Introduction Compared to western populations, diabetes mellitus is prevalent in China despite a relatively non-obese population. Exposures beyond lifestyle and genetics may be relevant. We hypothesised that liver infections, common in China, increase vulnerability to diabetes, via the physiological consequences of poor liver function.
Methods We used multivariable regression to examine the adjusted associations of alanine transaminase (ALT) and aspartate transaminase (AST) with diabetes in the Guangzhou Biobank Cohort Study phase 1 (2003–2004) for 10 121 older (≥50 years) Chinese and in NHANES III for 16 854 people. We similarly examined the associations of liver function related viruses (number of hepatitis A, B, C and E antibodies or of hepatitis A, hepatitis C and herpes simplex virus 1) with ALT, AST, diabetes and death from diabetes in NHANES III. As a control, we examined associations for viruses unrelated to liver function (cytomegalovirus, herpes simplex virus 2 and human herpes virus 8).
Results ALT was positively associated with diabetes in both settings, adjusted for age, sex, socio-economic position, smoking, alcohol and adiposity. Similarly adjusted, liver function related virus antibodies were associated with ALT (0.18 SDs, 95% CI 0.10 to 0.26 for 2+ compared with none) and diabetes (OR 1.43, 95% CI 1.02 to 2.02), but viruses unrelated to liver function were not.
Conclusion Prior exposure to endemic viruses damaging liver function could be an additional factor contributing to diabetes in China, which public health efforts infection control efforts may already be addressing. Prevention strategies may need to be contextually specific.
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