Association Between The Alanine Aminotransferase/Aspartate Aminotransferase Ratio And New-onset Non-alcoholic Fatty Liver Disease In A Nonobese Chinese Population

Background:The alanine aminotransferase(ALT)/aspartate aminotransferase(AST)ratio has been considered an alternative marker for hepatic steatosis.However,few studies have investigated the association of the ALT/AST ratio with non-alcoholic fatty liver disease(NAFLD)in nonobese people.Methods:A total of 12,127 nonobese participants who were free of NAFLD participated in this study.The participants were divided into quintiles of the ALT/AST ratio.Multiple Cox regression models were used to explore the association of the ALT/AST ratio with new-onset NAFLD.Results:During the five-year follow-up period,2147 individuals(17.7%)developed new-onset NAFLD.After adjusting for all non-collinear covariates,the multiple Cox regression analysis results showed that a higher ALT/AST ratio was independently associated with new-onset NAFLD in nonobese Chinese(adjusted hazard ratios[a HRs]: 2.10,95% confidence intervals: 1.88,2.36).The a HRs for NAFLD across increasing quintiles of the ALT/AST ratio were 1,1.63(1.30,2.04),2.07(1.65,2.60),2.84(2.33,3.48)and 3.49(2.78,4.39)(P for trend< 0.001).The positive association was more significant among people with high blood pressure,high blood lipids and hyperglycaemia,as well as in men.Additionally,the regression spline showed that the saturation effect of the ALT/AST ratio on NAFLD risk was at 0.93 in this study population,which was 1.22 in males and 0.89 in females.Conclusions:In nonobese Chinese individuals without NAFLD at baseline,the increase in the ALT/AST ratio is closely associated with the risk of new-onset NAFLD.