Retrospective Cohort Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 28, 2015; 21(24): 7478-7487
Published online Jun 28, 2015. doi: 10.3748/wjg.v21.i24.7478
Increased liver markers are associated with higher risk of type 2 diabetes
Sun-Hye Ko, Myong Ki Baeg, Kyung-Do Han, Seung-Hyun Ko, Yu-Bae Ahn
Sun-Hye Ko, Seung-Hyun Ko, Yu-Bae Ahn, Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 137-701, South Korea
Myong Ki Baeg, Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 137-701, South Korea
Kyung-Do Han, Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul 137-701, South Korea
Author contributions: Ko SH, Baeg MK and Han KD designed the research; Ko SH, Baeg MK and Ko SH analyzed the data; Ko SH, Baeg MK and Ahn YB wrote the paper; Ko SH and Ahn YB reviewed and edited the manuscript.
Ethics approval: The study was reviewed and approved by The College of Medicine, The Catholic University of Korea Institutional Review Board (IRB No. VC14EISI0212).
Informed consent: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest: All of the authors state that there are no potential conflicts of interest.
Data sharing: Technical appendix, statistical code, and dataset available from the corresponding author at ybahn@catholic.ac.kr.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Yu-Bae Ahn, MD, PhD, Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seocho-Gu, Seoul 137-701, South Korea. yoonk@catholic.ac.kr
Telephone: +82-31-2498070 Fax: +82-31-2538898
Received: December 31, 2014
Peer-review started: January 2, 2015
First decision: January 22, 2015
Revised: March 2, 2015
Accepted: April 28, 2015
Article in press: April 28, 2015
Published online: June 28, 2015
Abstract

AIM: To investigate the association between liver markers and the risk of type 2 diabetes (T2DM) and impaired fasting glucose (IFG).

METHODS: A total of 8863 participants (3408 men and 5455 women) over 30 years of age were analyzed from the fifth Korean National Health and Nutrition Examination Survey (2010-2011). The associations of serum liver markers such as aspartate aminotransferase (AST), alanine aminotransferase (ALT), AST/ALT, and gamma-glutamyltransferase (GGT) with T2DM and IFG were analyzed using logistic regression models. Participants were divided into sex-specific quartiles on the basis of liver markers.

RESULTS: The prevalence of T2DM and IFG were 11.3% and 18.3%. Increasing quartiles of ALT and GGT were positively and AST/ALT were negatively correlated with T2DM and IFG. Analysis of the liver marker combinations showed that if any two or more markers were in the highest risk quartile, the risks of both T2DM and IFG increased significantly. The risk was greatest when the highest ALT and GGT and lowest AST/ALT quartile were combined, with the risk of T2DM at 3.21 (95%CI: 1.829-5.622, P < 0.001) in men and 4.60 (95%CI: 3.217-6.582, P < 0.001) in women. Men and women with the highest AST and ALT and lowest AST/ALT quartile had a 1.99 and 2.40 times increased risk of IFG.

CONCLUSION: Higher levels of GGT and ALT and lower AST/ALT within the physiological range are independent, additive risk factors of T2DM and IFG.

Keywords: Type 2 diabetes mellitus, Liver markers, Impaired fasting glucose, Gamma-glutamyl transferase, Aspartate aminotransferase, Alanine aminotransferase

Core tip: We investigated the association between liver markers and the risk of type 2 diabetes (T2DM) and impaired fasting glucose (IFG) in a general Korean population. Increasing quartiles of alanine aminotransferase (ALT) and gamma-glutamyltransferase (GGT) were positively and aspartate aminotransferase (AST)/ALT was negatively correlated with both T2DM and IFG. Analysis of the liver marker combinations showed that if any two or more markers were in the highest risk quartile, the risks of both T2DM and IFG increased significantly. Higher levels of GGT and ALT and lower AST/ALT within the physiological range are independent, additive risk factors of T2DM and IFG.