High liver enzymes increase diabetes risk for US Hispanic adults
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Hispanic adults in the U.S. who have high levels of some liver enzymes have an increased risk for developing diabetes, according to a study published in Diabetic Medicine.
“Hispanics are at high risk of diabetes and its complications and are also at high risk for nonalcoholic fatty liver disease (NAFLD),” Carmen R. Isasi, MD, PhD, FAHA, an associate professor in the department of epidemiology and population health at Albert Einstein College of Medicine, told Healio. “Liver enzymes could be a simple clinical tool to screen individuals for diabetes risk, in addition to traditional factors.”
Isasi and colleagues analyzed data from 6,928 adults participating in the Hispanic Community Health Study/Study of Latinos (mean age, 38 years). Participants did not have diabetes at a baseline visit from 2008 to 2011 and returned for a follow-up examination a mean 6 years after baseline from 2014 to 2017. Alanine aminotransferase (ALT), aspartate aminotransferase (AST) and gamma-glutamyl transpeptidase (GGT) levels were measured at baseline. Researchers placed participants into quartiles for ALT, AST and GGT based on their baseline levels. Incident diabetes was identified at follow-up through laboratory measurements or the use of diabetes medication.
Of the 738 participants who had diabetes during follow-up, 533 were identified through blood tests. Adults were more likely to develop diabetes if they were men, older or of Puerto Rican background or had a lower education level, higher BMI, higher waist circumference or a lower score on an alternative healthy eating index.
After adjusting for demographics, socioeconomic status, diet, exercise, cardiovascular risk factors and CV medication use, adults in the highest ALT quartile had a greater risk for developing diabetes compared with those in the lowest quartile (RR = 1.51; 95% CI, 1.03-2.22; P = .006). Participants in the highest quartile for GGT also had an increased risk for diabetes at follow-up compared with the lowest quartile (RR = 2.39; 95% CI, 1.6-3.55; P = .001). Both associations remained after adjusting for baseline fasting glucose. After adjusting for homeostatic model assessment of insulin resistance, only a high GGT level was significantly associated with incident diabetes.
The risks for incident diabetes with ALT and GGT were similar for all Hispanic backgrounds except for Dominican ethnicity. ALT and GGT were both associated with incident diabetes regardless of obesity status. Those who had a high ALT and were light or moderate alcohol drinkers had an increased risk for incident diabetes (RR = 1.5; 95% CI, 1.2-1.86), but there was no increased risk for those who did not drink.
In addition to using liver enzyme testing to screen Hispanic adults for their diabetes risk, Isasi said the findings revealed that lifestyle modifications can reduce a person’s risk for both NAFLD and diabetes. She said more research is needed to see whether there is a link between NAFLD and diabetes in this population.
“The study relied on liver enzymes, which suggest suspected NAFLD,” Isasi said. “Future studies are needed with better identification of NAFLD cases to see if this is a risk factor for diabetes.”
For more information:
Carmen R. Isasi, MD, PhD, FAHA, can be reached at carmen.isasi@einsteinmed.org; Twitter: @CarmenRIsasi.
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