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Niemelä O, Bloigu A, Bloigu R, Aalto M, Laatikainen T. Associations between Liver Enzymes, Lifestyle Risk Factors and Pre-Existing Medical Conditions in a Population-Based Cross-Sectional Sample. J Clin Med 2023; 12:4276. [PMID: 37445311 DOI: 10.3390/jcm12134276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/20/2023] [Accepted: 06/24/2023] [Indexed: 07/15/2023] Open
Abstract
While alanine aminotransferase (ALT) and gamma-glutamyltransferase (GGT) enzymes are commonly used indicators of liver dysfunction recent studies have suggested that these may also serve as predictive biomarkers in the assessment of extrahepatic morbidity. In order to shed further light on the interactions between serum liver enzyme abnormalities, factors of lifestyle and health status we examined ALT and GGT activities in a population-based sample of 8743 adult individuals (4048 men, 4695 women from the National FINRISK 2002 Study, mean age 48.1 ± 13.1 years) with different levels of alcohol drinking, smoking, physical activity, body weight and the presence or absence of various pre-existing medical conditions. The assessments also included laboratory tests for inflammation, lipid status and fatty liver index (FLI), a proxy for fatty liver. The prevalence of ALT and GGT abnormalities were significantly influenced by alcohol use (ALT: p < 0.0005 for men; GGT: p <0.0005 for both genders), smoking (GGT: p <0.0005 for men, p =0.002 for women), adiposity (p < 0.0005 for all comparisons), physical inactivity (GGT: p <0.0005; ALT: p <0.0005 for men, p <0.05 for women) and coffee consumption (p <0.0005 for GGT in both genders; p <0.001 for ALT in men). The total sum of lifestyle risk factor scores (LRFS) influenced the occurrence of liver enzyme abnormalities in a rather linear manner. Significantly higher LRFS were observed in the subgroups of individuals with pre-existing medical conditions when compared with those having no morbidities (p <0.0005). In logistic regression analyses adjusted for the lifestyle factors, both ALT and GGT associated significantly with fatty liver, diabetes and hypertension. GGT levels also associated with coronary heart disease, angina pectoris, cardiac insufficiency, cerebrovascular disease, asthma and depression. Combinations of abnormal ALT and GGT activities significantly increased the odds for hypertension coinciding with abnormalities in biomarkers of inflammation, lipid status and FLI. The data indicates that ALT and GGT activities readily respond to unfavorable factors of lifestyle associating also with a wide array of pre-existing medical conditions. The data supports close links between both hepatic and extrahepatic morbidities and lifestyle risk factors and may open new insights on a more comprehensive use of liver enzymes in predictive algorithms for assessing mechanistically anchored disease conditions.
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Affiliation(s)
- Onni Niemelä
- Department of Laboratory Medicine and Medical Research Unit, Seinäjoki Central Hospital and Tampere University, 60220 Seinäjoki, Finland
| | - Aini Bloigu
- Research Unit of Population Health, Faculty of Medicine, University of Oulu, 90014 Oulu, Finland
| | - Risto Bloigu
- Infrastructure for Population Studies, Faculty of Medicine, University of Oulu, 90014 Oulu, Finland
| | - Mauri Aalto
- Department of Psychiatry, Seinäjoki Central Hospital and Tampere University, 33100 Tampere, Finland
| | - Tiina Laatikainen
- Department of Public Health and Social Welfare, Finnish Institute for Health and Welfare (THL), 00271 Helsinki, Finland
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70211 Kuopio, Finland
- Joint Municipal Authority for North Karelia Social and Health Services, 80210 Joensuu, Finland
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Abstract
The medical disorders of alcoholism rank among the leading public health problems worldwide and the need for predictive and prognostic risk markers for assessing alcohol use disorders (AUD) has been widely acknowledged. Early-phase detection of problem drinking and associated tissue toxicity are important prerequisites for timely initiations of appropriate treatments and improving patient's committing to the objective of reducing drinking. Recent advances in clinical chemistry have provided novel approaches for a specific detection of heavy drinking through assays of unique ethanol metabolites, phosphatidylethanol (PEth) or ethyl glucuronide (EtG). Carbohydrate-deficient transferrin (CDT) measurements can be used to indicate severe alcohol problems. Hazardous drinking frequently manifests as