Association between aspartate aminotransferase to alanine aminotransferase ratio and reversion to normoglycemia in people with impaired fasting glucose: a 5-year retrospective cohort study

Kebao Zhang¹Lidan Chen²Zhe Deng³Rong Rong²Lifen Xu²Lifting Xu²Shuting Zeng²Haofei Hu^4*

• ¹Department of Emergency, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
• ²Shenzhen Nanshan Medical Group Headquarter, Shenzhen, China
• ³Department of Emergency, Shenzhen Second People’s Hospital, Shenzhen, Shenzhen Second People's Hospital, Shenzhen, Guangdong Province, China
• ⁴Department of Nephrology, Shenzhen Second People's Hospital, Shenzhen, Guangdong, China

Background: Studies showed that AST/ALT ratio was related to pre-diabetes, diabetes and diabetes complications. However, there is poor evidence proving that the AST/ALT ratio was correlated with blood glucose reversion in impaired fasting glucose patients. In our study, we analyzed the relationship between AST/ALT ratio and blood glucose reversal in a large group of Chinese people with impaired fasting blood glucose. Methods: Participants were recruited from Rich Healthcare Group physical examinations in 2010 to 2016. Among all the participants, 11121 Chinese adults were enrolled in our study. Cox proportional-hazards regression was used to identify the association between the AST/ALT ratio and blood glucose reversal to normoglycemia in individuals with impaired fasting glucose. Generalized additive model (GAM) and smooth curve fitting were used to identify nonlinear relationship between AST/ALT ratio and blood glucose reversion. In addition, sensitive analyses and subgroup analysis were used to test the reliability of our study. Result: AST/ALT ratio was independently related to the blood glucose reversal in prediabetic populations of Chinese adults (HR = 1.20, 95% CI 1.11-1.30, P < 0.00001). Nonlinear relationship has been discovered between AST/ALT ratio and reversion to normoglycemia. On the right side of the inflection point, AST/ALT ratio actively related to the blood glucose reversal in populations with impaired fasting glucose (HR:1.37 95%CI: 1.23-1.52, P<0.0001). However, On the left side of the inflection point, their relationship was not closely related. Sensitivity analysis, competing risks multivariate Cox regression and subgroup analysis also confirmed our study results. Conclusion: Our study revealed that AST/ALT ratio was independently related with reversion to normoglycemia in prediabetic Chinese people. The relationship between AST/ALT ratio and reversion to normoglycemia from IFG was non-linear. When AST/ALT ratio>1.13, a significant positive relationship between AST/ALT ratio and reversion to normoglycemia was identified.