Background

Body-mass-index (BMI) and alcohol consumption predict elevated serum alanine (ALT) and aspartate (AST) aminotransferase levels in young adults. It is unclear if alcohol intake and BMI and their joint association have a differential effect on ALT and AST levels in older adults.

Objective

To determine the association between alcohol, BMI, and their combined effect with serum ALT and AST in older community-dwelling adults in the United States.

Design and Setting

A cross-sectional, population-based study in older adults

Participants

(n=2364) from the Rancho Bernardo Study (54% women; mean age: 70 years, BMI: 25 kg/m2, alcohol users: 63%) who attended a research visit in 1984-87. BMI was recorded by a trained nurse and alcohol use ascertained by a validated questionnaire.

Outcome

Multiply adjusted odds-ratio (OR) and 95% confidence intervals (CI) of elevated serum ALT and AST (defined as ≥ 30 U/L in men and ≥ 19 U/L in women) were calculated for alcohol and BMI separately and their joint exposure using multivariate logistic regression models adjusted for age, body mass index, total cholesterol, serum triglycerides, fasting plasma glucose, systolic blood pressure, and diabetes mellitus.

Results

In multivariate-adjusted logistic regression models, obesity independently increased the odds of elevated ALT in this cohort of older men and women by 3.0 (95% CI, 1.7-5.3) and 1.8 (95%CI, 1.1-2.7), respectively. Joint effects of consuming > 3 alcoholic drinks/day and obesity raised the odds of elevated ALT by 8.9 (95%CI, 2.4-33.1) and AST by 21-fold (95%CI, 2.6-170.1), demonstrating synergism. Obese had higher odds of elevated ALT even at 0 ≤ 1 drink/day.

Conclusions

In older men and women, combination of obesity with alcohol is synergistic in increasing the risk of liver injury. Older obese should restrict their alcohol intake as the risk of liver injury is higher.

Summary

We present results of a randomized, placebo-controlled trial to examine the effect of 50 mg daily oral DHEA supplementation for one year on bone mineral density (BMD), bone metabolism and body composition in 225 healthy adults aged 55 to 85 years.

Introduction

Dehydroepiandrosterone (DHEA) levels decline dramatically with age, concurrent with the onset of osteoporosis, suggesting a role for DHEA supplementation in preventing age-related bone loss.

Methods

We conducted a randomized, placebo-controlled trial to examine the effect of 50 mg daily oral DHEA supplementation for one year on bone mineral density (BMD), bone metabolism and body composition in 225 healthy adults aged 55 to 85 years.

Results

DHEA treatment increased serum DHEA and DHEA sulfate levels to concentrations seen in young adults. Testosterone, estradiol and insulin-like growth factor (IGF-1) levels increased in women (all p<0.001), but not men, receiving DHEA. Serum C-terminal telopeptide of type-1 collagen levels decreased in women (p=0.03), but not men, whereas bone-specific alkaline phosphatase levels were not significantly altered in either sex. After 12 months, there was a positive effect of DHEA on lumbar spine BMD in women (p=0.03), but no effect was observed for hip, femoral neck or total body BMD, and no significant changes were observed at any site among men. Body composition was not affected by DHEA treatment in either sex.

Conclusion

Among older healthy adults, daily administration of 50 mg of DHEA has a modest and selective beneficial effect on BMD and bone resorption in women, but provides no bone benefit for men.