Detailed Distribution of Liver Enzymes according to Gender, Age, and Body Mass Index in Health Checkup Subjects

Seung Ho Choi; Jong In Yang; Changhyun Lee; Hee Jin Byun; Jung Mook Kang; Se Young Kim; Jeong Yoon Yim

doi:10.4166/kjg.2014.64.4.213

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Choi, Yang, Lee, Byun, Kang, Kim, and Yim: Detailed Distribution of Liver Enzymes according to Gender, Age, and Body Mass Index in Health Checkup Subjects

Original Article

Korean J Gastroenterol 2014;64(4):213-223.

Published online: 4 October 2014

DOI: https://doi.org/10.4166/kjg.2014.64.4.213

Detailed Distribution of Liver Enzymes according to Gender, Age, and Body Mass Index in Health Checkup Subjects

Seung Ho Choi, Jong In Yang, Changhyun Lee, Hee Jin Byun, Jung Mook Kang, Se Young Kim¹, Jeong Yoon Yim

Department of Internal Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea

¹Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea

Correspondence to: Jong In Yang, Department of Internal Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, 152 Teheran-ro, Gangnam-gu, Seoul 135-984, Korea. Tel: +82-2-2112-5646, Fax: +82-2-2112-5794, E-mail: dr1004@snu.ac.kr

Received 3 March 20147 July 2014 Accepted 7 July 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background/Aims

The aim of this study was to examine the distribution of range of liver enzymes according to age and BMI in each gender using large-scale data.

Methods

Data were gathered from 65,715 subjects who underwent a routine health checkup and did not have HBsAg and anti-HCV. Boxplot analysis was used to examine the distribution of range of liver enzymes according to age and BMI in each gender. Multivariate linear regression analysis was performed for assessment of the association of liver enzymes with age and BMI, and to determine whether the range of liver enzymes was affected by risk factors for metabolic syndrome in each gender.

Results

ALT, AST, and GGT levels showed significant association with BMI in both male and female after adjusting for age. The range of ALT, AST, and GGT levels varied more widely according to the increase in BMI in males than in females, and this finding was more prominent in younger subjects than in older subjects. All risk factors for metabolic syndrome were shown to affect liver enzyme levels in male subjects. However, although most risk factors for metabolic syndrome affected liver enzyme levels, there might be weak or no effect of fasting hyperglycemia on AST, and low serum HDL-cholesterol level on GGT in female subjects.

Conclusions

Age, BMI, and other risk factors for metabolic syndrome had a significant effect on the distribution of range of liver enzymes in each gender, even in this study conducted from Korean health checkup subjects.

Keywords: Body mass index, Alanine aminotransferase, Aspartate aminotransferase, Gamma glutamyltranspeptidase, Metabolic syndrome X

References

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Fig. 1.

The distribution of range of ALT levels according to age and BMI in male subjects. The range of ALT level varied widely according to the increase in BMI, and this finding was more prominent in younger subjects than in older subjects.

Fig. 2.

The distribution of range of ALT levels according to age and BMI in female subjects. The range of ALT level varied more widely according to the increase in BMI in males than in females, and this finding was more prominent in younger subjects than in older subjects.

Fig. 3.

The distribution of range of AST levels according to age and BMI in male subjects. The range of AST level varied widely according to the increase in BMI in male subjects, and this finding was more prominent in younger subjects than in older subjects.

Fig. 4.

The distribution of range of AST levels according to age and BMI in female subjects.

Fig. 5.

The distribution of range of GGT levels according to age and BMI in male subjects. The range of GGT level varied widely according to the increase in BMI, and this finding was more prominent in younger subjects than in older subjects.

Fig. 6.

The distribution of range of GGT levels according to age and BMI in female subjects. The range of GGT level varied more widely according to the increase in BMI in males than in females, and this finding was more prominent in younger subjects than in older subjects.

Table 1.

