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| From
the Editor |
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Editorial
A. Abyad (Chief Editor) |
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Original contribution/Clinical Investigation
Diabetes
Mellitus - Knowledge, Management and Complications:
Survey report from Faisalabad-Pakistan
Ijaz Anwer, Ahmad Shahzad, Kashmira Nanji, Farah
Haider, Muhammad Masood Ahmad
Alanine
aminotransferase indicates excess weight and
dyslipidemia
Mehmet Rami Helvaci, Orhan Ayyildiz* Mustafa
Cem Algin, Yusuf Aydin, Abdulrazak Abyad, Lesley
Pocock
Comparative Analysis of Antimicrobial Peptides
Gene Expression in Susceptible/Resistant Mice
Macrophages to Leishmania major Infection
Hamid Daneshvar, Iraj Sharifi, Alireza Kyhani,
Amir Tavakoli Kareshk, Arash Asadi
Does
socio-economic status of the patients have effect
on clinical outcomes after coronary artery bypass
grafting surgery?
Forough Razmjooei, Afshin Mansourian, Saeed
Kouhpyma
Comparison
of the uterine artery Doppler indices during
pregnancy between gestational diabetes and diabetes
mellitus and healthy pregnant women
Nazanin Farshchian, Farhad Naleini, Amir Masoud
Jaafarnejhad,
Parisa Bahrami Kamangar
Survey
single dose Gentamicin in treatment of UTI in
children with range of 1 month to 13 years old
in Jahrom during 2015
Ehsan Rahmanian, Farideh Mogharab,
Vahid Mogharab
Evaluation
of control of bleeding by electro cauterization
of bleeding points of amplatz sheath tract after
percutaneous nephrolithotomy (PCNL) in Jahrom
Peymanieh hospital during year 2015-2016
Ali Reza Yousefi , Reza Inaloo
Comparison
of the three-finger tracheal palpation technique
with triple ID formula to determine endotracheal
tube depth in children 2-8 years in 2016-2017
Anahid Maleki, Alireza Ebrahim Soltani, Alireza
Takzare, Ebrahim Espahbodi,
Mehrdad Goodarzi , Roya Noori
Effect
of Sevoflurane and Propofol on pulmonary arterial
pressure during cardiac catheterization in children
with congenital heart diseases
Faranak Behnaz, Mahshid Ghasemi , Gholamreza
Mohseni, Azim Zaraki
Population and Community Studies
Prevalence
and risk factors of obesity in children aged
2-12 years in the Abu Dhabi Islands
Eideh Al-Shehhi, Hessa Al-Dhefairi, Kholoud
Abuasi, Noora Al Ali, Mona Al Tunaiji, Ebtihal
Darwish
Study
and comparison of psychological disorders in
normal students and students with multiple sclerosis
in Shahrekord
Neda Ardestani-Samani, Mohammad Rabiei, Mohammad
Ghasemi-Pirbalooti, Asghar Bayati, Saeid Heidari-Soureshjani
Comparative
study of self-concept, physical self-concept,
and time perspective between the students with
multiple sclerosis and healthy students in Shahrekord
Neda Ardestani-Samani, Mohammad Rabiei, Mohammad
Ghasemi-Pirbalooti, Asghar Bayati, Saeid Heidari-Soureshjani
Relationship
between Coping Styles and Religious Orientation
with Mental Health in the Students of the Nursing-Midwifery
Faculty of Zabol
Nasim Dastras, Mohsen Heidari Mokarrar, Majid
Dastras, Shirzad Arianmehr
Tuberculosis
in Abadan, Iran (2012-2016): An Epidemiological
Study
Ali-Asghar ValiPour, Azimeh Karimyan, Mahmood
Banarimehr, Marzieh Ghassemi, Maryam Robeyhavi,
Rahil Hojjati,
Parvin Gholizadeh
Family
Stability and Conflict of Spiritual Beliefs
and Superstitions among Yazdi People in Iran:
A Qualitative Study
Zahra Pourmovahed , Seyed Saied Mazloomy Mahmoodabad
; Hassan Zareei Mahmoodabadi ; Hossein Tavangar
; Seyed Mojtaba Yassini Ardekani ; Ali Akbar
Vaezi
A
comparative study of the self-actualization
in psychology and Islam
