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The Relationship of Hepatitis Antibodies and Elevated Liver Enzymes with Impaired Fasting Glucose and Undiagnosed Diabetes

From the Department of Family Medicine, Medical University of South Carolina, Charleston

Correspondence: Corresponding author: Arch G. Mainous III, PhD, Department of Family Medicine, Medical University of South Carolina, 295 Calhoun St., Charleston, SC 29425 (E-mail: mainouag{at}musc.edu)

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 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 glutamyl 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 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.

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