Low serum vitamin D is independently associated with unexplained elevated ALT only among non-obese men in the general population

Shira Zelber-Sagi, Reut Zur, Tamar Thurm, Alex Goldstein, Ofir Ben-Assuli, Gabriel Chodick, Oren Shibolet

Research output: Contribution to journalArticlepeer-review


Introduction and Objectives: There are inconsistent findings on the association between human non-alcoholic fatty liver disease (NAFLD) and vitamin D, perhaps due to insufficient specificity for gender and obesity status. We aimed to assess whether serum levels of 25-hydroxyvitamin D are associated with unexplained elevated alanine aminotransferase (ALT) in general population across gender and body mass index (BMI) levels. Materials and methods: A cross-sectional analysis of a population-based cohort with a nationwide-distribution using electronic medical database. The population consisted of individuals aged 20–60 years who underwent blood tests for ALT and vitamin D. Results: A total of 82,553 subjects were included (32.5% men, mean age 43.91 ± 10.15 years). The prevalence of elevated ALT was higher among men and women with vitamin D insufficiency or deficiency, but in multivariate analysis, adjusting for: age, BMI, serum levels of glucose, total cholesterol, triglycerides, statin use and season, only the association among men remained significant for the vitamin D deficiency category (OR = 1.16, 95%CI 1.04–1.29, P = 0.010). Stratification by BMI revealed that only among normal weight and overweight men vitamin D deficiency was associated with elevated ALT (OR = 1.27, 95%CI 1.01–1.59, P = 0.041 and OR = 1.27, 95%CI 1.08–1.50, P = 0.003, respectively). No independent association was shown among women at all BMI categories. Conclusions: In a “real-life” general population, the association between vitamin D deficiency and unexplained elevated ALT is specific for non-obese men. The clinical significance of vitamin D for human NAFLD should be further elucidated with attention for a modifying effect of gender and adiposity.

Original languageEnglish
Pages (from-to)578-584
Number of pages7
JournalAnnals of Hepatology
Issue number4
StatePublished - 1 Jul 2019

Bibliographical note

Publisher Copyright:
© 2019 Fundación Clínica Médica Sur, A.C.


  • 25(OH)D
  • BMI
  • Gender differences
  • Nonalcoholic fatty liver disease (NAFLD)
  • Obesity

ASJC Scopus subject areas

  • Hepatology


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