A better parameter in predicting insulin resistance: Obesity plus elevated alanine aminotransferase

doi:10.3748/wjg.15.5598

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Nov 28, 2009 (publication date) through Feb 4, 2025

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Gastroenterol. Nov 28, 2009; 15(44): 5598-5603
Published online Nov 28, 2009. doi: 10.3748/wjg.15.5598

Table 1 Basic characteristics of subjects, stratified by HOMA_IR (mean ± SD)

	The four sub-groups stratified by HOMA_IR¹				Total
	Q1 (327, 25%)	Q2 (326, 25%)	Q3 (328, 25%)	Q4 (327, 25%)	(1308, 100%)
Age (yr)	38.1 ± 10.0	38.5 ± 9.7	38.7 ± 10.0	39.7 ± 10.3	38.7 ± 10.0
Systolic blood pressure (mmHg)	124.4 ± 13.9	125.8 ± 14.7^a	128.0 ± 15.1^a	132.5 ± 16.0^a	127.7 ± 15.2
Diastolic blood pressure (mmHg)	77.3 ± 10.0	77.6 ± 10.4^a	79.6 ± 11.2^a	82.1 ± 11.7^a	79.1 ± 11.0
Body mass index (kg/m²)	22.8 ± 2.5	23.7 ± 2.5^a	25.1 ± 2.7^a	27.0 ± 3.4^a	24.7 ± 3.3
Waist circumference (cm)	83.6 ± 6.6	85.8 ± 6.1^a	88.9 ± 6.7^a	92.6 ± 7.5^a	87.7 ± 7.5
ALT (U/L)	22.4 ± 16.1	25.5 ± 18.1^a	36.1 ± 48.4^a	40.2 ± 26.4^a	31.0 ± 31.0
AST (U/L)	23.9 ± 11.1	24.2 ± 16.0^a	27.6 ± 20.2^a	28.0 ± 11.5^a	25.9 ± 15.3
Fasting glucose (mg/dL)	95.1 ± 7.6	97.9 ± 7.9^a	99.4 ± 7.9^a	102.5 ± 8.5^a	98.7 ± 8.4
Fasting insulin (U/mL)	3.6 ± 1.0	6.1 ± 0.9^a	8.9 ± 1.1^a	15.8 ± 6.5^a	8.6 ± 5.7
HOMA_IR	0.8 ± 0.2	1.5 ± 0.2^a	2.1 ± 0.2^a	3.9 ± 1.7^a	2.1 ± 1.5
Triglyceride (mg/dL)	113.9 ± 86.8	127.6 ± 86.2^a	157.9 ± 105.7^a	202.8 ± 156.9^a	150.6 ± 117.6
HDL (mg/dL)	52.8 ± 12.5	50.2 ± 9.8^a	47.4 ± 10.7^a	44.4 ± 8.9^a	48.7 ± 11.0

¹The subjects were stratified into four groups according to HOMA_IR; Q1 means the 1st quartile, Q2 means the 2nd, etc. ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; HDL: High-density lipoprotein; HOMA_IR: Insulin resistance assessed by homeostasis model assessment = fasting insulin (U/mL) × glucose (mmol/L)/22.5.

^aP < 0.05 vs Q1.

Table 2 Abnormality prevalence distribution, stratified by HOMA_IRn (%)

