Low glycated hemoglobin and liver disease in the U.S. population

OBJECTIVE - To characterize the association of low HbA1c values (<4.0%) with liver enzymes and steatosis. RESEARCH DESIGN AND METHODS - Cross-sectional study of 12,533 participants without diabetes aged <20 years in the ThirdNational Health and Nutrition Examination Survey (1988-1994). Logistic regression models were adjusted for demographic, lifestyle, and health status variables. RESULTS - HbA _1c values ranged from3.2 to 15.7%, and 84 participants had HbA _1c <4.0% in the population (mean age 44, 52% female, 15% black or Hispanic). We observed J-shaped associations between HbA _1c and liver enzymes and hepatic steatosis. In adjusted models, HbA _1c<4.0% was strongly associated with elevated alanine aminotransferase (OR 3.62 [95% CI 1.09-12.02]) and aspartate aminotransferase (6.80 [2.99-15.43]). CONCLUSIONS - Low HbA1c values were associated with liver enzymes and steatosis in the U.S. population. Liver disease may partially explain the association of HbA1c with mortality and other long-term outcomes.