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Discriminatory value of alanine aminotransferase for diabetes prediction: the Insulin Resistance Atherosclerosis Study.

ABSTRACT: AIMS:To examine the incremental usefulness of adding alanine aminotransferase to established risk factors for predicting future diabetes. METHODS:The study population of the Insulin Resistance Atherosclerosis Study included 724 people aged 40-69 years. We excluded people who had excessive alcohol intake or were treated with lipid-lowering agents. Incident diabetes was assessed after a mean follow-up period of 5.2 years. RESULTS:Alanine aminotransferase had a non-linear relationship with incident diabetes (Wald chi-squared test, P < 0.001; P for linearity = 0.005) independent of demographic variables, family history of diabetes, BMI and fasting glucose; therefore, we used Youden's J statistic to dichotomize alanine aminotransferase [threshold ? 0.43 ?kat/L ( ? 26 IU/l)]. Dichotomized alanine aminotransferase increased the area under the receiver-operating characteristic curve (0.805 vs. 0.823; P = 0.007) of a model that included demographic variables, family history of diabetes, BMI and fasting glucose as independent variables. The net reclassification improvement was 9.6% (95% CI 1.8-17.4; P = 0.016), and the integrated discrimination improvement was 0.031 (95% CI 0.011-0.050; P = 0.002). Dichotomized alanine aminotransferase reclassified a net of 9.6% of individuals more appropriately. CONCLUSIONS:Alanine aminotransferase may be useful for classifying individuals who are at risk of future diabetes after accounting for the effect of other risk factors, including family history, adiposity and plasma glucose.

SUBMITTER: Lorenzo C

PROVIDER: S-EPMC5075526 | biostudies-literature | 2016 Mar

REPOSITORIES: biostudies-literature

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Discriminatory value of alanine aminotransferase for diabetes prediction: the Insulin Resistance Atherosclerosis Study.

Lorenzo C C Hanley A J AJ Rewers M J MJ Haffner S M SM

Diabetic medicine : a journal of the British Diabetic Association 20150716 3

<h4>Aims</h4>To examine the incremental usefulness of adding alanine aminotransferase to established risk factors for predicting future diabetes.<h4>Methods</h4>The study population of the Insulin Resistance Atherosclerosis Study included 724 people aged 40-69 years. We excluded people who had excessive alcohol intake or were treated with lipid-lowering agents. Incident diabetes was assessed after a mean follow-up period of 5.2 years.<h4>Results</h4>Alanine aminotransferase had a non-linear rela ...[more]

PMID: 26094705

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Project description:UnlabelledBackgroundThe association between serum alanine aminotransferase (ALT) levels and hepatic insulin resistance (IR) has been evaluated with the hyperinsulinemic-euglycemic clamp. However, there is no information about the association of ALT with the Hepatic Insulin Resistance Index (HIRI). The aim of this study was to evaluate the association between serum ALT levels and HIRI in subjects with differing degrees of impaired glucose metabolism.MethodsThis cross-sectional study included subjects that had an indication for testing for type 2 diabetes mellitus (T2DM) with an oral glucose tolerance test (OGTT). Clinical and biochemical evaluations were carried out including serum ALT level quantification. HIRI was calculated for each participant. Correlation analyses and lineal regression models were used to evaluate the association between ALT levels and HIRI.ResultsA total of 324 subjects (37.6% male) were included. The mean age was 40.4?±?14.3?years and the mean body mass index (BMI) was 32.0?±?7.3?kg/m2. Individuals were divided into 1 of 5 groups: without metabolic abnormalities (n?=?113, 34.8%); with the metabolic syndrome (MetS, n?=?179, 55.2%), impaired fasting glucose (IFG, n?=?85, 26.2%); impaired glucose tolerance (IGT, n?=?91, 28.0%), and T2DM (n?=?23, 7.0%). The ALT (p?<?0.001) and HOMA2-IR (p?<?0.001) values progressively increased with HIRI quartiles, while ISI-Matsuda (p?<?0.001) progressively decreased. After adjustment for sex, age, and BMI, we identified a significant correlation between HIRI and ALT in persons with the MetS (r?=?0.22, p?=?0.003), IFG (r?=?0.33, p?<?0.001), IGT (r?=?0.37, p?<?0.001), and T2DM (r?=?0.72, p?<?0.001). Lineal regression analysis adjusting for age, HDL-C, TG and waist circumference (WC) showed an independent association between ALT and HIRI in subjects with the MetS (beta?=?0.07, p?=?0.01), IFG (beta?=?0.10, p?=?0.02), IGT (beta?=?0.09, p?=?0.007), and T2DM (beta?=?0.31, p?=?0.003). This association was not identified in subjects without metabolic abnormalities.ConclusionsALT levels are independently associated with HIRI in subjects with the MetS, IFG, IGT, and T2DM. The ALT value in these subjects may be an indirect parameter to evaluate hepatic IR.

Dataset Information

Discriminatory value of alanine aminotransferase for diabetes prediction: the Insulin Resistance Atherosclerosis Study.

Publications

Discriminatory value of alanine aminotransferase for diabetes prediction: the Insulin Resistance Atherosclerosis Study.

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