heavy episodic drinking or in combinations with other unfavorable lifestyle factors, such as smoking, physical inactivity, poor diet or adiposity, which aggravate the metabolic consequences of alcohol intake in a supra-additive manner. Such interactions are also reflected in multiple disease outcomes and distinct abnormalities in biomarkers of liver function, inflammation and oxidative stress. Use of predictive biomarkers either alone or as part of specifically designed biological algorithms helps to predict both hepatic and extrahepatic morbidity in individuals with such risk factors. Novel approaches for assessing progression of fibrosis, a major determinant of prognosis in AUD, have also been made available. Predictive algorithms based on the combined use of biomarkers and clinical observations may prove to have a major impact on clinical decisions to detect AUD in early pre-symptomatic stages, stratify patients according to their substantially different disease risks and predict individual responses to treatment.
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Affiliation(s)
- Onni Niemelä
- Department of Laboratory Medicine and Medical Research Unit, Seinäjoki Central Hospital and Tampere University, Seinäjoki, Finland.
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López-González ÁA, Riutord Sbert P, Arroyo Bote S, González San Miguel H, Vidal Real C, Ramirez-Manent JI. Determination of Cardiovascular Risk in 56,262 Spanish Construction Workers: Cardiovascular Risk in Construction Workers. J Occup Environ Med 2021; 63:e911-e917. [PMID: 34860208 DOI: 10.1097/jom.0000000000002402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate different cardiovascular risk scales in construction workers. METHODS A descriptive, cross-sectional study was carried out in 56,262 Spanish construction workers. Scales of obesity and fatty liver, metabolic syndrome, atherogenic indices, and cardiovascular risk scales, among others, were assessed. RESULTS In women, 19.6% were obese, 18.2% hypertensive, 12.6% had metabolic syndrome, 12% were at high risk of non-alcoholic fatty liver disease, and 4.3% were at moderate or high risk on the SCORE scale. In men, 20.1% were obese, 30.1% hypertensive, 17.5% had metabolic syndrome, and 27.6% had high or moderate risk on the SCORE scale. CONCLUSIONS Knowing the cardiovascular risk of a large number of construction workers by means of a large number of scales may be of great interest to occupational health professionals, as it may enable them to establish prevention strategies.
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Affiliation(s)
- Ángel Arturo López-González
- Department of ADEMA University School Palma, Balearic Islands, Spain (Dr López-González, Dr Sbert, Dr Arroyo, Dr Miguel, Dr Real); Balearic Islands Health Service (Dr Ramirez-Manent); University of the Balearic Islands, Balearic Islands, Spain (Dr Ramirez-Manent)
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Božić T, Meštrović T, Profozić Z, Profozić V. The role of occupational medicine in assessing work limitation: A cross-sectional study on construction workers over a five-year period in Croatia. Work 2017; 58:439-446. [DOI: 10.3233/wor-172644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Tajana Božić
- Occupational Health and Sports Medicine Unit, Health Care Institution “Profozić”, Zagreb, Croatia
| | | | - Zora Profozić
- Occupational Health and Sports Medicine Unit, Health Care Institution “Profozić”, Zagreb, Croatia
- Polyclinic “Dr. Zora Profozić”, Zagreb, Croatia
| | - Velimir Profozić
- Occupational Health and Sports Medicine Unit, Health Care Institution “Profozić”, Zagreb, Croatia
- Polyclinic “Dr. Zora Profozić”, Zagreb, Croatia
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Sung KC, Ryu S, Kim BS, Cheong ES, Park DI, Kim BI, Kwon MJ, Wild SH, Byrne CD. γ-Glutamyl Transferase Is Associated with Mortality Outcomes Independently of Fatty Liver. Clin Chem 2015; 61:1173-81. [PMID: 26152752 DOI: 10.1373/clinchem.2015.240424] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 06/18/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND High serum enzyme activity levels of γ-glutamyl transferase (GGT) are associated with increased risk of mortality, but whether this is mediated by fatty liver, as a common cause of high GGT levels, is uncertain. Our aim was to test whether GGT levels are associated with all-cause, cancer, and cardiovascular (CVD) mortality, independently of fatty liver. METHODS In an occupational cohort (n = 278 419), causes of death (International Statistical Classification of Diseases and Related Health Problems, 10th revision) were recorded