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

Arch G. Mainous; Vanessa A. Diaz; Dana E. King; Charles J. Everett; Marty S. Player

doi:10.3122/jabfm.2008.06.080047

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Table 1.

Characteristics of the Sample from the National Health and Nutrition Examination Survey 1999 to 2004

Unweighted (n)	5234
Weighted (n)	172,626,805
Diabetes (%)
Diagnosed diabetes	7.0
Undiagnosed diabetes	2.6
Impaired fasting glucose	25.5
Normal	64.9
Hepatitis B core antibody
Positive (%)	6.0
Hepatitis C core antibody
Positive (%)	1.5
CRP (%)
Low (<0.3 mg/dL)	61.3
High (≥0.3 mg/dL)	38.7
GGT (%)
Low (<29.48 u/l)	74.6
High (≥29.48 u/l)	25.4
AST (%)
Low (<25.51 u/l)	73.2
High (≥25.51 u/l)	26.8
ALT (%)
Low (<27.78 u/l)	73.0
High (≥27.78 u/l)	27.0
Age (%)
20 to 44 years	50.5
45 to 64 years	33.3
≥65 years	16.1
Gender (%)
Male	46.0
Female	54.0
Race/Ethnicity (%)
Non-Hispanic white	72.3
Non-Hispanic black	10.9
Hispanic	12.6
Other	4.1
Body mass index (kg/m²)
<25.0	35.0
25.0–29.9	33.9
≥30.0	31.1
Previously diagnosed (%)
High cholesterol
Yes	27.7
No or not tested	72.3
Hypertension
Yes	27.2
No	72.8

CRP, C-reactive protein; GGT, γglutamyl transferase; AST, aspartate aminotransferase; ALT, alanine aminotransferase.

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Table 2.

Hepatitis B Core Antibody, Hepatitis C Antibody (Confirmed), C-Reactive Protein, and Liver Enzymes by Diabetes/Impaired Fasting Glucose Categories

	Diagnosed Diabetes	Undiagnosed Diabetes	Impaired Fasting Glucose	Normal	P
Hepatitis B core antibody
Positive (%)	13.83	7.98	5.59	5.22	.001
Hepatitis C antibody (confirmed)
Positive (%)	2.11	2.12	1.38	1.40	.90
CRP (%)
Low	50.34	47.18	56.79	64.85	<.01
High	49.66	52.82	43.21	35.15
ALT (%)
Low	70.48	56.98	65.60	76.88	<.01
High	29.52	43.02	34.40	23.12
AST (%)
Low	73.78	71.67	67.87	75.22	<.01
High	26.22	28.33	32.13	24.78
GGT (%)
Low	58.93	48.94	67.90	79.89	<.01
High	41.07	51.06	32.10	20.11

CRP, C-reactive protein; ALT, alanine aminotransferase; AST, aspartate aminotransferase; GGT, γglutamyl transferase.

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Table 3.

Adjusted Regressions Predicting Undiagnosed Diabetes or Impaired Fasting Glucose or Undiagnosed Diabetes Alone Using Hepatitis B Core Antibody, Hepatitis C Antibody (Confirmed), and Liver Enzymes*

	Undiagnosed Impaired Fasting Glucose	Undiagnosed Diabetes
Hepatitis B core antibody
Positive	0.98 (0.64–1.52)	1.42 (0.63–3.24)
Negative	1.00 (—)	1.00 (—)
Hepatitis C core antibody (confirmed)
Positive	1.12 (0.55–2.25)	2.23 (0.44–11.20)
Negative	1.00 (—)	1.00 (—)
ALT
Low	1.00 (—)	1.00 (—)
High	1.44 (1.15–1.79)	1.84 (1.06–3.20)
AST
Low	1.00 (—)	1.00 (—)
High	1.12 (0.95–1.34)	0.78 (0.44–1.37)
GGT
Low	1.00 (—)	1.00 (—)
High	1.23 (1.00–1.53)	2.15 (1.44–3.20)

* Adjusted for age, gender, race/ethnicity, body mass index, high cholesterol and hypertension. All data provided as odds ratio (95% CI).
ALT, alanine aminotransferase; AST, aspartate aminotransferase; GGT, γglutamyl transferase.

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Table 4.

Adjusted Logistic Regressions Predicting Undiagnosed Diabetes or Impaired Fasting Glucose or Undiagnosed Diabetes Alone Using C-Reactive Protein and Liver Enzymes Combined*

	Impaired Fasting Glucose	Undiagnosed Diabetes
ALT and CRP
Low ALT, low CRP	1.00 (—)	1.00 (—)
Low ALT, high CRP	1.11 (0.90–1.36)	0.97 (0.60–1.55)
High ALT, low CRP	1.49 (1.14–1.96)	1.61 (0.82–3.19)
High ALT, high CRP	1.50 (1.14–1.97)	2.02 (0.99–4.15)
AST and CRP
Low AST, low CRP	1.00 (—)	1.00 (—)
Low AST, high CRP	1.10 (0.93–1.31)	1.19 (0.77–1.84)
High AST, low CRP	1.16 (0.93–1.44)	0.91 (0.45–1.84)
High AST, high CRP	1.19 (0.91–1.56)	0.78 (0.34–1.82)
GGT and CRP
Low GGT, low CRP	1.00 (—)	1.00 (—)
Low GGT, high CRP	1.01 (0.81–1.26)	1.08 (0.66–1.77)
High GGT, low CRP	1.15 (0.88–1.51)	2.26 (1.31–3.89)
High GGT, high CRP	1.34 (1.07–1.68)	2.19 (1.22–3.96)

* Adjusted for age, gender, race/ethnicity, body mass index, high cholesterol and hypertension. All data provided as odds ratio (95% CI).
ALT, alanine aminotransferase; CRP, C-reactive protein; AST, aspartate aminotransferase; GGT, γglutamyl transferase.