ALT/AST ratio: the useful predictive marker for insulin resistance

Abstract

Abstract Background and Aims: Insulin resistance is common pathophysiology in type 2 diabetes mellitus, cardiovascular disease, and non-alcoholic fatty liver disease. As increased to the prevalence of these diseases, screening the risk for IR becomes important to prevent disease progression. To predict insulin resistance in the general population, regardless of comorbidity, we analyzed the health examination data using Alanine aninotransferase/Aspartate aminotransferase ratio for analysis. Method: 2015, 2019, and 2020 Korea National Health and Nutrition Examination Survey (KNHANES) were analyzed to validate our hypothesis. For the evaluation of insulin resistance, the following four indices were implemented: fasting serum glucose (Glc) and insulin; Homeostatic Model Assessment for Insulin Resistance (HOMA- IR) and β cell function (HOMA- β). Pearson correlation coefficient (PCC) was implemented to evaluate the degree of association of liver profiles with indices for IR. Linear or logistic regression (LiR or LR) was implemented to identify the association of liver profiles with IR value or status, respectively. Classification performance was evaluated based on the area under curve of Receiver Operating Characteristic (AUC). Results: Based on PCC, serum ALT in Korean men and women was positively related to four IR indices, including Glc, insulin, HOMA-IR, and HOMA-β. These positive relationships remained after selecting subjects diagnosed with diabetes or dyslipidemia, alcohol consumption, or subjects having general obesity or abdominal obesity. ALT/AST ratio was also robustly correlated with the four IR indices. In the multivariate LiR, when comparing ALT levels, ALT/AST ratio in Korean men exhibited better predictive performance for Glc and HOMA-β, besides, that in Korean women provided improved outcomes for all IR indices. Based on the prediction for the binary form of IR status, the ALT/AST ratio in Korean men and women could well predict HOMA-β and HOMA-IR, compared to the sole ALT level, respectively. Conclusion: In the analysis that includes a large community-based population, ALT/AST ratio is a useful predictive marker compared with HOMA-IR. A simple, precise marker that is represented to ALT/AST could be a practical method to screen insulin resistance in the general population regardless of Diabetes mellitus (DM), alcohol intake, and gender.