Volume 145, Issue 6, Pages 1271-1279.e3 (December 2013) Association Between High-Normal Levels of Alanine Aminotransferase and Risk Factors for Atherogenesis  M. Shadab Siddiqui, Richard K. Sterling, Velimir A. Luketic, Puneet Puri, R. Todd Stravitz, Iliana Bouneva, Sherry Boyett, Michael Fuchs, Carol Sargeant, G. Russell Warnick, Shahrzad Grami, Arun J. Sanyal  Gastroenterology  Volume 145, Issue 6, Pages 1271-1279.e3 (December 2013) DOI: 10.1053/j.gastro.2013.08.036 Copyright © 2013 AGA Institute Terms and Conditions

Figure 1 Serum ALT levels are related directly to (A) VLDL size, (B) %sdLDL-C, and the (D) desmosterol:cholesterol ratio in an apparently healthy population. (C) %sdLDL-C is related directly to VLDL size. (D and E) Percentage sdLDL-C and LDL-P concentrations increase from lean to overweight to obese cohorts (P < .001). Although percentage sdLDL-C and LDL-P were similar between overweight and obese individuals with normal ALT levels, they increased dramatically in those with increased ALT levels (P < .01). *P < .05 between normal and increased ALT levels. All data are represented as means ± SEM. Increased ALT level is defined as greater than 19 U/L in women and greater than 31 U/L in women. Gastroenterology 2013 145, 1271-1279.e3DOI: (10.1053/j.gastro.2013.08.036) Copyright © 2013 AGA Institute Terms and Conditions

Figure 2 (A) Liver fat score progressively increases from the lowest ALT quartile (Q1) to the highest ALT quartile (Q4). (B) LDL-P concentration, (C) %sdLDL cholesterol, (D) VLDL size, and (E) sdLDL-C are increased in individuals with increased liver fat across the 3 ALT groups. (F) HDL2-C is lower in individuals with increased liver fat scores. Low-normal (Low-Nml) ALT level is defined as an ALT level less than 19 U/L in women and less than 31 U/L in men, an increased ALT level is defined as an ALT level greater than 40 U/L, and high-normal (High-Nml) is any ALT value between these 2 groups. All data represent means ± SEM. *P < .001 between normal and increased liver fat. Nml, normal. Gastroenterology 2013 145, 1271-1279.e3DOI: (10.1053/j.gastro.2013.08.036) Copyright © 2013 AGA Institute Terms and Conditions

Figure 3 Presence of increased ALT was associated with a worsening expanded cardiovascular profile in both individuals with normal or increased serum insulin concentrations. There was a synergistic increase seen in serum LDL-P concentrations, sdLDL-C, %sdLDL-C, and sdLDL-P concentrations in individuals with both increased insulin and increased ALT concentrations. The increase in VLDL size was additive in individuals with increased ALT and insulin concentrations. *P < .001 increased ALT vs increased insulin; **P < .001 increased insulin vs increased insulin and increased ALT. Increased ALT is defined as greater than 19 U/L in women and greater than 31 U/L in women. Gastroenterology 2013 145, 1271-1279.e3DOI: (10.1053/j.gastro.2013.08.036) Copyright © 2013 AGA Institute Terms and Conditions