Combining Fat-to-Muscle Ratio and Alanine Aminotransferase/Aspartate Aminotransferase Ratio in the Prediction of Cardiometabolic Risk: A Cross-Sectional Study

Figures & data

Table 1 Baseline Characteristics of the Study Participants According to Cardiometabolic Risk

Variables	Total (n)	Female (n=461)			Male (n=1096)
		Low-Risk	High-Risk	P value	Low-Risk	High-Risk	P value
	1557	(n=200)	(n=261)		(n=283)	(n=813)
Age, year	56.4±9.0	53.3±8.4	60.9±9.4	<0.001	56.0±9.0	55.9±8.6	0.953
BMI, kg/m^2	25.4±2.9	23.1±2.4	25.3±3.1	<0.001	24.7±2.5	26.3±2.7	<0.001
FMR	0.40±0.12	0.46±0.10	0.55±0.11	<0.001	0.33±0.08	0.36±0.07	<0.001
SBP, mmHg	132±30	122±15	136±15	<0.001	125±14	135±38	<0.001
DBP, mmHg	82±11	75±11	82±11	<0.001	79±11	84±11	<0.001
TC, mmol/L	4.62±0.94	4.86±0.83	4.69±0.99	0.039	4.55±0.88	4.56±0.96	0.836
TG, mmol/L	1.93±1.68	1.00±0.37	1.94±1.78	<0.001	1.16±0.46	2.43±1.89	<0.001
HDL-C, mmol/L	1.13±0.32	1.49±0.32	1.17±0.28	<0.001	1.26±0.29	0.99±0.24	<0.001
LDL-C, mmol/L	2.78±0.83	2.95±0.70	2.79±0.85	0.025	2.84±0.81	2.72±0.85	0.044
ALT, U/L	26.19±19.78	15.59±6.66	24.00±20.08	<0.001	23.93±16.83	30.28±21.54	<0.001
AST, U/L	23.18±11.29	19.63±4.79	22.78±11.71	<0.001	23.06±12.52	24.22±11.67	0.160
ALT/AST ratio	1.09±0.41	0.79±0.25	1.00±0.36	<0.001	1.02±0.39	1.21±0.42	<0.001
UA, umol/L	366.02±97.05	270.08±64.11	319.98±84.81	<0.001	370.25±76.31	402.92±91.65	<0.001
FBG, mmol/L	5.53±1.68	4.78±0.48	5.79±1.93	<0.001	4.92±1.29	5.85±1.79	<0.001
Tobacco use, n(%)	516(33.1)	4(2.0)	4(1.5)	0.703	122(43.1)	386(47.5)	0.204
Alcohol use, n(%)	503(32.3)	6(3.0)	5(1.9)	0.543	123(43.5)	369(45.4)	0.575
Hypertension, n(%)	897(57.6)	35(17.5)	169(64.8)	<0.001	98(34.6)	595(73.2)	<0.001
Diabetes, n(%)	444(28.5)	3(1.5)	94(36.0)	<0.001	7(2.5)	340(41.8)	<0.001

Abbreviations: BMI, body mass index; FMR, fat-to-muscle ratio; SBP, systolic blood pressure; DBP, diastolic blood pressure; TC, total cholesterol; TG, triglyceride; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; ALT, alanine aminotransferase; AST, aspartate aminotransferase; UA, uric acid; FBG, fasting blood glucose.

Figure 1 Proportion of a high cardiometabolic risk score according to tertile stratification of FMR in women (A) and men (B) and according to tertile stratification of ALT/AST ratio in women (C) and men (D).

Abbreviation: FMR, fat-to-muscle ratio.

Figure 2 Proportion (95% confidence interval) of each cardiometabolic risk score category in women and men. *P value=Chi-squared test within sex. **P value=Chi-squared test between sexes.

