Copyright
©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Jun 27, 2023; 15(6): 813-825
Published online Jun 27, 2023. doi: 10.4254/wjh.v15.i6.813
Published online Jun 27, 2023. doi: 10.4254/wjh.v15.i6.813
Lower alanine aminotransferase levels are associated with increased all-cause and cardiovascular mortality in nonalcoholic fatty liver patients
Jia-Rui Zheng, Zi-Long Wang, Su-Zhen Jiang, Hong-Song Chen, Bo Feng, Peking University Hepatology Institute, Peking University People's Hospital, Beijing 100044, China
Author contributions: Feng B designed the study; Zheng JR and Wang ZL contributed to the acquisition, analysis and interpretation of data and drafted the manuscript; Jiang SZ contributed to the critical revision of the manuscript for important intellectual content and Chen HS contributed to the study supervision; all authors have made a significant contribution to this study and have approved the final manuscript.
Institutional review board statement: The NHANES protocol was approved by the Ethics Review Committee of the National Center for Health Statistics, which obtained informed consent from all subjects.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: The authors have declared no conflict of interest.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Bo Feng, MD, PhD, Chief Doctor, Professor, Research Fellow, Peking University Hepatology Institute, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing 100044, China. fengbo@pkuph.edu.cn
Received: October 19, 2022
Peer-review started: October 19, 2022
First decision: March 15, 2023
Revised: March 22, 2023
Accepted: May 16, 2023
Article in press: May 16, 2023
Published online: June 27, 2023
Peer-review started: October 19, 2022
First decision: March 15, 2023
Revised: March 22, 2023
Accepted: May 16, 2023
Article in press: May 16, 2023
Published online: June 27, 2023
Core Tip
Core Tip: The risk of nonalcoholic fatty liver disease (NAFLD) was positively correlated with alanine aminotransferase (ALT) level, but all-cause and cardiovascular mortality were the highest when ALT < 0.5 upper limits of normal. Regardless of the severity of NAFLD, normal or lower ALT levels are associated with higher mortality than elevated ALT levels. Clinicians should be aware of not only high ALT, indicating liver injury, but also low ALT associated with higher risk of death.