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World J Gastroenterol. May 14, 2008; 14(18): 2867-2871
Published online May 14, 2008. doi: 10.3748/wjg.14.2867
Persistent alanine aminotransferase elevation among the general Iranian population: Prevalence and causes
Raika Jamali, Mahmoodreza Khonsari, Shahin Merat, Masoud Khoshnia, Elham Jafari, Alireza Bahram Kalhori, Hassan Abolghasemi, Sedighe Amini, Mahtab Maghsoudlu, Mohammad Reza Deyhim, Houri Rezvan, Akram Pourshams
Raika Jamali, Masoud Khoshnia, Shahin Merat, Elham Jafari, Akram Pourshams, Digestive Disease Research Center, Shariati Hospital, Medical Sciences/University of Tehran, Tehran 14117, Iran
Mahmoodreza Khonsari, Department of Internal Medicine Hamadan, Hamadan University of Medical Sciences, Iran
Alireza Bahram Kalhori, Department of Radiology Gonbad, Social Insurance Organization Khatam Hospital, Golestan, Iran
Hassan Abolghasemi, Sedighe Amini, Mahtab Maghsoudlu, Mohammad Reza Deyhim, Houri Rezvan, Iranian Blood Transfusion Research Center, Tehran 14117, Iran
Author contributions: Pourshams A designed the research; Merat S, Jamali R, Khoshnia M, Jafari E and Khonsari M performed the research and wrote the paper; Bahram Kalhori A, Abolghasemi H, Amini S, Maghsoudlu M, Deyhim MR and Rezvan H analyzed the data.
Correspondence to: Dr. Akram Pourshams, Digestive Disease Research Center, Medical Sciences/University of Tehran, Shariati Hospital, North Kargar Avenue, Tehran 14117, Iran. purshams@ams.ac.ir
Telephone: +98-21-2415140
Fax: +98-21-2415400
Received: September 28, 2007
Revised: February 20, 2008
Published online: May 14, 2008
Abstract

AIM: To determine the prevalence and causes of persistently elevated alanine aminotransferase (ALT) levels among the general population in northern Iran.

METHODS: A total of 2292 (1376 female, aged 18-75 year), were selected by systematic clustered random sampling from the cities and villages of Gonbad and Kalaleh in Golestan Province and invited to participate in the study. A comprehensive history regarding alcohol drinking and medication was taken. Body mass index (BMI), viral markers and ALT levels were measured. If ALT level was ≥ 40 U/L, it was rechecked twice within 6 mo. Those with ≥ 2 times elevation of ALT were considered as having persistently elevated ALT level. Non-alcoholic fatty liver disease (NAFLD) was diagnosed based on evidence of fatty liver upon sonography and excluding other etiology.

RESULTS: A total of 2049 (1351 female) patients participated in the study, 162 (7.9%) had elevated ALT level at the first measurement. Persistently elevated ALT level was detected in 64 (3.1%) participants, with 51 (79.6%) with no obvious etiology, six (9.3%) with Hepatitis B, four (6.2%) with Hepatitis C virus (HCV) infection and three (4.6%) with alcoholic hepatitis. The prevalence of NAFLD and alcoholic hepatitis was 2.04% (42 patients) and 0.1% (three), respectively. There was correlation between NAFLD and male gender, overweight, diabetes and living in an urban area [odds ratio = 3.03 (95% CI: 1.6-5.72), 4.21 (95% CI: 1.83-9.68), 2.86 (95% CI: 1.05-7.79) and 2.04 (95% CI: 1.00-4.16) respectively].

CONCLUSION: NAFLD is the most common cause of persistently elevated serum ALT level among the general population of Iran.

Keywords: Alanine aminotransferase; Iran; Non-alcoholic fatty liver disease; Viral hepatitis