Table 2 Association Between Tertiles of Fat-to-Muscle Ratio and Cardiometabolic Risk Factors

Outcome Variables	Tertile of FMR	Female						Male
		Model 1			Model 2			Model 1			Model 2
		OR	(95% CI)	P value	OR	(95% CI)	P value	OR	(95% CI)	P value	OR	(95% CI)	P value
Elevated TG	T1	Ref			Ref			Ref			Ref
	T2	1.97	1.12–3.45	0.019	1.94	1.07–3.50	0.028	1.83	1.36–2.47	<0.001	1.96	1.44–2.67	<0.001
	T3	2.79	1.61–4.83	<0.001	2.75	1.49–5.08	0.001	2.12	1.58–2.86	<0.001	2.88	2.09–3.96	<0.001
Reduced HDL-C	T1	Ref			Ref			Ref			Ref
	T2	2.16	1.37–3.41	0.001	2.00	1.23–3.26	0.005	1.29	0.96–1.74	0.092	1.39	1.03–1.88	0.031
	T3	2.71	1.70–4.32	<0.001	2.51	1.48–4.27	0.001	1.50	1.11–2.02	0.008	1.68	1.23–2.30	0.001
Elevated blood pressure	T1	Ref			Ref			Ref			Ref
	T2	3.45	2.16–5.52	<0.001	2.04	1.22–3.42	0.007	1.34	0.96–1.86	0.088	1.25	0.89–1.76	0.192
	T3	6.89	4.10–11.57	<0.001	3.08	1.72–5.51	<0.001	3.28	2.20–4.89	<0.001	2.76	1.84–4.15	<0.001
Hyperglycemia	T1	Ref			Ref			Ref			Ref
	T2	2.60	1.44–4.67	0.001	1.70	0.92–3.17	0.093	1.45	1.07–1.96	0.018	1.45	1.06–1.97	0.019
	T3	5.36	3.04–9.46	<0.001	2.91	1.56–5.43	0.001	2.76	2.04–3.73	<0.001	2.54	1.86–3.46	<0.001
A high cardiometabolic risk score	T1	Ref			Ref			Ref			Ref
	T2	3.56	2.22–5.70	<0.001	2.37	1.43–3.92	0.001	1.62	1.18–2.23	0.003	1.66	1.21–2.30	0.002
	T3	7.45	4.48–12.38	<0.001	4.03	2.31–7.04	<0.001	2.81	1.98–3.99	<0.001	3.00	2.09–4.31	<0.001

Notes: Elevated TG, TG ≥ 1.7 mmol/l or drug treatment for elevated TG. Reduced HDL-C, HDL-C < 1.03 mmol/l in men or <1.29 mmol/l in women, or drug treatment for reduced HDL-C. Elevated blood pressure, SBP ≥ 130 mmHg or/and DBP ≥ 85 mmHg, or previously diagnosed hypertension. Hyperglycemia, FBG ≥ 5.6 mmol/l or previously diagnosed type 2 diabetes.

Abbreviations: TG, triglyceride; HDL-C, high-density lipoprotein cholesterol; SBP, systolic blood pressure; DBP, diastolic blood pressure; FMR, fat-to-muscle ratio; OR, odds ratio; CI, confidence interval.

Table 3 Association Between Tertiles of ALT/AST Ratio and Cardiometabolic Risk Factors

