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

Abstract

ObjectiveRecent 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.MethodsThis 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.ResultsThe 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.ConclusionThis 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.

Triglyceride-glucose index is associated with the risk of impaired fasting glucose: A 5-year retrospective cohort study in Chinese elderly people

“…This suggests that one out of every two Chinese adults may be at risk of developing diabetes if proper measures are not taken 20 . Studies have indicated that the standardized incidence rate of prediabetes in the overall population of China is 62.6 cases per 1000 person-years (73.8 cases per 1000 person-years among males and 51.2 cases per 1000 person-years among females) 21 . Additionally, another cohort study in China, which included 4093 Chinese adults with a median follow-up time of 3.25 years, found that 26.2% of participants developed prediabetes 22 .…”

Global research trends in prediabetes over the past decade: Bibliometric and visualized analysis

“…A 5-year cohort study in a Chinese adult population revealed that the triglyceride (TG)/HDL-c ratio was positively associated with the incidence of diabetes in prediabetic patients, which was supported by the results of a 10-year follow-up study in Iran. [36,37] However, the aspartate aminotransferase (AST)/ ALT ratio was negatively associated with the risk of diabetes in prediabetic patients, [38,39] suggesting that regular monitoring of liver function levels in prediabetic patients could help prevent or slow the progression of diabetes.…”