The association of alanine transaminase with aging, frailty, and mortality

Abstract

The relationships between blood tests of liver function and injury (alanine transaminase [ALT], gamma-glutamyl transferase, bilirubin, and albumin) with age, frailty, and survival were investigated in 1,673 community-dwelling men aged 70 years or older. ALT was lower in older participants. Those participants with ALT below the median at baseline had reduced survival (hazard ratio 2.10, 95% confidence interval [CI] 1.53-2.87) up to 4.9 years. Older age, frailty, low albumin, low body mass index, and alcohol abstinence also were associated with reduced survival, with age and frailty being the most powerful predictors. Low ALT was associated with frailty (odds ratio 3.54, 95% CI 2.45-5.11), and the relationship between ALT and survival disappeared once frailty and age were included in the survival analysis. Low ALT activity is a predictor of reduced survival; however, this seems to be mediated by its association with frailty and increasing age. ALT has potential value as a novel biomarker of aging.

Figure 1.

Relationship between age, albumin, and alanine transaminase (ALT). (The fitted line is a simple linear regression.)

Figure 2.

Kaplan–Meier curves comparing survival in those participants with alanine transaminase (ALT) activity above or below the median.

Figure 3.

Kaplan–Meier curves comparing survival according to Cardiovascular Health Study frailty rating scale.