Excessive liver enzymes enhance diabetes danger for US Hispanic adults

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March 16, 2021

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Isasi does not report any relevant financial information. In the study you will find all relevant financial information from all other authors.

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Hispanic adults in the United States who have high levels of liver enzymes are at increased risk of developing diabetes, according to a study published in Diabetic Medicine.

“Hispanics are at high risk for diabetes and its complications and at high risk for non-alcoholic fatty liver disease (NAFLD).” Carmen R. Isasi, MD, PhD, FAHA, Healio said, an associate professor in the Department of Epidemiology and Population Health at Albert Einstein College of Medicine. “Liver enzymes, in addition to conventional factors, could be a simple clinical tool to screen people for diabetes risk.”

Isasi is a Associate Professor in the Department of Epidemiology and Population Health at Albert Einstein College of Medicine.

Isasi and colleagues analyzed data from 6,928 adults who participated in the Hispanic Community Health Study / Study on Latinos (mean age 38 years). Participants had no diabetes on a base visit from 2008 to 2011 and returned for a follow-up examination an average of 6 years after the start of the study from 2014 to 2017. Alanine aminotransferase (ALT), aspartate aminotransferase (AST) and gamma-glutamyl transpeptidase (GGT) were measured at baseline. The researchers classified the participants into quartiles for ALT, AST, and GGT based on their baseline values. Incidental diabetes was identified during follow-up through laboratory measurements or the use of diabetes medication.

Of the 738 participants who had diabetes during the follow-up visit, 533 were identified through blood tests. Adults were more likely to develop diabetes if they were men, older or Puerto Rican, or had a lower level of education, a higher BMI, a higher waist size, or a lower score for an alternative healthy eating index.

After adjusting for demographics, socioeconomic status, diet, exercise, cardiovascular risk factors, and use of CV drugs, adults in the highest quartile of ALT were at greater risk of developing diabetes than adults in the lowest quartile (RR = 1.51; 95% CI , 1.03) -2.22; P = 0.006). Participants in the highest quartile for GGT also had an increased risk of diabetes at follow-up compared to the lowest quartile (RR = 2.39; 95% CI, 1.6-3.55; P = 0.001). Both associations persisted after adjusting the fasting glucose at the start of the study. After adjustment to the homeostatic model assessment of insulin resistance, only a high GGT level was significantly associated with diabetes.

The risks for diabetes with ALT and GGT were similar for all Hispanic backgrounds except for the Dominican ethnicity. ALT and GGT were both associated with diabetes regardless of their obesity status. Those who had high ALT and were light or moderate alcohol drinkers had an increased risk of diabetes (RR = 1.5; 95% CI, 1.2-1.86), but there was no increased risk for those who did did not drink.

In addition to using liver enzyme tests to screen Hispanic adults for their risk of diabetes, the results showed that lifestyle changes can reduce a person’s risk for both NAFLD and diabetes. She said more research is needed to see if there is a link between NAFLD and diabetes in this population.

“The study relied on liver enzymes, which suggest a suspicion of NAFLD,” Isasi said. “Future studies to better identify NAFLD cases are needed to determine whether this is a risk factor for diabetes.”

For more informations:

Carmen R. Isasi, MD, PhD, FAHA, can be reached at carmen.isasi@einsteinmed.org; Twitter: @CarmenRIsasi.

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Race and medicine

Race and medicine