Simin Afrasibi, Zakieh Fattahi
The
effectiveness of cognitive - behavioral therapy
in reducing the post-traumatic stress symptoms
in male students survivors of earthquake in
the central district of Varzeghan
Sakineh Salamat, Dr.Ahad Ahangar, Robab Farajzadeh
Reviews
Effects
and mechanisms of medicinal plants on stress
hormone (cortisol): A systematic review
Kamal Solati, Saeid Heidari-Soureshjani, Lesley
Pocock
Comparing
Traditional and medical treatments for constipation
: A Review Article
Mohammad Yaqub Rajput
A review
of anti-measles and anti-rubella antibodies
in 15- 25 year old women in Jahrom City in 2011
Ehsan Rahmania , Farideh Mogharab, Vahid Mogharab
Review
of percutaneous nephrolithotomy in children
below 12 years old in Jahrom hospital, during
2010-2014
Ali Reza Yousefi , Reza Inaloo
Physical
and mental health in Islam
Bahador Mehraki, Abdollah Gholami
International Health Affairs
The Challenges
of Implementation of Professional Ethics Standards
in Clinical Care from the viewpoint of Nursing
Students and Nurses
Saeedeh Elhami, Kambiz Saberi, Maryam Ban, Sajedeh
Mousaviasl, Nasim Hatefi Moadab, Marzieh Ghassemi
Cognitive
Determinants of Physical Activity Intention among
Iranian Nurses: An Application of Integrative
Model of Behavior Prediction
Arsalan Ghaderi, Firoozeh Mostafavi, Behzad Mahaki,
Abdorrahim Afkhamzadeh,
Yadolah Zarezadeh , Erfan Sadeghi
Effect
of resilience-based intervention on occupational
stress among nurses
Hossein Jafarizadeh, Ebrahim Zhiyani, Nader
Aghakhani, Vahid Alinejad, Yaser Moradi
Education and Training
Calculation
of Salaries and Benefits of Faculty Members
in the Ministry of Health and Medical Education
of Iran
Abdolreza Gilavand
The
effect of education on self-care behaviors of
gastrointestinal side effects on patients undergoing
chemotherapy
Shokoh Varaei, Ehsan Abadi Pishe, Shadan Pedram
Razie, Lila Nezam Abadi Farahani
Creating
and Validating the Faith Inventory for Students
at Islamic Azad University of Ahvaz
Solmaz Choheili, Reza Pasha, Gholam Hossein
Maktabi, Ehsan Moheb
Creating
and Validating the Adjustment Inventory for
the Students of Islamic Azad University of Ahvaz
Homa Choheili, Reza Pasha, Gholam Hossein Maktabi,
Ehsan Moheb
Evaluating
the Quality of Educational Services from the
Viewpoints of Radiology Students of Ahvaz Jundishapur
University of Medical Sciences
Abdolreza Gilavand, Jafar Fatahiasl
An
Investigation of Psychosocial aspect of Iranian
Nursing Students' Clinical Setting
Mahsa Boozaripour , Zanyar Karimi, Sima Zohari
Anbohi, Amir Almasi-Hashiani, Fariba Borhani
Clinical Research and Methods
Comparison
of the Antibacterial Effects of Chlorhexidine
Mouth washes with Jaftex Mouth wash on Some
Common Oral Microorganisms (An in Vitro Study)
Ebrahim Babadi, Zahra Bamzadeh, Fatemeh Babadi
Study
of the effect of plasma jet on Fusarium isolates
with ability to produce DON toxins
Elham Galin Abbasian, Mansour Bayat, Arash chaichi
Nosrati, Seyed Jamal Hashemi, Mahmood Ghoranneviss
The
comparison of anti-inflammatory effect in two
methods of topical dexamethasone injection and
topical application of ginger alcoholic extract
after removing mandibular wisdom teeth
Sahar Zandi, Seyyed Muhammadreza Alavi, Kamran
Mirzaie, Ramin Seyedian, Narges Aria, Saman
Jokar
The effect
of curcumin on growth and adherence of major
microorganisms causing tooth decay
Leila Helalat, Ahmad Zarejavid, Alireza Ekrami,
Mohammd Hosein Haghighizadeh, Mehdi Shiri Nasab
|
|
Chief
Editor -
Abdulrazak
Abyad
MD, MPH, MBA, AGSF, AFCHSE
.........................................................
