Abstract P072: Elevated Liver Enzymes Are Associated With Incident Diabetes in Hispanic/Latino Adults: Results From HCHS/SOL

Abstract

Introduction: Non-alcoholic fatty liver disease (NAFLD) as measured by ultrasonography or elevated liver enzymes, such as alanine aminotransferase (ALT), aspartate aminotransferase (AST) and gamma-glutamyl transpeptidase (GGT), has been associated with increased risk of incident diabetes. But such evidence is lacking in the Hispanic/Latino population, which has high prevalence of obesity and NAFLD. Methods: We conducted a prospective cohort study of 6928 adults of Hispanic/Latino background who had no diabetes at baseline (2008-2011). Incident diabetes was defined by self-reported diagnosis of diabetes, glucose measurements or antidiabetic medication use at repeat visits on average 6 years from baseline. We examined the associations of baseline liver enzymes (sex-specific quartiles of ALT, AST, GGT) with incident diabetes using survey-weighted Poisson regression with follow-up time as an offset. Results: The weighted mean age was 38 years at baseline. A total of 793 adults developed diabetes during 6 years of follow-up. After adjusting for demographics and socioeconomic status, versus the lowest quartile, highest quartiles of ALT, AST and GGT were significantly associated with 1.5 to 3.5-fold increased risk of incident diabetes. Further adjusting for behavioral variables including diet and exercise, cardiovascular risk factors and cardiovascular medication use, the associations were attenuated and remained statistically significant for ALT (RR quartile 4 vs 1: 1.42[95% CI 1.07-1.90], P-trend=0.001) and GGT (RR quartile 4 vs 1: 1.97[1.34-2.88], P-trend<0.001) but not AST (RR quartile 4 vs 1: 1.28[0.96-1.70], P-trend=0.02). Adjusting for HOMA-IR further attenuated the associations, and GGT but not ALT remained significantly associated with incident diabetes. Conclusion: Elevated ALT and GGT levels are associated with increased risk of developing diabetes among Hispanics/Latinos. Additional work is needed to understand the relationship between NAFLD and diabetes risk in this population.