title: Low glycated hemoglobin and liver disease in the U.S. population.
abstract: OBJECTIVE
  To characterize the association of low HbA(1c) values (<4.0%) with liver enzymes and steatosis.
  
  
  METHODS
  Cross-sectional study of 12,533 participants without diabetes aged <20 years in the Third National Health and Nutrition Examination Survey (1988-1994). Logistic regression models were adjusted for demographic, lifestyle, and health status variables.
  
  
  RESULTS
  HbA(1c) values ranged from 3.2 to 15.7%, and 84 participants had HbA(1c) <4.0% in the population (mean age 44, 52% female, 15% black or Hispanic). We observed J-shaped associations between HbA(1c) and liver enzymes and hepatic steatosis. In adjusted models, HbA(1c) <4.0% was strongly associated with elevated alanine aminotransferase (OR 3.62 [95% CI 1.09-12.02]) and aspartate aminotransferase (6.80 [2.99-15.43]).
  
  
  CONCLUSIONS
  Low HbA(1c) values were associated with liver enzymes and steatosis in the U.S. population. Liver disease may partially explain the association of HbA(1c) with mortality and other long-term outcomes.
authors.affiliation: Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA. andrea.christman@gmail.com
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Christman
authors.forename: Mariana
authors.initials: M
authors.lastname: Lazo
authors.forename: Jeanne M
authors.initials: JM
authors.lastname: Clark
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Selvin
mesh_terms: D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000097:blood* / Q000401:mortality; D005234:Fatty Liver / Q000201:enzymology* / Q000401:mortality; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D008297:Male; D009749:Nutrition Surveys; D014481:United States / Q000453:epidemiology; D005723:gamma-Glutamyltransferase / Q000097:blood
chemical_list: D000410:Alanine Transaminase; D001219:Aspartate Aminotransferases; D006442:Glycated Hemoglobin; D005723:gamma-Glutamyltransferase