Editorial
Office -
Abyad Medical Center & Middle East Longevity
Institute
Azmi Street, Abdo Center,
PO BOX 618
Tripoli, Lebanon
Phone: (961) 6-443684
Fax: (961) 6-443685
Email:
aabyad@cyberia.net.lb
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Publisher
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Pocock
medi+WORLD International
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Sherbrooke 3789
AUSTRALIA
Phone: +61 (3) 9005 9847
Fax: +61 (3) 9012 5857
Email:
lesleypocock@mediworld.com.au
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While all
efforts have been made to ensure the accuracy
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expressed are those of the authors and do not
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Editor or the Editorial Board. The publishers,
Editor and Editorial Board cannot be held responsible
for errors or any consequences arising from
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under the Australian Copyright Act, no part
of this program may be reproduced without the
permission of the publisher.
|
|
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| November 2017
- Volume 15, Issue 9 |
|
|
Alanine aminotransferase
indicates excess weight and dyslipidemia
Mehmet Rami Helvaci (1)
Orhan Ayyildiz (1)
Mustafa Cem Algin (2)
Yusuf Aydin (1)
Abdulrazak Abyad (3)
Lesley Pocock (4)
(1) Specialist of Internal Medicine, MD
(2) Specialist of General Surgery, MD
(3) Middle-East Academy for Medicine of Aging,
MD
(4) medi+WORLD International
Corresponding author:
Mehmet Rami Helvaci, MD
07400, Alanya,
Turkey
Phone: 00-90-506-4708759
Email: mramihelvaci@hotmail.com
|
Abstract
Background: There
may be some hepatic indicators of metabolic
syndrome. We tried to understand whether
or not there is an association between
alanine aminotransferase (ALT) value and
excess weight.
Methods:
We took consecutive patients below the
age of 70 years to avoid debility induced
weight loss in elders. Patients were divided
into three groups as normal weight, overweight,
and obesity.
Results: The
study included 47 females and 82 males,
totally. Although the nonsignificant differences
according to the mean age between the
three groups (p>0.05 for all), female
ratio showed significant increases from
the overweight towards the obesity groups
(28.3% versus 50.0%, p<0.001). Although
the presence of significant differences
according to the body mass index and body
weight between the three groups (p<0.000
for all), there was a significant increase
according to the mean ALT value only from
the normal weight towards the overweight
groups (39.7 versus 53.5 U/L, p<0.001),
but not from the overweight towards the
obesity groups (53.5 versus 53.5 U/L,
p>0.05). Interestingly, the same trend
was also present for dyslipidemia, and
prevalence of dyslipidemia was higher
in the overweight than the normal weight
groups (45.2% versus 25.0%, p<0.001),
but there was anonsignificant difference
between the overweightand obesity groups
(45.2% versus 37.5%, respectively, p>0.05).
Conclusion:
Higher ALT value in serum may indicate
excess weight and dyslipidemia. On the
other hand, there were nonsignificant
differences according to mean ALT value
and prevalence of dyslipidemia between
the overweight and obesity groups.
Key words:
Alanine aminotransferase, overweight,
obesity, hepatosteatosis, dyslipidemia,
metabolic syndrome
|
Excess weight is becoming a major health problem
all over the world, particularly in developed
countries. For example, almost one third of
adults in the United States can be classified
as obese (1). Obesity is a disorder characterized
by increased mass of adipose tissue that results
from a systemic imbalance between food intake
and energy expenditure. Excess weight comes
with significant health problems (2-14), and
the risk of death from all causes increases
with an increasing body mass index (BMI) (4).
