ArticlePloS one2020
Association between alanine aminotransferase within the normal range and all-cause and cause-specific mortality: A nationwide cohort study.
Article in PloS one, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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Who cites it
6 citing papers in PubMed, 8 citations in OpenAlex.
- Interaction Between Photoperiod and Sex on Hepatic Lipid Homeostasis in Rats Fed an Obesogenic Diet.FASEB journal : official publication of the Federation of American Societies for Experimental Biology · 2025Article
- An Update on the Role of Alanine Aminotransferase in the Detection of Chronic Liver Diseases Relevant to Primary Care.Oman medical journal · 2025Review
- Article
- Association between alanine aminotransferase and all-cause mortality rate: Findings from a study on Japanese community-dwelling individuals.Journal of clinical laboratory analysis · 2022Article
- High Aspartate Aminotransferase/Alanine Aminotransferase Ratio May Be Associated with All-Cause Mortality in the Elderly: A Retrospective Cohort Study Using Artificial Intelligence and Conventional Analysis.Healthcare (Basel, Switzerland) · 2022Article
- Serum alanine aminotransferase activity and risk factors for cardiovascular disease in a Caucasian population: the Tromsø study.BMC cardiovascular disorders · 2021Article
Corrections and comments
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Authors and funding
4 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
BACKGROUND AND
aimWe sought to determine the association between alanine aminotransferase (ALT) in the normal range and mortality in the absence of liver dysfunction to better understand ALT's clinical significance beyond liver injury and inflammation.
methodsA cohort of 2,708 male and 3,461 female adults aged 20-75 years without liver dysfunction (ALT<30 in males & <19 in females, negative viral serologies, negative ultrasound-based steatosis, no excess alcohol consumption) from the National Health and Nutrition Examination Survey (NHANES)-III (1988-1994) were linked to the National Death Index through December 31, 2015. Serum ALT levels were categorized into sex-specific quartiles (Females: <9, 9-11, 11-14, ≥14 IU/L, Male: <12, 12-15, 15-20, ≥20 U/L). The primary outcome was all-cause mortality. Hazard ratios (HRs) were estimated, adjusting for covariates and accounting for the complex survey design.
resultsRelative to males in the lowest quartile (Q1), males in the highest quartile (Q4) had 44% decreased risk of all-cause mortality (aHR [95% CI]: 0.56 [0.42, 0.74]). Females in Q4 had 45% decreased risk of all-cause mortality (aHR [95% CI]: 0.55 [0.40, 0.77]). Males with BMI <25 kg/m2 in Q4 had significantly lower risk of all-cause mortality than Q1; however, this association did not exist in males with BMI ≥25 (BMI<25: 0.36 [0.20, 0.64], BMI≥25: 0.77 [0.49, 1.22]). Risk of all-cause mortality was lower in males ≥50 years than in males<50 (age≥50: 0.55 [0.39, 0.77], age<50: 0.81 [0.39, 1.69]). These age- and BMI-related differences were not seen in females.
conclusionALT within the normal range was inversely associated with all-cause mortality in U.S. adults.
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