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Minato-Inokawa S, Tsuboi-Kaji A, Honda M, Takeuchi M, Kitaoka K, Kurata M, Wu B, Kazumi T, Fukuo K. Associations of ALT/AST, a marker of hepatosteatosis, with pulse rate in young women and with blood pressure in middle-aged women independently of abdominal fat accumulation and insulin resistance. Diabetol Int 2024; 15:270-277. [PMID: 38524930 PMCID: PMC10959855 DOI: 10.1007/s13340-023-00689-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 12/21/2023] [Indexed: 03/26/2024]
Abstract
We examined whether alanine aminotransferase/aspartate aminotransferase (ALT/AST), a marker of hepatosteatosis, may be associated with a wider constellation of variables related to metabolic syndrome in Japanese women. Body fat and distribution, and metabolic syndrome-related variables were measured in 311 young and 148 middle-aged women. We had Pearson's correlation analysis and then stepwise multivariate linear regression analyses. In both middle-aged and young women, ALT/AST was associated with homeostasis model assessment insulin resistance (HOMA-IR), trunk/leg fat ratio and pulse rate. In middle-aged women but not in young women, ALT/AST was associated with waist circumference, fasting glucose, triglyceride, HDL cholesterol (inversely), systolic, diastolic and mean blood pressure (BP). Further, in middle-aged women only, the ratio was associated with BMI, percentage body fat, apolipoprotein B and plasminogen activator inhibitor-1. Among these variables, pulse rate in young women and systolic BP in middle-aged women were associated with ALT/AST independently of trunk/leg fat ratio, a sophisticated measures of abdominal fat accumulation, HOMA-IR, fasting glucose, triglyceride and HDL cholesterol. In conclusion, ALT/AST was associated with pulse rate in young women and with systolic BP in middle-aged women independently of abdominal fat accumulation and insulin resistance. It is noted that their waist circumference averaged < 80 cm and ALT < 30 U/L, suggesting minimum accumulation of abdominal and hepatic fat, respectively, key drivers of insulin resistance and metabolic syndrome. Supplementary Information The online version contains supplementary material available at 10.1007/s13340-023-00689-z.
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Affiliation(s)
- Satomi Minato-Inokawa
- Research Institute for Nutrition Sciences, Mukogawa Women’s University, Nishinomiya, Hyogo Japan
- Laboratory of Community Health and Nutrition, Department of Bioscience, Graduate School of Agriculture, Ehime University, Matsuyama, Ehime, Japan
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Ayaka Tsuboi-Kaji
- Research Institute for Nutrition Sciences, Mukogawa Women’s University, Nishinomiya, Hyogo Japan
- Department of Nutrition, Osaka City Juso Hospital, Osaka, Japan
| | - Mari Honda
- Open Research Center for Studying of Lifestyle-Related Diseases, Mukogawa Women’s University, Nishinomiya, Hyogo Japan
- Department of Health, Sports, and Nutrition, Faculty of Health and Welfare, Kobe Women’s University, Kobe, Hyogo Japan
| | - Mika Takeuchi
- Research Institute for Nutrition Sciences, Mukogawa Women’s University, Nishinomiya, Hyogo Japan
| | - Kaori Kitaoka
- Research Institute for Nutrition Sciences, Mukogawa Women’s University, Nishinomiya, Hyogo Japan
- Department of Advanced Epidemiology, Noncommunicable Disease (NCD) Epidemiology Research Center, Shiga University of Medical Science, Otsu, Shiga Japan
| | - Miki Kurata
- Research Institute for Nutrition Sciences, Mukogawa Women’s University, Nishinomiya, Hyogo Japan
- Department of Food Sciences and Nutrition, Mukogawa Women’s University, Nishinomiya, Hyogo Japan
| | - Bin Wu
- Open Research Center for Studying of Lifestyle-Related Diseases, Mukogawa Women’s University, Nishinomiya, Hyogo Japan
- Department of Endocrinology, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan China
| | - Tsutomu Kazumi
- Research Institute for Nutrition Sciences, Mukogawa Women’s University, Nishinomiya, Hyogo Japan
- Open Research Center for Studying of Lifestyle-Related Diseases, Mukogawa Women’s University, Nishinomiya, Hyogo Japan
- Department of Medicine, Kohan Kakogawa Hospital, Kakogawa, Hyogo Japan
| | - Keisuke Fukuo
- Research Institute for Nutrition Sciences, Mukogawa Women’s University, Nishinomiya, Hyogo Japan
- Open Research Center for Studying of Lifestyle-Related Diseases, Mukogawa Women’s University, Nishinomiya, Hyogo Japan
- Department of Food Sciences and Nutrition, Mukogawa Women’s University, Nishinomiya, Hyogo Japan
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Dang SW, Gao L, Li YJ, Zhang R, Xu J. Metabolic characteristics of non-obese and obese metabolic dysfunction-associated fatty liver disease in type 2 diabetes mellitus and its association with diabetic peripheral neuropathy and diabetic retinopathy. Front Med (Lausanne) 2023; 10:1216412. [PMID: 37828942 PMCID: PMC10566373 DOI: 10.3389/fmed.2023.1216412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 08/28/2023] [Indexed: 10/14/2023] Open
Abstract
Aim To assess the metabolic characteristics of non-obese metabolic dysfunction-associated fatty liver disease (MAFLD) compared with obese MAFLD and the relationship of MAFLD with diabetic peripheral neuropathy and diabetic retinopathy in patients with Type 2 diabetes mellitus (T2DM). Methods Data were obtained from 536 T2DM patients (355 women, 181 men; age 58.2 ± 12.0 years). We explored the difference in clinical characteristics between obese MAFLD (body mass index ≥25 kg/m2) and non-obese MAFLD (body mass index <25 kg/m2) in T2DM patients. One-way analysis of variance (ANOVA) was used to compare the means of continuous variables, and the Chi-squared test was used to compare the differences in frequencies of categorical variables. Logistic regression models were adopted to calculate odds ratios. Results The prevalence of MAFLD in hospitalized Chinese T2DM patients was calculated to be 42.7%. Both obese and non-obese MAFLD patients had higher levels of body mass index (BMI), waist circumfere nce, triglyceride, alanine aminotransferase, aspar tate aminotransferase, γ-glutamyltransferase, you nger age, higher prevalence of hyperlipidemia and shorter duration of T2DM and lower incidence of diabetic retinopathy, compared with participants with out MAFLD in the same weight group. Uric acid levels were positively correlated with the risk of MAFLD only in non-obese subjects but not in obese subjects. In non-obese patients with T2DM, a negative correlation was found between the prevalence of MAFLD and diabetic retinopathy. Conclusion Even in non-obese patients with T2DM, BMI was found to be an independent risk factor for MAFLD. These findings support a more structured, risk-factor-based approach to MAFLD management, particularly in patients with T2DM. Non-obese MAFLD has unique results in metabolic characteristics and the correlation with diabetic retinopathy and diabetic peripheral neuropathy, which should be further explored.
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Affiliation(s)
- Si-Wen Dang
- Department of Endocrinology, The Second Affiliated Hospital, Xi’an Jiaotong University, Xi’an, China
- International Center for Obesity and Metabolic Disease Research, Xi’an Jiaotong University, Xi’an, China
| | - Lei Gao
- Department of Endocrinology, The Second Affiliated Hospital, Xi’an Jiaotong University, Xi’an, China
- International Center for Obesity and Metabolic Disease Research, Xi’an Jiaotong University, Xi’an, China
| | - Yu-Jun Li
- Department of Endocrinology, The Second Affiliated Hospital, Xi’an Jiaotong University, Xi’an, China
- International Center for Obesity and Metabolic Disease Research, Xi’an Jiaotong University, Xi’an, China
| | - Ruo Zhang
- Department of Endocrinology, The Second Affiliated Hospital, Xi’an Jiaotong University, Xi’an, China
- International Center for Obesity and Metabolic Disease Research, Xi’an Jiaotong University, Xi’an, China
| | - Jing Xu
- Department of Endocrinology, The Second Affiliated Hospital, Xi’an Jiaotong University, Xi’an, China
- International Center for Obesity and Metabolic Disease Research, Xi’an Jiaotong University, Xi’an, China
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Abera W, Wube TB, Alemayehu T. The association of aspartate transaminase-to-alanine transaminase ratio and metabolic syndrome among HIV patients in Sidama Region, South Ethiopia. SAGE Open Med 2023; 11:20503121231196701. [PMID: 37694128 PMCID: PMC10483979 DOI: 10.1177/20503121231196701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 08/07/2023] [Indexed: 09/12/2023] Open
Abstract
Objective Studies on the association of the aspartate transaminase-to-alanine transaminase ratio with the metabolic syndrome and its components among HIV patients were scarce. This study aims to determine the association between the aspartate transaminase-to-alanine transaminase ratio and the metabolic syndrome and its components in adult HIV patients on highly active antiretroviral therapy. Methods This was a cross-sectional study conducted on 302 HIV patients from January 15 to June 30, 2021. Sociodemographic, clinical, and anthropometric data were collected using a structured questionnaire. The patient's medical records were reviewed. Biochemical analysis was performed after 5 ml of venous blood was collected from each study participant. Metabolic syndrome was defined by the third report of the national cholesterol education program-adult treatment panel. Logistic regression was done to assess the association of MetS with the independent variables, and correlation analysis was performed to see the correlation of MetS components with the aspartate aminotransferase-to-alanine aminotransferase ratio. Result 302 HIV-positive patients on highly active antiretroviral therapy were included in this study, and 54.6% were female. The median and interquartile range of the age of the study participants were 41 (35-50) years. The prevalence of metabolic syndrome was 29.5% (confidence interval = 24.5-35.1). Chronic illness (Adjusted odds ratio = 4.8, confidence interval = 2.2-10.9) and aspartate aminotransferase-to-alanine aminotransferase ratio (adjusted odds ratio = 2.5, confidence interval = 1.4-4.4) were significantly associated with Metabolic syndrome among the study participants. The aspartate aminotransferase-to-alanine aminotransferase ratio was significantly correlated with blood pressure. Conclusion This study found the existence of a significant association between the aspartate aminotransferase-to-alanine aminotransferase ratio and metabolic syndrome among HIV patients.
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Affiliation(s)
- Wondwossen Abera
- School of Medical Laboratory Science, College of Medicine and Health Science, Hawassa University, Hawassa, Ethiopia
| | - Temesgen Bizuayehu Wube
- School of Medical Laboratory Science, College of Medicine and Health Science, Hawassa University, Hawassa, Ethiopia
| | - Tsegaye Alemayehu
- School of Medical Laboratory Science, College of Medicine and Health Science, Hawassa University, Hawassa, Ethiopia
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Khalili P, Ayoobi F, Kahkesh Pour F, Esmaeili-Nadimi A, Abassifard M, La Vecchia C, Jamali Z. Serum liver enzymes and metabolic syndrome from the Rafsanjan Cohort Study. J Investig Med 2023; 71:140-148. [PMID: 36647299 DOI: 10.1177/10815589221141830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Our investigation aimed at evaluating the relationship between metabolic syndrome, alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma glutamyl transferase (GGT), and alkaline phosphatase (ALP) in the Rafsanjan cohort study (RCS). We used data obtained from the RCS, as a part of the prospective epidemiological research studies in Iran. In this cross-sectional research, 9895 participants from the baseline phase of RCS who completed medical questionnaire were included. Metabolic syndrome (MetS) defined using NCEP-ATP III criteria. The relationship between elevated serum liver enzymes levels even within the normal range and metabolic syndrome was evaluated by logistic regressions. The prevalence of MetS was 34.42% in the participants of study. The mean concentrations of AST, ALT, ALP, and GGT increased with increasing MetS components. After adjusting for all potential confounders, elevated serum concentrations of ALT, AST, GGT, and ALP even within the normal range were related with an increased odds of MetS. MetS was associated with increased levels of liver enzymes even within the normal range. These results indicated the potential for elevated liver enzymes as biomarkers for the possible presence of MetS.
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Affiliation(s)
- Parvin Khalili
- Social Determinants of Health Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.,Department of Epidemiology, School of Public Health, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Fatemeh Ayoobi
- Non-Communicable Diseases Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Firoozeh Kahkesh Pour
- Social Determinants of Health Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Ali Esmaeili-Nadimi
- Non-Communicable Diseases Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Mitra Abassifard
- Non-Communicable Diseases Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.,Department of Internal Medicine, Ali ibn Abi Talib Hospital, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, Università degli Study di Milano, Milan, Italy
| | - Zahra Jamali
- Non-Communicable Diseases Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
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Wang X, Li H, Ji L, Cang J, Zhao H. Association between aspartate aminotransferase to alanine aminotransferase ratio and the risk of diabetes in Chinese prediabetic population: A retrospective cohort study. Front Public Health 2023; 10:1045141. [PMID: 36684872 PMCID: PMC9846751 DOI: 10.3389/fpubh.2022.1045141] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 12/05/2022] [Indexed: 01/06/2023] Open
Abstract
Background Accumulating evidence has revealed that the aspartate aminotransferase to alanine aminotransferase (AST/ALT) ratio is a promising novel biomarker for insulin resistance (IR) and metabolic diseases. However, research on the association between the AST/ALT ratio and the incidence of diabetes progressing from prediabetes remains lacking. Herein, this study aimed to evaluate the relationship between the baseline AST/ALT ratio and risks of diabetes in patients with prediabetes. Methods This was a retrospective cohort study involving a total of 82,683 participants across 32 regions and 11 cities in China from 2010 to 2016. Data was obtained based on the DATADRYAD database from the health check screening program. Participants were stratified according to the interquartile range of the AST/ALT ratio (groups Q1 to Q4). The Cox proportional hazard model and smooth curve fitting were used to explore the relationship between the baseline AST/ALT ratio and the risk of diabetes in prediabetic patients. In addition, subgroup analysis was used to further validate the stability of the results. Results The mean age of the selected participants was 49.9 ± 14.0 years, with 66.8% of them being male. During the follow-up period 1,273 participants (11.3%) developed diabetes progressing from prediabetes during the follow-up period. Participants who developed diabetes were older and were more likely to be male. The fully-adjusted Cox proportional hazard model revealed that the AST/ALT ratio was negatively associated with the risk of diabetes in prediabetic patients (HR = 0.40, 95% CI: 0.33 to 0.48, P < 0.001). Higher AST/ALT ratio groups (Q4) also presented with a lower risk of progressing into diabetes (HR = 0.35, 95% CI: 0.29 to 0.43, P < 0.001, respectively) compared with the lowest quintile group (Q1). Through subgroup analysis and interaction tests, it was found that the association stably existed in all subgroup variables, and there were a stronger interactive effects in people with age < 45 years, and TG ≤ 1.7 mmol/L in the association between AST/ALT ratio and diabetes incidences in patients with prediabetes (P for interaction < 0.05). Conclusion According to our study, a higher AST/ALT ratio is associated with a lower risk of progressing into diabetes from prediabetes. Regular monitoring of AST/ALT ratio dynamics and corresponding interventions can help prevent or slow prediabetes progression for diabetes.
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Affiliation(s)
- Xiaoqing Wang
- Department of Anaesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - He Li
- Department of Anesthesiology, Affiliated Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Lin Ji
- Department of Anesthesiology, Yancheng Third People's Hospital, The Yancheng School of Clinical Medicine of Nanjing Medical University, Yancheng, Jiangsu, China
| | - Jing Cang
- Department of Anaesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hang Zhao
- Department of Anesthesiology, Yancheng Third People's Hospital, The Yancheng School of Clinical Medicine of Nanjing Medical University, Yancheng, Jiangsu, China
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Yan F, Nie G, Zhou N, Zhang M, Peng W. Combining Fat-to-Muscle Ratio and Alanine Aminotransferase/Aspartate Aminotransferase Ratio in the Prediction of Cardiometabolic Risk: A Cross-Sectional Study. Diabetes Metab Syndr Obes 2023; 16:795-806. [PMID: 36945296 PMCID: PMC10024880 DOI: 10.2147/dmso.s401024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 03/05/2023] [Indexed: 03/17/2023] Open
Abstract
PURPOSE Altered body composition and liver enzymes are known to be related to cardiometabolic risk. Our study aimed to evaluate the association between fat-to-muscle ratio (FMR), alanine aminotransferase/aspartate aminotransferase (ALT/AST) ratio and cardiometabolic risk. METHODS In total, 1557 participants aged ≥40 years were included. A bioelectrical impedance analyzer (BIA) was used to measure fat mass and muscle mass. We created a cardiometabolic risk score with one point for each cardiometabolic risk factor, including elevated triglycerides (TGs), decreased high-density lipoprotein cholesterol (HDL-C), elevated blood pressure (BP), and abnormal blood glucose, yielding a score of 0-4 for each participant (≥2 for high-risk and <2 for low-risk). Logistic regression analyses were used to analyze the relationship between FMR, ALT/AST ratio and cardiometabolic risk. RESULTS FMR and ALT/AST ratio were significantly higher in the high-risk group than in the low-risk group (P<0.001). FMR and ALT/AST ratio were both positively correlated with a higher cardiometabolic risk score and the presence of each cardiometabolic risk factor. In subgroup analyses categorized according to FMR and ALT/AST ratio cutoffs, the high-FMR/high-ALT/AST group had the highest cardiometabolic risk (OR=8.51; 95% CI 4.46-16.25 in women and OR=5.09; 95% CI 3.39-7.65 in men) after adjusting for confounders. CONCLUSION FMR and ALT/AST ratio were positively associated with cardiometabolic risk. Combining these two indicators improved the prediction of cardiometabolic risk.
