Abstract 4137: Long-term Elevation of Liver Enzymes is Associated with Increased Cardio-metabolic Risk in Young Adults: The Bogalusa Heart Study
Background Recent evidence suggests important clinical implications of liver enzymes related to cardio-metabolic risk. The present study examines persistent elevation of liver enzymes and its influence on cardio-metabolic risk factors in young adults.
Methods A longitudinal cohort of 489 subjects (40% male, 73% white, baseline age: 17–32 years) was followed up for 12 years in a biracial (black-white) community-based population study with repeat observations of cardio-metabolic risk factors and liver enzymes.
Results At baseline and follow-up, γ-glutamyl transferase (GGT) showed significant race (black>white, p<0.0001) and gender (male>female, p<0.0001) differences while alanine aminotransferase (ALT) showed significant gender, but not race, difference (male>female, p<0.0001). Of those individuals who had elevated (>age-, race-, sex-specific 80th percentile) levels of liver enzymes at baseline, more than 45% for ALT and 50% for GGT continued to have elevated levels after 12 years. Compared with subjects with levels of ALT and GGT persistently in the lowest quintile, those with levels persistently in highest quintile showed higher (p<0.0001) levels of body mass index, waist circumference, triglycerides, LDL cholesterol, insulin, glucose, HOMA-IR, systolic and diastolic blood pressure and lower (p<0.0001) levels of HDL cholesterol. Individuals with persistently elevated enzyme level versus those with persistently lower enzyme level had significantly increased prevalence of obesity, hypertension, dyslipidemia, metabolic syndrome, and also had higher prevalence of parental history of diabetes and heart diseases. In addition, significant (p<0.05) clustering of two or more risk factors of metabolic syndrome defined by the National Cholesterol Education Program ATP III occurred in subjects with persistent elevation of both ALT and GGT. Further, in multivariate analysis using two separate models for baseline ALT and baseline GGT, both enzymes at baseline were predictive of insulin resistance index at follow-up.
Conclusion Adverse levels of liver enzymes persist over time and relate to clinically relevant adverse cardio-metabolic risk profile in young adults.