	The four sub-groups stratified by HOMA_IR				Total
Abnormality¹	Q1 327 (25)	Q2 326 (25)	Q3 328 (25)	Q4 327 (25)	1308 (100)
Obesity	20 (6.1)	29 (8.9)	81 (24.7)^a	153 (46.8)^a	283 (21.6)
Elevated ALT	25 (7.6)	36 (11.0)	74 (22.6)^a	118 (36.1)^a	253 (19.3)
Metabolic syndrome components
Abdominal obesity	45 (13.8)	74 (22.7)^a	126 (38.4)^a	188 (57.5)^a	433 (33.1)
Elevated blood pressure	110 (33.6)	118 (36.2)	136 (41.5)^a	187 (57.2)^a	551 (42.1)
Elevated fasting glucose	16 (4.9)	22 (6.7)	37 (11.3)^a	62 (19.0)^a	137 (10.5)
Elevated triglyceride	58 (17.7)	83 (25.5)^a	132 (40.2)^a	195 (59.6)^a	468 (35.8)
Hypo-HDL cholesterolemia	39 (11.9)	47 (14.4)	71 (21.6)^a	108 (33.0)^a	265 (20.3)
Alcohol consumption	83 (25.4)	56 (17.2)	74 (22.6)	73 (22.3)	286 (21.9)
Cigarette smoking	122 (37.3)	118 (36.2)^a	108 (32.9)	109 (33.3)	457 (34.9)

¹Obesity: Body mass index ≥ 27 kg/m²; Elevated ALT: ALT > 40 U/L; Abdominal obesity: waist circumference ≥ 90 cm in male adults; Elevated blood pressure: blood pressure ≥ 130/85 mmHg; Elevated fasting glucose: fasting glucose ≥ 100 mg/dL; Elevated triglyceride: triglyceride ≥ 150 mg/dL; Hypo-HDL cholesterolemia: HDL cholestero1 < 40 mg/dL; Hypercholesterolemia: total cholesterol ≥ 200 mg/dL; Elevated LDL: LDL cholesterol ≥ 130 mg/dL; Alcohol consumption: more than once per week; Cigarette smoking: more than one pack per day.

^aP < 0.05 vs Q1 (χ² test).

Table 3 OR of risk factors, presented as OR (95% CI)

Model¹	Model 1	Model 2	Model 3
Both obesity and elevated ALT	-	-	4.3 (2.7-6.8)
Obesity	2.5² (1.7-3.6)	3.0² (2.1-4.2 )	-
Elevated ALT	2.1² (1.4-3.0)	2.1² (1.5-2.9)	-
Metabolic syndrome	-	2.6² (1.8-3.7)	3.6 (2.6-5.0)
Abdominal obesity	1.6² (1.2-2.2)	-	-
Elevated blood pressure	1.7² (1.2-2.4)	-	-
Elevated fasting glucose	2.8² (1.8-4.4)	-	-
Elevated triglyceride	2.2² (1.6-3.1)	-	-
Hypo-HDL cholesterolemia	1.6² (1.1-2.2)	-	-
Alcohol consumption	1.2 (0.8-1.7)	1.2 (0.8-1.6)	1.2 (0.9-1.7)
Cigarette smoking	0.9 (0.7-1.2)	0.9 (0.6-1.2)	0.9 (0.6-1.2)

¹Risk factors of metabolic syndrome were regarded as five individual factor in model 1 and as a single factor in model 2; both obesity and elevated ALT were regarded as a single factor in model 3;

²Significant odds ratio (OR), adjusted for age.

Table 4 Synergistic effect of obesity and elevated ALT on insulin resistance¹

	OR	(95% CI)	SI	95% CI
Neither obesity nor elevated ALT	1.0	Reference	No risk	-
Obesity only	2.3	(1.5-3.5)	One risk only	-
Elevated ALT only	1.8	(1.1-2.9)	One risk only	-
Obesity plus elevated ALT	5.5	(3.2-9.3)	2.1	(1.01-4.3)

¹Insulin resistance is defined as the 4th quartile of the HOMA_IR.

SI: Synergistic index.

Citation: Chen PH, Chen JD, Lin YC. A better parameter in predicting insulin resistance: Obesity plus elevated alanine aminotransferase. World J Gastroenterol 2009; 15(44): 5598-5603
URL: https://www.wjgnet.com/1007-9327/full/v15/i44/5598.htm
DOI: https://dx.doi.org/10.3748/wjg.15.5598