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Affiliation(s)
- Fengqin Yan
- Department of General Practice, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Guqiao Nie
- Department of General Practice, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Nianli Zhou
- Department of General Practice, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Meng Zhang
- Department of General Practice, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Wen Peng
- Department of General Practice, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
- Correspondence: Wen Peng, Department of General Practice, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Jianghan District, Wuhan, People’s Republic of China, Tel +86 13986074846, Email
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Lee SH, Choi EJ, Kim UJ, Park H, Park B, Lee HA, Park H. Synergistic effect of serum uric acid and body mass index trajectories during middle to late childhood on elevation of liver enzymes in early adolescence: Findings from the Ewha Birth and Growth Study. PLoS One 2023; 18:e0282830. [PMID: 37093811 PMCID: PMC10124883 DOI: 10.1371/journal.pone.0282830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 02/23/2023] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND/OBJECTIVES We aimed to determine whether serum uric acid (SUA) and body mass index (BMI) trajectories in childhood have longitudinal association with liver enzymes in adolescence. METHODS We conducted a study using data from the Ewha Birth and Growth Cohort. Individual trajectories of SUA (n = 203) and BMI (n = 206) from 5, 7, and 9 years were defined by group-based trajectory modeling. Also, liver function enzymes were collected at 11 to 12 year of age (Aspartate Aminotransferase [AST], Alanine transaminase [ALT], and Gamma-glutamyl transferase [γ-GTP]) (n = 206). Using a generalized linear model, the effects of SUA trajectory and BMI trajectory on liver function enzymes were assessed. We also assessed the interaction effect of SUA and BMI trajectories on liver enzymes. RESULTS For trajectory patterns, both SUA and BMI were classified into two distinct groups (High or Low). Both trajectory of SUA and BMI in childhood were positively associated with levels of liver enzymes at 11-12 years of age. The results showed that the combined effect of SUA and BMI trajectories on liver enzymes had a higher means in high-risk group (high SUA-high BMI trajectories group) than in low-risk group (low SUA-low BMI trajectories group) for ALT and γ-GTP, respectively. It remained significant association when adjusted for covariates. In addition, the interaction of BMI and SUA trajectories showed a significant synergistic effect. CONCLUSION Elevated childhood SUA and BMI trajectories are associated with increased liver enzymes in beginning of adolescent. This finding suggesting that early interventions in SUA and BMI may need for optimization of liver enzymes as potential marker for development of related disease in later life.
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Affiliation(s)
- Sung Hee Lee
- Department of Preventive Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Eun Jeong Choi
- Department of Preventive Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Ui Jeong Kim
- Department of Preventive Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
- Department of Preventive Medicine, Graduate Program in System Health Science and Engineering, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Hyunjin Park
- Department of Preventive Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
- Department of Preventive Medicine, Graduate Program in System Health Science and Engineering, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Bomi Park
- Department of Preventive Medicine, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Hye Ah Lee
- Clinical Trial Center, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Hyesook Park
- Department of Preventive Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
- Department of Preventive Medicine, Graduate Program in System Health Science and Engineering, College of Medicine, Ewha Womans University, Seoul, Korea
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Visaria A, Pai S, Cheung M, Ahlawat S. Association between aspartate aminotransferase-to-alanine aminotransferase ratio and insulin resistance among US adults. Eur J Gastroenterol Hepatol 2022; 34:316-323. [PMID: 34074988 DOI: 10.1097/meg.0000000000002215] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVE To determine whether a low aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio (AST/ALT ratio) is associated with insulin resistance among those without liver dysfunction. METHODS In this cross-sectional study of the National Health and Nutrition Examination Survey (NHANES) 2011-2016, we included 2747 (1434 male and 1313 nonpregnant female) adults ≥20 years without evidence of liver dysfunction (ALT<30 in male and <19 in female, negative viral serologies, no excess alcohol consumption, no elevated transferrin saturation, AST/ALT <2). Serum AST/ALT ratio was categorized into sex-specific quartiles (female: <1.12, 1.12-1.29, 1.29-1.47, ≥1.47 and male: <0.93, 0.93-1.09, 1.09-1.26, ≥1.26). The primary outcome was insulin resistance, as determined by Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) index score ≥3. Covariate-adjusted odds ratios (ORs) were estimated. Study analysis completed from 13 March 2020 to 21 April 2021. RESULTS Among the 2747 individuals, 33% had insulin resistance. Those in the lowest quartile (Q1) of AST/ALT had 75% higher adjusted odds of insulin resistance compared to the highest quartile (Q4) [aOR (95% confidence interval (CI), 1.75 (1.20-2.57)]. This association was more pronounced in those with elevated BMI [Q1 vs. Q4; BMI ≥ 25: 2.29 (1.58-3.33), BMI < 25: 0.66 (0.26-1.69); NAFLD per Fatty Liver Index ≥ 60: 2.04 (1.21-3.44), No NAFLD: 1.68 (0.94-3.01)]. CONCLUSION Lower AST/ALT ratio is associated with increased insulin resistance among those with healthy-range ALT, especially in those with BMI greater than or equal to 25 kg/m2.
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Affiliation(s)
- Aayush Visaria
- Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
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Cao C, Zhang X, Yuan J, Zan Y, Zhang X, Xue C, Wang Y, Zheng X. Nonlinear relationship between aspartate aminotransferase to alanine aminotransferase ratio and the risk of prediabetes: A retrospective study based on chinese adults. Front Endocrinol (Lausanne) 2022; 13:1041616. [PMID: 36387912 PMCID: PMC9640919 DOI: 10.3389/fendo.2022.1041616] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 10/10/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Recent evidence has revealed that the aspartate aminotransferase to alanine aminotransferase ratio (AST/ALT ratio) may be closely associated with metabolic syndrome and insulin resistance. However, it is unclear whether the AST/ALT ratio correlates with prediabetes risk. The aim of our study was to examine the association between AST/ALT ratios and the risk of prediabetes among a large cohort of Chinese subjects. METHODS This retrospective cohort study recruited 75204 Chinese adults with normoglycemia at baseline who underwent physical examinations at the Rich Healthcare Group from 2010 to 2016. The AST/ALT ratio at baseline was the target independent variable, and the risk of developing prediabetes during follow-up was the dependent variable. Cox proportional-hazards regression was used to evaluate the independent association between the AST/ALT ratio and prediabetes. This study identified nonlinear relationships by applying a generalized additive model (GAM) and smooth curve fitting. In order to assess the robustness of this study, we performed a series of sensitivity analyses. Moreover, we performed a subgroup analysis to evaluate the consistency of the association in different subgroups. Data from this study have been updated on the DATADRYAD website. RESULTS The AST/ALT ratio was negatively and independently related to the prediabetes risk among Chinese adults (HR: 0.76, 95% CI: 0.75-0.84, P<0.0001) after adjusting demographic and biochemical covariates. Furthermore, a nonlinear relationship between the AST/ALT ratio and the risk of developing prediabetes was found at an inflection point of 1.50 for the AST/ALT ratio. When the AST/ALT ratio was to the left of the inflection point (AST/ALT ratio ≤ 1.50), the AST/ALT ratio was negatively related to the prediabetes risk (HR:0.70, 95%CI: 0.65-0.76, P<0.0001). In contrast, the relationship tended to be saturated when the AST/ALT ratio was more than 1.50 (HR: 1.01, 95%CI: 0.89-1.15, P=0.8976). Our findings remained robust across a range of sensitivity analyses. Subgroup analysis revealed that other variables did not alter the relationship between the AST/ALT ratio and prediabetes risk. CONCLUSION This study revealed that AST/ALT ratio was negatively and independently associated with prediabetes risk among Chinese participants. The relationship between the AST/ALT ratio and prediabetes risk was nonlinear, and AST/ALT ratio ≤ 1.50 was strongly inversely correlated with prediabetes risk.
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Affiliation(s)
- Changchun Cao
- Department of Rehabilitation, Shenzhen Dapeng New District Nan’ao People’s Hospital, Shenzhen, Guangdong, China
| | - Xiaohua Zhang
- Department of Rehabilitation, Shenzhen Dapeng New District Nan’ao People’s Hospital, Shenzhen, Guangdong, China
| | - Junhu Yuan
- Department of Orthopedics, Foshan First People’s Hospital, Foshan, Guangdong, China
| | - Yibing Zan
- Department of Rehabilitation, Shenzhen Dapeng New District Nan’ao People’s Hospital, Shenzhen, Guangdong, China
| | - Xin Zhang
- Department of Rehabilitation, Shenzhen Dapeng New District Nan’ao People’s Hospital, Shenzhen, Guangdong, China
| | - Chao Xue
- Department of Rehabilitation, Shenzhen Dapeng New District Nan’ao People’s Hospital, Shenzhen, Guangdong, China
| | - Yulong Wang
- Department of Rehabilitation, Shenzhen Dapeng New District Nan’ao People’s Hospital, Shenzhen, Guangdong, China
- *Correspondence: Yulong Wang, ; Xiaodan Zheng,
| | - Xiaodan Zheng
- Department of Neurology, Shenzhen Samii International Medical Center (The Fourth People’s Hospital of Shenzhen), Shenzhen, Guangdong, China
- *Correspondence: Yulong Wang, ; Xiaodan Zheng,
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Niu H, Zhou Y. Nonlinear Relationship Between AST-to-ALT Ratio and the Incidence of Type 2 Diabetes Mellitus: A Follow-Up Study. Int J Gen Med 2021; 14:8373-8382. [PMID: 34819745 PMCID: PMC8608244 DOI: 10.2147/ijgm.s341790] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 11/05/2021] [Indexed: 12/15/2022] Open
Abstract
Background The aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio has been demonstrated to be associated with insulin resistance and metabolic syndrome. However, few studies have directly explored the association between the AST/ALT ratio and the incidence of type 2 diabetes mellitus (T2DM). As such, the present study aimed to investigate the relationship between the AST/ALT ratio and incident T2DM during follow-up in a population-based cohort. Methods This retrospective cohort analysis included 15,464 Japanese males and females without DM at baseline between 2004 and 2015. The association between AST/ALT ratio and T2DM was retrospectively examined using the Cox proportional hazard model after adjusting for multiple potential confounders. Results After follow-up, 373 (2.41%) patients developed T2DM. A nonlinear relationship between the AST/ALT ratio and T2DM was observed after adjusting for potential confounders. The risk for developing T2DM decreased with AST/ALT ratio up to a threshold of 0.93 (adjusted hazard ratio [HR] 0.14 [95% confidence interval (CI) = 0.02-0.90; P = 0.0385]). An AST/ALT ratio >0.93 was not associated with the risk for developing T2DM (adjusted HR = 0.67, 95% CI = 0.17-2.65; P = 0.5718). Conclusion The AST/ALT ratio was associated with a lower incidence of T2DM in a nonlinear pattern. The threshold AST/ALT ratio for developing T2DM was 0.93. AST/ALT levels were inversely correlated with the occurrence of T2DM when AST/ALT ratio ≤0.93.
