RESEARCH ARTICLE
Incremental Predictive Value of Serum ASTto-ALT Ratio for Incident Metabolic Syndrome: The ARIRANG Study Dhananjay Yadav1☯, Eunhee Choi2☯*, Song Vogue Ahn1,3, Soon Koo Baik4, Youn zoo Cho4, Sang Baek Koh1, Ji Hye Huh4, Yoosoo Chang6, Ki-Chul Sung7, Jang Young Kim3,5*
a11111
1 Department of Preventive Medicine, Yonsei University, Wonju College of Medicine, Wonju, Korea, 2 Institute of Lifestyle Medicine, Yonsei University, Wonju College of Medicine, Wonju, Korea, 3 Institute of Genomic Cohort, Yonsei University, Wonju College of Medicine, Wonju, Korea, 4 Department of Internal Medicine, Yonsei University, Wonju College of Medicine, Wonju, Korea, 5 Department of Cardiology, Yonsei University, Wonju College of Medicine, Wonju, Korea, 6 Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, Korea, 7 Division of Cardiology, Department of Medicine, Kangbuk Samsumg Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea ☯ These authors contributed equally to this work. * [email protected] (EHC); [email protected] (JYK)
OPEN ACCESS Citation: Yadav D, Choi E, Ahn SV, Baik SK, Cho Yz, Koh SB, et al. (2016) Incremental Predictive Value of Serum AST-to-ALT Ratio for Incident Metabolic Syndrome: The ARIRANG Study. PLoS ONE 11(8): e0161304. doi:10.1371/journal.pone.0161304 Editor: Sheng-Nan Lu, Chang Gung Memorial Hospital Kaohsiung Branch, TAIWAN Received: April 20, 2016 Accepted: August 3, 2016 Published: August 25, 2016 Copyright: © 2016 Yadav et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the paper and its Supporting Information files. Funding: This study was supported in part by a grant of the Korea Centers for Disease Control and Prevention (2005-E71013-00, 2006-E71002-00, 2007-E71013-00, 2008-E71004-00, 2009- E7100600, 2010-E71003-00). There was no additional external funding received for this study. Competing Interests: The authors have declared that no competing interests exist.
Abstract Aims The ratio of aspartate aminotransferase (AST) to alanine aminotransferase (ALT) is of great interest as a possible novel marker of metabolic syndrome. However, longitudinal studies emphasizing the incremental predictive value of the AST-to-ALT ratio in diagnosing individuals at higher risk of developing metabolic syndrome are very scarce. Therefore, our study aimed to evaluate the AST-to-ALT ratio as an incremental predictor of new onset metabolic syndrome in a population-based cohort study.
Material and Methods The population-based cohort study included 2276 adults (903 men and 1373 women) aged 40–70 years, who participated from 2005–2008 (baseline) without metabolic syndrome and were followed up from 2008–2011. Metabolic syndrome was defined according to the harmonized definition of metabolic syndrome. Serum concentrations of AST and ALT were determined by enzymatic methods.
Results During an average follow-up period of 2.6-years, 395 individuals (17.4%) developed metabolic syndrome. In a multivariable adjusted model, the odds ratio (95% confidence interval) for new onset of metabolic syndrome, comparing the fourth quartile to the first quartile of the AST-to-ALT ratio, was 0.598 (0.422–0.853). The AST-to-ALT ratio also improved the area under the receiver operating characteristic curve (AUC) for predicting new cases of
PLOS ONE | DOI:10.1371/journal.pone.0161304 August 25, 2016
1 / 14
Serum AST-to-ALT Ratio and Incident Metabolic Syndrome
metabolic syndrome (0.715 vs. 0.732, P = 0.004). The net reclassification improvement of prediction models including the AST-to-ALT ratio was 0.23 (95% CI: 0.124–0.337, P
Incremental Predictive Value of Serum ASTto-ALT Ratio for Incident Metabolic Syndrome: The ARIRANG Study Dhananjay Yadav1☯, Eunhee Choi2☯*, Song Vogue Ahn1,3, Soon Koo Baik4, Youn zoo Cho4, Sang Baek Koh1, Ji Hye Huh4, Yoosoo Chang6, Ki-Chul Sung7, Jang Young Kim3,5*
a11111
1 Department of Preventive Medicine, Yonsei University, Wonju College of Medicine, Wonju, Korea, 2 Institute of Lifestyle Medicine, Yonsei University, Wonju College of Medicine, Wonju, Korea, 3 Institute of Genomic Cohort, Yonsei University, Wonju College of Medicine, Wonju, Korea, 4 Department of Internal Medicine, Yonsei University, Wonju College of Medicine, Wonju, Korea, 5 Department of Cardiology, Yonsei University, Wonju College of Medicine, Wonju, Korea, 6 Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, Korea, 7 Division of Cardiology, Department of Medicine, Kangbuk Samsumg Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea ☯ These authors contributed equally to this work. * [email protected] (EHC); [email protected] (JYK)
OPEN ACCESS Citation: Yadav D, Choi E, Ahn SV, Baik SK, Cho Yz, Koh SB, et al. (2016) Incremental Predictive Value of Serum AST-to-ALT Ratio for Incident Metabolic Syndrome: The ARIRANG Study. PLoS ONE 11(8): e0161304. doi:10.1371/journal.pone.0161304 Editor: Sheng-Nan Lu, Chang Gung Memorial Hospital Kaohsiung Branch, TAIWAN Received: April 20, 2016 Accepted: August 3, 2016 Published: August 25, 2016 Copyright: © 2016 Yadav et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the paper and its Supporting Information files. Funding: This study was supported in part by a grant of the Korea Centers for Disease Control and Prevention (2005-E71013-00, 2006-E71002-00, 2007-E71013-00, 2008-E71004-00, 2009- E7100600, 2010-E71003-00). There was no additional external funding received for this study. Competing Interests: The authors have declared that no competing interests exist.
Abstract Aims The ratio of aspartate aminotransferase (AST) to alanine aminotransferase (ALT) is of great interest as a possible novel marker of metabolic syndrome. However, longitudinal studies emphasizing the incremental predictive value of the AST-to-ALT ratio in diagnosing individuals at higher risk of developing metabolic syndrome are very scarce. Therefore, our study aimed to evaluate the AST-to-ALT ratio as an incremental predictor of new onset metabolic syndrome in a population-based cohort study.
Material and Methods The population-based cohort study included 2276 adults (903 men and 1373 women) aged 40–70 years, who participated from 2005–2008 (baseline) without metabolic syndrome and were followed up from 2008–2011. Metabolic syndrome was defined according to the harmonized definition of metabolic syndrome. Serum concentrations of AST and ALT were determined by enzymatic methods.
Results During an average follow-up period of 2.6-years, 395 individuals (17.4%) developed metabolic syndrome. In a multivariable adjusted model, the odds ratio (95% confidence interval) for new onset of metabolic syndrome, comparing the fourth quartile to the first quartile of the AST-to-ALT ratio, was 0.598 (0.422–0.853). The AST-to-ALT ratio also improved the area under the receiver operating characteristic curve (AUC) for predicting new cases of
PLOS ONE | DOI:10.1371/journal.pone.0161304 August 25, 2016
1 / 14
Serum AST-to-ALT Ratio and Incident Metabolic Syndrome
metabolic syndrome (0.715 vs. 0.732, P = 0.004). The net reclassification improvement of prediction models including the AST-to-ALT ratio was 0.23 (95% CI: 0.124–0.337, P
