A High Alanine Aminotransferase/Aspartate Aminotransferase Ratio Determines Insulin Resistance and Metabolically Healthy/Unhealthy Obesity in a General Adult Population in Korea: The Korean National Health and Nutritional Examination Survey 2007–2010

Abstract

Aims Early identification of individuals with insulin resistance (IR) and metabolically unhealthy state can help prevent various diseases and improve quality of life. In this study, we investigated a possible marker of IR and metabolic health status, alanine aminotransferase/aspartate aminotransferase (ALT/AST) ratio, and aimed to confirm its feasibility in a large population study. Methods A total of 16,371 adults from Korean National Health and Examination Survey were studied. Participants were divided into four groups according to their ALT/AST ratio quartiles. The homeostatic model assessment of insulin resistance level and proportion of people with IR, impaired fasting glucose, and undiagnosed type 2 diabetes were compared for each group. Receiver-operating characteristics (ROC) curve was also used to assess the usefulness of ALT/AST ratio to identify individuals with IR and metabolically unhealthy. Results In the groups with higher ALT/AST ratio, HOMA-IR level, proportion of IR, and proportion of individuals with IFG or type 2 diabetes mellitus was higher than that in those with low ALT/AST ratio. When analyzed with other factors related to IR, the data showed that the ALT/AST ratio was an independent predictor of IR (odds ratio 1.363, 95% confidential interval 1.323–1.405, p<0.001). When ROC curve analysis was done, area under curve (AUC) for identifying individuals with IR was 0.634. In addition, metabolically unhealthy individuals showed significantly higher ALT/AST ratio than metabolically healthy individuals (0.9780 vs 0.8511, p<0.001). Conclusions ALT/AST ratio was well-correlated with IR, IR-related conditions, and metabolic health status. This easily accessible method to estimate IR may facilitate the early screening of IR, which can result in prevention of IR-related morbid conditions.

Association between the alanine aminotransferase/aspartate aminotransferase ratio and new-onset non-alcoholic fatty liver disease in a nonobese Chinese population: a population-based longitudinal study

“…Some possible reasons may explain why a higher ALT/ AST ratio could easily lead to new-onset NAFLD. (i) A higher ALT/AST ratio has been associated with hepatic fat infiltration and hepatic steatosis [20,21]; (ii) in the Asian population, the ALT/AST ratio was considered to be a reliable marker of insulin resistance (IR) [37,38,42], while IR was a key pathophysiological factor for NAFLD [43]; and (iii) a higher ALT/AST ratio is closely related to inflammation in the liver [24], and chronic inflammation could further induce steatosis and IR in the liver [1,24]. In summary, a higher ALT/AST ratio may lead to chronic inflammation of the liver, IR and steatosis of the liver, which further leads to the occurrence of NAFLD.…”

Alteration of Serum Phospholipid n‐6 Polyunsaturated Fatty Acid Compositions in Nonalcoholic Fatty Liver Disease in the Japanese Population: A Cross‐Sectional Study

“…The change in AST to ALT ratio is not unique to NAFLD. Kwon and Lee (2019) reported that the ratio of AST to ALT correlated with IR A binary logistic regression was performed on ratio of ARA to DGLA and the ratio of AST to ALT. Variables with predicting value were selected by forward likelihood ratio test and the corresponding predicted probability were derived out.…”

“…The change in AST to ALT ratio is not unique to NAFLD. Kwon and Lee (2019) reported that the ratio of AST to ALT correlated with IR and metabolically health obesity. The broad association with various diseases may be the reason that the ratio of AST to ALT showed low specificity.…”

Association of Alanine Transaminase to Aspartate Aminotransferase Ratio and Incident Diabetes in Chinese Adults: A Second Retrospective Cohort Study

“…In former study, ALT/AST has been brought into evaluate insulin resistance (7,14,15). Hanley et al have informed that ALT/AST could be used for assessing metabolic syndrome through decide insulin sensitivity and acute insulin response (16,17).…”