Abstract
There is an increasing interest for the role of liver enzymes as predictors of non-liver-related morbidity and mortality. The American Heart Association (AHA) described the ideal cardiovascular health concept as a score of seven cardiovascular health behaviors and factors that can be used to monitor and predict ideal cardiovascular health over time. This study aimed to examine the association of the ideal cardiovascular health (ICH), as defined by the AHA, with liver enzyme levels in European adolescents. A total of 637 adolescents (54.6% females), aged 14.6 ± 1.2 years from nine European countries participated in this cross-sectional study. Blood levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma-glutamyltransferase were measured and the AST/ALT ratio calculated. Ideal cardiovascular health was defined as meeting ideal levels of the following components: four behaviors (smoking, body mass index, physical activity, and diet) and three factors (total cholesterol, blood pressure, and glucose). A higher number of ideal cardiovascular health behaviors, factors, and ideal cardiovascular health index were associated with lower ALT (P < 0.05, P < 0.001, and P < 0.001, respectively) and gamma-glutamyltransferase (P < 0.001, P < 0.01, and P < 0.001, respectively) levels. Similarly, a higher number of ideal cardiovascular health behaviors (P < 0.01), factors (P < 0.01), and ideal cardiovascular health index (P < 0.001) were associated with a higher aspartate aminotransferase to alanine aminotransferase ratio. These findings reinforce the usefulness of the ICH index as an instrument to identify target individuals and promote cardiovascular health in adolescents, and it also extends these observations to the liver manifestation of the metabolic syndrome.
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Abbreviations
- AHA:
-
American Heart Association
- ALT:
-
Alanine aminotransferase
- AST/ALT:
-
Aspartate aminotransferase to alanine aminotransferase ratio
- AST:
-
Aspartate aminotransferase
- Gamma-GT:
-
Gamma glutamyltransferase
- HELENA:
-
Healthy Lifestyle in Europe by Nutrition in Adolescence
- HELENA-DIAT:
-
HELENA-Dietary Assessment Tool
- ICH:
-
Ideal cardiovascular health
- MSM:
-
Multiple Source Method
- NAFLD:
-
Non-alcoholic fatty liver disease
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Acknowledgments
We thank the children and adolescents who participated in the study and their parents and teachers for their collaboration. Many thanks to Anke Carstensen for her contribution to the laboratory work. We also acknowledge the members involved in the fieldwork for their efforts.
Author’s contribution
IL conceived the hypothesis, wrote the manuscript, and performed the statistical analysis; JRR, JRR, IH, FBO MCG, MC, MS, MGG, YM, KW, AK, CB, GR, JD, FG, and LAM contributed to the interpretation and discussion of the results. All authors contributed to the interpretation and discussion of the results and critically revised the drafted manuscript.
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All procedures involving human participants were approved by the ethics committee of each involved city. Written informed consent and assent were obtained from both adolescents and their parents before being enrolled in the study.
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The authors declare that they have no conflict of interest.
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The authors declare no relationship with an industry that might pose a conflict of interest. The HELENA project was supported by the European Community Sixth RTD Framework Programme (contract FOOD-CT-2005-007034), by the Spanish Ministry of Science and Innovation (RYC-2010-05957, RYC-2011-09011), and by the University of the Basque Country (GIU14/21). This study was also supported by the Spanish Ministry of Health (CIBERobn CB12/03/30038). The content of this paper reflects the authors’ views alone and the European Community is not liable for any use that may be made of the information contained herein.
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Labayen, I., Ruiz, J.R., Huybrechts, I. et al. Ideal cardiovascular health and liver enzyme levels in European adolescents; the HELENA study. J Physiol Biochem 73, 225–234 (2017). https://doi.org/10.1007/s13105-016-0546-9
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DOI: https://doi.org/10.1007/s13105-016-0546-9