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Affiliation(s)
- Hua Niu
- Department of Ultrasound Medicine, Xidian Group Hospital, Xi'an, 710077, People's Republic of China
| | - Yinghua Zhou
- Department of Ultrasound Medicine, Xi'an Gaoxin Hospital, Xi'an, 710075, People's Republic of China
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Chen L, Zhang K, Li X, Wu Y, Liu Q, Xu L, Li L, Hu H. Association Between Aspartate Aminotransferase to Alanine Aminotransferase Ratio and Incidence of Type 2 Diabetes Mellitus in the Japanese Population: A Secondary Analysis of a Retrospective Cohort Study. Diabetes Metab Syndr Obes 2021; 14:4483-4495. [PMID: 34785918 PMCID: PMC8590482 DOI: 10.2147/dmso.s337416] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 10/20/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The study on the association between aspartate aminotransferase to alanine aminotransferase (AST/ALT) ratio and the risk of type 2 diabetes mellitus (T2DM) was limited. Therefore, we conducted a secondary analysis based on online data to explore whether there was an association between the AST/ALT ratio and incident T2DM among a large number of Japanese people. METHODS The study was a retrospective cohort study. We downloaded the NAGALA (NAfld in Gifu area) data from DATADRYAD website between 2004 and 2015. This present study included 15,291 participants. Cox proportional-hazards regression, generalized additive models and subgroup analyses were used to find out the association between the AST/ALT ratio and T2DM events. RESULTS The negative relationship was shown between AST/ALT ratio and incident T2DM (HR = 0.617, 95% CI: 0.405-0.938) in our study. A non-linear relationship and saturation effect were found between them, and the inflection point was 0.882. It indicated that the AST/ALT ratio was negatively correlated with incident T2DM when the AST/ALT ratio was less than the inflection point (HR = 0.287, 95% CI: 0.126-0.655, p = 0.0030). We found that exercise modified their relationship (P for interaction = 0.0024), and people who did not exercise associated strongly (HR = 0.464 95% CI: 0.290-0.741). CONCLUSION AST/ALT ratio was negatively associated with T2DM risk, and their relationship was non-linear and had a saturation effect. When the AST/ALT ratio was less than 0.882, they showed a significant negative correlation.
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Affiliation(s)
- Lidan Chen
- Shenzhen Nanshan Medical Group Headquarter, Shenzhen, Guangdong Province, 518000, People’s Republic of China
| | - Kebao Zhang
- Department of Emergency, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518000, Guangdong Province, People’s Republic of China
| | - Xue Li
- Department of Emergency, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518000, Guangdong Province, People’s Republic of China
| | - Yang Wu
- Department of Endocrinology, Shenzhen Second People’s Hospital, Shenzhen, 518000, Guangdong Province, People’s Republic of China
| | - Qingwen Liu
- Shenzhen Second People’s Hospital, Shenzhen, 518000, Guangdong Province, People’s Republic of China
| | - Liting Xu
- Shenzhen Nanshan Medical Group Headquarter, Shenzhen, Guangdong Province, 518000, People’s Republic of China
| | - Liuyan Li
- Shenzhen Second People’s Hospital, Shenzhen, 518000, Guangdong Province, People’s Republic of China
| | - Haofei Hu
- Department of Nephrology, Shenzhen Second People’s Hospital, Shenzhen, 518000, Guangdong Province, People’s Republic of China
- Correspondence: Haofei Hu Department of Nephrology, Shenzhen Second People’s Hospital, No. 3002 Sungang Road, Futian District, Shenzhen, 518000, Guangdong Province, People’s Republic of ChinaTel +86-755-83366388 Email
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Metabolic risk associated with liver enzymes, uric acid, and hemoglobin in adolescents. Pediatr Res 2020; 88:945-949. [PMID: 32172279 DOI: 10.1038/s41390-020-0832-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 02/19/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND The associations of renal, hepatic, and hematologic markers with metabolic risk (MR) have already been shown in adolescents. However, it is still controversial which marker best predicts metabolic changes in youth. The aim of this study was to verify the association of MR with alanine aminotransferase (ALT), aspartate aminotransferase (AST), uric acid, and hemoglobin (Hb) in adolescents. METHODS We evaluated 1713 Brazilian adolescents aged 10 to 17 years. MR was calculated using a continuous metabolic risk score, including the sum of Z-scores of waist circumference, systolic blood pressure, fasting glucose, high-density lipoproteins, triglycerides, and cardiorespiratory fitness. Cutoff points were set for MR prediction for five metabolic components (ALT, AST, AST/ALT ratio, uric acid, and Hb). RESULTS MR was strongly associated with increased uric acid (odds ratio [OR]: 2.50; 95% confidence interval [CI]: 1.74-3.59), ALT (OR: 2.64; 95% CI: 1.63-4.27), and AST levels (OR: 2.53; 95% CI: 1.24-5.18). Uric acid was shown to be the best predictor for MR (sensitivity: 55.79%; specificity: 61.35%; area under the curve: 0.616). CONCLUSION Elevated hepatic, renal, and hematological markers were associated with MR in adolescents, especially ALT, AST, and uric acid levels. IMPACT Elevated hepatic, renal, and hematological markers were associated with metabolic risk in adolescents, especially ALT, AST, and uric acid levels. It is still controversial which marker best predicts metabolic changes in adolescents. In addition, association of Hb with metabolic risk is under-studied in this population. It is important to further investigate the relationship between elevated Hb and hepatic markers, since there are key aspects not addressed yet. Our results highlight the importance of creating public health policies aimed to child and adolescent population, to prevention of metabolic disorders from an early age.
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Soltani D, Jafari S, Ashraf H, Sobh-Rakhshankhah A, Kolahchi Z, Masoudkabir F, Boroumand MA, Vasheghani-Farahani A. Ratio of Serum Aspartate to Alanine Aminotransferase as a Marker of Isolated Coronary Artery Ectasia and its Severity. Heart Int 2020; 14:43-48. [PMID: 36277666 PMCID: PMC9524754 DOI: 10.17925/hi.2020.14.1.43] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 04/27/2020] [Indexed: 04/24/2024] Open
Abstract
BACKGROUND Several studies have reported an association between elevated liver enzymes and increased risks for developing inflammatory diseases. The aim of our study was to examine how serum liver transaminases, as inexpensive and routinely measured markers, and the De Ritis ratio are associated with the presence of coronary artery ectasia (CAE) and its severity. METHODS Participants were recruited from patients admitted to Tehran Heart Center for diagnostic coronary angiography due to suspected myocardial ischaemia. These participants also underwent concurrent laboratory routine biochemical and liver enzyme tests. RESULTS A total of 104 participants were included; 59 had CAE and 45 were controls without coronary artery disease (CAD). The CAE group was split into a further two subgroups: those with isolated CAE (n=27) and those with CAD and coexisting CAE (n=32). In the adjusted multivariate analysis, a lower ratio of aspartate aminotransferase to ALT (AST/ALT) was, uniquely among the variables, a statistically significant marker for isolated CAE. In the CAD + CAE group, the AST/ALT ratio was not significant after adjustments for the confounding factors. The multivariate linear regression for the Markis score showed that the AST/ALT ratio was inversely associated with the severity of CAE. CONCLUSIONS We conclude that the AST/ALT ratio and, to some extent, ALT independently of other inflammatory factors, can be associated with the presence and severity of isolated CAE.
