carried out a population-based study Talazoparib ic50 in Korea that enrolled approximately 4 600 000 government and private school employees and their dependents; the etiologies of the liver diseases in this study were unknown. The study’s primary end-point was mortality, and it showed that the best cut-off values for identifying men at risk of death from liver disease were 31 IU/L for aspartate aminotransferase (AST) and 30 IU/L for ALT in men, but it failed to identify the cut-off value for women.[34] Chang et al. studied the onset of NAFLD by enrolling 5237 healthy

Korean men who had either ALT or GGT levels below the upper reference range.[24] They reported that the hazard ratios (HRs) (95% CI) were 1.53 (1.18–1.98), 1.66 (1.29–2.13), 1.62 (1.26–2.08), and 2.21 (1.73–2.81) for ALT concentrations of 16–18, 19–21, 22–25, and 26–34 U/L, respectively, compared with an ALT concentration of < 16 U/L, after adjusting for age, weight change, BMI, blood glucose level, blood pressure (BP), triglyceride (TG) level, high-density lipoprotein-cholesterol (HDL-c) level, smoking, alcohol consumption, regular exercise, homeostasis model assessment of insulin resistance (HOMA-IR), C-reactive protein (CRP) level, and incident

diabetes (Table 2). They showed that an increased serum ALT concentration, even if it was below the normal upper limit, was an independent predictor of NAFLD. Linear increases in ALT levels were shown to be associated with the presence and onset of NAFLD. Increased ALT levels are one of the most popular markers for the diagnosis of NAFLD in clinical practice. Thus, clinicians should be more aware of this evidence. Bilirubin is a product of heme catabolism that may have Doxorubicin clinical trial potent antioxidant and cytoprotective properties.[35, 36] Some studies acetylcholine have shown that higher bilirubin levels are inversely associated with HOMA-IR and insulin levels,[37] and with the prevalence of CVD[38, 39] and diabetes.[40] In this regard, Kwak et al. conducted a hospital-based retrospective study of 17 348 Korean people undergoing health checkups to examine the relationship between total bilirubin levels and NAFLD.[15] They conducted a multivariate regression analysis, adjusted for

age, gender, BMI, waist circumference (WC), smoking, total cholesterol (TC) level, hypertension, and diabetes, and showed that the total bilirubin level was inversely associated with the prevalence of NAFLD (OR 0.88; 95% CI 0.80–0.97). Furthermore, they found an inverse, dose-dependent association between NAFLD and total bilirubin levels (OR 0.83, 95% CI 0.75–0.93 in the third quartile and OR 0.80, 95% CI 0.71–0.90 in the fourth quartile versus the lowest quartile; the P-value for this trend was < 0.001) (Table 1). In terms of the prospective association between serum bilirubin concentrations (total, direct, and indirect) and the risk of NAFLD onset, a cohort study was conducted among 5900 Korean men, without evidence of liver disease or major risk factors for liver disease.