Association between aspartate aminotransferase-to-alanine aminotransferase ratio and insulin resistance among US adults

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: 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/m 2 .

Low aspartate aminotransferase/alanine aminotransferase (DeRitis) ratio assists in predicting diabetes in Chinese population

“…In the Korean population, a high ALT/AST ratio determined insulin resistance and obesity in adults ( 14 ). Similarly, surveys based on American populations revealed an increased risk of insulin resistance with lower AST/ALT ratio ( 32 ). Since insulin resistance is an important characteristic of diabetes, several recent studies based on Japanese populations also further elucidated a conclusion that there was also a correlation between low AST/ALT ratio and the incidence of diabetes ( 15 , 16 , 33 ).…”

Nonlinear relationship between aspartate aminotransferase to alanine aminotransferase ratio and the risk of prediabetes: A retrospective study based on chinese adults

“…Patients with prediabetes displayed markers of liver function injury, such as elevated ALT and AST levels (35). Among them, decreased AST/ALT can lead to functional impairment of pancreatic b cells, leading to aggravation of IR, forming a vicious circle, and accelerating the progression from prediabetes to type 2 diabetes (13). In a study of 808 Korean adolescents, Lee and Yang et al (15) found that a positive relationship existed between ALT and metabolic syndrome prevalence, while a negative relationship existed between the AST/ALT ratio and metabolic syndrome prevalence.…”

“…Excess glucose is returned to the liver, where it may hinder gluconeogenesis and encourage lipogenesis when insulin-resistant tissue is unable to increase glucose absorption (42)(43)(44). As a result of the fat buildup and inflammation that follows, the liver's structure is distorted and destroyed, raising ALT levels (13). AST, a vital enzyme for aerobic metabolism, is not only found in the liver but also in other tissues such as the heart, skeletal muscle, kidney, and red blood cells.…”

“…Decreased AST/ALT ratio is one of the best surrogates for nonalcoholic steatohepatitis ( 32 ). Recent studies have pointed out that the AST/ALT ratio can be used as one of the surrogate indicators of hyperinsulinemia and insulin resistance ( 13 , 33 ). In addition, studies have shown that with the increase in the AST/ALT ratio, the future risk of cardiovascular disease, metabolic syndrome, and DM will gradually decrease ( 14 , 15 , 34 ).…”

“…Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) play a variety of physiological roles and have consistently been recognized as important markers of NAFLD (12). Several studies have reported that the AST to ALT ratio (AST/ALT ratio) accurately identifies insulin resistance (IR) and is considered a potential biomarker (13). Furthermore, some researchers have revealed that the AST/ALT ratio may also be useful for assessing disease risks, such as NAFLD, diabetes mellitus, hyperinsulinemia, cardiovascular disease, and metabolic syndrome (14)(15)(16)(17).…”