Baseline Characteristics of the Study Subjects

Characteristic	Total	Males	Females
Subjects (n)	65,715	34,915	30,800
Age (yr) ^a	47 (38–55)	47 (39–55)	47 (38–55)
Height (cm) ^a	164.8 (158.4-171.1)	170.6 (166.6-174.5)	158.2 (154.6-161.9)
Body weight (kg) ^a	63.0 (54.6-71.9)	70.7 (65.0-76.9)	54.6 (50.4-59.5)
BMI (kg/m²) ^a	23.3 (21.2-25.4)	24.4 (22.7-26.1)	21.8 (20.0-23.9)
ALT (IU/L) ^a	20 (14–30)	25 (18–36)	16 (12–21)
AST (IU/L) ^a	21 (18–26)	23 (19–29)	20 (17–24)
GGT (IU/L) ^a	22 (15–37)	32 (22–51)	15 (12–20)
Systolic BP (mmHg) ^a	116 (106–128)	120 (111–130)	111 (102–123)
Diastolic BP (mmHg) ^a	75 (68–84)	80 (72–87)	70 (64–79)
Fasting glucose (mg/dL) ^a	95 (88–103)	98 (91–106)	92 (86–99)
Triglyceride (mg/dL) ^a	94 (67–138)	114 (81–165)	77 (59–107)
HDL-cholesterol (mg/dL) ^a	53 (44–63)	48 (41–56)	59 (50–68)
Obesity (BMI ≥25 kg/m²)	18,749 (28.5)	13,955 (40.0)	4,794 (15.6)
BP ≥130 / ≥85 mmHg	20,056 (30.5)	13,914 (39.9)	6,142 (19.9)
Fasting glucose ≥100 mg/dL	22,176 (33.7)	15,316 (43.9)	6,860 (22.8)
Triglycerides ≥150 mg/dL	13,781 (21.0)	10,769 (30.8)	3,012 (9.8)
HDL-C <40 mg/dL (male); <50 mg/dL (female)	13,883 (21.1)	6,441 (18.5)	7,442 (24.2)

Values are presented as n only, median (interquartile range), or n (percentile).

BP, blood pressure.

^a Data are expressed as median and interquartile range because age, BMI, liver enzyme levels, and risk factors for metabolic syndrome were all skewed and did not fit a standard normal distribution.

Table 2.

Multivariate Linear Regression Coefficients of Age and BMI to Log-Transformed Liver Enzyme Levels in Male Subjects

	Age			BMI			R-squared ^c
	Unstandardized coefficient (SD) ^a	Standardized coefficient (95% CI) ^b	p-value	Unstandardized coefficient (SD) ^a	Standardized coefficient (95% CI) ^b	p-value	R-squared ^c
ALT	−0.00211 (0.00022)	−0.04812 (−0.05775-−0.03849)	<0.0001	0.07277 (0.00090)	0.39591 (0.38629-0.40554)	<0.0001	0.1605
AST	0.00279 (0.00014)	0.10044 (0.09035-0.11053)	<0.0001	0.03086 (0.00060)	0.26439 (0.25431-0.27448)	<0.0001	0.0777
GGT	0.00102 (0.00027)	0.01884 (0.00887-0.02881)	0.0002	0.07133 (0.00115)	0.31547 (0.30550-0.32543)	<0.0001	0.0993

^a Calculated by multivariate regression analysis using log-transformed liver enzyme levels as a dependent variable, and age and BMI as independent variables.

^b Calculated by multivariate regression analysis after standardizing the independent variables to make their variances into 1. Standardized coefficient enables comparison of the effect of independent variables with different units on the dependent variables.

^c Introduced for estimation of the percentage of explanatory power of each multivariate regression analysis for each liver enzyme.

Table 3.

Multivariate Linear Regression Coefficients of Age and BMI to Log-Transformed Liver Enzyme Levels in Female Subjects

	Age			BMI			R-squared ^c
	Unstandardized coefficient (SD) ^a	Standardized coefficient (95% CI) ^b	p-value	Unstandardized coefficient (SD) ^a	Standardized coefficient (95% CI) ^b	p-value	R-squared ^c
ALT	0.01045 (0.00023)	0.26233 (0.25115-0.27350)	<0.0001	0.03563 (0.00092)	0.22127 (0.21011-0.23244)	<0.0001	0.1646
AST	0.00872 (0.00014)	0.35123 (0.33992-0.36254)	<0.0001	0.00608 (0.00058)	0.06053 (0.04922-0.07183)	<0.0001	0.1440
GGT	0.00860 (0.00024)	0.20698 (0.19544-0.21853)	<0.0001	0.03075 (0.00099)	0.18303 (0.17149-0.19458)	<0.0001	0.1069

^a Calculated by multivariate regression analysis using log-transformed liver enzyme levels as a dependent variable, and age and BMI as independent variables.

