Hyperferritinemia and Hyperuricemia May Be Associated with Liver
Function Abnormality in Obese Adolescents
Solomon Chih Cheng Chen1,2*, Ya Fang Huang3, Jung Der Wang4
1 Department of Pediatrics, Chia-Yi Christian Hospital, Chia-Yi City,
Taiwan,
2 Department of Pediatrics, Medical College, Taipei Medical
University, Taipei City, Taiwan,
3 Department of Clinical Laboratory, Pingtung Christian Hospital,
Pingtung City, Taiwan,
4 Department of Public Health, National Cheng Kung University College
of Medicine and Hospital, Tainan, Taiwan

Abstract Top
Background
The iron status in human body and its association with liver function
in adolescents was rarely studied. The objective was to investigate
the association among the levels of serum ferritin, uric acid and
alanine aminotransferase (ALT) in adolescents.

Methods and Results
A total of 2090 adolescents negative for hepatitis B surface antigen
from one junior high school (786, 12–13 years), three senior high
schools (973, 15–16 years) and one college (331, 18–19 years)
participated in this survey. Anthropometric and biochemical
measurements, including complete blood count, ALT, serum ferritin and
uric acid were performed. An ALT>42 U/L was defined as elevated, a
ferritin level >200 µg/L was defined as hyperferritinemia. A uric acid
level >460 µmol/L in males and >340 µmol/L in females was defined as
hyperuricemia. The chi-squared test, linear regression and
multivariate logistic regression were used for the data analysis.
Elevated ALT levels were detected in 76 (3.6%) students and were more
prevalent in males than females (6.4% vs. 2.0%, p<0.001). The
univariate analysis found gender, age group, body mass index, ferritin
level, uric acid level and white blood cell count all to be
significantly associated with elevated ALT. Linear regression showed a
positive correlation among log(ferritin), uric acid level and ALT
level. Elevated ALT occurred more frequently at ferritin level >100 µg/
L. The logistic regression analysis found that body mass index,
hyperferritinemia and hyperuricemia were significant factors
associated with the ALT elevation, but gender, age, and white blood
cell count were not.

Conclusions
Hyperferritinemia and hyperuricemia are two independently significant
factors associated with ALT elevation among obese adolescents. More
studies are needed to corroborate any hypothesis related to these
phenomena.

Citation: Chen SCC, Huang YF, Wang JD (2012) Hyperferritinemia and
Hyperuricemia May Be Associated with Liver Function Abnormality in
Obese Adolescents. PLoS ONE 7(10): e48645. doi:10.1371/journal.pone.
0048645

Editor: Pal Bela Szecsi, Gentofte University Hospital, Denmark

Received: June 7, 2012; Accepted: September 27, 2012; Published:
October 31, 2012

Copyright: © 2012 Chen et al. This is an open-access article
distributed under the terms of the Creative Commons Attribution
License, which permits unrestricted use, distribution, and
reproduction in any medium, provided the original author and source
are credited.

Funding: This study was funded by a grant (NSC99-2314-B-475-001) from
the National Science Council, Taiwan (http://web1.nsc.gov.tw/). The
funder had no role in study design, data collection and analysis,
decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing
interests exist.

* E-mail: solomon....@gmail.com

http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.00...

--------------

Gender Difference of Alanine Aminotransferase Elevation May Be
Associated with Higher Hemoglobin Levels among Male Adolescents
Solomon Chih-Cheng Chen1, Jun-Jun Yeh2, Mei-Hwei Chang3, Yu-Kuei
Liao4, Li-Chen Hsiao4, Choo-Aun Neoh4, Teck-Siang Tok1, Jung-Der
Wang5,6,7*

1 Department of Pediatrics, Pingtung Christian Hospital, Pingtung,
Taiwan, 2 Department of Internal Medicine, Pingtung Christian
Hospital, Pingtung, Taiwan, 3 Department of Pediatrics, National
Taiwan University Hospital, Taipei, Taiwan, 4 Department of Community
Health, Pingtung Christian Hospital, Pingtung, Taiwan, 5 Department
of
Public Health, National Cheng Kung University College of Medicine,
Tainan, Taiwan, 6 Departments of Internal Medicine, Environmental and
Occupational Medicine, National Cheng Kung University Hospital,
Tainan, Taiwan, 7 Institute of Occupational Medicine and Industrial
Hygiene, National Taiwan University, Taipei, Taiwan

Abstract Top
Background
To explore the gender difference of ALT elevation and its association
with high hemoglobin levels.

Methods
A cross-sectional study of 3547 adolescents (2005 females, mean age
of
16.5?.3 years) who were negative for hepatitis B surface antigen
received health checkups in 2006. Body mass index (BMI), levels of
hemoglobin, ALT and cholesterol were measured. ALT >42 U/L was
defined
as elevated ALT. Elevated ALT levels were detected in 112 of the 3547
participants (3.3%), more prevalent in males than in females (5.4%
vs.
1.4%, p<0.001). Hemoglobin levels had a significant linear
correlation
with ALT levels in both genders. Abnormal ALT started to occur if
hemoglobin >11 g/dl in females or >13.5 g/dl in males, but the
cumulative cases of elevated ALT increased more quickly in males.
Proportion of elevated ALT increased as either the BMI or hemoglobin
level rise, more apparent in male adolescents. Logistic regression
modeling showed odds ratio (95% confidence interval) were 24.7 (15.0–
40.6) for BMI ≥27 kg/m2; 5.5 (2.9–10.4) for BMI 24–27 kg/m2; 2.7
(1.3–
5.5) for Q5 (top 20th percentile) hemoglobin level; and 2.6 (1.6–4.1)
for male gender. Further separately fitting the logistic models for
two genders, the significance of Q5 hemoglobin level only appeared in
the males.

Conclusions
High hemoglobin level is a significant risk factor of ALT elevation
after control hepatitis B, obesity and gender. Males have greater
risk
of abnormal liver function which may be associated with higher
hemoglobin levels.

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