Abstract

Background: Obesity can lead to hepatic steatosis and inflammation, resulting in elevated alanine aminotransferase (ALT) levels. Although a previous study reported a high prevalence of elevated ALT in obese individuals, few studies have examined its relationship with cardiometabolic risk factors in Korean adolescents. This study investigated the association between elevated ALT levels and cardiometabolic risk in Korean adolescents. Methods: Data were analyzed from 1,660 adolescents (905 boys and 755 girls; aged 10–18 years) who participated in KNHANES VIII (2019–2021). Cardiometabolic risk factors—including body mass index (BMI), waist circumference (WC), blood pressure, fasting glucose, and lipid profile—were measured. Elevated ALT was defined as ≥24.1 U/L for boys and ≥17.7 U/L for girls. Overweight and obesity were defined as BMI ≥85th and ≥95th percentiles, respectively, according to the 2017 Korean National Growth Charts. Statistical analyses accounted for sampling weights and complex sample design. Results: Among participants, 164 (9.1%) were classified as overweight and 266 (16.6%) as obese. Systolic blood pressure and triglyceride levels were higher in both boys and girls with elevated ALT levels. After adjusting for age, residential area, household income, alcohol consumption, and BMI, boys with elevated ALT had higher odds of diastolic blood pressure (OR 1.89; 95% CI, 1.11 to 3.23, P = 0.017) and hypertriglyceridemia (OR 1.65; 95% CI, 1.00 to 2.73, P = 0.048). In girls, elevated ALT was associated with elevated systolic blood pressure (OR 2.94; 95% CI, 1.44 to 6.01, P = 0.003) and hypertriglyceridemia (OR 1.92; 95% CI, 1.04 to 3.54, P = 0.037). Conclusion: Elevated ALT levels were associated with elevated diastolic blood pressure and triglycerides in boys, and with elevated systolic blood pressure and triglyceride in girls.