^c Introduced to estimate the percentage of explanatory power of each multivariate regression analysis for each liver enzyme.

Table 4.

The Significant Effect of the Risk Factors for Metabolic Syndrome on the Range of Liver Enzyme Levels in Male Subjects

Liver enzyme	Risk factor of metabolic syndrome	Median of liver enzyme levels	Mann-Whitney U-test ^a	Slope
Liver enzyme	Risk factor of metabolic syndrome	Risk factor for MS positive vs. negative	p-value	Unstandardized coefficient (SD) ^b	Standardized coefficient (95% CI) ^c	Variantion inflation factor ^d	p-value	R-squared ^e
ALT	Obesity (BMI≥25 kg/m²)	31 vs. 22	−0.0001	0.26245 (0.00548)	0.24616 (0.23608-0.25624)	1.08482	−0.0001	0.1491
	Blood pressure ≥130/≥85 mmHg	27 vs. 24	−0.0001	0.05968 (0.00546)	0.05595 (0.04592-0.06598)	1.07344	−0.0001
	Fasting glucose ≥100 mg/dL	27 vs. 24	−0.0001	0.06216 (0.00548)	0.05907 (0.04886-0.06927)	1.11206	−0.0001
	Triglycerides ≥150 mg/dL	31 vs. 23	−0.0001	0.20565 (0.00594)	0.18187 (0.17156-0.19217)	1.13342	−0.0001
	HDL-cholesterol −40 mg/dL	29 vs. 24	−0.0001	0.07365 (0.00689)	0.05470 (0.04468-0.06473)	1.07173	−0.0001
AST	Obesity (BMI≥25 kg/m²)	25 vs. 22	−0.0001	0.11608 (0.00363)	0.17145 (0.16094-0.18195)	1.08483	−0.0001	0.0761
	Blood pressure ≥130/≥85 mmHg	24 vs. 22	−0.0001	0.04308 (0.00361)	0.06359 (0.05314-0.07404)	1.07344	−0.0001
	Fasting glucose ≥100 mg/dL	24 vs. 23	−0.0001	0.02511 (0.00363)	0.03757 (0.02694-0.04821)	1.11206	−0.0001
	Triglycerides ≥150 mg/dL	25 vs. 22	−0.0001	0.09288 (0.00393)	0.12935 (0.11861-0.14008)	1.13344	−0.0001
	HDL-cholesterol −40 mg/dL	24 vs. 23	−0.0001	−0.01500 (0.00456)	−0.01755 (−0.02799-−0.00710)	1.07173	0.001
GGT	Obesity (BMI≥25 kg/m²)	40 vs. 27	−0.0001	0.22062 (0.00661)	0.16821 (0.15833-0.17809)	1.08488	−0.0001	0.1828
	Blood pressure ≥130/≥85 mmHg	37 vs. 29	−0.0001	0.12213 (0.00658)	0.09307 (0.08325-0.10290)	1.07354	−0.0001
	Fasting glucose ≥100 mg/dL	37 vs. 28	−0.0001	0.16222 (0.00661)	0.12529 (0.11530-0.13529)	1.11178	−0.0001
	Triglycerides ≥150 mg/dL	45 vs. 28	−0.0001	0.40950 (0.00717)	0.29437 (0.28427-0.30447)	1.13338	−0.0001
	HDL-cholesterol −40 mg/dL	34 vs. 31	−0.0001	−0.11024 (0.00830)	−0.06656 (−0.07638-−0.05673)	1.07178	−0.0001

MS, metabolic syndrome.

^a Mann-Whitney U-test was performed if there were significant differences in the level of liver enzymes according to the existence of each risk factor for metabolic syndrome.

^b Calculated by multivariate regression analysis using log-transformed liver enzyme levels as a dependent variable, and age and each risk factor for metabolic syndrome as independent variables.

^c Calculated by multivariate regression analysis after standardizing the independent variables to make their variances into 1. Standardized coefficient enables comparison of the effect of independent variables with different units on the dependent variables.

