In the United States, elevated serum alanine aminotransferase(ALT) activity in the absence of viral hepatitis or excessive alcohol consumption is most commonly attributed to nonalcoholic fatty liver disease(NAFLD). NA...In the United States, elevated serum alanine aminotransferase(ALT) activity in the absence of viral hepatitis or excessive alcohol consumption is most commonly attributed to nonalcoholic fatty liver disease(NAFLD). NAFLD is related to predictors of coronary heart disease (CHD) such as insulin resistance and central obesity. We examined the association between elevated serum ALT activity and the 10-year risk of CHD as estimated using the Framingham risk score(FRS).We performed a cross-sectional analysis comparing participants in the Third National Health and Nutrition Examination Survey with normal and elevated ALT activity (>43 IU/L), examining the mean levels of FRS. Among participants without viral hepatitis or excessive alcohol consumption, those with elevated ALT activity (n = 267) had a higher FRS than those with normal ALT activity (n = 7,259), both among men (mean difference in FRS 0.25, 95%CI 0.07-0.4; hazard ratio for CHD 1.28, 95%CI 1.07-1.5) and women (mean difference in FRS 0.76, 95%CI 0.4-1.1; hazard ratio for CHD 2.14, 95%CI 1.5-3.0). The ALT threshold for increased risk of CHD was higher in men (>43 IU/L) than in women(>30 IU/L). Elevated ALT activity was not associated with higher FRS among nonobese participants with viral hepatitis or excessive alcohol consumption. In conclusion, individuals with elevated serum ALT activity in the absence of viral hepatitis or excessive alcohol consumption, most of whom have NAFLD, have an increased calculated risk of CHD. This association is more prominent in women.展开更多
Background: Subcortical ischemic vascular dementia has been ascribed to promin ent frontal lobe dysfunction secondary to ischemic lesions in frontothalamic cir cuits. Whether smallvessel disease in fact predominantly ...Background: Subcortical ischemic vascular dementia has been ascribed to promin ent frontal lobe dysfunction secondary to ischemic lesions in frontothalamic cir cuits. Whether smallvessel disease in fact predominantly affects the frontal lob es is not well documented. defective: To investigate the effects of subcortical lesions (lacunes and white matter lesions [WML]) on cortical function, as refl ec ted in glucose metabolism and cognitive function, in elderly individuals. Design : Cross sectional analyses of case series. Setting: Multicenter, university ba sed study of subcortical vascular dementia. Patients: Persons with normal cognit ion, mild cognitive impairment, or dementia and with and without lacunes on magn etic resonance images. Main Outcome Measures: Regional cerebral glucose metaboli sm, normalized regional metabolic activity,and neuropsychological test scores. M ajor hypotheses were that volume of lacunes and WML correlate selectively with h ypometabolism of prefrontal cortex and failure of executive cognitive ability. R esults: Lacunes correlated with metabolic rates in dorsolateral frontal cortex ( DLF); WML substantially reduced metabolic rates throughout cortex, most strongly so in DLF. When regional metabolic activity was normalized to whole brain activ ity, lacunes remained correlated with DLF activity, whereas the WML effect was n o longer found, probably because of its general distribution. Regional cerebral glucose metabolism and normalized activity in DLFalso correlated with cortical a trophy. Metabolic activity in DL F correlated with executive function, memory, and global cognitive function, whi le activity in middle temporal gyrus correlated with memory and global function but not executive function. Conclusions: The metabolic effects of lacunes and WM L are most apparent in DLF, but the effects of WML are generalized and frontal h ypometabolism correlates with memory and global impairment, cognitive as well as executive function. The effects of subcortical cerebrovascular disease appear t o converge on the frontal lobes but are diffuse, complex, and of modest magnitud e.展开更多
文摘In the United States, elevated serum alanine aminotransferase(ALT) activity in the absence of viral hepatitis or excessive alcohol consumption is most commonly attributed to nonalcoholic fatty liver disease(NAFLD). NAFLD is related to predictors of coronary heart disease (CHD) such as insulin resistance and central obesity. We examined the association between elevated serum ALT activity and the 10-year risk of CHD as estimated using the Framingham risk score(FRS).We performed a cross-sectional analysis comparing participants in the Third National Health and Nutrition Examination Survey with normal and elevated ALT activity (>43 IU/L), examining the mean levels of FRS. Among participants without viral hepatitis or excessive alcohol consumption, those with elevated ALT activity (n = 267) had a higher FRS than those with normal ALT activity (n = 7,259), both among men (mean difference in FRS 0.25, 95%CI 0.07-0.4; hazard ratio for CHD 1.28, 95%CI 1.07-1.5) and women (mean difference in FRS 0.76, 95%CI 0.4-1.1; hazard ratio for CHD 2.14, 95%CI 1.5-3.0). The ALT threshold for increased risk of CHD was higher in men (>43 IU/L) than in women(>30 IU/L). Elevated ALT activity was not associated with higher FRS among nonobese participants with viral hepatitis or excessive alcohol consumption. In conclusion, individuals with elevated serum ALT activity in the absence of viral hepatitis or excessive alcohol consumption, most of whom have NAFLD, have an increased calculated risk of CHD. This association is more prominent in women.
文摘Background: Subcortical ischemic vascular dementia has been ascribed to promin ent frontal lobe dysfunction secondary to ischemic lesions in frontothalamic cir cuits. Whether smallvessel disease in fact predominantly affects the frontal lob es is not well documented. defective: To investigate the effects of subcortical lesions (lacunes and white matter lesions [WML]) on cortical function, as refl ec ted in glucose metabolism and cognitive function, in elderly individuals. Design : Cross sectional analyses of case series. Setting: Multicenter, university ba sed study of subcortical vascular dementia. Patients: Persons with normal cognit ion, mild cognitive impairment, or dementia and with and without lacunes on magn etic resonance images. Main Outcome Measures: Regional cerebral glucose metaboli sm, normalized regional metabolic activity,and neuropsychological test scores. M ajor hypotheses were that volume of lacunes and WML correlate selectively with h ypometabolism of prefrontal cortex and failure of executive cognitive ability. R esults: Lacunes correlated with metabolic rates in dorsolateral frontal cortex ( DLF); WML substantially reduced metabolic rates throughout cortex, most strongly so in DLF. When regional metabolic activity was normalized to whole brain activ ity, lacunes remained correlated with DLF activity, whereas the WML effect was n o longer found, probably because of its general distribution. Regional cerebral glucose metabolism and normalized activity in DLFalso correlated with cortical a trophy. Metabolic activity in DL F correlated with executive function, memory, and global cognitive function, whi le activity in middle temporal gyrus correlated with memory and global function but not executive function. Conclusions: The metabolic effects of lacunes and WM L are most apparent in DLF, but the effects of WML are generalized and frontal h ypometabolism correlates with memory and global impairment, cognitive as well as executive function. The effects of subcortical cerebrovascular disease appear t o converge on the frontal lobes but are diffuse, complex, and of modest magnitud e.
