aumentar os benefícios do treinamento e para evitar o supertreinamento, melhorando o desempenho, a saúde e a qualidade de vida do atleta.
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Alatalo P, Koivisto H, Kultti J, Bloigu R, Niemelä O. Evaluation of reference intervals for biomarkers sensitive to alcohol consumption, excess body weight and oxidative stress. Scandinavian Journal of Clinical and Laboratory Investigation 2010; 70:104-11. [PMID: 20073674 DOI: 10.3109/00365510903548818] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Unexplained liver enzyme activities are often found in health screening programs and constitute an increasingly common cause for referral to specialized clinics. Recent studies have indicated that both excess body weight and alcohol consumption may lead to metabolic aberrations which are readily reflected in the activities of liver enzymes in circulation. MATERIALS AND METHODS We compared various laboratory markers and their upper normal limits in relation to information on alcohol consumption and BMI in a large population of apparently healthy individuals collected from Nordic countries. RESULTS Based on the data obtained from normal weight abstainers (BMI 19-25 kg/m(2)) the upper normal limits in men should be 50 U/L for ALT, and 45 U/L (<40 years) and 70 U/L (>or=40 years) for GGT, while the current recommendations are 70 U/L, 80 U/L, and 115 U/L, respectively. Already in comparisons between normal weight abstainers and corresponding moderate drinkers notable impacts (+14% - +74%) on upper limits for these analytes were seen, which further grew when adiposity occurred together with alcohol drinking (+75% - +186%, BMI >or=27 kg/m(2)). In addition to liver enzymes, similar changes were also found for uric acid. CONCLUSIONS Alcohol consumption and excess body weight even in apparently healthy individuals have a significant influence on liver enzyme activities, which may be due to a cumulative oxidative stress burden. The metabolic changes induced by adiposity or ethanol intake should be considered in the definition of normal ranges for all laboratory parameters sensitive to oxidative stress.
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Affiliation(s)
- Päivikki Alatalo
- Department of Laboratory Medicine and Medical Research Unit, Seinäjoki Central Hospital, Seinäjoki, Finland.
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Geffré A, Friedrichs K, Harr K, Concordet D, Trumel C, Braun JP. Reference values: a review. Vet Clin Pathol 2009; 38:288-98. [DOI: 10.1111/j.1939-165x.2009.00179.x] [Citation(s) in RCA: 230] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Reexamining transaminase elevation in Phase I clinical trials: the importance of baseline and change from baseline. Eur J Clin Pharmacol 2009; 65:1025-35. [PMID: 19554320 DOI: 10.1007/s00228-009-0684-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2009] [Revised: 06/05/2009] [Accepted: 06/05/2009] [Indexed: 01/14/2023]
Abstract
PURPOSE The aims of the present analysis were to determine prevalence of transaminase elevation in placebo-treated healthy volunteers in our historical phase I clinical trials and to assess which factors were associated with it. METHODS We performed a retrospective analysis of alanine transaminase (ALT) levels in 481 placebo-treated healthy volunteers from 20 phase I trials by examining ALT elevation rates using the upper limit of normal values (ULN) as the cutoff as well as changes from baseline in actual ALT values. RESULTS The ULN for ALT ranged from 32 to 72 IU/L across the studies. Although the overall ALT elevation rate (4.4%) from pooled datasets was low, the elevation rates were higher in more recent studies than in earlier ones. While elevation rates at baseline and during placebo treatment did not differ significantly, ALT maximal levels during placebo treatment were significantly higher than baseline levels. Moreover, baseline ALT levels were found to be more important in predicting ALT elevation during placebo treatment than demographic and study design factors. CONCLUSION Baseline level and changes from baseline in transaminase are important variables to examine in addition to elevation above ULN for more reliably interpreting liver signals in Phase I clinical trials.
