No Independent Association of Alanine Aminotransferase With Risk of Future Type 2 Diabetes in the Hoorn Study

We read with great interest the article by Nannipieri et al. (1), which reported no association between aspartate aminotransferase, alanine aminotransferase (ALT), or alkaline phosphatase and the 7-year incidence of impaired glucose tolerance and type 2 diabetes. Interestingly, γ-glutamyltransferase was, but ALT was not, a significant predictor of impaired glucose tolerance or type 2 diabetes. This is, as the authors stated, in contrast to previously published papers that found significant prospective associations of ALT with incident type 2 diabetes after adjustment for obesity, insulin sensitivity, or inflammation (C-reactive protein) (2–4). We studied the …