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

Abstract

Background The alanine aminotransferase (ALT)/aspartate aminotransferase (AST) ratio has been considered an alternative marker for hepatic steatosis. However, few studies have investigated the association of the ALT/AST ratio with non-alcoholic fatty liver disease (NAFLD) in nonobese people. Methods A total of 12,127 nonobese participants who were free of NAFLD participated in this study. The participants were divided into quintiles of the ALT/AST ratio. Multiple Cox regression models were used to explore the association of the ALT/AST ratio with new-onset NAFLD. Results During the five-year follow-up period, 2147 individuals (17.7%) developed new-onset NAFLD. After adjusting for all non-collinear covariates, the multiple Cox regression analysis results showed that a higher ALT/AST ratio was independently associated with new-onset NAFLD in nonobese Chinese (adjusted hazard ratios [aHRs]: 2.10, 95% confidence intervals: 1.88, 2.36). The aHRs for NAFLD across increasing quintiles of the ALT/AST ratio were 1, 1.63 (1.30, 2.04), 2.07 (1.65, 2.60), 2.84 (2.33, 3.48) and 3.49 (2.78, 4.39) (P for trend< 0.001). The positive association was more significant among people with high blood pressure, high blood lipids and hyperglycaemia, as well as in men. Additionally, the regression spline showed that the saturation effect of the ALT/AST ratio on NAFLD risk was at 0.93 in this study population, which was 1.22 in males and 0.89 in females. Conclusions In nonobese Chinese individuals without NAFLD at baseline, the increase in the ALT/AST ratio is closely associated with the risk of new-onset NAFLD.

The albumin-to-alkaline phosphatase ratio as an independent predictor of future non-alcoholic fatty liver disease in a 5-year longitudinal cohort study of a non-obese Chinese population

“…Model 4 adjusted for model 3 plus lipid metabolic markers (TG, HDL-C, and LDL-C). Additionally, considering that the correlation between the AAPR and NAFLD may be different under different conditions [ 4 , 5 , 11 ], the researchers also conducted an exploratory hierarchical analysis in some subgroups and checked the differences between different hierarchical groups by the likelihood ratio test to determine whether there was an interaction.…”

“…NAFLD is generally thought to be caused by overweight and obesity [2,8], and in the past, related studies were mainly conducted in obese people. However, in recent years, an increasing number of studies have focused on non-obese NAFLD [9][10][11]. In a recent meta-analysis of more than 2 million people in 24 countries, nonobese people accounted for 40.8% of NAFLD patients globally [12], and in Asia, this situation seems to be more common [13,14].…”

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

“…It was believed that the AST/ALT ratio could help distinguish NAFLD from the alcoholic cause of liver disease, and the AST/ALT ratio was one of the best indicators to quantify liver fat infiltration. 15,[31][32][33] What's more, the AST/ALT ratio was one of the best predictors for IR in the Asian population, which was a prominent marker for metabolic syndrome and T2DM. 9,11,14,33,34 Liver enzyme markers, especially ALT and AST/ALT ratio, were the surrogate marker for incidence of T2DM and impaired fasting glucose (IFG) tolerance.…”

“…15,[31][32][33] What's more, the AST/ALT ratio was one of the best predictors for IR in the Asian population, which was a prominent marker for metabolic syndrome and T2DM. 9,11,14,33,34 Liver enzyme markers, especially ALT and AST/ALT ratio, were the surrogate marker for incidence of T2DM and impaired fasting glucose (IFG) tolerance. 11,12,35,36 A cross-sectional study includes 8863 Korean participants conducted by Ko et al 12 showed that AST/ALT was negatively associated with the incidence of T2DM, which showed the same conclusion with our present cohort study.…”

Metabolic surgery may protect against admission for COVID-19 in persons with nonalcoholic fatty liver disease

“… 12 This lab and BMI-based definition was used in addition to ICD coding because NASH and NAFLD are significantly underdiagnosed in the her, 13 , 14 and because elevated ALT is more specific for NAFLD/NASH than elevated AST. 15 …”