For example, blood pressure (BP) pattern was
changed from the sustained normotension (NT)
towards white coat hypertension (WCH) and hypertension
(HT) parallel to the increasing BMI in the same
direction (15). In addition to the WCH and HT,
type 2 diabetes mellitus (DM), hyperbetalipoproteinemia,
dyslipidemia, and coronary artery disease (CAD)
also showed significant increases parallel to
the increasing BMI (15). Additionally, obesity
is highly correlated with dietary intake of
increased calories and fat, both of which were
linked to various cancers (16). For instance,
a recent study of 900,000 people found that
obese patients are more likely die from a number
of cancers (17). Similarly, there may also be
some hepatic consequences of excess weight.
Nonalcoholic fatty liver disease (NAFLD) is
a term used to define a spectrum of disorders
characterized by macrovesicular steatosis which
occurs in the absence of consumption of alcohol
in amounts considered to be harmful to liver.
Because the chance of NAFLD is directly proportional
to body weight and presence of a higher prevalence
of excess weight in society, NAFLD is also becoming
an important health problem all over the world.
According to the literature, sustained liver
injury will lead to progressive fibrosis and
cirrhosis in 10% to 25% of affected patients
(18). We tried to understand whether or not
there is an association between alanine aminotransferase
(ALT) value and excess weight in the present
study.
The study was performed on routine check up
patients in the Internal Medicine Polyclinic
of the Dumlupinar University between August
2005 and March 2007. We took consecutive patients
below the age of 70 years to avoid debility
induced weight loss in elders. Their medical
histories including smoking habit and alcohol
and already used medications were learnt, and
a routine check up procedure including serum
ALT, aspartate aminotransferase, gamma glutamyl
transpeptidase (GGT), alkaline phosphatase (ALP),
direct and indirect bilirubins, low density
lipoprotein cholesterol (LDL-C), triglyceride
(TG), and high density lipoprotein cholesterol
(HDL-C) values, hepatitis B surface antigen
(HBsAg), anti-hepatitis C virus antibody (anti-HCV
Ab), and anti-human immunodeficiency antibody
(anti-HIV Ab) was performed. In HBsAg or anti-HCV
Ab positive individuals, HBV DNA and HCV RNA
were studied by quantitative polymerase chain
reaction (PCR) methods, respectively. PCR positive
cases were excluded from the study. Current
daily smokers at least for the last 12-months
and cases with a history of five pack-years
were accepted as smokers. Regular daily drinkers
without any limitation in amount and social
drinkers with a drink in the last week, patients
with anti-HIV Ab positivity or prominent GGT
and ALP elevations, and multi-drug users with
any cause were excluded from the study. BMI
of each case was calculated by the measurements
of the Same Physician instead of verbal expressions.
Weight in kilograms is divided by height in
meters squared, and obesity is defined as a
BMI of 30 or greater, overweight between 25–29.9,
normal weight between 18.5-24.9, and underweight
as lower than 18.5 kg/m2 (19). Insulin using
diabetics, and patients with devastating illnesses
including malignancies, acute or chronic renal
failure, hyper- or hypothyroidism, and heart
failure were excluded to avoid their possible
effects on weight. Additionally patients with
dyslipidemia were detected by using the National
Cholesterol Education Program Expert Panel’s
recommendations for defining dyslipidemic subgroups
(19). Dyslipidemia is diagnosed with the LDL-C
value of 160 or greater or TG value of 200 or
greater or the HDL-C value of lower than 40
mg/dL. Eventually, mean age, female ratio, BMI,
body weight, and ALT values and prevalences
of smoking and dyslipidemia were detected in
the underweight, normal weight, overweight,
and obesity groups and the results were compared
in between. Mann-Whitney U test, Independent-Samples
T test, and comparison of proportions were used
as the methods of statistical analyses.
The
study
included
47
females
and
82
males,
totally.
There
were
20
patients
(20.0%
female)
in
the
normal
weight,
53
patients
(28.3%
female)
in
the
overweight,
and
56
patients
(50.0%
female)
in
the
obesity
groups
without
any
detected
case
in
the
underweight
group.
So
84.4%
of
the
study
cases
were
either
overweight
or
obese
with
a
mean
age
of
44.2
years.
Although
the
nonsignificant
differences
according
to
the
mean
age
between
the
three
groups
(p>0.05
for
all),
female
ratio
showed
significant
increases
from
the
overweight
towards
the
obesity
groups
(28.3%
versus
50.0%,
p<0.001)
(Table
1).
