Aims: We determined age-stratified associations of elevated alanine aminotransferase (ALAT), as a likely indicator of non-alcoholic steatonecrosis (NASH), with body mass index (BMI) and diabetes among older male, veteran outpatients.
Methods: Administrative files at three, urban Veteran Administration Healthcare Systems were surveyed. 47.916 male outpatients, mean age 69.2 years, without ICD-9CM documented liver diseases or alcohol- or drug-abuse, had the highest of one or more ALAT results analyzed. Logistic regression determined age-stratified predictors of elevated ALAT among groups <50 ("younger-aged"), 50-70 ("middle-aged") and >70 ("older-aged"). BMI, diabetes and "statin" use were predictors.
Results: 1272 (2.7%) patients had their highest ALAT greater than the upper limit of normal (mean=98.4U/L). 4.9% of all diabetics and 15.2, 6.1 and 3.4% of the "younger-aged", middle-aged" and "older-aged" diabetics, respectively, had elevated ALATs. BMI values from 25 to <30 and 30 to 45, compared with those from >20 to <25, predicted elevated ALAT in the two younger groups. In contrast, among "older-aged" patients, diabetes independently predicted elevated ALAT, whereas BMI did not.
Conclusions: The cross-sectional findings support previous epidemiologic data associating ALAT elevations with obesity and diabetes, and provide new evidence that in elderly male patients, ALAT elevations, absent other known liver diseases, may selectively associate with diabetes.