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Heiduk M, Päge I, Kliem C, Abicht K, Klein G. Pediatric reference intervals determined in ambulatory and hospitalized children and juveniles. Clin Chim Acta 2009; 406:156-61. [PMID: 19549511 DOI: 10.1016/j.cca.2009.06.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2009] [Revised: 05/15/2009] [Accepted: 06/05/2009] [Indexed: 01/20/2023]
Abstract
OBJECTIVES The aim of this study was to determine reference intervals in children and juveniles with nine recently developed and widely used laboratory methods. METHODS More than 800 ambulatory and hospitalized individuals of the University pediatry were carefully selected according to clinical status and chemical profile in an a posteriori process over a period of two and a half years. The reference group with well-balanced gender proportions and steady age distribution between 1 day and 17 years was subdivided in five age classes. The laboratory methods were: the enzyme methods ALT, AST, LDH and GGT, all reliably reference standardized with traceability to the IFCC reference methods at 37 degrees C; ALT and AST without pyridoxal-phosphate activation; ALP as not yet approved IFCC method; the soluble transferrin receptor (sTfR) and ferritin, the latter being the only heterogeneous procedure. RESULTS The results confirm in most cases the typical age concentration relationship of the measured quantities documented for similar methods. In some critical cases, in particular for sTfR and ferritin, the study produces limits which differ distinctly from those earlier reported. Gender differentiation was outlined according to statistical calculations. CONCLUSION Proposals for reference intervals were derived from the central 95 percentile values.
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Affiliation(s)
- Matthias Heiduk
- University Hospital Magdeburg, Children's Hospital, Magdeburg, Germany
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Manesis EK. Values for upper limit of normal should be given for liver enzymes. Hepatology 2009; 49:1783-4; author reply 1784. [PMID: 19402113 DOI: 10.1002/hep.22788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
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Malati T. Whether western normative laboratory values used for clinical diagnosis are applicable to Indian population? An overview on reference interval. Indian J Clin Biochem 2009; 24:111-22. [PMID: 23105819 PMCID: PMC3453230 DOI: 10.1007/s12291-009-0022-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Reference Intervals denote normative values related to laboratory parameters/analytes used by diagnostic centers for clinical diagnosis. International guidelines recommend that every country must establish reference intervals for healthy individuals belonging to a group of homogeneous population. Considering enormous racial and ethnic diversity of Indian population, it is mandatory to establish reference intervals specific to Indian population. The overview on reference interval describes why the national organizations in India need to initiate nationwide efforts to establish its own laboratory standards for apparently healthy reference individuals belonging to our polygenetic, polyethnic, polyracial, multilinguistic and multicultural predominantly rural and appreciable urban Indian population with varied dietary habits.
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Affiliation(s)
- T. Malati
- Department of Biochemistry, Nizam’s Institute of Medical Sciences, Punjagutta, Hyderabad, 500 082 Andhra Pradesh
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Kechagias S, Ernersson Å, Dahlqvist O, Lundberg P, Lindström T, Nystrom FH. Fast-food-based hyper-alimentation can induce rapid and profound elevation of serum alanine aminotransferase in healthy subjects. Gut 2008; 57:649-54. [PMID: 18276725 PMCID: PMC2565580 DOI: 10.1136/gut.2007.131797] [Citation(s) in RCA: 130] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To study the effect of fast-food-based hyper-alimentation on liver enzymes and hepatic triglyceride content (HTGC). DESIGN Prospective interventional study with parallel control group. SETTING University Hospital of Linköping, Sweden. PARTICIPANTS 12 healthy men and six healthy women with a mean (SD) age of 26 (6.6) years and a matched control group. INTERVENTION Subjects in the intervention group aimed for a body weight increase of 5-15% by eating at least two fast-food-based meals a day with the goal to double the regular caloric intake in combination with adoption of a sedentary lifestyle for 4 weeks. MAIN OUTCOME MEASURES Weekly changes of serum aminotransferases and HTGC measured by proton nuclear magnetic resonance spectroscopy at baseline and after the intervention. RESULTS Subjects in the intervention group increased from 67.6 (9.1) kg to 74.0 (11) kg in weight (p<0.001). Serum ALT increased from 22.1 (11.4) U/l at study start to an individual mean maximum level of 97 (103) U/l (range 19.4-447 U/l). Eleven of the 18 subjects persistently showed ALT above reference limits (women >19 U/l, men >30 U/l) during the intervention. Sugar (mono- and disaccharides) intake during week 3 correlated with the maximal ALT/baseline ALT ratio (r = 0.62, p = 0.006). HTGC increased from 1.1 (1.9)% to 2.8 (4.8)%, although this was not related to the increase in ALT levels. ALT levels were unchanged in controls. CONCLUSION Hyper-alimentation per se can induce profound ALT elevations in less than 4 weeks. Our study clearly shows that in the evaluation of subjects with elevated ALT the medical history should include not only questions about alcohol intake but also explore whether recent excessive food intake has occurred.