over 7 years. Liver function tests and liver fat [measured by ultrasonographic standard criteria or fatty liver index (FLI)] were assessed at baseline. We used Cox proportional hazards models to estimate adjusted hazard ratios (HRs) and 95% CIs of all-cause, cancer, and CVD mortality for GGT quartiles (with lowest GGT quartile as reference). RESULTS There were 136, 167, 265, and 342 deaths across increasing GGT quartiles. After adjusting for liver fat (by ultrasound diagnosis) in the fully adjusted model, all-cause and cancer mortality were increased in the highest GGT quartile [HR 1.50 (95% CI 1.15-1.96) and 1.57 (1.05-2.35), respectively]. For CVD mortality, the hazard was attenuated: HR 1.35 (95% CI 0.72-2.56). After adjusting for FLI in the fully adjusted model, HRs for all-cause, cancer, and CVD mortality were 1.46 (0.72-2.56), 2.03 (1.02-4.03), and 1.16 (0.41,3.24), respectively. CONCLUSIONS There were similar hazards for all-cause and cancer mortality and attenuated hazards for CVD mortality for people in the highest GGT quartile, adjusting for fatty liver assessed by either ultrasound or FLI.
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Affiliation(s)
| | - Seungho Ryu
- Department of Occupational and Environmental Medicine
| | - Bum-Soo Kim
- Division of Cardiology, Department of Medicine
| | | | - Dong-Il Park
- Division of Gastroenterology, Department of Medicine
| | - Byung Ik Kim
- Division of Gastroenterology, Department of Medicine
| | - Min-Jung Kwon
- Center for Cohort Studies, Total Healthcare Center, and Department of Laboratory Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sarah H Wild
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Christopher D Byrne
- Nutrition and Metabolism Unit and Southampton National Institute for Health Research Biomedical Research Centre, Southampton General Hospital, University of Southampton, Southampton, UK.
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Seneff S, Davidson RM, Lauritzen A, Samsel A, Wainwright G. A novel hypothesis for atherosclerosis as a cholesterol sulfate deficiency syndrome. Theor Biol Med Model 2015; 12:9. [PMID: 26014131 PMCID: PMC4456713 DOI: 10.1186/s12976-015-0006-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 05/18/2015] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Despite a vast literature, atherosclerosis and the associated ischemia/reperfusion injuries remain today in many ways a mystery. Why do atheromatous plaques make and store a supply of cholesterol and sulfate within the major arteries supplying the heart? Why are treatment programs aimed to suppress certain myocardial infarction risk factors, such as elevated serum homocysteine and inflammation, generally counterproductive? METHODS Our methods are based on an extensive search of the literature in atherosclerotic cardiovascular disease as well as in the area of the unique properties of water, the role of biosulfates in the vascular wall, and the role of electromagnetic fields in vascular flow. Our investigation reveals a novel pathology linked to atherosclerosis that better explains the observed facts than the currently held popular view. RESULTS We propose a novel theory that atherosclerosis can best be explained as being due to cholesterol sulfate deficiency. Furthermore, atheromatous plaques replenish the supply of cholesterol and sulfate to the microvasculature, by exploiting the inflammatory agent superoxide to derive sulfate from homocysteine and other sulfur sources. We argue that the sulfate anions attached to the glycosaminoglycans in the glycocalyx are essential in maintaining the structured water that is crucial for vascular endothelial health and erythrocyte mobility through capillaries. Sulfate depletion leads to cholesterol accumulation in atheromas, because its transport through water-based media depends on sulfurylation. We show that streaming potential induces nitric oxide (NO) release, and NO derivatives break down the extracellular matrix, redistributing sulfate to the microvasculature. We argue that low (less negative) zeta potential due to insufficient sulfate anions leads to hypertension and thrombosis, because these responses can increase streaming potential and induce nitric-oxide mediated vascular relaxation, promoting oxygen delivery. Our hypothesis is a parsimonious explanation of multiple features of atherosclerotic cardiovascular disease. CONCLUSIONS If our interpretation is correct, then it would have a significant impact on how atherosclerosis is treated. We recommend a high intake of sulfur-containing foods as well as an avoidance of exposure to toxicants that may impair sulfate synthesis.
