Kwon Soon Sung, Lee Sang-Guk
Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Korea.
Exp Clin Endocrinol Diabetes. 2019 Oct;127(10):677-684. doi: 10.1055/a-0752-0217. Epub 2018 Oct 26.
Early identification of individuals with insulin resistance (IR) and metabolically unhealthy state can help prevent various diseases and improve quality of life. In this study, we investigated a possible marker of IR and metabolic health status, alanine aminotransferase/aspartate aminotransferase (ALT/AST) ratio, and aimed to confirm its feasibility in a large population study.
A total of 16,371 adults from Korean National Health and Examination Survey were studied. Participants were divided into four groups according to their ALT/AST ratio quartiles. The homeostatic model assessment of insulin resistance level and proportion of people with IR, impaired fasting glucose, and undiagnosed type 2 diabetes were compared for each group. Receiver-operating characteristics (ROC) curve was also used to assess the usefulness of ALT/AST ratio to identify individuals with IR and metabolically unhealthy.
In the groups with higher ALT/AST ratio, HOMA-IR level, proportion of IR, and proportion of individuals with IFG or type 2 diabetes mellitus was higher than that in those with low ALT/AST ratio. When analyzed with other factors related to IR, the data showed that the ALT/AST ratio was an independent predictor of IR (odds ratio 1.363, 95% confidential interval 1.323-1.405, p<0.001). When ROC curve analysis was done, area under curve (AUC) for identifying individuals with IR was 0.634. In addition, metabolically unhealthy individuals showed significantly higher ALT/AST ratio than metabolically healthy individuals (0.9780 vs 0.8511, p<0.001).
ALT/AST ratio was well-correlated with IR, IR-related conditions, and metabolic health status. This easily accessible method to estimate IR may facilitate the early screening of IR, which can result in prevention of IR-related morbid conditions.
早期识别胰岛素抵抗（IR）和代谢不健康状态的个体有助于预防各种疾病并提高生活质量。在本研究中，我们调查了IR和代谢健康状况的一个可能标志物，即丙氨酸氨基转移酶/天冬氨酸氨基转移酶（ALT/AST）比值，并旨在在一项大型人群研究中证实其可行性。
对韩国国民健康与体检调查中的16371名成年人进行了研究。参与者根据其ALT/AST比值四分位数分为四组。比较了每组的胰岛素抵抗水平的稳态模型评估以及IR、空腹血糖受损和未诊断的2型糖尿病患者的比例。还使用了受试者工作特征（ROC）曲线来评估ALT/AST比值对识别IR和代谢不健康个体的有用性。
在ALT/AST比值较高的组中，HOMA-IR水平、IR比例以及空腹血糖受损或2型糖尿病患者的比例高于ALT/AST比值低的组。当与其他与IR相关的因素进行分析时，数据表明ALT/AST比值是IR的独立预测因子（优势比1.363，95%置信区间1.323 - 1.405，p<0.001）。进行ROC曲线分析时，识别IR个体的曲线下面积（AUC）为0.634。此外，代谢不健康个体的ALT/AST比值显著高于代谢健康个体（0.9780对0.8511，p<0.001）。
ALT/AST比值与IR、IR相关状况和代谢健康状况密切相关。这种易于获取的估计IR的方法可能有助于IR的早期筛查，从而预防与IR相关的疾病。
