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Updated: May 29, 2026

Optimized Analysis of In Vivo and In Vitro Hepatic Steatosis
Published on: March 11, 2017
Low glycated hemoglobin and liver disease in the U.S. population
Andrea L Christman1, Mariana Lazo, Jeanne M Clark
1Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA. andrea.christman@gmail.com
Objective:
To characterize the association of low HbA(1c) 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 Third National Health and Nutrition Examination Survey (1988-1994). Logistic regression models were adjusted for demographic, lifestyle, and health status variables.
Results:
HbA(1c) values ranged from 3.2 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 HbA(1c) values were associated with liver enzymes and steatosis in the U.S. population. Liver disease may partially explain the association of HbA(1c) with mortality and other long-term outcomes.
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