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Affiliation(s)
- Stephanie Seneff
- Computer Science and Artificial Intelligence Laboratory, MIT, Cambridge, MA, 02139, USA.
| | - Robert M Davidson
- Internal Medicine Group Practice, PhyNet, Inc, 4002 Technology Center, Longview, TX, 75605, USA.
| | | | - Anthony Samsel
- Research Scientist and Consultant, Deerfield, NH, 03037, USA.
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Nüesch E, Pablo P, Dale CE, Prieto-Merino D, Kumari M, Bowling A, Ebrahim S, Casas JP. Incident disability in older adults: prediction models based on two British prospective cohort studies. Age Ageing 2015; 44:275-82. [PMID: 25349151 DOI: 10.1093/ageing/afu159] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To develop and validate a prediction model for incident locomotor disability after 7 years in older adults. SETTING Prospective British cohort studies: British Women's Heart and Health Study (BWHHS) for development and the English Longitudinal Study of Ageing (ELSA) for validation. SUBJECTS Community-dwelling older adults. METHODS Multivariable logistic regression models after selection of predictors with backward elimination. Model performance was assessed using metrics of discrimination and calibration. Models were internally and externally validated. RESULTS Locomotor disability was reported in BWHHS by 861 of 1,786 (48%) women after 7 years. Age, a history of arthritis and low physical activity levels were the most important predictors of locomotor disability. Models using routine measures as predictors had satisfactory calibration and discrimination (c-index 0.73). Addition of 31 blood markers did not increase the predictive performance. External validation in ELSA showed reduced discrimination (c-index 0.65) and an underestimation of disability risks. A web-based calculator for locomotor disability is available (http://www.sealedenvelope.com/trials/bwhhsmodel/). CONCLUSIONS We developed and externally validated a prediction model for incident locomotor disability in older adults based on routine measures available to general practitioners, patients and public health workers, and showed an adequate discrimination. Addition of blood markers from major biological pathways did not improve the performance of the model. Further replication in additional data sets may lead to further enhancement of the current model.
