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Background: The aspartate transaminase to alanine aminotransferase ratio (AST/ALT) has been proposed as a potential biomarker for metabolic dysfunction, but its association with type 2 diabetes mellitus (T2DM) remains controversial. This study aimed to investigate the relationship between AST/ALT ratio and risk of T2DM using a nationally representative sample.
Methods: We analyzed data from the National Health and Nutrition Examination Survey (NHANES) between 1999 and 2004, collecting details on their T2DM status, AST/ALT ratio, and several other essential variables. There were 12,527 participants, with 13.9% (1,746/12,527) who experienced T2DM. Logistic regression, curve fitting, interaction effects were utilized to investigate the association between AST/ALT ratio and T2DM.
Results: There was a substantial difference in AST/ALT ratios between the groups, with T2DM patients exhibiting significantly lower values (p < 0.001). Logistic regression analysis revealed a negative association between AST/ ALT ratio and T2DM, even after adjusting for the confounding variables (odds ratio: 0.28, 95% confidence interval: 0.25 - 0.32, p < 0.001). In addition, curve fitting after adjusting for all the confounding variables showed that there was a linear relationship between AST/ALT ratio and T2DM (p for non-linearity = 0.107). AST/ALT ratio was negatively correlated with T2DM.
Conclusions: The AST/ALT ratio was associated with a lower risk of T2DM in a linear pattern, suggesting its potential role as a clinical indicator of metabolic risk. Further prospective studies are needed to clarify causality.
DOI: 10.7754/Clin.Lab.2025.250806
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