Serum Alanine Transaminase as a Predictor of Type 2 Diabetes Incidence: The Yuport Prospective Cohort Study

Serum Alanine Transaminase as a Predictor of Type 2 Diabetes Incidence: The Yuport Prospective Cohort Study

YU HATANO,¹ KAZUO INOUE,² SAORI KASHIMA,³ MASATOSHI MATSUMOTO⁴ and KIMIHIKO AKIMOTO⁵

¹Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC, USA
²Department of Community Medicine, Chiba Medical Center, Teikyo University School of Medicine, Ichihara, Chiba, Japan
³Environmental Health Sciences Laboratory, Graduate School of Advanced Science and Engineering, Hiroshima University, Higashi-Hiroshima, Hiroshima, Japan
⁴Department of Community-Based Medical System, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Hiroshima, Japan
⁵Akimoto Occupational Health Consultant Office, Tokyo, Japan

Prior studies have shown an association between the incidence of diabetes with liver enzymes, such as alanine transaminase (ALT). Liver fibrosis scores, such as the Fibrosis-4 index which indicates chronic liver damage, were also associated with diabetes development. However, no literature compared predictive accuracy between ALT and Fibrosis-4 index. Thus, we aimed to determine it, and to assess its association using inverse probability of treatment weighting. This was a non-concurrent prospective cohort study of 9,748 subjects without diabetes receiving Yuport Health Checkup in Japan between 1998 and 2006. ALT was categorized into three groups: the highest ALT group (men ge; 30 U/L and women ge; 20 U/L), the middle (men ge; 20 and < 30 U/L, and women ge; 14 and < 20 U/L), and the lowest (men < 20 U/L and women < 14 U/L). The primary outcome was the new onset of diabetes. The area under the receiver operating characteristic curves (AUC) of ALT for predicting the diabetes development was higher than that of any other markers of liver damage. The AUC for ALT was 0.71, while that for the Fibrosis-4 index was 0.51 (p < 0.001 for the difference between the AUCs). The highest and middle ALT groups had a significantly higher incidence of diabetes than the lowest group: adjusted relative risk 1.79 [95% confidence interval (CI): 1.29, 2.58], and 1.64 [95% CI: 1.17, 2.38] respectively. Of the various indicators of liver function, ALT is likely to be the most accurate and associated predictor of diabetes development.

Keywords —— alanine transaminase; Fibrosis-4 index; inverse probability of treatment weighting; liver inflammation; type 2 diabetes

===============================

Tohoku J. Exp. Med., 2020 July, 251(3), 183-191.

Correspondence: Yu Hatano, M.D., M.P.H., Department of Family Medicine and Community Health, Duke University School of Medicine, 2200 West Main Street, Suite 600 Room 627, Durham, NC 27705, USA.

e-mail: m03077yh@gmail.com