The nonlinear correlation between alanine aminotransferase to high-density lipoprotein cholesterol ratio and the risk of diabetes: a historical Japanese cohort study

Abstract

Background Low levels of high-density lipoprotein cholesterol (HDL-C) and high levels of alanine aminotransferase (ALT) are related to insulin resistance, metabolic syndrome, and diabetes mellitus (DM). However, evidence on the connection between the alanine aminotransferase to high-density lipoprotein cholesterol (ALT/HDL-C) ratio and diabetes mellitus (DM) risk was limited. The study aimed to investigate the relationship between baseline ALT/HDL-C ratio and DM among Japanese individuals. Methods This second analysis was based on a cohort study using open-source data. Data from 15,342 individuals who participated in the medical examination program were recorded at Murakami Memorial Hospital in Japan between 2004 and 2015. Smooth curve fitting, subgroup analysis, Cox proportional-hazards regression, and a series of sensitivity analyses were conducted to examine the relationship between ALT/HDL-C ratio and incident diabetes. The ability of the ALT/HDL-C ratio to predict diabetes was evaluated using a receiver operating characteristic curve analysis. Results After controlling for confounding covariates, the ALT/HDL-C ratio was found to be positively correlated to the DM risk in Japanese adults (HR: 1.01, 95%CI: 1.00–1.02, P = 0.049). This study also found a stable relationship between ALT/HDL-C ratio and diabetes after employing a series of sensitivity analyses. Additionally, there was a non-linear association between the ALT/HDL-C ratio and incident diabetes, and the ALT/HDL-C ratio inflection point was 30.12. When the ALT/HDL-C ratio was below 30.12, the present study discovered a significant positive association between the ALT/HDL-C ratio and incident diabetes (HR: 1.04, 95%CI: 1.02–1.06, P = 0.001). Furthermore, among liver enzymes, blood lipids, and anthropometric indicators, the ALT/HDL-C ratio best predicts DM (AUC = 0.75, 95%CI: 0.73–0.78). Conclusion Increased ALT/HDL-C ratio levels at baseline correlated to incident DM. The relationship between ALT/HDL-C ratio and incident DM was also non-linear. When the ALT/HDL-C ratio is below 30.12, there is a statistically significant positive correlation between the ALT/HDL-C ratio and incident DM.

The association of ALT to HDL-C ratio with type 2 diabetes in 50–74 years old adults: a population-based study

“…This conclusion was obtained in a multiple regression model and after controlling of confounding variables such as waist circumference, hypertension and sex. To the best of our knowledge, this report is the first study in Iran that measured the association between this ratio and DM, furthermore, it is one of the few reports worldwide investigating this issue, with results similar to two other existing articles 20 , 21 . Our findings indicate that individuals with DM tend to have higher levels of ALT and lower levels of HDL-C. Other studies have also demonstrated that individuals with DM have higher ALT levels compared to those without DM, and that elevated ALT levels are directly linked to the development of DM 11 – 13 , 24 – 26 .…”

“…On the other hand, HDL-C has not been a reliable predictor for DM 28 . Therefore, when ALT increases and HDL-C decreases, the ALT/HDL-C ratio increases and can be a more effective predictor for DM compared to other risk factors 20 . It is important to note that over time, DM is associated with metabolic syndrome and other conditions such as hypertension and dyslipidemia, which are associated with reduced HDL-C levels.…”

“…The relationship between ALT/HDL-C ratio and DM is non-linear. Individuals with a higher ratio are more likely to develop DM 20 . Compared to other tests such as ALT, GGT, AST, TG, TC, waist circumference, HDL-C and even BMI, the ALT/HDL-C ratio demonstrates superior predictive ability for DM 20 .…”

“…Individuals with a higher ratio are more likely to develop DM 20 . Compared to other tests such as ALT, GGT, AST, TG, TC, waist circumference, HDL-C and even BMI, the ALT/HDL-C ratio demonstrates superior predictive ability for DM 20 . Recently, a longitudinal study with a follow-up period of 3.1 years revealed that the ratio of ALT to HDL was positively associated with the prediction of diabetes.…”

Association between alanine aminotransferase to high-density lipoprotein cholesterol ratio and nonalcoholic fatty liver disease: a retrospective cohort study in lean Chinese individuals

“…According to several recent research, the risk of T2DM and NAFLD was correlated with HDL-C and ALT levels 20 , 26 . Recent cohort research also found a positive correlation between higher alanine aminotransferase to high-density lipoprotein cholesterol (ALT/HDL-C) ratio levels and T2DM 27 . However, there was no proof that the ALT/HDL-C ratio increased the incident NFLAD.…”