Association of alanine transaminase to aspartate aminotransferase ratio and incident diabetes in Chinese adults: a second retrospective cohort study

Abstract Background : Previous studies have indicated that serum alanine aminotransferase ( ALT ) level, serum aspartate aminotransferase ( AST ) level or ALT/AST ratio may be bound up with diabetes. But the association of ALT/AST ratio and incident diabetes in Chinese adults have not been elaborated yet. The main objective of the present study was to analyze whether ALT/AST ratio was an independent risk factor which attached to the risk of incident diabetes in Chinese adults. Methods: From 2010 to 2016, 685,277 Chinese adults who received a health check in Rich Healthcare Group including all medical records, and the present article was a second retrospective cohort analysis based on above population. As the target independent variable, ALT/AST ratio was measured at baseline while the dependent variable, incident diabetes appeared during follow-up. We used Cox proportional hazard regression models to analyze the prognostic value of ALT/AST on the risk of incident diabetes. Results: ALT/AST demonstrated undeniable correlation with incident diabetes (HR=2.535, 95%CI: 2.190 to 2.934, P <0.00001). The association between ALT/AST and incident diabetes is only linear. The cumulative incidence (95% CI) rate of incident diabetes in total participants, ALT/AST quartile 1, 2, 3, and 4 was 2.112 (2.016-2.208), 0.992 (.0.857-1.127), 1.430 (1.274-1.586), 2.396 (2.192-2.600) and 3.559 (3.314-3.803), separately. The population with age (30 to <40 years), BMI (<24kg/m2) and SBP (<140mmHg) was found to be the stronger association in subgroup analysis. Conclusion: In Chinese adults, ALT/AST ratio is an independent risk factor for incident diabetes .