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

2021; Lippincott Williams & Wilkins; Volume: 34; Issue: 3 Linguagem: Inglês

10.1097/meg.0000000000002215

1473-5687

Aayush Visaria, Suraj Pai, Maggie S.H. Cheung, Sushil Ahlawat,

Folate and B Vitamins Research

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: 2.29 (1.58–3.33), 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 .