Although
the
presence
of
significant
differences
between
the
three
groups
according
to
the
BMI
and
body
weight
(p<0.000
for
all),
there
was
a
significant
increase
according
to
the
mean
ALT
value
only
from
the
normal
weight
towards
the
overweight
groups
(39.7
versus
53.5
U/L,
p<0.001),
but
not
from
the
overweight
towards
the
obesity
groups
(53.5
versus
53.5
U/L,
p>0.05).
As
a
similar
trend,
prevalence
of
dyslipidemia
was
significantly
lower
in
the
normal
weight
than
the
overweight
groups
(25.0%
versus
45.2%,
p<0.001),
but
there
was
a
nonsignificant
difference
between
the
overweight
and
obesity
groups
(45.2%
versus
37.5%,
p>0.05).
On
the
other
hand,
prevalence
of
smoking
increased
from
the
normal
weight
(25.0%)
towards
the
overweight
(35.8%)
and
obesity
groups
(33.9%),
but
the
differences
were
nonsignificant
(p>0.05
for
both)
probably
due
to
the
small
sample
sizes
of
the
groups.
Table
1:
Characteristic
features
of
the
study
cases
Excess
weight,
smoking,
alcohol,
and
chronic
infections
and
inflammations
are
related
with
an
increased
BP,
dyslipidemia,
HT,
DM,
CAD,
cirrhosis,
chronic
renal
disease
(CRD),
chronic
obstructive
pulmonary
disease
(COPD),
peripheric
artery
disease
(PAD),
stroke,
and
an
increased
all-cause
mortality
rate,
and
this
relationship
has
been
known
for
many
years
under
the
title
of
metabolic
syndrome
(20-22).
The
syndrome
can
be
reversed
with
appropriate
nonpharmaceutical
approaches
including
lifestyle
changes,
diet,
and
exercise
before
the
development
of
irreversible
fibrotic
changes
on
vascular
endothelium
(23).
Excessive
fat
accumulation
in
hepatocytes
is
called
hepatosteatosis.
It
progresses
to
NAFLD,
steatohepatitis,
fibrosis,
cirrhosis,
hepatocellular
carcinoma,
and
hepatic
failure.
There
are
two
histologic
patterns
of
NAFLD
including
fatty
liver
alone
and
nonalcoholic
steatohepatitis
(NASH).
NASH
represents
a
shift
from
simple
steatosis
to
an
inflammatory
component.
Excess
weight
may
be
the
main
factor
in
exacerbating
hepatic
inflammation
and
fibrogenesis
in
NASH.
NAFLD
affects
up
to
a
third
of
the
world
population,
and
it
has
become
the
most
common
cause
of
chronic
liver
disease
even
in
children
and
adolescents
(24,
25).
The
recent
rise
in
the
prevalence
of
excess
weight
likely
explains
the
NAFLD
epidemic,
worldwide
(26).
NAFLD
is
a
marker
of
pathological
fat
deposition
combined
with
a
low-grade
chronic
inflammatory
state,
which
results
with
hypercoagulability,
endothelial
dysfunction,
and
an
accelerated
atherosclerotic
process
(26).
NAFLD
shares
many
features
of
the
metabolic
syndrome
as
a
highly
atherogenic
condition,
and
may
cause
hepatic
inflammation
and
cellular
injury
especially
at
the
endothelial
level.
Beside
terminating
with
cirrhosis,
NAFLD
is
associated
with
a
significantly
greater
overall
mortality
as
well
as
with
an
increased
prevalence
of
cardiovascular
diseases
(25).
Authors
reported
independent
associations
between
NAFLD
and
impaired
flow-mediated
vasodilation
and
increased
carotid
artery
intimal
medial
thickness
as
the
reliable
markers
of
subclinical
atherosclerosis
(25),
so
NAFLD
may
also
be
a
predictor
of
cardiovascular
disease
(27,
28).
NAFLD
may
be
considered
as
the
common
hepatic
component
of
the
metabolic
syndrome
since
hepatic
fat
is
highly
correlated
with
all
components
the
syndrome
(29).
