Association of AST and ALT Ratio with Incidence of Diabetes in Chinese Adults: A Retrospective Cohort Study

Abstract Purpose Little research exits on the effect of the aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio on the incidence of diabetes mellitus (DM). This study used the large-scale cohort study data of the Chinese population to explore the effect of the AST/ALT ratio on the incidence of DM. Patients and methods The data was downloaded from a computerized database (DATADRYAD, available at www.datadryad.org) including 32 sites and 11 cities in China which were collected between 2010 and 2016 by the Rich Healthcare Group in China. This study was a retrospective cohort study that, included 86,145 participants for the secondary analysis. Multivariable Cox proportional hazards regression and a two-piecewise linear regression model were used to explore the relationship between the AST/ ALT ratio and DM. Results The AST/ALT ratio was negatively correlated with the incidence of DM after adjusting for potential co-variables [HR = 0.44, (95%CI:0.38–0.51), P < 0.001]. By using the two-piecewise linear regression model, the inflection point was 1.3. On the left of the inflection point, the effect size was HR = 0.3 (0.2–0.3, P < 0.001). On the right side of the inflection point, the effect size was HR = 0.9 (0.7 to 1.2; P = 0.561). Conclusion The AST/ALT ratio could be an independent predictor of incident DM and was negatively correlated with DM events.