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Affiliation(s)
- S Kechagias
- Division of Internal Medicine, Department of Medicine and Care, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Å Ernersson
- Division of Internal Medicine, Department of Medicine and Care, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - O Dahlqvist
- Division of Radiation Physics and Radiology, Center for Medical Image Science and Visualization, Department of Medicine and Care, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - P Lundberg
- Division of Internal Medicine, Department of Medicine and Care, Faculty of Health Sciences, Linköping University, Linköping, Sweden,Division of Radiation Physics and Radiology, Center for Medical Image Science and Visualization, Department of Medicine and Care, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - T Lindström
- Division of Internal Medicine, Department of Medicine and Care, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - F H Nystrom
- Division of Internal Medicine, Department of Medicine and Care, Faculty of Health Sciences, Linköping University, Linköping, Sweden,Diabetes Research Centre. Linköping University, Linköping, Sweden
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Lazarim FL, Antunes-Neto JMF, da Silva FOC, Nunes LAS, Bassini-Cameron A, Cameron LC, Alves AA, Brenzikofer R, de Macedo DV. The upper values of plasma creatine kinase of professional soccer players during the Brazilian National Championship. J Sci Med Sport 2008; 12:85-90. [PMID: 18069060 DOI: 10.1016/j.jsams.2007.10.004] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2007] [Revised: 09/19/2007] [Accepted: 10/18/2007] [Indexed: 11/17/2022]
Abstract
The current schedule of the Brazilian Soccer Championship may not give players enough recovery time between games. This could increase the chances of muscle damage and impaired performance. We hypothesized that plasma creatine kinase (CK) activity could be a reliable indirect marker of muscle overload in soccer players, so we sought to identify the reference values for upper limits of CK activity during a real-life elite competition. This study analyzed changes in plasma CK activity in 128 professional soccer players at different times during the Brazilian Championship. The upper limits of the 97.5th and 90th percentiles determined for CK activity were 1.338U/L and 975U/L, respectively, markedly higher than values previously reported in the literature. We also evaluated a team monthly throughout the Championship. The upper limit of the 90th percentile, 975U/L, was taken as the decision limit. Six players showing plasma CK values higher than this were asked to decrease their training for 1 week. These players presented lower CK values afterwards. Only one player with a CK value higher than the decision limit (1800U/L 1 day before a game) played on the field and was unfortunately injured during the game. The CK activity in all the other players showed a significant decrease over the course of the Championship, and the values became more homogeneous at the end. The results presented here suggest that plasma CK upper limit values can be used as a practical alternative for early detection of muscle overload in competing soccer players.
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Ichihara K, Itoh Y, Lam CWK, Poon PMK, Kim JH, Kyono H, Chandrawening N, Muliaty D. Sources of Variation of Commonly Measured Serum Analytes in 6 Asian Cities and Consideration of Common Reference Intervals. Clin Chem 2008; 54:356-65. [DOI: 10.1373/clinchem.2007.091843] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Background: In a previous study to determine the feasibility of common reference intervals in Asia, we found significant differences among populations from 6 cities. In this study, we attempted to define the sources of these differences.
Methods: We enrolled 580 healthy volunteers (279 men, 301 women, 20–62 years old), after a selection process that was based on the Clinical and Laboratory Standards Institute guidelines, and used a lifestyle questionnaire. All sera were obtained at a basal state and frozen at −80 °C until the collective assay was done. We measured 21 basic chemical analytes and 10 serum proteins.
