First National Report on Aminotransaminases` Percentiles in Children of the Middle East and North Africa (MENA): the CASPIAN-III Study


Roya Kelishadi 1 , * , Seyed-Hossein Abtahi 2 , Mostafa Qorbani 3 , Ramin Heshmat 4 , Mohammad Motlagh 5 , Mahnaz Taslimi 6 , Tahereh Aminaee 7 , Gelayol Ardalan 7 , Parinaz Poursafa 1 , Payam Moin 1

1 Department of Pediatrics, Child Growth and Development Research Center, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, IR Iran

2 Medical Students’ Research Center, Isfahan University of Medical Sciences, Isfahan, IR Iran

3 Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, IR

4 Department of Epidemiology, Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, IR Iran

5 Department of Pediatrics, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran

6 Bureau of Health and Fitness, Ministry of Education and Training, Tehran, IR Iran

7 Bureau of Population, Family and School Health, Ministry of Health and Medical Education, Tehran, IR Iran

How to Cite: Kelishadi R, Abtahi S, Qorbani M, Heshmat R, Motlagh M, et al. First National Report on Aminotransaminases` Percentiles in Children of the Middle East and North Africa (MENA): the CASPIAN-III Study, Hepat Mon. 2012 ; 12(11):e93040. doi: 10.5812/hepatmon.7711.


Hepatitis Monthly: 12 (11); e93040
Published Online: November 30, 2012
Article Type: Research Article
Received: May 06, 2019
Accepted: August 12, 2012


Background: By the current global obesogenic environment, non-alcoholic fatty liver disease is becoming an important health problem in the pediatric age group.

Objectives: This study aimed to determine the first age-and gender-specific percentiles and upper limit normal limit (ULN) of alanine aminotransaminase (ALT) and aspartate aminotransaminase (AST) among a nationally-representative sample of children and adolescents in the Middle East and North Africa (MENA). The second objective was to determine the linear association of obesity indexes and age with serum ALT and AST levels.

Patients and Methods: This nationwide study was conducted among a representative sample of 4078 students aged 10-18 years, who were selected by multistage random cluster sampling from 27 provinces of Iran. ALT and AST were measured on fresh sera. Body mass index (BMI) was calculated as an index of generalized obesity, and waist- to- height ratio (WHtR) as an index of abdominal obesity. The age- and gender-specific percentiles of ALT and AST were constructed, and the 95th percentile of each enzyme was considered as the ULN. Gender-specific linear regression analysis was employed to examine the association of BMI or WHtR with the levels of ALT and AST.

Results: Data of ALT and AST were available for 4078 (2038 girls) and 4150 (2061 girls),respectively. Participants had a mean (SD) age of 14.71 (2.41).The ULN of ALT for boys, girls,and the total individuals were 36.00; 38.00; and, 37.00 U/L, respectively. In both genders,ALT and AST had linear association with age. The association with BMI was significant for ALT in both genders and for AST only in boys, the association of ALT with WHtR was significant in both genders; the corresponding figures were not significant for AST.

Conclusions: The findings of the current study confirmed the current ULN value of 40 U/L commonly used for the pediatric age group. The linear association of indexes for generalized and abdominal obesity with ALT underscores the importance of timely prevention and control of childhood obesity.



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