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Age Impacts Ability of Aspartate–Alanine Aminotransferase Ratio to Predict Advanced Fibrosis in Nonalcoholic Fatty Liver Disease

Digestive Diseases and Sciences volume 60, pages 1825–1831 (2015)Cite this article

Abstract

Background and Aim

While histological differences have been reported between pediatric and adult nonalcoholic fatty liver disease (NAFLD), potential age-related changes in serum transaminases and liver histology remain largely unexplored. Our study sought to investigate the clinical and histological characteristics of NAFLD across age.

Methods

This was a prospective cross-sectional study of 502 biopsy-proven NAFLD patients. Clinical data were evaluated and compared among different age groups; group A (ages 18–44), B (ages 45–64), and C (≥ages 65).

Results

34.9, 56.0, and 9.1 % of the cohort were distributed among group A, B, and C, respectively. While the prevalence of nonalcoholic steatohepatitis (NASH) was comparable across age groups, the prevalence of advanced fibrosis increased with age (p = 0.000). Although the mean ALT progressively decreased with age; 87, 64, 56 U/L in group A, B, and C, respectively (p = 0.000), there was no difference in mean AST (p = 0.939) across age. The AST:ALT ratio (AAR) progressively increased from 0.7, 0.9, and 1.1 in group A, B, and C, respectively (p = 0.000). In group C, an AAR ≥1 was found in 74 and 40 % of patients with and without advanced fibrosis.

Conclusion

With advancing age, ALT levels progressively declined while AST levels remained stable, leading to a higher AAR. Although higher AAR is often used as a surrogate measure of advanced fibrosis, advancing age can also contribute to increased AAR. In fact, an AAR ≥1 was found in significant number of elderly patients without advanced fibrosis. Consequently, an increased AAR may be a function of decreasing ALT with age in addition to progressive fibrosis.

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Acknowledgments

G.B.B.G. was supported by Singapore SingHealth HMDP. M.R.P. was supported by NIH T32 DK061917. S.D., J.D., A.J.M., R.S., C.H. were supported by NIH DK U.

Conflict of interest

None.

Author information

Affiliations

  1. Department of Gastroenterology, Cleveland Clinic Foundation, 9500 Euclid Avenue/A30, Cleveland, OH, 44195, USA

    George Boon-Bee Goh, Mangesh R. Pagadala, Achuthan Sourianarayanane, Ruth Sargent, Srinivasan Dasarathy & Arthur J. McCullough

  2. Department of Family Medicine, MetroHealth Medical Center, Cleveland, OH, USA

    Jaividhya Dasarathy, Amer Khiyami & Carol Hawkins

  3. Department of Pathology, Cleveland Clinic Foundation, Cleveland, OH, USA

    Rish K. Pai & Lisa Yerian

  4. Department of Pathobiology, Cleveland Clinic Foundation, Cleveland, OH, USA

    Srinivasan Dasarathy & Arthur J. McCullough

  5. National Institutes of Diabetes and Digestive and Kidney Diseases, BG 2DEM RM 659, 6707 Democracy Blvd, Bethesda, MD, 20817, USA

    Aynur Unalp-Arida

  6. Department of Gastroenterology, Singapore General Hospital, Singapore, Singapore

    George Boon-Bee Goh

Authors
  1. George Boon-Bee Goh
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  2. Mangesh R. Pagadala
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  6. Lisa Yerian
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  8. Achuthan Sourianarayanane
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  9. Ruth Sargent
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  11. Srinivasan Dasarathy
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  12. Arthur J. McCullough
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Corresponding author

Correspondence to Arthur J. McCullough.

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Goh, G.BB., Pagadala, M.R., Dasarathy, J. et al. Age Impacts Ability of Aspartate–Alanine Aminotransferase Ratio to Predict Advanced Fibrosis in Nonalcoholic Fatty Liver Disease. Dig Dis Sci 60, 1825–1831 (2015). https://doi.org/10.1007/s10620-015-3529-8

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  • DOI: https://doi.org/10.1007/s10620-015-3529-8

Keywords

  • NAFLD
  • Liver transaminases
  • Age-related changes
  • Advanced fibrosis