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

Purpose: Altered body composition and liver enzymes are known to be related to cardiometabolic risk. Our study aimed to evaluate the association between fat-to-muscle ratio (FMR), alanine aminotransferase/aspartate aminotransferase (ALT/AST) ratio and cardiometabolic risk.

Methods: In total, 1557 participants aged ≥40 years were included. A bioelectrical impedance analyzer (BIA) was used to measure fat mass and muscle mass. We created a cardiometabolic risk score with one point for each cardiometabolic risk factor, including elevated triglycerides (TGs), decreased high-density lipoprotein cholesterol (HDL-C), elevated blood pressure (BP), and abnormal blood glucose, yielding a score of 0-4 for each participant (≥2 for high-risk and <2 for low-risk). Logistic regression analyses were used to analyze the relationship between FMR, ALT/AST ratio and cardiometabolic risk.

Results: FMR and ALT/AST ratio were significantly higher in the high-risk group than in the low-risk group (P<0.001). FMR and ALT/AST ratio were both positively correlated with a higher cardiometabolic risk score and the presence of each cardiometabolic risk factor. In subgroup analyses categorized according to FMR and ALT/AST ratio cutoffs, the high-FMR/high-ALT/AST group had the highest cardiometabolic risk (OR=8.51; 95% CI 4.46-16.25 in women and OR=5.09; 95% CI 3.39-7.65 in men) after adjusting for confounders.

Conclusion: FMR and ALT/AST ratio were positively associated with cardiometabolic risk. Combining these two indicators improved the prediction of cardiometabolic risk.