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Affiliation(s)
- Eveline Nüesch
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Perel Pablo
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Caroline E Dale
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - David Prieto-Merino
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Meena Kumari
- Institute of Epidemiology and Health, University College London, London, UK
| | - Ann Bowling
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Shah Ebrahim
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Juan P Casas
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK Institute of Epidemiology and Health, University College London, London, UK
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Wiegand J, Berg T. The etiology, diagnosis and prevention of liver cirrhosis: part 1 of a series on liver cirrhosis. DEUTSCHES ARZTEBLATT INTERNATIONAL 2013; 110:85-91. [PMID: 23451000 DOI: 10.3238/arztebl.2013.0085] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Accepted: 07/13/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Cirrhosis of the liver is the end stage of chronic liver disease. Among the many liver disorders that can lead to cirrhosis, some progress rapidly (years) and others more slowly (decades). In Germany, cirrhosis is often a consequence of fatty liver disease due to alcoholism or other causes, but can also be caused by hepatitis B and hepatitis C. Cirrhosis is more common in overweight persons and smokers. The underlying causes of cirrhosis determine its rate of progression and are the focus of preventive efforts and treatment. The prevalence of cirrhosis in Germany is rising; it now ranks among the top 20 causes of death in the country. METHODS This article is based on a selective review of pertinent literature, including reviews and current guidelines. RESULTS Strictly speaking, cirrhosis is a pathological diagnosis; it is, nevertheless, usually diagnosed clinically, by history, physical examination (e.g., cutaneous signs of liver disease), ancillary testing (e.g., ultrasonography, transient elastography) and laboratory analyses (e,g., APRI, which is the quotient of the GOT concentration and the platelet count). There are no laboratory cutoff values for the diagnosis of cirrhosis. Early detection of chronic liver disease, followed by individually tailored, risk-adapted treatment, is the best way to prevent it. Esophagogastroduodenoscopy can be performed early on to assess the risk of variceal bleeding. In most patients, the progression of fibrosis can be averted by early detection and appropriate treatment. CONCLUSION Screening for chronic liver disease should include history and physical examination, serum transaminase measurement, upper abdominal ultrasonography, and, in some cases, transient elastography.
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Affiliation(s)
- Johannes Wiegand
- Clinic of Gastroenterology and Rheumatology, Division of Hepatology, Leipzig University Hospital, Leipzig, Germany
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Longo-Mbenza B, Muaka MM, Mokondjimobe E, Ndembe DK, Mona DT, Buassabu-Bu-Tsumbu B. Oxidative stress-elevated high gamma glutamyl transferase levels, and aging, intake of tropical food plants, migration and visual disability in Central Africans. Int J Ophthalmol 2012; 5:493-8. [PMID: 22937512 PMCID: PMC3428548 DOI: 10.3980/j.issn.2222-3959.2012.04.17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Accepted: 06/25/2012] [Indexed: 11/02/2022] Open
Abstract
AIM To investigate the independent pathogenic role of high serum gamma-glutamyl transferase (GGT) levels, sociodemographic data, dietary and environmental risk factors for visual disability (VD). METHODS This was a case-control study, run in 200 black Congolese patients managed in Saint Joseph Hospital Ophthalmology Division from Kinshasa town. Logistic regression model was used to identify determinants of VD (n=58) among sex, age, cigarette smoking, alcohol abuse, rural-urban migration, education levels, aging ≥60 years, intake of red Beans, Safou fruit and Taro leaves, lipid profile, residence, socioeconomic status, and GGT. RESULTS After adjusting for confounding factors, we identified migration (OR=3.7 95% CI: 1.2-11.3; P=0.023), low education level (OR=3.1 95% CI 1.1-8.5; P=0.026), no intake of Safou fruit (OR=34.2 95% CI 11.5-102; P<0.0001), age ≥ 60 years (OR=2.5 95% CI 1.01-6.5; P=0.049), and serum GGT ≥10 U/L (OR=3.6 95% CI 1.3-9.6; P=0.012) as the significant and independent determinants of VD. CONCLUSION VD appears as a major public health problem in Central Africa to be prevented or delayed by control of migration, lifestyle changes, antioxidant supplements, appropriate diet, nutrition education, and blocking of oxidative stress.
