Abstract
Aims Early identification of individuals with insulin resistance (IR) and metabolically
unhealthy state can help prevent various diseases and improve quality of life. In
this study, we investigated a possible marker of IR and metabolic health status, alanine
aminotransferase/aspartate aminotransferase (ALT/AST) ratio, and aimed to confirm
its feasibility in a large population study.
Methods A total of 16,371 adults from Korean National Health and Examination Survey were
studied. Participants were divided into four groups according to their ALT/AST ratio
quartiles. The homeostatic model assessment of insulin resistance level and proportion
of people with IR, impaired fasting glucose, and undiagnosed type 2 diabetes were
compared for each group. Receiver-operating characteristics (ROC) curve was also used
to assess the usefulness of ALT/AST ratio to identify individuals with IR and metabolically
unhealthy.
Results In the groups with higher ALT/AST ratio, HOMA-IR level, proportion of IR, and proportion
of individuals with IFG or type 2 diabetes mellitus was higher than that in those
with low ALT/AST ratio. When analyzed with other factors related to IR, the data showed
that the ALT/AST ratio was an independent predictor of IR (odds ratio 1.363, 95% confidential
interval 1.323–1.405, p<0.001). When ROC curve analysis was done, area under curve
(AUC) for identifying individuals with IR was 0.634. In addition, metabolically unhealthy
individuals showed significantly higher ALT/AST ratio than metabolically healthy individuals
(0.9780 vs 0.8511, p<0.001).
Conclusions ALT/AST ratio was well-correlated with IR, IR-related conditions, and metabolic health
status. This easily accessible method to estimate IR may facilitate the early screening
of IR, which can result in prevention of IR-related morbid conditions.
Key words Insulin sensitivity - Endocrinology - Prediction of diabetes - Screening