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Affiliation(s)
- Danesh Soltani
- Students’ Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Samira Jafari
- Students’ Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Haleh Ashraf
- Cardiac Primary Prevention Research Center (CPPRC), Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Cardiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Sobh-Rakhshankhah
- Cardiac Primary Prevention Research Center (CPPRC), Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Kolahchi
- Students’ Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Farzad Masoudkabir
- Cardiac Primary Prevention Research Center (CPPRC), Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Boroumand
- Department of Pathology and Laboratory Medicine, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Vasheghani-Farahani
- Cardiac Primary Prevention Research Center (CPPRC), Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
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Parrinello CM, Rudolph BJ, Lazo M, Gallo LC, Thyagarajan B, Cotler SJ, Qi Q, Seeherunvong T, Vidot DC, Strickler HD, Kaplan RC, Isasi CR. Associations of Insulin Resistance and Glycemia With Liver Enzymes in Hispanic/Latino Youths: Results From the Hispanic Community Children's Health Study/Study of Latino Youth (SOL Youth). J Clin Gastroenterol 2019; 53:e46-e53. [PMID: 29099463 PMCID: PMC5934331 DOI: 10.1097/mcg.0000000000000946] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Associations of insulin resistance and hyperglycemia with a panel of liver enzymes have not been well studied in a young, heterogenous Hispanic/Latino population. We aimed to assess the associations of insulin resistance and glycemia with nonalcoholic fatty liver disease (NAFLD), as measured by liver enzymes and the pediatric NAFLD fibrosis index (PNFI), and whether these associations are modified by body mass index and mediated by inflammation or endothelial dysfunction. MATERIALS AND METHODS We conducted a cross-sectional study of 1317 boys and girls aged 8 to 16 years from the Hispanic Community Children's Health Study/Study of Latino Youth. We used Poisson regression to assess the associations of fasting glucose, hemoglobin A1c, and homeostasis model assessment of insulin resistance (HOMA-IR) with elevated alanine aminotransferase (ALT) (>25 U/L in boys, >22 U/L in girls), aspartate aminotransferase (AST) (≥37 U/L), gamma-glutamyl transpeptidase (GGT) (≥17 U/L), and PNFI (≥9; a function of age, waist circumference, and triglyceride level). RESULTS HOMA-IR was associated with elevated ALT, AST, GGT, and PNFI [prevalence ratios (95% confidence intervals) for each 1-unit increase in the natural log of HOMA-IR: 1.99 (1.40-2.81), 2.15 (1.12-4.12), 1.70 (1.26-2.30), and 1.98 (1.43-2.74), respectively]. Associations were observed in overweight/obese children, but not in normal weight children (P-interaction=0.04 for AST and P-interaction=0.07 for GGT). After further adjustment for adiponectin, high-sensitivity C-reactive protein, e-selectin, and PAI-1, associations of HOMA-IR with liver enzymes and PNFI were attenuated, but remained statistically significant for AST and PNFI. CONCLUSION Insulin resistance was associated with NAFLD in overweight/obese Hispanic/Latino youth, and this association may be partially mediated by inflammation and endothelial dysfunction.
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Affiliation(s)
- Christina M. Parrinello
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Bryan J. Rudolph
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Mariana Lazo
- Johns Hopkins School of Medicine and the Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD, USA
| | - Linda C. Gallo
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Bharat Thyagarajan
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Scott J. Cotler
- The Program for Experimental and Theoretical Modeling, Division of Hepatology, Department of Medicine, Loyola University Chicago, Medical Center, Maywood, IL, USA
| | - Qibin Qi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Tossaporn Seeherunvong
- Division of Pediatric Endocrinology, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Denise C. Vidot
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Howard D. Strickler
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Robert C. Kaplan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Carmen R. Isasi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
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Lin S, Tang L, Jiang R, Chen Y, Yang S, Li L, Li P. The Relationship Between Aspartate Aminotransferase To Alanine Aminotransferase Ratio And Metabolic Syndrome In Adolescents In Northeast China. Diabetes Metab Syndr Obes 2019; 12:2387-2394. [PMID: 31819564 PMCID: PMC6873971 DOI: 10.2147/dmso.s217127] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 09/26/2019] [Indexed: 11/23/2022] Open
Abstract
AIM To investigate the relationship of the aspartate aminotransferase to alanine aminotransferase ratio (AST/ALT) and metabolic syndrome (MetS) in adolescents in northeast China. METHODS A stratified cluster random sample of 935 students 11-16 years of age in a city in the northeast of China were enrolled in 2010-2011. Participants were given a physical examination and a laboratory evaluation, and 93 participants were followed-up after 5 years. RESULTS AST/ALT was negatively correlated with waist circumference (WC), waist-to-hip ratio, body mass index (BMI), diastolic blood pressure, triglycerides, low-density lipoprotein, uric acid, fasting insulin, and insulin resistance. It was positively correlated with high-density lipoprotein. Multivariate logistic regression showed that the risk of MetS was 6.02 times greater in adolescents with the lowest, compared with the highest, AST/ALT. Central obesity was the MetS component most closely associated with low AST/ALT [odds ratio (OR) =5.13, 95% CI: 2.83, 9.28]. Five years later, baseline AST/ALT was negatively correlated with WC (r=-0.21, P=0.046), BMI (r=-0.29, P=0.005) and fasting plasma glucose (r=-0.25, P=0.017). CONCLUSION In adolescents, AST/ALT was significantly associated with MetS and its components and predicted overweight/obesity in adulthood.
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Affiliation(s)
- Shuang Lin
- Department of Endocrinology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, People’s Republic of China
- Department of Cardiology, Zhongyi Northeast International Hospital, Shenyang, Liaoning Province, People’s Republic of China
| | - Lei Tang
- Department of Endocrinology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, People’s Republic of China
| | - Ranhua Jiang
- Department of Endocrinology, Liaoyang Diabetes Hospital, Liaoyang, Liaoning Province, People’s Republic of China
| | - Yu Chen
- Department of Endocrinology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, People’s Republic of China
| | - Sheng Yang
- Department of Endocrinology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, People’s Republic of China
| | - Ling Li
- Department of Endocrinology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, People’s Republic of China
- Ling Li Department of Endocrinology, Shengjing Hospital of China Medical University, No.36, Sanhao Street, Heping District, Shenyang110004, Liaoning Province, People’s Republic of ChinaTel +86 18940251181Fax +86 02425944460 Email
| | - Ping Li
- Department of Endocrinology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, People’s Republic of China
- Correspondence: Ping Li Department of Endocrinology, Shengjing Hospital of China Medical University, No.39, Huaxiang Road, Tiexi District, Shenyang110022, Liaoning Province, People’s Republic of ChinaTel +86 18940255673 Email
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AST to ALT ratio and arterial stiffness in non-fatty liver Japanese population:a secondary analysis based on a cross-sectional study. Lipids Health Dis 2018; 17:275. [PMID: 30509277 PMCID: PMC6278163 DOI: 10.1186/s12944-018-0920-4] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 11/20/2018] [Indexed: 12/29/2022] Open
Abstract
Background Previous studies have revealed that triglyceride to high-density lipoprotein cholesterol (HDL-C) ratio (henceforth TG/HDL-C) is one of the major risk factors for cardiovascular disease, insulin resistance and metabolism syndrome. However, there are fewer investigations of the correlations between the aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio and brachial ankle pulse wave velocity (baPWV). This study was undertaken to investigate the relationship between the AST to ALT ratio and brachial-ankle pulse wave velocity (baPWV) in a Japanese population. Methods The present study was a cross-sectional study. A total of 646 Japanese men and women without fatty liver, aged 24—84 years old, received a health medical check-up programme including the results from baPWV inspection and various standardized questionnaires in a health examination centre in Japan. Main outcome measures included AST/ALT ratio, baPWV, fatty liver and postmenopausal status. Abdominal ultrasonography was used to diagnose fatty liver. A postmenopausal state was defined as beginning 1 year following the cessation of menses. Results After adjusting for potential confounders (age, sex, BMI, SBP, DBP, AST, ALT, GGT, uric acid, fasting glucose, TC, LDL, eGFR, smoking and exercise statuses, fatty liver, alcohol consumption and ABI), a non-linear relationship was detected between AST/ALT and baPWV, which had an inflection point of 5.6. The effect sizes and the confidence intervals on the left and right sides of the inflection point were 12.7 (1.9 to 23.5) and − 16.7 (− 36.8 to 3.3), respectively. Subgroup analysis in participants with excessive alcohol consumption (more than 280 g/week) showed that AST/ALT had a negative correlation with baPWV (β = − 30.7, 95%CI (− 53.1, − 8.4)), and the P value for the interaction was less than 0.05. Conclusion The relationship between AST/ALT and baPWV is non-linear. AST/ALT was positively correlated with baPWV when AST/ALT was less than 5.6. In addition, the trend was the opposite in subjects who consumed excessive amounts of alcohol.
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Association between Serum Liver Enzymes and Metabolic Syndrome in Korean Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15081658. [PMID: 30081587 PMCID: PMC6121325 DOI: 10.3390/ijerph15081658] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 07/26/2018] [Accepted: 08/02/2018] [Indexed: 12/26/2022]
Abstract
The purpose of this study was to evaluate the association between alanine aminotransferase (ALT) and aspartate aminotransferase (AST), and metabolic syndrome (MS) in the Korean population. A total of 11,587 adults ≥30 years of age and with complete data were selected from Korea National Health and Nutrition Examination Survey VI conducted from 2013 to 2015. Normal ALT and AST levels were divided into quartiles, and their associations with MS were assessed by logistic regression analysis. Elevated levels of ALT [adjusted odds ratio (aOR) = 7.90, 95% confidence interval (CI) = 6.50–9.60] and AST (aOR = 3.81, 95% CI = 3.10–4.74) were both significantly associated with a higher prevalence of MS. The quartile group containing the highest levels of ALT and AST within the normal range also showed an increased risk of MS and its components. Elevated levels of ALT and AST, even within the normal range, were associated with prevalence of MS.