Results: We used 3-level nested ANOVA to separate the variation (SD) into between-city (SD-city), between-sex (SD-sex), between-age (SD-age), and between-individual (SD-indiv) components. SD-indiv corresponds to one-quarter of the “pure” reference interval obtained after removing variations due to city, sex, and age. The SD-sex to SD-indiv ratio was >0.8 for creatinine, urate, retinol-binding protein, and transthyretin. We observed high SD-city to SD-indiv ratios, ranging from 0.4 to 0.7, for 11 analytes including lactate dehydrogenase (LDH), electrolytes, IgG, and complement components and SD-age to SD-indiv ratios >0.4 for LDH, alkaline phosphatase, and total cholesterol. Multiple regression analysis demonstrated several other relevant sources of variation, including body mass index, alcohol consumption, and cigarette smoking, although their contributions were generally smaller than those for sex, region, or age.
Conclusion: We observed unacceptably large regional differences in measured values of some analytes even after adjustment for age, sex, and lifestyle variables. Genetic and environmental factors may account for the residual differences.
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Affiliation(s)
| | - Yoshihisa Itoh
- Department of Laboratory Medicine, Asahikawa Medical College, Asahikawa, Japan
| | - Christopher W K Lam
- Department of Chemical Pathology, Chinese University of Hong Kong, Hong Kong
| | - Priscilla M K Poon
- Department of Chemical Pathology, Chinese University of Hong Kong, Hong Kong
| | - Jeong-Ho Kim
- Department of Laboratory Medicine, Yonsei University, Seoul, Korea
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Brancaccio P, Maffulli N, Buonauro R, Limongelli FM. Serum Enzyme Monitoring in Sports Medicine. Clin Sports Med 2008; 27:1-18, vii. [DOI: 10.1016/j.csm.2007.09.005] [Citation(s) in RCA: 126] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Puukka K, Hietala J, Koivisto H, Anttila P, Bloigu R, Niemelä O. Obesity and the clinical use of serum GGT activity as a marker of heavy drinking. Scandinavian Journal of Clinical and Laboratory Investigation 2007; 67:480-8. [PMID: 17763184 DOI: 10.1080/00365510601146035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
OBJECTIVE Gamma-glutamyl transferase (GGT) is a widely used clinical marker of alcohol abuse. However, although obesity may also elevate serum GGT activities, the effects of overweight on the interpretation of GGT testing have remained poorly defined. MATERIAL AND METHODS GGT activities from 1147 moderate drinkers and 449 abstainers who were classified according to body mass index (BMI) were compared with those of 208 heavy drinkers admitted for detoxification. RESULTS GGT upper normal limits, defined based on normal weight abstainers (men 53 U/L; women 45 U/L) were lower than those based on moderate drinkers (men 68 U/L; women 50 U/L). The relative increases in GGT activities in male moderate drinkers with overweight (54%) or obesity (125%) exceeded the corresponding changes found in women (25% and 75%, respectively). The BMI-dependent variation on the sensitivity of GGT for correctly classifying heavy drinkers ranged from 29% to 67%. The rates of false-positive values in the subgroups from low to high BMI varied from 0% to 27%, respectively. CONCLUSIONS The data indicate that the diagnostic value of serum GGT testing could be improved by using reference data derived from databases of abstainers with normal weight or BMI-based categorization of reference ranges.
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Affiliation(s)
- K Puukka
- Department of Laboratory Medicine and Medical Research Unit, Seinäjoki Central Hospital, Seinäjoki, Finland
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Abstract
BACKGROUND The serum concentration of creatine kinase (CK) is used widely as an index of skeletal muscle fibre damage in sport and exercise. Since athletes have higher CK values than non-athletes, comparing the values of athletes to the normal values established in non-athletes is pointless. The purpose of this study was to introduce reference intervals for CK in athletes. METHOD CK was assayed in serum samples from 483 male athletes and 245 female athletes, aged 7-44. Samples had been obtained throughout the training and competition period. For comparison, CK was also assayed in a smaller number of non-athletes. Reference intervals (2.5th to 97.5th percentile) were calculated by the non-parametric method. RESULTS The reference intervals were 82-1083 U/L (37 degrees C) in male and 47-513 U/L in female athletes. The upper reference limits were twice the limits reported for moderately active non-athletes in the literature or calculated in the non-athletes in this study. The upper limits were up to six times higher than the limits reported for inactive individuals in the literature. When reference intervals were calculated specifically in male football (soccer) players and swimmers, a threefold difference in the upper reference limit was found (1492 vs 523 U/L, respectively), probably resulting from the different training and competition demands of the two sports. CONCLUSION Sport training and competition have profound effects on the reference intervals for serum CK. Introducing sport-specific reference intervals may help to avoid misinterpretation of high values and to optimise training.
