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Cardiorespiratory Fitness, Waist Circumference, and Alanine Aminotransferase in Youth


Medicine & Science in Sports & Exercise: April 2013 - Volume 45 - Issue 4 - p 722–727
doi: 10.1249/MSS.0b013e31827aa875

Purpose Nonalcoholic fatty liver disease (NAFLD) is considered the liver component of the metabolic syndrome and is strongly associated with cardiometabolic diseases. In adults, cardiorespiratory fitness (CRF) is inversely associated with alanine aminotransferase (ALT), a blood biomarker for NAFLD. However, information regarding these associations is scarce for youth. The objective of this study is to examine associations between CRF, waist circumference, and ALT in youth.

Methods Data were obtained from youth (n = 2844, 12–19 yr) in the National Health and Nutrition Examination Survey 2001–2004. CRF was dichotomized into youth FITNESSGRAM® categories of “low” and “adequate” CRF. Logistic and quantile regression were used for a comprehensive analysis of associations, and variables with previously reported associations with ALT were a priori included in the models.

Results Results from logistic regression suggested that youth with low CRF had 1.5 times the odds of having an ALT >30 than youth with adequate CRF, although the association was not statistically significant (P = 0.09). However, quantile regression demonstrated that youth with low CRF had statistically significantly higher ALT (+1.04, +1.05, and +2.57 U·L−1) at the upper end of the ALT distribution (80th, 85th, and 90th percentiles, respectively) than youth with adequate CRF. For every 1-cm increase in waist circumference, the odds of having an ALT >30 increased by 1.06 (P < 0.001), and the strength of this association increased across the ALT distribution.

Conclusions Future studies should examine whether interventions to improve CRF can decrease hepatic fat and liver enzyme concentrations in youth with ALT ≥80th percentile or in youth diagnosed with NAFLD.

1Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, Greenville, SC; 2Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC; 3Institute of Environmental Medicine, Unit of Biostatistics, Karolinska Institutet, Stockholm, SWEDEN; and 4Preventive Medicine Laboratory, Pennington Biomedical Research Center, Baton Rouge, LA

Address for correspondence: Jennifer L. Trilk, Ph.D., Department of Biomedical Sciences, University of South Carolina School of Medicine, Greenville, 701 Grove Rd., Greenville, SC 29605. E-mail:

Submitted for publication July 2012.

Accepted for publication October 2012.

©2013The American College of Sports Medicine