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Liu CF, Zhou WN, Lu Z, Wang XT, Qiu ZH. The associations between liver enzymes and the risk of metabolic syndrome in the elderly. Exp Gerontol 2018; 106:132-136. [PMID: 29499373 DOI: 10.1016/j.exger.2018.02.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Revised: 10/28/2017] [Accepted: 02/25/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Studies have demonstrated that liver enzymes are associated with metabolic syndrome (MetS). However, little information is available regarding these relationships in elderly populations. Our present study aimed to explore the associations between liver enzymes and the risk of MetS in elderly populations. METHODS This cross-sectional study included 1444 elder participants (970 men and 474 women) who attended annual physical examinations. Univariate and multivariate logistic regressions were performed to estimate the associations between liver enzymes and the risk of MetS and its components according to quartiles of the concentration of each liver enzyme. RESULTS The prevalence of MetS and its components increased remarkably with increasing quartiles of alanine aminotransferase (ALT), gamma-glutamyltransferase (GGT) and alkaline phosphatase (ALP) but not with aspartate aminotransferase (AST) in the elderly. Compared with subjects in the bottom quartile, the adjusted odds ratio for MetS in the highest ALT, GGT and ALP quartiles were 1.78 (95% CI 1.21-2.61), 2.58 (95% CI 1.77-3.78) and 1.85 (95%CI 1.27-2.70) respectively. No statistically significant increases in the odds ratio for MetS according to increased quartiles of AST were found in either the univariate or multivariate logistic regression analyses. CONCLUSIONS Elevated liver enzymes levels (mainly ALT, GGT and ALP but not AST) are positively associated with the prevalence of MetS in elderly populations.
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Affiliation(s)
- Cun-Fei Liu
- Department of Cardiology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200336, China; Department of Cardiology, Linyi People's Hospital, Linyi, Shandong 276000, China
| | - Wei-Ning Zhou
- Department of Pathology, East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Zheng Lu
- Department of Cardiology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200336, China
| | - Xue-Ting Wang
- Department of Cardiology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200336, China
| | - Zhao-Hui Qiu
- Department of Cardiology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200336, China.
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Serum alanine aminotransferase/aspartate aminotransferase ratio is one of the best markers of insulin resistance in the Chinese population. Nutr Metab (Lond) 2017; 14:64. [PMID: 29051770 PMCID: PMC5633891 DOI: 10.1186/s12986-017-0219-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 09/28/2017] [Indexed: 02/08/2023] Open
Abstract
Background The alanine aminotransferase (ALT)/aspartate aminotransferase (AST) ratio is reportedly associated with insulin resistance (IR). However, few studies have explored the relationship between the ALT/AST ratio and IR in the Chinese population. Here, we aimed to explore whether the ALT/AST ratio is associated and, if so, to what extent, with IR in the Chinese population as categorized by waist circumference (WC). Methods Our data were obtained from the SPECT-China study, a cross-sectional survey on the prevalence of metabolic diseases and risk factors in East China from 2014 to 2015. A total of 8398 participants aged 52.16 ± 13.16 (mean ± standard deviation) years were included in this study. Anthropometric indices, biochemical parameters and clinical characteristics were measured. IR was defined as the top quartile of the homeostasis model assessment of insulin resistance (HOMA-IR > 1.6), and central obesity was defined as a WC ≥90 cm in males or ≥80 cm in females. Linear regression and receiver operating characteristic curve analyses were conducted. Results The ALT/AST ratio was significantly correlated and associated with HOMA-IR in both non-centrally obese (r = 0.284, B = 0.509, 95% confidence interval (CI): 0.459–0.559, P < 0.001) and centrally obese subjects (r = 0.372, B = 0.607, 95%CI: 0.532–0.683, P < 0.001) after adjusting for potential confounders. The ALT/AST ratio was one of the best markers of IR, with areas under the curve (AUC) values of 0.66 (0.64–0.68) in non-centrally and 0.68 (0.66–0.70) in centrally obese subjects. In the prediction model for IR, the AUCs were significantly augmented after adding the ALT/AST ratio in both non-centrally obese [AUC 95%CI 0.69(0.67–0.71) vs 0.72(0.70–0.74), P<0.001] and central obese [AUC 95%CI 0.69(0.67–0.71) vs 0.73(0.72–0.75), P<0.001] subjects. The optimal cut-off points of the ALT/AST ratio for identifying IR were 0.80 in non-centrally obese people and 0.78 in centrally obese people, respectively. Conclusion The ALT/AST ratio may be one of the best markers for IR in the Chinese population. Whether the ALT/AST ratio should be regarded as an additional metabolic syndrome component in the Chinese population warrants further investigation. Electronic supplementary material The online version of this article (10.1186/s12986-017-0219-x) contains supplementary material, which is available to authorized users.
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Using controlled attenuation parameter combined with ultrasound to survey non-alcoholic fatty liver disease in hemodialysis patients: A prospective cohort study. PLoS One 2017; 12:e0176027. [PMID: 28426815 PMCID: PMC5398606 DOI: 10.1371/journal.pone.0176027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 04/04/2017] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND AND AIMS Controlled attenuation parameter (CAP) is a non-invasive method for measuring hepatic steatosis (HS). Non-alcoholic fatty liver disease (NAFLD) is closely related to cardiovascular diseases (CVDs). CVDs are the leading cause of morbidity and mortality in hemodialysis patients. The aim of this study was to investigate the prevalence of NAFLD in hemodialysis patients. METHOD We prospectively enrolled patients undergoing chronic hemodialysis, as well as patients with normal renal function who served as controls. The control group patients were referred by an endocrinologist to be tested for NAFLD; most of these patients had diabetes, hypertension, or dyslipidemia. We excluded those with excess alcohol intake, use of drugs known to induce HS, chronic viral hepatitis, or CAP failure. CAP ≥ 238 dB/m was used as a cutoff suggesting HS. An increased liver kidney contrast, as defined by ultrasound, was used to make the diagnosis of HS. RESULTS Three hundred and forty-three hemodialysis patients and 252 control group patients were enrolled. Among the hemodialysis patients, 192 (56.0%) had CAP- or ultrasound-identified HS compared with 91 (26.5%) who only had ultrasound-identified HS (P<0.001). Among the control group patients, 212 (84.1%) had CAP- or ultrasound-identified HS compared with 180 (71.4%) who only had ultrasound-identified HS (P<0.001). CONCLUSIONS The prevalence of NAFLD in the hemodialysis patients was 56%. The number of diagnoses of NAFLD made by using CAP combined with ultrasound was more than 2 times the number made with ultrasound alone in the hemodialysis patients. Therefore, we suggest the use of CAP combined with ultrasound to screen for NAFLD in hemodialysis patients.
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Yadav D, Choi E, Ahn SV, Baik SK, Cho YZ, Koh SB, Huh JH, Chang Y, Sung KC, Kim JY. Incremental Predictive Value of Serum AST-to-ALT Ratio for Incident Metabolic Syndrome: The ARIRANG Study. PLoS One 2016; 11:e0161304. [PMID: 27560931 PMCID: PMC4999188 DOI: 10.1371/journal.pone.0161304] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 08/03/2016] [Indexed: 12/12/2022] Open
Abstract
Aims The ratio of aspartate aminotransferase (AST) to alanine aminotransferase (ALT) is of great interest as a possible novel marker of metabolic syndrome. However, longitudinal studies emphasizing the incremental predictive value of the AST-to-ALT ratio in diagnosing individuals at higher risk of developing metabolic syndrome are very scarce. Therefore, our study aimed to evaluate the AST-to-ALT ratio as an incremental predictor of new onset metabolic syndrome in a population-based cohort study. Material and Methods The population-based cohort study included 2276 adults (903 men and 1373 women) aged 40–70 years, who participated from 2005–2008 (baseline) without metabolic syndrome and were followed up from 2008–2011. Metabolic syndrome was defined according to the harmonized definition of metabolic syndrome. Serum concentrations of AST and ALT were determined by enzymatic methods. Results During an average follow-up period of 2.6-years, 395 individuals (17.4%) developed metabolic syndrome. In a multivariable adjusted model, the odds ratio (95% confidence interval) for new onset of metabolic syndrome, comparing the fourth quartile to the first quartile of the AST-to-ALT ratio, was 0.598 (0.422–0.853). The AST-to-ALT ratio also improved the area under the receiver operating characteristic curve (AUC) for predicting new cases of metabolic syndrome (0.715 vs. 0.732, P = 0.004). The net reclassification improvement of prediction models including the AST-to-ALT ratio was 0.23 (95% CI: 0.124–0.337, P<0.001), and the integrated discrimination improvement was 0.0094 (95% CI: 0.0046–0.0143, P<0.001). Conclusions The AST-to-ALT ratio independently predicted the future development of metabolic syndrome and had incremental predictive value for incident metabolic syndrome.