Outcome Variables	Tertile of ALT/AST Ratio	Female						Male
		Model 1			Model 2			Model 1			Model 2
		OR	(95% CI)	P value	OR	(95% CI)	P value	OR	(95% CI)	P value	OR	(95% CI)	P value
Elevated TG	T1	Ref			Ref			Ref			Ref
	T2	1.07	0.61–1.88	0.817	1.01	0.57–1.79	0.973	2.20	1.63–2.97	<0.001	2.16	1.59–2.94	<0.001
	T3	2.47	1.47–4.15	0.001	2.43	1.44–4.11	0.001	3.00	2.21–4.06	<0.001	2.65	1.94–3.62	<0.001
Reduced HDL-C	T1	Ref			Ref			Ref			Ref
	T2	1.99	1.26–3.13	0.003	1.85	1.16–2.93	0.009	1.61	1.20–2.17	0.001	1.63	1.21–2.19	0.001
	T3	3.53	2.18–5.70	<0.001	3.67	2.24–6.01	<0.001	2.36	1.74–3.21	<0.001	2.34	1.71–3.21	<0.001
Elevated blood pressure	T1	Ref			Ref			Ref			Ref
	T2	1.80	1.14–2.85	0.012	1.50	0.89–2.51	0.127	1.40	0.98–1.99	0.063	1.55	1.08–2.23	0.017
	T3	2.69	1.67–4.33	<0.001	2.55	1.50–4.32	0.001	1.38	0.97–1.96	0.074	1.78	1.23–2.57	0.002
Hyperglycemia	T1	Ref			Ref			Ref			Ref
	T2	2.29	1.29–4.06	0.005	2.05	1.12–3.76	0.021	1.75	1.29–2.36	<0.001	1.90	1.40–2.58	<0.001
	T3	4.38	2.52–7.62	<0.001	4.76	2.63–8.61	<0.001	1.82	1.35–2.46	<0.001	2.22	1.62–3.04	<0.001
A high cardiometabolic risk score	T1	Ref			Ref			Ref			Ref
	T2	2.00	1.27–3.15	0.003	1.75	1.06–2.89	0.03	2.37	1.72–3.28	<0.001	2.46	1.78–3.41	<0.001
	T3	5.17	3.16–8.47	<0.001	5.63	3.28–9.65	<0.001	3.68	2.59–5.25	<0.001	3.96	2.76–5.70	<0.001

Notes: Elevated TG, TG ≥ 1.7 mmol/l or drug treatment for elevated TG. Reduced HDL-C, HDL-C < 1.03 mmol/l in men or <1.29 mmol/l in women, or drug treatment for reduced HDL-C. Elevated blood pressure, SBP ≥ 130 mmHg or/and DBP ≥ 85 mmHg, or previously diagnosed hypertension. Hyperglycemia, FBG ≥ 5.6 mmol/l or previously diagnosed type 2 diabetes.

Abbreviations: TG, triglyceride; HDL-C, high-density lipoprotein cholesterol; SBP, systolic blood pressure; DBP, diastolic blood pressure; OR, odds ratio; CI, confidence interval.

Figure 3 ROC curves of FMR and ALT/AST ratio for the detection of cardiometabolic risk in women (A) and men (B).

Abbreviations: ROC, receiver operating characteristic; FMR, fat-to-muscle ratio; AUC, area under curve.

Table 4 Association of Different Subgroups with a High Cardiometabolic Risk Score According to the Cutoffs of Fat-to-Muscle Ratio and ALT/AST Ratio

Groups	Female						Male
	Model 1			Model 2			Model 1			Model 2
	OR	(95% CI)	P value	OR	(95% CI)	P value	OR	(95% CI)	P value	OR	(95% CI)	P value
Low-FMR/Low-ALT/AST	Ref			Ref			Ref			Ref
High-FMR/Low-ALT/AST	4.19	2.19–8.03	<0.001	2.10	1.03–4.28	0.041	1.76	1.16–2.67	0.008	1.74	1.14–2.66	0.011
Low-FMR/High-ALT/AST	3.04	1.48–6.26	0.002	3.02	1.42–6.40	0.004	2.46	1.74–3.48	<0.001	2.49	1.75–3.54	<0.001
High-FMR/High-ALT/AST	14.15	7.67–26.09	<0.001	8.51	4.46–16.25	<0.001	5.03	3.35–7.54	<0.001	5.09	3.39–7.65	<0.001

Abbreviations: FMR, fat-to-muscle ratio; OR, odds ratio; CI, confidence interval.