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J Physiol Biochem. 2017 May;73(2):225-234. doi: 10.1007/s13105-016-0546-9. Epub 2017 Jan 6.

Ideal cardiovascular health and liver enzyme levels in European adolescents; the HELENA study.

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Department of Nutrition and Food Sciences, University of the Basque Country, UPV/EHU, Vitoria-Gasteiz, Spain.
Nutrition, Exercise and Health Research Group, Elikadura, Ariketa Fisikoa eta Osasuna, ELIKOS Group, University of the Basque Country, UPV/EHU, Vitoria-Gasteiz, Spain.
PROmoting FITness and Health Through Physical Activity Research Group (PROFITH), Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain.
Department of Biosciences and Nutrition at NOVUM, Karolinska Institutet, Huddinge, Sweden.
Department of Public Health, Ghent University, Ghent, Belgium.
International Agency for Research on Cancer, Dietary Exposure Assessment Group, Lyon, France.
Departament of Physiology, Medicine School, University of Granada, Granada, Spain.
Faculty of Physical Activity and Sport Sciences (INEF), Universidad Politécnica de Madrid, Madrid, Spain.
Department of Nutrition and Dietetics, Harokopio University, Athens, Greece.
Division of Nutrition and Metabolism, Department of Pediatrics, Medical University of Vienna, Vienna, Austria.
School of Medicine, University of Crete, Crete, Greece.
Department of Nutrition and Food Science, University of Bonn, Bonn, Germany.
Department of Pediatrics, University of Zaragoza, Instituto Aragonés de Ciencias de la Salud, Zaragoza, Spain.
INSERM, U744, Univ Lille Nord de France, Institut Pasteur de Lille, F-59000, Lille, France.
Department of Pediatrics, Jeanne de Flandre Children's University Hospital, Lille, France.
GENUD (Growth, Exercise, Nutrition and Development) Research Group, University of Zaragoza, Zaragoza, Spain.
Department of Preventive Medicine, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil.


There is an increasing interest for the role of liver enzymes as predictors of non-liver-related morbidity and mortality. The American Heart Association (AHA) described the ideal cardiovascular health concept as a score of seven cardiovascular health behaviors and factors that can be used to monitor and predict ideal cardiovascular health over time. This study aimed to examine the association of the ideal cardiovascular health (ICH), as defined by the AHA, with liver enzyme levels in European adolescents. A total of 637 adolescents (54.6% females), aged 14.6 ± 1.2 years from nine European countries participated in this cross-sectional study. Blood levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma-glutamyltransferase were measured and the AST/ALT ratio calculated. Ideal cardiovascular health was defined as meeting ideal levels of the following components: four behaviors (smoking, body mass index, physical activity, and diet) and three factors (total cholesterol, blood pressure, and glucose). A higher number of ideal cardiovascular health behaviors, factors, and ideal cardiovascular health index were associated with lower ALT (P < 0.05, P < 0.001, and P < 0.001, respectively) and gamma-glutamyltransferase (P < 0.001, P < 0.01, and P < 0.001, respectively) levels. Similarly, a higher number of ideal cardiovascular health behaviors (P < 0.01), factors (P < 0.01), and ideal cardiovascular health index (P < 0.001) were associated with a higher aspartate aminotransferase to alanine aminotransferase ratio. These findings reinforce the usefulness of the ICH index as an instrument to identify target individuals and promote cardiovascular health in adolescents, and it also extends these observations to the liver manifestation of the metabolic syndrome.


Adolescents; Ideal cardiovascular health (ICH); Liver enzymes

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