^d Variance inflation factor for each risk factor for metabolic syndrome was calculated to quantify the severity of multicollinearity in multivariate regression analysis. There may be no colinearity among the risk factors for metabolic syndrome because variance inflation factor greater than 10 is regarded as suggesting the existence of collinearity.

^e R-squared was introduced to estimate the percentage of explanatory power of each multivariate regression analysis for each liver enzyme.

Table 5.

The Significant Effect of the Risk Factors for Metabolic Syndrome on the Range of Liver Enzyme Levels in Female Subjects

Liver enzyme	Risk factor of metabolic syndrome	Median of liver enzyme levels	Mann-Whitney U-test ^a	Slope
Liver enzyme	Risk factor of metabolic syndrome	Risk factor for MS positive vs. negative	p-value	Unstandardized coefficient (SD) ^b	Standardized coefficient (95% CI) ^c	Variantion inflation factor ^d	p-value	R-squared ^e
ALT	Obesity (BMI ≥25 kg/m²)	20 vs. 15	−0.0001	0.18416 (0.00737)	0.13896 (0.12806-0.14987)	1.13875	−0.0001	0.1640
	Blood pressure ≥130/≥85 mmHg	18 vs. 15	−0.0001	0.02197 (0.00680)	0.01827 (0.00718-0.02936)	1.17735	0.0012
	Fasting glucose ≥100 mg/dL	19 vs. 15	−0.0001	0.06556 (0.00647)	0.05678 (0.04580-0.06775)	1.15455	−0.0001
	Triglycerides ≥150 mg/dL HDL-cholesterol −40 mg/dL	21 vs. 15 17 vs. 15	−0.0001 −0.0001	0.15030 (0.00906) 0.02409 (0.00617)	0.09293 (0.08195-0.10390) 0.02146 (0.01068-0.03224)	1.15399 1.11202	−0.0001 −0.0001
AST	Obesity (BMI ≥25 kg/m²)	22 vs. 19	−0.0001	0.05057 (0.00464)	0.06120 (0.05019-0.07221)	1.13879	−0.0001	0.1482
	Blood pressure ≥130/≥85 mmHg	21 vs. 19	−0.0001	0.01047 (0.00428)	0.01397 (0.00277-0.02516)	1.17733	0.0145
	Fasting glucose ≥100 mg/dL	21 vs. 19	−0.0001	0.00037728 (0.00407)	0.00052397 (–0.01055-0.01160)	1.15442	0.9261
	Triglycerides ≥150 mg/dL	22 vs. 19	−0.0001	0.05487 (0.00570)	0.05440 (0.04333-0.06548)	1.15387	−0.0001
	HDL-cholesterol −40 mg/dL	20 vs. 19	−0.0001	−0.02418 (0.00388)	−0.03456 (–0.04543-–0.02368)	1.11193	−0.0001
GGT	Obesity (BMI ≥25 kg/m²)	19 vs. 14	−0.0001	0.15822 (0.00782)	0.11440 (0.10331-0.12548)	1.13866	−0.0001	0.1355
	Blood pressure ≥130/≥85 mmHg	17 vs. 14	−0.0001	0.04232 (0.00722)	0.03372 (0.02245-0.04500)	1.17742	−0.0001
	Fasting glucose ≥100 mg/dL	18 vs. 14	−0.0001	0.12433 (0.00686)	0.10317 (0.09202-0.11433)	1.15418	−0.0001
	Triglycerides ≥150 mg/dL	21 vs. 15	−0.0001	0.24552 (0.00961)	0.14545 (0.13430-0.15661)	1.15371	−0.0001
	HDL-cholesterol −40 mg/dL	16 vs. 15	−0.0001	−0.00639 (0.00655)	−0.00545 (–0.01641-0.00550)	1.11200	0.3293

MS, metabolic syndrome.

^a Mann-Whitney U-test was performed if there were significant differences in the level of liver enzymes according to the existence of each risk factor for metabolic syndrome.

^b Calculated by multivariate regression analysis using log-transformed liver enzyme levels as a dependent variable, and age and each risk factor for metabolic syndrome as independent variables.

^e R-squared was introduced to estimate the percentage of explanatory power of each multivariate regression analysis for each liver enzyme.

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