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Steinmetz J, Schiele F, Gueguen R, Férard G, Henny J. Standardization of γ-glutamyltransferase assays by intermethod calibration. Effect on determining common reference limits. ACTA ACUST UNITED AC 2007; 45:1373-80. [DOI: 10.1515/cclm.2007.290] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AbstractClin Chem Lab Med 2007;45:1373–80.
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49
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Niemelä O. Biomarkers in alcoholism. Clin Chim Acta 2006; 377:39-49. [PMID: 17045579 DOI: 10.1016/j.cca.2006.08.035] [Citation(s) in RCA: 162] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2006] [Revised: 08/28/2006] [Accepted: 08/30/2006] [Indexed: 12/18/2022]
Abstract
Alcoholism ranks as one of the main current threats to the health and safety of people in most Western countries. Therefore, a high priority should be given to aims at reducing its prevalence through more effective diagnosis and early intervention. The need for objective methods for revealing alcohol abuse in its early phase has also been widely acknowledged. It is postulated here that the diagnosis of alcohol use disorders could be markedly improved by a more systematic use of specific questionnaires and laboratory tests, including blood ethanol, serum gamma-glutamyltransferase (GGT), carbohydrate-deficient transferrin (CDT), and mean corpuscular volume of erythrocytes (MCV). Recent research has provided new insights into the relationships between ethanol intake, biomarkers, and factors affecting their diagnostic validation, including gender, age, and the effects of moderate drinking and obesity. It appears that the concept of reference intervals for several ethanol-sensitive parameters in laboratory medicine needs to be revisited. CDT is currently the most specific marker of alcohol abuse, and when combined with GGT using a mathematically formulated equation a high sensitivity is reached without loss of assay specificity. Possible new biomarkers include minor ethanol metabolites (protein-acetaldehyde condensates and associated autoimmune responses, ethylglucuronide, and phosphatidylethanolamine), 5-hydroxytryptophol, and genetic markers although so far their routine applications have been limited.
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Affiliation(s)
- Onni Niemelä
- Department of Laboratory Medicine and Medical Research Unit, Seinäjoki Central Hospital and University of Tampere, FIN-60220 Seinäjoki, Finland.
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Puukka K, Hietala J, Koivisto H, Anttila P, Bloigu R, Niemelä O. Age-related changes on serum ggt activity and the assessment of ethanol intake. Alcohol Alcohol 2006; 41:522-7. [PMID: 16855003 DOI: 10.1093/alcalc/agl052] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
AIMS Gamma-glutamyl transferase (GGT) is a commonly used marker of ethanol abuse. However, although increasing age has also been suggested to elevate serum GGT activities, the magnitude of such effects on GGT in the assessment of ethanol intake have remained poorly defined. METHODS GGT activities from 208 heavy drinkers were compared with those from a reference population including 1330 moderate drinkers and 1160 abstainers, who were further classified to following age intervals: 18-30, 30-50, 50-70, and >70 years. RESULTS GGT activities increased with increasing age until after 70 years decreasing values were noted in male abstainers. The heavy drinkers belonging to age groups 18-30, 30-50, and 50-70 years showed 2.7-, 8.0-, and 6.9-fold higher mean GGT activities than those in the corresponding groups of abstainers, respectively. The values in the group of moderate drinkers also exceeded those of abstainers in all age groups of men, whereas in women the difference was significant only among those aged 18-30 years. CONCLUSIONS The data indicate that GGT activities respond to ethanol intake in an age-dependent manner, which should be considered in the clinical use of GGT measurements for detecting alcohol use disorders.
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Affiliation(s)
- Katri Puukka
- Seinäjoki Central Hospital, Laboratory, FIN-60220 Seinäjoki, Finland
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