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Affiliation(s)
- Dhananjay Yadav
- Department of Preventive Medicine, Yonsei University, Wonju College of Medicine, Wonju, Korea
| | - Eunhee Choi
- Institute of Lifestyle Medicine, Yonsei University, Wonju College of Medicine, Wonju, Korea
- * E-mail: (EHC); (JYK)
| | - Song Vogue Ahn
- Department of Preventive Medicine, Yonsei University, Wonju College of Medicine, Wonju, Korea
- Institute of Genomic Cohort, Yonsei University, Wonju College of Medicine, Wonju, Korea
| | - Soon Koo Baik
- Department of Internal Medicine, Yonsei University, Wonju College of Medicine, Wonju, Korea
| | - Youn zoo Cho
- Department of Internal Medicine, Yonsei University, Wonju College of Medicine, Wonju, Korea
| | - Sang Baek Koh
- Department of Preventive Medicine, Yonsei University, Wonju College of Medicine, Wonju, Korea
| | - Ji Hye Huh
- Department of Internal Medicine, Yonsei University, Wonju College of Medicine, Wonju, Korea
| | - Yoosoo Chang
- Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | - Ki-Chul Sung
- Division of Cardiology, Department of Medicine, Kangbuk Samsumg Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jang Young Kim
- Institute of Genomic Cohort, Yonsei University, Wonju College of Medicine, Wonju, Korea
- Department of Cardiology, Yonsei University, Wonju College of Medicine, Wonju, Korea
- * E-mail: (EHC); (JYK)
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Zhang L, Ma X, Jiang Z, Zhang K, Zhang M, Li Y, Zhao X, Xiong H. Liver enzymes and metabolic syndrome: a large-scale case-control study. Oncotarget 2016; 6:26782-8. [PMID: 26449189 PMCID: PMC4694952 DOI: 10.18632/oncotarget.5792] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 08/29/2015] [Indexed: 12/28/2022] Open
Abstract
Previous studies suggested that elevated liver enzymes could be used as potential novel biomarkers of Metabolic syndrome (MetS) and its clinical outcomes, although the results were inconsistent and the conclusions were underpowered. A case-control study with 6,268 MetS subjects and 6,330 frequency-matched healthy controls was conducted to systematically evaluated levels of four liver enzymes (ALT, AST, GGT and ALP), both in overall populations and in subjects with normal liver enzymes, with MetS risk using both quartiles and continuous unit of liver enzymes. We found significant associations were detected for all above analyses. Compared with quartile 1 (Q1), other quartiles have significant higher MetS risk, with ORs ranging from 1.15 to 18.15. The highest effected was detected for GGT, for which the OR value for the highest versus lowest quartile was 18.15 (95% CI: 15.7-20.9). Mutual adjustment proved the independence of the relations for all four liver enzymes. Sensitivity analyses didn’t materially changed the trend. To the best of our knowledge, this study should be the largest, which aimed at evaluating the association between liver enzymes measures and MetS risk. The results can better support that liver enzyme levels could be used as clinical predictors of MetS.
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Affiliation(s)
- Lu Zhang
- Department of Epidemiology, College of Preventive Medicine, Third Military Medical University, Chongqing, China.,Division of Scientific Research, Third Military Medical University, Chongqing, China
| | - Xiangyu Ma
- Department of Epidemiology, College of Preventive Medicine, Third Military Medical University, Chongqing, China
| | - Zhi Jiang
- Health Care Center of Southwest Hospital, The First Affiliated Hospital of The Third Military Medical University, Chongqing, China
| | - Kejun Zhang
- Department of Clinical Laboratory, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Mengxuan Zhang
- Department of Epidemiology, College of Preventive Medicine, Third Military Medical University, Chongqing, China
| | - Yafei Li
- Department of Epidemiology, College of Preventive Medicine, Third Military Medical University, Chongqing, China
| | - Xiaolan Zhao
- Health Care Center of Southwest Hospital, The First Affiliated Hospital of The Third Military Medical University, Chongqing, China
| | - Hongyan Xiong
- Department of Epidemiology, College of Preventive Medicine, Third Military Medical University, Chongqing, China
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Yin X, Subramanian S, Willinger CM, Chen G, Juhasz P, Courchesne P, Chen BH, Li X, Hwang SJ, Fox CS, O'Donnell CJ, Muntendam P, Fuster V, Bobeldijk-Pastorova I, Sookoian SC, Pirola CJ, Gordon N, Adourian A, Larson MG, Levy D. Metabolite Signatures of Metabolic Risk Factors and their Longitudinal Changes. J Clin Endocrinol Metab 2016; 101:1779-89. [PMID: 26908103 PMCID: PMC4880163 DOI: 10.1210/jc.2015-2555] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
CONTEXT Metabolic dysregulation underlies key metabolic risk factors—obesity, dyslipidemia, and dysglycemia. OBJECTIVE To uncover mechanistic links between metabolomic dysregulation and metabolic risk by testing metabolite associations with risk factors cross-sectionally and with risk factor changes over time. DESIGN Cross-sectional—discovery samples (n = 650; age, 36–69 years) from the Framingham Heart Study (FHS) and replication samples (n = 670; age, 61–76 years) from the BioImage Study, both following a factorial design sampled from high vs low strata of body mass index, lipids, and glucose. Longitudinal—FHS participants (n = 554) with 5–7 years of follow-up for risk factor changes. SETTING Observational studies. PARTICIPANTS Cross-sectional samples with or without obesity, dysglycemia, and dyslipidemia, excluding prevalent cardiovascular disease and diabetes or dyslipidemia treatment. Age- and sex-matched by group. INTERVENTIONS None. MAIN OUTCOME MEASURE(S) Gas chromatography-mass spectrometry detected 119 plasma metabolites. Cross-sectional associations with obesity, dyslipidemia, and dysglycemia were tested in discovery, with external replication of 37 metabolites. Single- and multi-metabolite markers were tested for association with longitudinal changes in risk factors. RESULTS Cross-sectional metabolite associations were identified with obesity (n = 26), dyslipidemia (n = 21), and dysglycemia (n = 11) in discovery. Glutamic acid, lactic acid, and sitosterol associated with all three risk factors in meta-analysis (P < 4.5 × 10−4). Metabolites associated with longitudinal risk factor changes were enriched for bioactive lipids. Multi-metabolite panels explained 2.5–15.3% of longitudinal changes in metabolic traits. CONCLUSIONS Cross-sectional results implicated dysregulated glutamate cycling and amino acid metabolism in metabolic risk. Certain bioactive lipids were associated with risk factors cross-sectionally and over time, suggesting their upstream role in risk factor progression. Functional studies are needed to validate findings and facilitate translation into treatments or preventive measures.
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Sun HL, Pei D, Lue KH, Chen YL. Uric Acid Levels Can Predict Metabolic Syndrome and Hypertension in Adolescents: A 10-Year Longitudinal Study. PLoS One 2015; 10:e0143786. [PMID: 26618358 PMCID: PMC4664290 DOI: 10.1371/journal.pone.0143786] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 11/08/2015] [Indexed: 02/07/2023] Open
Abstract
The relationships between uric acid and chronic disease risk factors such as metabolic syndrome, type 2 diabetes mellitus, and hypertension have been studied in adults. However, whether these relationships exist in adolescents is unknown. We randomly selected 8,005 subjects who were between 10 to 15 years old at baseline. Measurements of uric acid were used to predict the future occurrence of metabolic syndrome, hypertension, and type 2 diabetes. In total, 5,748 adolescents were enrolled and followed for a median of 7.2 years. Using cutoff points of uric acid for males and females (7.3 and 6.2 mg/dl, respectively), a high level of uric acid was either the second or third best predictor for hypertension in both genders (hazard ratio: 2.920 for males, 5.222 for females; p<0.05). However, uric acid levels failed to predict type 2 diabetes mellitus, and only predicted metabolic syndrome in males (hazard ratio: 1.658; p<0.05). The same results were found in multivariate adjusted analysis. In conclusion, a high level of uric acid indicated a higher likelihood of developing hypertension in both genders and metabolic syndrome in males after 10 years of follow-up. However, uric acid levels did not affect the occurrence of type 2 diabetes in both genders.
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Affiliation(s)
- Hai-Lun Sun
- Department of Pediatrics, Chung Shan Medical University Hospital, School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- * E-mail: (HLS); (YLC)
| | - Dee Pei
- Department of Internal Medicine, Cardinal Tien Hospital, School of Medicine, Fu-Jen Catholic University, New Taipei, Taiwan
| | - Ko-Huang Lue
- Department of Pediatrics, Chung Shan Medical University Hospital, School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Yen-Lin Chen
- Department of Pathology, Cardinal Tien Hospital, School of Medicine, Fu-Jen Catholic University, New Taipei, Taiwan
- * E-mail: (HLS); (YLC)
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Asparagine attenuates hepatic injury caused by lipopolysaccharide in weaned piglets associated with modulation of Toll-like receptor 4 and nucleotide-binding oligomerisation domain protein signalling and their negative regulators. Br J Nutr 2015; 114:189-201. [PMID: 26079268 DOI: 10.1017/s0007114515001476] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Pro-inflammatory cytokines play a key role in many models of hepatic damage. In addition, asparagine (Asn) plays an important role in immune function. We aimed to investigate whether Asn could attenuate lipopolysaccharide (LPS)-induced liver damage. Forty-eight castrated barrows were allotted to four groups including: (1) non-challenged control; (2) LPS-challenged control; (3) LPS + 0.5% Asn; and (4) LPS + 1.0% Asn. After 19 d feeding with control, 0.5 or 1.0% Asn diets, pigs were injected with LPS or saline. Blood and liver samples were obtained at 4 h (early stage) and 24 h (late stage) post-injection. Asn alleviated liver injury, indicated by reduced serum aspartate aminotransferase and alkaline phosphatase activities linearly and quadratically; it increased claudin-1 protein expression linearly and quadratically at 24 h, and less severe liver morphological impairment at 4 or 24 h. In addition, Asn decreased mRNA expression of TNF-α and heat shock protein 70 (HSP70) linearly and quadratically at 4 h; it increased TNF-α mRNA expression, and HSP70 protein expression linearly and quadratically at 24 h. Moreover, Asn increased inducible NO synthase activity linearly and quadratically. Finally, Asn down-regulated the mRNA expression of Toll-like receptor 4 (TLR4) signalling molecules (TLR4, IL-1 receptor-associated kinase 1 (IRAK1), TNF-α receptor-associated factor 6), nucleotide-binding oligomerisation domain protein (NOD) signalling molecules (NOD1, NOD2 and their adaptor molecule receptor-interacting serine/threonine-protein kinase 2 (RIPK2)), and NF-κB p65 linearly or quadratically at 4 h. Oppositely, Asn up-regulated mRNA expressions of TLR4 and NOD signalling molecules (TLR4, myeloid differentiation factor 88, IRAK1, NOD2 and RIPK2), and their negative regulators (radioprotective 105, single Ig IL-1R-related molecule, Erbb2 interacting protein and centaurin β1) linearly or quadratically at 24 h. These results indicate that, in early and late stages of LPS challenge, Asn improves liver integrity and exerts different regulatory effects on mRNA expression of TLR4 and NOD signalling molecules.
