Low Glycated Hemoglobin and Liver Disease in the U.S. Population

Abstract

OBJECTIVE To characterize the association of low HbA1c values (<4.0%) with liver enzymes and steatosis. RESEARCH DESIGN AND METHODS Cross-sectional study of 12,533 participants without diabetes aged <20 years in the Third National Health and Nutrition Examination Survey (1988–1994). Logistic regression models were adjusted for demographic, lifestyle, and health status variables. RESULTS HbA1c values ranged from 3.2 to 15.7%, and 84 participants had HbA1c <4.0% in the population (mean age 44, 52% female, 15% black or Hispanic). We observed J-shaped associations between HbA1c and liver enzymes and hepatic steatosis. In adjusted models, HbA1c <4.0% was strongly associated with elevated alanine aminotransferase (OR 3.62 [95% CI 1.09–12.02]) and aspartate aminotransferase (6.80 [2.99–15.43]). CONCLUSIONS Low HbA1c values were associated with liver enzymes and steatosis in the U.S. population. Liver disease may partially explain the association of HbA1c with mortality and other long-term outcomes.