Identifying Significant Liver Disease in Older Adults

Lowering the upper limit currently considered normal for serum alanine aminotransferase levels may help identify older adults at risk of significant liver disease, according to a study published online in PLoS One.

“Recently,” researchers explained, “clinical guidelines have suggested lowering the upper limit of normal of serum alanine aminotransferase for men and women.”

The study included nearly 50,000 community-dwelling adults age 65 and older with an alanine aminotransferase measurement in 2002. Researchers looked at the prevalence of significant liver disease over the next decade in those with alanine aminotransferase levels between the current and newly suggested upper limit of normal, which they termed the delta range.

People whose alanine aminotransferase levels were in the delta range had a significantly higher rate of chronic liver disease compared with people whose alanine aminotransferase levels were in the newly suggested normal range, the study found.

In men, the rate of liver disease was 15.3% among those in the delta range, compared with 4.9% for those in the suggested normal range. In women, the rate of liver disease was 7.8% in the delta range and 3.3% in the suggested normal range, according to the study.

The rate of cirrhosis in men in the delta range was 4.2%, compared with a rate of 0.9% in the suggested normal range. In women, the cirrhosis rate was 1.5% in the delta range and 0.4% in the suggested normal range.

Adults in the delta range also had higher mean fibrosis scores compared with those in the suggested normal range.

“This finding indicates that elderly individuals who meet the currently accepted normal range of alanine aminotransferase may in fact harbor clinically significant liver disease,” researchers wrote.

—Jolynn Tumolo

Reference:

Schmilovitz-Weiss H, Gingold-Belfer R, Grossman A, et al. Lowering the upper limit of serum alanine aminotransferase levels may reveal significant liver disease in the elderly. PLoS One. 2019;22(3):284-292. 2019 April 11;14(4):e0212737.