Interestingly,
although
the
presence
of
significant
progressions
according
to
the
BMI
and
body
weight
(p<0.000
for
all)
from
the
normal
weight
towards
the
overweight
and
obesity
groups
and
although
the
presence
of
a
highly
significant
difference
according
to
the
ALT
values
between
the
normal
weight
and
overweight
groups
(39.7
versus
53.5
U/L,
p<0.001),
the
difference
between
the
overweight
and
obesity
groups
was
nonsignificant
according
to
the
mean
ALT
values
in
serum
(53.5
versus
53.5
U/L,
p>0.05).
As
a
similar
trend,
prevalence
of
dyslipidemia
was
significantly
lower
in
the
normal
weight
than
the
overweight
groups
(25.0%
versus
45.2%,
p<0.001),
but
there
was
a
nonsignificant
difference
between
the
overweight
and
obesity
groups,
too
(45.2%
versus
37.5%,
p>0.05).
These
findings
may
be
explained
with
the
idea
that
excess
weight,
either
overweight
or
obesity,
probably
causes
similar
risks
for
hepatosteatosis.
Smoking
has
major
effects
on
systemic
atherosclerotic
processes
including
COPD,
digital
clubbing,
cirrhosis,
CRD,
PAD,
CAD,
stroke,
and
cancers
(30).
Its
atherosclerotic
effects
are
the
most
obvious
in
COPD
and
Buerger’s
disease.
Buerger’s
disease
has
never
been
reported
in
the
absence
of
smoking
in
the
literature.
Smoking
induced
endothelial
damage
is
probably
seen
in
pulmonary
vasculature
much
more
than
the
other
organs
due
to
the
higher
concentration
of
its
products
in
lungs.
But
smoking
may
even
cause
cirrhosis,
CRD,
PAD,
CAD,
stroke,
and
cancers
by
the
transport
of
toxic
products
within
the
blood.
On
the
other
hand,
beside
the
strong
atherosclerotic
effects,
smoking
in
human
beings
and
nicotine
in
animals
may
be
associated
with
some
weight
loss
(31).
There
may
be
an
increased
energy
expenditure
during
smoking
(32),
and
nicotine
may
decrease
caloric
intake
in
a
dose-related
manner
(33).
Nicotine
may
lengthen
intermeal
time,
and
decrease
amount
of
meal
eaten
(34).
Similarly,
BMI
seems
to
be
the
highest
in
the
former
and
the
lowest
in
the
current
smokers
(35).
Probably
toxic
substances
of
tobacco
smoke
cause
a
diffuse
inflammation
on
vascular
endothelium
all
over
the
body,
and
it
is
the
major
cause
of
loss
of
appetite
during
circulation
of
the
substances
within
the
blood,
since
the
body
does
not
want
to
eat
during
fighting.
So
regular
smoking
causes
a
prominent
weight
loss,
clinically.
On
the
other
hand,
as
a
pleasure
in
life,
smoking
may
also
show
the
weakness
of
volition
to
control
eating.
For
example,
prevalences
of
HT,
DM,
and
smoking
were
the
highest
in
the
highest
TG
having
group
as
another
significant
parameter
of
the
metabolic
syndrome
(12).
Additionally,
although
CAD
was
detected
with
similar
prevalences
in
both
sexes,
smoking
and
COPD
were
higher
in
males
against
the
higher
prevalences
of
BMI
and
its
consequences
including
dyslipidemia,
HT,
and
DM
in
females
(13).
The
proportion
of
smokers
is
consistently
higher
in
men
in
the
literature
(36).
Although
the
decreased
male
prevalences
from
the
normal
weight
towards
the
overweight
and
obesity
groups,
prevalence
of
smoking
increased
from
the
normal
weight
(25.0%)
towards
the
overweight
(35.8%)
and
obesity
groups
(33.9%)
but
the
differences
were
nonsignificant
(p>0.05
for
both)
probably
due
to
the
small
sample
sizes
of
the
groups
in
the
present
study.
As
a
conclusion,
higher
ALT
value
in
serum
may
indicate
excess
weight
and
dyslipidemia.
On
the
other
hand,
there
were
nonsignificant
differences
according
to
ALT
value
and
prevalence
of
dyslipidemia
between
the
overweight
and
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