Korean J Health Promot KJHP Korean Journal of Health Promotion 2234-2141 2093-5676 Korean Society for Health Promotion and Disease Prevention 10.15384/kjhp.2017.17.2.64 Original Article Association between Alcohol Drinking and the Ratio of Aspartate Aminotransferase to Alanine Aminotransferase in Korean Adult Male Cho Young Hee Kim Jong Sung Kim Sung Soo Jung Jin Kyu Yoon Seok Joon Kim Hyeun Young Bae Yoon Kyung Department of Family Medicine, Research Institute for Medical Sciences, Chungnam National University School of Medicine, Daejeon, Korea. Corresponding author: Jong Sung Kim, MD, PhD. Department of Family Medicine, Research Institute for Medical Sciences, Chungnam National University School of Medicine, 282 Munhwa-ro, Jung-gu, Daejeon 35015, Korea. Tel: +82-42-280-8172, Fax: +82-42-280-7879, josephkim@cnu.ac.kr 06 2017 30 06 2017 17 2 64 70 06 03 2017 05 06 2017 Copyright © 2017 Korean Society for Health Promotion and Disease Prevention 2017 This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Background

The aspartate transaminase (AST)/alanine transferase (ALT) ratio increases with alcohol consumption. This study investigated AST/ALT ratio according to alcohol drinking and predictive power of AST/ALT ratio for heavy drinking in Korean men.

 Methods

In 2015, 830 men with no history of disease or medication affecting liver function values were selected. Using 14 g of alcohol as the standard glass, odd ratios (ORs) of AST/ALT ratio over 1 among the drinking group were compared with the non-drinking group by multiple logistic analyses. Screening of heavy drinkers was conducted according to both NIAAA and Korean guidelines. Using AST/ALT ratio >1, sensitivity, specificity, positive predictive values, negative predictive values, positive likelihood ratios, negative likelihood ratios and odds ratios were investigated.

 Results

After correcting for age, body mass index, exercising, and smoking history, ORs (95% confidence interval) of AST/ALT >1 were 1.607 (1.048-2.464) in <8 glasses group, 2.172 (1.160-4.065) in the 14 glasses group, and 3.670 (2.218-6.053) in the >14 glasses group. When AST/ALT >1 in the drinking group, sensitivity, specificity, positive predictive values, negative predictive values, likelihood ratios (LR)+, LR- and OR according to NIAAA guidelines, were 57.2%, 52.7%, 23.2%, 76.8%, 1.21 (1.04-1.41), 0.81 (0.67-0.98), and 1.49 (1.05-2.01), respectively. By Korean guidelines, these values were 55.2%, 55.3%, 33.7%, 66.3%, 1.24 (1.03-1.36), 0.84 (0.72-0.98), and 1.40 (1.04-1.89), respectively.

 Conclusions

Healthy male adults showed a positive correlation between risk of AST/ALT >1 and drinking amount compared to the non-drinking group. Use of the AST/ALT >1 in combination with other blood markers to predict excessive drinking is advisable.

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Abbreviations: AST, aspartate transaminase; ALT, alanine transferase.

Values are presented as mean±standard deviation or number (%).

P-value were calculated by Chi-square test for categorical variable or by ANOVA with scheffe post hoc for continuous variables.

a1 standard drink: Ethanol 14 g.

 Odds ratio for AST/ALT >1 according to drinking amount

aCalculated by Logistic regression with adjustment for age, body mass index, smoking and exercise.

 Distribution of subjects according to AST/ALT >1 and drinking

Abbreviations: AST, aspartate transaminase; ALT, alanine transferase; NIAAA, National Institute on Alcohol Abuse and Alcoholism.

Values are presented as number.

 Usefulness of AST/ALT >1 for screening of heavy drinking considering NIAAA guideline and Korean guideline

Abbreviations: AST, aspartate transaminase; ALT, alanine transferase; NIAAA, National Institute on Alcohol Abuse and Alcoholism; CI, confidence interval.

Values are presented as number (%), unless otherwise stated.

Calculated by Likelihood ratio test for LR(+/-) and logistic regression test for odds ratio (95% CI).

 Cut-off point of AST/ALT ratio for predicting heavy drinking according to NIAAA guideline and Korean guideline

Abbreviations: AST, aspartate transaminase; ALT, alanine transferase; NIAAA, National Institute on Alcohol Abuse and Alcoholism; AUROC, area under the receiver operating characteristic curve; CI, confidence interval.

Proper cut off value calculated by receiver operating characteristic (ROC) curves analysis.