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Pei D, Hsia TL, Chao TT, Lin JD, Hsu CH, Wu CZ, Hsieh CH, Liang YJ, Chen YL. γ-glutamyl transpeptidase in men and alanine aminotransferase in women are the most suitable parameters among liver function tests for the prediction of metabolic syndrome in nonviral hepatitis and nonfatty liver in the elderly. Saudi J Gastroenterol 2015; 21:158-64. [PMID: 26021775 PMCID: PMC4455146 DOI: 10.4103/1319-3767.157564] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND/AIMS Nonalchoholic fatty liver disease (NAFLD) has been reported as a hepatic manifestation of metabolic syndrome (MetS); it is common and accounts for 80% of the cases with abnormal liver function tests (LFTs). In addition, several studies have proved that there is a correlation between abnormal LFTs and MetS. Therefore, LFTs may represent the abnormal metabolic status of livers in the patients with MetS. To identify the early state of metabolic dysfunction, we investigate the value of LFTs for the future MetS development in the relatively healthy (non-NAFLD) elderly. PATIENTS AND METHODS A total of 16,912 subjects met the criteria for analysis. In the first stage of this study, subjects were enrolled in the cross-sectional study in order to find out the optimal cutoff value in different LFTs with higher chances to have MetS. In the second stage of the present study, subjects with MetS at baseline were excluded from the same study group, and a median 5.6-year longitudinal study was conducted on the rest of the group. RESULTS Among all LFTs, only aspartate aminotransferase in both genders and the α-fetal protein in women failed to show the significance in distinguishing subjects with MetS by the receiver operating characteristic curve. In the Kaplan-Meier plot, only γ-glutamyl transpeptidase (γ-GT) in men and the alanine aminotransferase (ALT) in women could be used to successfully separate subjects with higher risk of developing the MetS from those with lower risk. Finally, in the multivariant Cox regression model, similar results were identified. Still, the hazard ratio (HR) to have future MetS, γ-GT in men, and ALT in women showed significance (HR = 1.511 in men and 1.504 in women). CONCLUSION Among all the different LFTs, γ-GT (>16 U/L) in male and ALT (>21 U/L) in female were the best predictors for the development of MetS in healthy elderly. These two liver markers could be an ancillary test in predicting future MetS development/diagnosis. Elevation of the LFTs without underlying liver diseases should be treated as a warning sign of the possible MetS development in the elderly.
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Affiliation(s)
- Dee Pei
- Department of Internal Medicine, Cardinal Tien Hospital, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - Te-Lin Hsia
- Department of Internal Medicine, Cardinal Tien Hospital, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - Ting-Ting Chao
- Medical Research Center, Cardinal Tien Hospital, School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - Jiunn-Diann Lin
- Division of Endocrinology and Metabolism, Department of Medicine, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Chun-Hsien Hsu
- Department of Family Medicine, Cardinal Tien Hospital, School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - Chung-Ze Wu
- Division of Endocrinology and Metabolism, Department of Medicine, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Chang-Hsun Hsieh
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC, Taiwan
| | - Yao-Jen Liang
- Department of Life-Science, Fu-Jen Catholic University, Taipei, Taiwan
| | - Yen-Lin Chen
- Department of Pathology, Cardinal Tien Hospital, School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan,Address for correspondence: Dr. Yen-Lin Chen, Department of Pathology, Cardinal Tien Hospital, No. 362, Zhongzheng Road, Xindian District, New Taipei City 231, Taiwan. E-mail:
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Tao LX, Li X, Zhu HP, Huo D, Zhou T, Pan L, Luo YX, Wang W, Wang ZP, Chen DN, Wu LJ, Guo XH. Association of hematological parameters with metabolic syndrome in Beijing adult population: a longitudinal study. Endocrine 2014; 46:485-95. [PMID: 24091543 DOI: 10.1007/s12020-013-0067-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 09/13/2013] [Indexed: 12/16/2022]
Abstract
The purposes of the study were to estimate the incidence of metabolic syndrome (MetS) and to systematically evaluate the relationship between hematological parameters and MetS in a 5-year follow-up of Beijing adult population. The longitudinal study included 3,180 adults, aged 20-65 years, who attended health check-ups in Beijing Tongren Hospital in 2007 and 2012. Multivariate logistic regression was conducted to explore the associations between hematological parameters and MetS. The 5-year cumulative incidence of MetS in this sample was 10.82 % (14.22 % for males and 7.59 % for females). Among all the hematological parameters, white blood cell count (WBC) was positively associated with MetS for 20-35-year-old (male OR 1.482, 95 % CI 1.169-2.974; female OR 1.398, 95 % CI 1.145-3.011), and 36-50-year-old (male OR 2.012, 95 % CI 1.290-4.010; female OR 3.400, 95 % CI 1.818-4.528) male and female subjects. Alanine aminotransferase (ALT) was significantly associated with the incidence of MetS for males (20-35-year-old OR 2.080, 95 % CI 1.371-3.159; 36-50-year-old OR 2.421, 95 % CI 1.335-3.412; 51-65-year-old OR 4.267, 95 % CI 1.161-6.781). Low-density lipoprotein cholesterol (LDL-C) was positively associated with MetS for 51-65-year-old (male OR 3.078, 95 % CI 2.468-5.131; female OR 2.140, 95 % CI 1.524-4.359) for male and female subjects. WBC is positively associated with MetS for young adults, while LDL-C is positively associated with MetS for elderly people. ALT is positively associated with MetS for males. Our findings provide further evidence in support of using hematological markers for early detection of individuals at risk for MetS.
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Affiliation(s)
- Li-Xin Tao
- School of Public Health, Capital Medical University, 10 Xitoutiao, Youanmenwai, Fengtai, Beijing, 100069, China
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Association between γ-glutamyl transferase and metabolic syndrome: a cross-sectional study of an adult population in Beijing. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2013; 10:5523-40. [PMID: 24173138 PMCID: PMC3863858 DOI: 10.3390/ijerph10115523] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 09/26/2013] [Accepted: 10/11/2013] [Indexed: 12/19/2022]
Abstract
The relationship between liver enzymes and clustered components of metabolic syndrome (MetS) is explored and the predictive power of γ-glutamyl transferase (GGT) for the diagnosis of MetS in an adult population in Beijing is investigated. A total of 10,553 adults aged 20-65 years who underwent health examinations at Beijing Tongren Hospital in 2012 were enrolled in the study. Multivariate logistic regression analysis is conducted to determine the associations between the levels of various liver enzymes and clustered components of MetS. A receiver operating characteristic analysis is used to determine the optimal cut-off value of GGT for the diagnosis of MetS. A high level of GGT is found to be positively associated with clustered components of MetS in both men and women after adjusting for age, body mass index (BMI), history of alcoholic fatty liver, and the presence of taking anti-hypertensive, anti-dyslipidemic, and anti-diabetic drugs. Among all components of MetS, GGT is more predictive of triglyceride, and BMI. The area-under-the-curve values of GGT for discriminating MetS from normal metabolic status in men and women are 0.73 and 0.80, respectively. The optimal cut-off value of GGT for men is 31.50 U/L, demonstrating a sensitivity of 74.00% and specificity of 62.00%. For women, it is 19.50 U/L (sensitivity 76.00% and specificity 70.00%). GGT is therefore recommended as a useful diagnostic marker for MetS, because the test is inexpensive, highly sensitive, and frequently encountered in clinical practice.
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Park TJ, Hwang JY, Go MJ, Lee HJ, Jang HB, Choi Y, Kang JH, Park KH, Choi MG, Song J, Kim BJ, Lee JY. Genome-wide association study of liver enzymes in korean children. Genomics Inform 2013; 11:149-54. [PMID: 24124411 PMCID: PMC3794088 DOI: 10.5808/gi.2013.11.3.149] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 08/22/2013] [Accepted: 08/23/2013] [Indexed: 12/13/2022] Open
Abstract
Liver enzyme elevations, as an indicator of liver function, are widely associated with metabolic diseases. Genome-wide population-based association studies have identified a genetic susceptibility to liver enzyme elevations and their related traits; however, the genetic architecture in childhood remains largely unknown. We performed a genome-wide association study to identify new genetic loci for liver enzyme levels in a Korean childhood cohort (n = 484). We observed three novel loci (rs4949718, rs80311637, and rs596406) that were multiply associated with elevated levels of alanine transaminase and aspartate transaminase. Although there are some limitations, including genetic power, additional replication and functional characterization will support the clarity on the genetic contribution that the ST6GALNAC3, ADAMTS9, and CELF2 genes have in childhood liver function.
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Affiliation(s)
- Tae-Joon Park
- Division of Structural and Functional Genomics, Center for Genome Science, Korea National Institute of Health, Cheongwon 363-951, Korea
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