title: Increased liver markers are associated with higher risk of type 2 diabetes.
abstract: OBJECTIVE
  To investigate the association between liver markers and the risk of type 2 diabetes (T2DM) and impaired fasting glucose (IFG).
  
  
  METHODS
  A total of 8863 participants (3408 men and 5455 women) over 30 years of age were analyzed from the fifth Korean National Health and Nutrition Examination Survey (2010-2011). The associations of serum liver markers such as aspartate aminotransferase (AST), alanine aminotransferase (ALT), AST/ALT, and gamma-glutamyltransferase (GGT) with T2DM and IFG were analyzed using logistic regression models. Participants were divided into sex-specific quartiles on the basis of liver markers.
  
  
  RESULTS
  The prevalence of T2DM and IFG were 11.3% and 18.3%. Increasing quartiles of ALT and GGT were positively and AST/ALT were negatively correlated with T2DM and IFG. Analysis of the liver marker combinations showed that if any two or more markers were in the highest risk quartile, the risks of both T2DM and IFG increased significantly. The risk was greatest when the highest ALT and GGT and lowest AST/ALT quartile were combined, with the risk of T2DM at 3.21 (95%CI: 1.829-5.622, P < 0.001) in men and 4.60 (95%CI: 3.217-6.582, P < 0.001) in women. Men and women with the highest AST and ALT and lowest AST/ALT quartile had a 1.99 and 2.40 times increased risk of IFG.
  
  
  CONCLUSIONS
  Higher levels of GGT and ALT and lower AST/ALT within the physiological range are independent, additive risk factors of T2DM and IFG.
authors.affiliation: Sun-Hye Ko, Seung-Hyun Ko, Yu-Bae Ahn, Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 137-701, South Korea.
authors.forename: Sun-Hye
authors.initials: SH
authors.lastname: Ko
authors.affiliation: Sun-Hye Ko, Seung-Hyun Ko, Yu-Bae Ahn, Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 137-701, South Korea.
authors.forename: Myong Ki
authors.initials: MK
authors.lastname: Baeg
authors.affiliation: Sun-Hye Ko, Seung-Hyun Ko, Yu-Bae Ahn, Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 137-701, South Korea.
authors.forename: Kyung-Do
authors.initials: KD
authors.lastname: Han
authors.affiliation: Sun-Hye Ko, Seung-Hyun Ko, Yu-Bae Ahn, Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 137-701, South Korea.
authors.forename: Seung-Hyun
authors.initials: SH
authors.lastname: Ko
authors.affiliation: Sun-Hye Ko, Seung-Hyun Ko, Yu-Bae Ahn, Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 137-701, South Korea.
authors.forename: Yu-Bae
authors.initials: YB
authors.lastname: Ahn
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000032:analysis; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000175:diagnosis / Q000201:enzymology / Q000453:epidemiology*; D005215:Fasting / Q000097:blood; D005260:Female; D006306:Health Surveys; D006801:Humans; D008099:Liver / Q000201:enzymology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D015995:Prevalence; D056910:Republic of Korea / Q000453:epidemiology; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D015854:Up-Regulation; D005723:gamma-Glutamyltransferase / Q000097:blood
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D005723:gamma-Glutamyltransferase; C554782:gamma-glutamyltransferase, human; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase
keywords: Alanine aminotransferase; Aspartate aminotransferase; Gamma-glutamyl transferase; Impaired fasting glucose; Liver markers; Type 2 diabetes mellitus