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Affiliation(s)
- Benjamin Longo-Mbenza
- Faculty of Health Sciences, Walter Sisulu University, Mthatha 5117, Eastern Cape, South Africa
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Breitling LP, Claessen H, Drath C, Arndt V, Brenner H. Gamma-glutamyltransferase, general and cause-specific mortality in 19,000 construction workers followed over 20 years. J Hepatol 2011; 55:594-601. [PMID: 21256904 DOI: 10.1016/j.jhep.2010.12.029] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Revised: 10/22/2010] [Accepted: 12/06/2010] [Indexed: 01/06/2023]
Abstract
BACKGROUND & AIMS Associations of serum gamma-glutamyltransferase levels with a variety of incident diseases and mortality have been suggested. The present study attempted to expand the body of evidence to especially relevant occupational cohorts in which exposure to established γ-GT determinants may greatly differ from the general population. METHODS The study was based on occupational health examinations conducted from 1986 to 1992 in 19,090 German male workers from the construction industry, aged 25-64years. Sociodemographics and other health-related information were collected during the exam. Vital status follow-up was conducted through 2008. Associations of baseline γ-GT levels (measurements at 25°C) with all-cause and cause-specific mortality were examined by Kaplan-Meier plotting and multiple adjusted Cox regression models. RESULTS A total of 2170 deaths occurred during 303,198 person-years of follow-up. The risk of death due to any cause was 2.5-fold increased in subjects in the highest (⩾39U/L) versus lowest (<11U/L) γ-GT quintile. To varying extents, elevated γ-GT was associated with higher mortality due to cancer, circulatory, respiratory, and digestive causes, as well as accidents/poisoning. CONCLUSIONS The findings in this cohort provide evidence for γ-GT being associated with a broad range of causes of death, including less investigated outcomes. Some characteristics of the observed patterns need to be seen in the context of our cohort, featuring particularly high γ-GT levels.
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Affiliation(s)
- Lutz Philipp Breitling
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, D-69120 Heidelberg, Germany.
| | - Heiner Claessen
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, D-69120 Heidelberg, Germany
| | - Christoph Drath
- Workmen's Compensation Board for Construction Workers, Occupational Health Service, D-71029 Böblingen, Germany
| | - Volker Arndt
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, D-69120 Heidelberg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, D-69120 Heidelberg, Germany
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Breitling LP, Arndt V, Drath C, Rothenbacher D, Brenner H. Smoking and γ-glutamyltransferase: opposite interactions with alcohol consumption and body mass index. PLoS One 2010; 5. [PMID: 20927196 PMCID: PMC2948041 DOI: 10.1371/journal.pone.0013116] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Accepted: 09/05/2010] [Indexed: 11/23/2022] Open
Abstract
Background Smoking has recently been suggested to synergistically interact with alcohol intake as a determinant of serum gamma-glutamyltransferase (γ-GT), an emergent powerful predictor of disease and mortality. This study investigated whether this also applies to higher smoking and alcohol exposure ranges and to body mass index (BMI), which likewise is strongly associated with γ-GT. Methodology/Principal Findings Analyses were based on occupational health examinations of more than 15,000 German male workers aged 16–64 years, predominantly from the construction industry. Sociodemographics and other health-related information were collected during the exam. Joint associations of smoking and alcohol consumption or BMI with elevated or log-transformed γ-GT were examined by tabulation and multiple adjusted regression models. Cigarette smoking exerted no effect on γ-GT in teetotalers, but there was a statistically significant effect of smoking among participants with higher alcohol consumption intensity, odds of elevated γ-GT being increased by 24% and 27% per additional 10 cigarettes smoked per day in subjects drinking 61–90 and >90 gram alcohol per day, respectively (P for interaction = 0.039). The interaction was opposite for BMI, where no association was seen in obese subjects, whereas odds of elevated γ-GT were increased by 24% per 10 cigarettes below 25 kg/m2 (P for interaction = 0.040). This novel interaction was replicable in an independent cohort. Conclusion The evidence for opposite interactions of smoking with alcohol and BMI as determinants of serum γ-GT suggests that different physiological pathways are responsible for the associations between these factors.
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Affiliation(s)
- Lutz P Breitling
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany.
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