title: The relationship of hepatitis antibodies and elevated liver enzymes with impaired fasting glucose and undiagnosed diabetes.
abstract: OBJECTIVE
  The aim of this study was to examine the relationship of hepatitis antibodies and liver enzymes with impaired fasting glucose and undiagnosed diabetes in adults.
  
  
  METHODS
  We analyzed the National Health and Nutrition Examination Survey, 1999 to 2004, a nationally representative sample of the noninstitutionalized US population. Among adults (aged >or=20 years of age) who were not problem drinkers, we examined hepatitis B and C antibodies and the liver enzymes aspartate aminotransferase (AST), alanine aminotransferase (ALT), and gammaglutamyl transaminase (GGT) with impaired fasting glucose and undiagnosed diabetes (unweighted, n = 5234; weighted, n = 172,626,805). Logistic regression models were computed controlling for major risk factors that drive diabetes screening, including age, gender, race, diagnosed hypertension, diagnosed hypercholesterolemia, and obesity.
  
  
  RESULTS
  In unadjusted analyses 51% of individuals with undiagnosed diabetes have elevated GGT versus 20% of individuals without diabetes or impaired fasting glucose (P = .01). Similarly, 43% of individuals with undiagnosed diabetes have elevated ALT versus 23% of individuals without diabetes or impaired fasting glucose (P = .01). AST and Hepatitis C antibodies were not associated with undiagnosed diabetes. In adjusted analyses, elevated GGT (odds ratio, 2.15; 95% CI, 1.44-3.20) and ALT (odds ratio, 1.84; 95% CI, 1.06-3.20) are associated with undiagnosed diabetes. Similarly, in adjusted analyses, elevated GGT (odds ratio, 1.23; 95% CI, 1.00-1.53) and ALT (odds ratio, 1.44; 95% CI, 1.15-1.79) are associated with impaired fasting glucose. Hepatitis antibodies, reporting a current liver problem, or AST were not [corrected] associated with having undiagnosed diabetes in adjusted analyses.
  
  
  CONCLUSIONS
  Liver function is associated with undiagnosed diabetes and impaired fasting glucose and may justify further investigation as a risk stratification variable for undiagnosed diabetes or impaired fasting glucose.
authors.affiliation: Department of Family Medicine, Medical University of South Carolina, 295 Calhoun St., Charleston, SC 29425, USA. mainouag@musc.edu
authors.forename: Arch G
authors.initials: AG
authors.lastname: Mainous
authors.forename: Vanessa A
authors.initials: VA
authors.lastname: Diaz
authors.forename: Dana E
authors.initials: DE
authors.lastname: King
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Everett
authors.forename: Marty S
authors.initials: MS
authors.lastname: Player
mesh_terms: D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood*; D001219:Aspartate Aminotransferases / Q000097:blood*; D001786:Blood Glucose / Q000378:metabolism*; D016001:Confidence Intervals; D003920:Diabetes Mellitus / Q000097:blood* / Q000175:diagnosis / Q000378:metabolism / Q000503:physiopathology*; D005215:Fasting / Q000378:metabolism; D005260:Female; D006306:Health Surveys; D006510:Hepatitis B Antibodies / Q000097:blood*; D018937:Hepatitis C Antibodies / Q000097:blood*; D006801:Humans; D008111:Liver Function Tests; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010865:Pilot Projects; D018570:Risk Assessment
chemical_list: D001786:Blood Glucose; D006510:Hepatitis B Antibodies; D018937:Hepatitis C Antibodies; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase