Distribution and population determinants of gamma-glutamyltransferase in a random sample of Sardinian inhabitants. 'ATS-SARDEGNA' Research Group

Relationship between presarcopenia and event occurrence in patients with primary hepatocellular carcinoma

Presarcopenia is a prognostic factor in patients with hepatocellular carcinoma (HCC). The Japan integrated staging (JIS) score is a prognostic method that combines the Child–Turcotte–Pugh classification and the tumor-node-metastasis (TNM) staging for HCC. We investigated the relationship between presarcopenia, the JIS score, and prognosis in patients with primary HCC. This retrospective study included 153 patients with primary HCC who were hospitalized from October 2011 to March 2018 at Municipal Hospital of Kofu. The skeletal muscle mass was measured using simplified psoas muscle mass index (PMI) based on CT imaging, and PMI using the volume analyzer SYNAPSE VINCENT ver3.0. We diagnosed presarcopenia based on the cut off value according to the assessment criteria for sarcopenia in liver disease defined by the Japan Society of Hepatology. Forty-three patients (28%) were diagnosed with presarcopenia. The median event-free survival was significantly worse in patients with presarcopenia than those without presarcopenia (P = 0.016). In multivariate analysis, presence of presarcopenia, JIS score ≥3, alpha-fetoprotein ≥200 ng/ml, and prothrombin induced by vitamin K absence-II ≥ 200 mAU/ml were significant prognostic factors. Among the patients with JIS scores ≥3, there was no difference in the event occurrence rate with presence of presarcopenia (P = 0.96). Among the patients with JIS scores ≤2, the median event-free-survival was significantly shorter in those with presarcopenia than those without presarcopenia (P = 0.045). Presarcopenia was an independent prognostic factor in patients with primary HCC. In patients with JIS scores ≤2, the median event-free survival was significantly shorter in those with presarcopenia compared to those without presarcopenia. In the patients with JIS scores ≥3, there was no difference in the event occurrence rates in those with and without presarcopenia.

Serum gamma-glutamyltransferase activity and Parkinson's disease risk in men and women

We evaluated serum gamma-glutamyltransferase (GGT) and the risk of Parkinson’s disease (PD). Using data from the National Health Insurance Service (NHIS) database, we constructed a cohort consisting of individuals aged above 40 years who underwent a health check-up in 2009. After excluding individuals with heavy alcohol consumption, hepatobiliary and pancreatic disorders, and a previous history of PD, each quartile group of baseline serum GGT levels was monitored for the development of PD for 7 years. Adjusted hazard ratios (HRs) for PD were estimated by Cox proportional hazard models adjusting for potential confounding variables. We additionally analyzed the possible interaction between GGT and obesity or metabolic syndrome. Among the 6,098,405 individuals who were included, PD developed in 20,895 individuals during the follow-up (0.34%, 9,512 men and 11,383 women). The top quartile of serum GGT (geometric means, 90.44 IU/L in men and 41.86 IU/L in women) was associated with a lower risk in men (adjusted HR = 0.72 (95% CI: 0.67–0.76)) and a higher risk in women (adjusted HR = 1.30 (95% CI: 1.23–1.37)) using the lower GGT quartiles as a reference. Obesity and metabolic syndrome increased PD risk in both sexes, and there was only a subadditive interaction between serum GGT and obesity in women.

Potential nutraceutical and food additive properties and risks of coffee: a comprehensive overview

Coffee is a composite mixture of more than a thousand diverse phytochemicals like alkaloids, phenolic compounds, vitamins, carbohydrates, lipids, minerals and nitrogenous compounds. Coffee has multifunctional properties as a food additive and nutraceutical. As a nutraceutical, coffee has anti-inflammatory, anti-oxidant, antidyslipidemic, anti-obesity, type-2 diabetes mellitus (DM), and cardiovascular diseases (CVD), which can serve for the treatment and prevention of metabolic syndrome and associated disorders. On the other hand, as a food additive, coffee has antimicrobial activity against a wide range of microorganisms, inhibits lipid peroxidation (LPO), and can function as a prebiotic. The outcomes of different studies also revealed that coffee intake may reduce the incidence of numerous chronic diseases, like liver disease, mental health, and it also overcomes the all-cause mortality, and suicidal risks. In some studies, high intake of coffee is linked to increase CVD risk factors, like cholesterol, plasma homocysteine and blood pressure (BP). There is also a little evidence that associated the coffee consumption with increased risk of lung tumors in smokers. Among adults who consume the moderate amount of coffee, there is slight indication of health hazards with strong indicators of health benefits. Moreover, existing literature suggests that it may be cautious for pregnant women to eliminate the chances of miscarriages and impaired fetal growth. The primary purpose of this narrative review is to provide an overview of the findings of the positive impacts and risks of coffee consumption on human health. In conclusion, to date, the best available evidence from research indicates that drinking coffee up to 3-4 cups/day provides health benefits for most people.

Prognostic value of systemic inflammation score in patients with hepatocellular carcinoma after hepatectomy

Inflammation plays an important role in cancer progression. In this study, we aimed to investigate the prognostic value of the systemic inflammatory biomarkers in hepatocellular carcinoma (HCC) patients undergoing curative resection. Data from 271 HCC patients who underwent curative resection in Zhongshan Hospital between 2008 and 2011 were included. Kaplan-Meier survival analysis showed that gamma-glutamyltransferase (GGT) and lymphocyte-to-monocyte ratio (LMR) were significantly associated with overall survival(OS) and time to recurrence(TTR). We created a systemic inflammation score (SIS) basing on preoperative serum GGT and LMR. Low SIS was also significantly associated with increased OS and TTR. Univariate and multivariate analyses revealed the LMR, GGT and SIS were independent predictors for OS and TTR. The predictive ability of the SIS, as assessed by area under the receiver operating characteristic curve, was 0.682 (95% CI, 0.618-0.746) for OS, which was higher than GGT and LMR. In conclusion, low preoperative LMR and high preoperative GGT were associated with a poor prognosis in HCC patients after hepatectomy. Our results confirmed that the SIS qualifies as a novel prognostic predictor of HCC patients after hepatectomy.

Coffee and Liver Disease

Coffee is the most popular beverage in the world. Consumption of coffee has been shown to benefit health in general, and liver health in particular. This article reviews the effects of coffee intake on development and progression of liver disease due to various causes. We also describe the putative mechanisms by which coffee exerts the protective effect. The clinical evidence of benefit of coffee consumption in Hepatitis B and C, as well as nonalcoholic fatty liver disease and alcoholic liver disease, has also been presented. Coffee consumption is associated with improvement in liver enzymes (ALT, AST, and GGTP), especially in individuals with risk for liver disease. Coffee intake more than 2 cups per day in patients with preexisting liver disease has been shown to be associated with lower incidence of fibrosis and cirrhosis, lower hepatocellular carcinoma rates, as well as decreased mortality.

Impact of coffee on liver diseases: a systematic review

Coffee is one of the most commonly consumed beverages in the world. Its health benefits including improved overall survival have been demonstrated in a variety of disease states. To examine the association of coffee consumption with liver disease, a systematic review of studies on the effects of coffee on liver associated laboratory tests, viral hepatitis, nonalcoholic fatty liver disease (NAFLD), cirrhosis and hepatocellular carcinoma (HCC) was performed. Coffee consumption was associated with improved serum gamma glutamyltransferase, aspartate aminotransferase and alanine aminotransferase values in a dose dependent manner in individuals at risk for liver disease. In chronic liver disease patients who consume coffee, a decreased risk of progression to cirrhosis, a lowered mortality rate in cirrhosis patients, and a lowered rate of HCC development were observed. In chronic hepatitis C patients, coffee was associated with improved virologic responses to antiviral therapy. Moreover, coffee consumption was inversely related to the severity of steatohepatitis in patients with non-alcoholic fatty liver disease. Therefore, in patients with chronic liver disease, daily coffee consumption should be encouraged.

Association of serum γ-glutamyltransferase level and incident prehypertension in Korean men

Several lines of evidence indicate that prehypertension is more atherogenic than normal blood pressure. Serum γ-glutamyltransferase (GGT) is known to be positively associated with prehypertensive status and the progression of hypertension. However, there have been no prospective studies of serum GGT level as a predictor of prehypertension. Apparently 13,435 healthy men (mean age 42.0 ± 6.6 yr) with normal blood pressure were included in a prospective cohort study in 2005 and were followed up to 2010 with the endpoint being incident of prehypertension. During the follow up period (median 2.80 ± 1.44 yr; actual follow-up 37,679.1 person-year), prehypertension was developed in 7,867 (58.6%) participants. Risk estimations for incident prehypertension were analyzed based on quartiles of serum GGT levels using multivariate adjusted Cox proportional hazards model. In unadjusted model, the hazard ratio for incident prehypertension for the highest 3 quartiles of baseline serum GGT level was 1.21 (1.13-1.29), 1.29 (1.21-1.38), and 1.57 (1.47-1.67) compared the lowest quartile of serum GGT level, respectively (P for trend < 0.001). These associations still remained statistically significant, even after adjusting for multiple covariates. These findings indicate that increased serum GGT level is independently associated with incident prehypertension in Korean men.

Relationship between carbohydrate-deficient transferrin, gamma-glutamyl transferase, and mean corpuscular volume levels and alcohol-related brain volume decreases in male drinkers

OBJECTIVE

We investigated the association between mean corpuscular volume (MCV), carbohydrate-deficient transferrin (CDT), and gamma-glutamyl transferase (GGT) levels and gray and white brain matter in male drinkers to find out which if any of these biomarkers of alcohol consumption is indicative for alcohol-related differences in brain volume.

METHOD

Plasma levels of CDT, GGT, and MCV and magnetic resonance imaging-determined brain gray and white matter volumes were assessed in 55 male drinkers. Current alcohol intake and lifetime alcohol intake were determined by self-report measures. The relationship between MCV, CDT, and GGT and brain volumes was explored using multiple linear regression analyses.

RESULTS

There was a significant negative relationship between plasma GGT and MCV levels and gray matter volumes. Middle-aged male drinkers with highly elevated GGT and MCV levels (twice the standard deviation above the mean) have 4-12% less parietal and occipital gray matter than males with average GGT and MCV levels. There was no association between CDT levels and brain gray or white matter.

CONCLUSIONS

Elevated GGT and MCV levels may be indicative of alcohol-related gray-matter decline in male drinkers. The link with GGT may reflect that elevated GGT levels are a sign of increased oxidative stress. The link with MCV levels may reflect a decreased oxygen transport to the brain.

The Association between Serum Gamma-Glutamyltransferase within Normal Levels and Metabolic Syndrome in Office Workers: A 4-Year Follow-up Study

Background

Serum gamma-glutamyltransferase (GGT) has been suggested as a predictor for development of the metabolic syndrome in non-Korean population, but studies in Korean population are scarce. Therefore, we examined the association between serum GGT levels and the incidence of the metabolic syndrome in Korean male office workers.

Methods

The study population consisted of 32,692 office workers who underwent health checkups in both 2005 and 2009. A total of 17,583 with elevated GGT levels, the presence of metabolic syndrome, medication history at baseline, and female office workers were excluded. Finally, 15,109 subjects were included in the final analysis. We measured serum GGT levels and individual metabolic components.

Results

As a quartile of serum GGT increased, 4-year follow-up incidence of the metabolic syndrome increased. After adjustment for age, alcohol drinking status and smoking status in 2005, logistic regression analysis showed that the odds ratios (95% confidence interval) for incident metabolic syndrome in 2009 compared to the lowest quartile and upper quartiles were 1.00 (reference), 1.57 (1.24-2.00), 2.73 (2.17-3.43), 3.78 (3.02-4.74), and statistically significant (P < 0.001), respectively.

Conclusion

These results showed that the higher serum GGT predicted the future development of metabolic syndrome. In Korean male office workers without the metabolic syndrome, the serum GGT levels despite normal levels were associated with an increased risk of incident metabolic syndrome.

Caffeine is protective in patients with non-alcoholic fatty liver disease

BACKGROUND

Non-alcoholic fatty liver disease (NAFLD), the hepatic manifestation of metabolic syndrome, is the most common cause of primary liver disease. Although recent studies have found that coffee drinking is protective against end stage chronic liver disease, there are scarce caffeine intake data in NAFLD specifically.

AIM

To investigate the effects of dietary behaviour in NAFLD patients, using four continuous cycles of the National Health and Nutrition Examination Surveys (NHANES 2001-2008).

METHODS

Using data from four continuous cycles of NHANES, dietary intake questionnaires that list 62 nutrition components. Logistic regression was used to identify independent predictors of NAFLD among nutrition components after adjustment for potential clinical confounders. All analyses were run using sas 9.1 and SUDAAN 10.0 (SAS Institute Inc., Cary, NC, USA).

RESULTS

Of the 62 nutrient components used for the univariate analysis, 38% were significant (P-value <0.05) in NAFLD with caffeine consumption being higher in the control group (P-value <0.001). The multivariate analysis using demographics, clinical parameters and nutritional components found five factors independently associated with NAFLD [African American Race P-value <0.001); Male gender P-value <0.001); Obesity (BMI ≥ 30) P-value <0.001); Caffeine intake (mg) P-value <0.001) and total plain water consumption (g) P-value ≤ 0.02)].

CONCLUSIONS

Our analysis shows that caffeine intake is independently associated with a lower risk for NAFLD suggesting a potential protective effect. These data necessitate further research to elucidate the mechanism by which caffeine can protect against NAFLD.

Association of caffeine intake and histological features of chronic hepatitis C

BACKGROUND & AIMS

The severity of chronic hepatitis C (CHC) is modulated by host and environmental factors. Several reports suggest that caffeine intake exerts hepatoprotective effects in patients with chronic liver disease. The aim of this study was to evaluate the impact of caffeine consumption on activity grade and fibrosis stage in patients with CHC.

METHODS

A total of 238 treatment-naïve patients with histologically-proven CHC were included in the study. Demographic, epidemiological, environmental, virological, and metabolic data were collected, including daily consumption of alcohol, cannabis, tobacco, and caffeine during the six months preceding liver biopsy. Daily caffeine consumption was estimated as the sum of mean intakes of caffeinated coffee, tea, and caffeine-containing sodas. Histological activity grade and fibrosis stage were scored according to Metavir. Patients (154 men, 84 women, mean age: 45±11 years) were categorized according to caffeine consumption quartiles: group 1 (<225 mg/day, n=59), group 2 (225-407 mg/day, n=57), group 3 (408-678 mg/day, n=62), and group 4 (>678 mg/day, n=60).

RESULTS

There was a significant inverse relationship between activity grade and daily caffeine consumption: activity grade>A2 was present in 78%, 61%, 52%, and 48% of patients in group 1, 2, 3, and 4, respectively (p<0.001). By multivariate analysis, daily caffeine consumption greater than 408 mg/day was associated with a lesser risk of activity grade>A2 (OR=0.32 (0.12-0.85). Caffeine intake showed no relation with fibrosis stage.

CONCLUSIONS

Caffeine consumption greater than 408 mg/day (3 cups or more) is associated with reduced histological activity in patients with CHC. These findings support potential hepatoprotective properties of caffeine in chronic liver diseases.

Coffee consumption and risk of liver cancer: a meta-analysis

BACKGROUND & AIMS

Mounting evidence indicates that coffee drinking may protect against liver injury and lower the risk of liver cancer. We quantitatively assessed the relation between coffee consumption and the risk of liver cancer in a meta-analysis of epidemiologic studies.

METHODS

Relevant studies were identified by searching MEDLINE (from 1966 to February 2007) and the reference lists of retrieved articles. We included cohort and case-control studies that reported relative risk (RR) estimates with 95% confidence intervals (CIs) of primary liver cancer or hepatocellular carcinoma by quantitative categories of coffee consumption. Study-specific RRs were pooled using a random-effects model.

RESULTS

Four cohort and 5 case-control studies, involving 2260 cases and 239,146 noncases, met the inclusion criteria. All studies observed an inverse relation between coffee consumption and risk of liver cancer, and in 6 studies the association was statistically significant. Overall, an increase in consumption of 2 cups of coffee per day was associated with a 43% reduced risk of liver cancer (RR, 0.57; 95% CI, 0.49-0.67). There was no statistically significant heterogeneity among studies (P = .17). In stratified analysis, the summary RRs of liver cancer for an increase in consumption of 2 cups of coffee per day were 0.69 (95% CI, 0.55-0.87) for persons without a history of liver disease and 0.56 (95% CI, 0.35-0.91) for those with a history of liver disease.

CONCLUSIONS

Findings from this meta-analysis suggest that an increased consumption of coffee may reduce the risk of liver cancer.

The relationship between gamma-glutamyltransferase and adiponectin in nonalcoholic women

The relationship between adiponectin and gamma-glutamyltransferase (GGT) has yet to be clearly demonstrated especially in women. Among the parameters of the liver function test (LFT), it has become increasingly evident that GGT is associated with metabolic disease. The objective of this study was to characterize the relationship between adiponectin and GGT in nonalcoholic women without liver disease. The subjects in this study were recruited from participants in routine health examinations during February of 2004. Among the total of 115 subjects considered for recruitment, we ultimately included 86 patients without liver disease in the study after performing LFT and abdominal sonography. After a 12-hour overnight fast, levels of aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, GGT, total cholesterol, high-density lipoprotein cholesterol, triglycerides, fasting plasma glucose, fasting insulin, and adiponectin were measured in all subjects. We found a significant negative correlation between adiponectin and GGT (r=-0.35, P<.001) and a significant positive correlation between GGT and homeostasis model assessment (HOMA) (r=0.29, P<.01) after controlling for the confounding influences of age and fat mass. Although GGT is clearly related to adiponectin and HOMA, we determined aspartate aminotransferase, alanine aminotransferase, and alkaline phosphatase were not significantly associated with adiponectin and HOMA. The present study suggests that only GGT among the LFTs is related to adiponectin in nonalcoholic women without liver disease.

Inverse association between coffee drinking and the risk of hepatocellular carcinoma: a case-control study in Japan

Coffee use has consistently been associated with lower serum liver enzyme levels and a reduced risk of liver cirrhosis. A limited number of cohort and case-control studies also suggest a decreased risk of hepatocellular carcinoma (HCC) among coffee drinkers, but mostly without consideration of hepatitis virus infection. In the present case-control study, we recruited 209 incident HCC cases and three different controls (1308 community controls, 275 hospital controls, and 381 patients with chronic liver disease [CLD] without HCC), all of whom were aged 40-79 years and residents of Saga Prefecture, Japan. A questionnaire survey elicited information on coffee use during the last 1-2 years and 10 years before, and plasma hepatitis B surface antigen and antibodies to hepatitis C virus were tested for all but community controls. After adjustment for sex, age, heavy alcohol use, smoking status and hepatitis virus markers (except for community controls), coffee use during the last 1-2 years was associated with a decreased risk against any control group. For coffee use 10 years before, comparison between HCC cases and either community controls or CLD patients revealed a decreased risk; adjusted odds ratios for occasional use, 1-2 cups/day and > or =3 cups/day compared with no use were 0.33, 0.27 and 0.22 (P trend < 0.001), respectively, against community controls, and 0.86, 0.62 and 0.53 (P trend = 0.05), respectively, against CLD patients. These results suggest that coffee may protect against the development of HCC, yet further elaborate studies (hopefully, intervention studies) are warranted to corroborate these findings.

Coffee and tea consumption and risk of hepatocellular carcinoma in Italy

The role of coffee in the aetiology of hepatocellular carcinoma has raised great interest. In Italy, coffee consumption is high, thus allowing the investigation of the topic over a broad range of consumption. A hospital-based case-control study was conducted in Italy in 1999-2002, including 185 incidents, histologically confirmed cases of hepatocellular carcinoma aged 43-84 years. Controls were 412 subjects admitted to the same hospitals' networks for acute, non-neoplastic diseases unrelated to diet. Coffee and tea consumption were assessed using a validated food-frequency questionnaire. Odds ratios (ORs) and corresponding the 95% confidence intervals (CI) were computed using unconditional multiple logistic regression, adjusting for hepatitis viruses seropositivity, alcohol intake, smoking habits and other potential confounding factors. Compared to people who drunk <14 cups/week of coffee, the risk of hepatocellular carcinoma decreased for increasing levels of consumption (OR=0.4, 95% CI: 0.2-1.1 for >or=28 cups/week, p for trend = 0.02). In the present study, inverse relations were observed across strata of hepatitis C and, B virus infections and alcohol drinking. No significant association emerged with consumption of decaffeinated coffee (OR=0.7, 95% CI=0.2-2.5) or tea (OR=1.4, 95% CI=0.8-2.7). The present study supports the hypothesis of a favourable effect of coffee, though not decaffeinated coffee and tea, on the risk on hepatocellular carcinoma.

Coffee and health: a review of recent human research

Coffee is a complex mixture of chemicals that provides significant amounts of chlorogenic acid and caffeine. Unfiltered coffee is a significant source of cafestol and kahweol, which are diterpenes that have been implicated in the cholesterol-raising effects of coffee. The results of epidemiological research suggest that coffee consumption may help prevent several chronic diseases, including type 2 diabetes mellitus, Parkinson's disease and liver disease (cirrhosis and hepatocellular carcinoma). Most prospective cohort studies have not found coffee consumption to be associated with significantly increased cardiovascular disease risk. However, coffee consumption is associated with increases in several cardiovascular disease risk factors, including blood pressure and plasma homocysteine. At present, there is little evidence that coffee consumption increases the risk of cancer. For adults consuming moderate amounts of coffee (3-4 cups/d providing 300-400 mg/d of caffeine), there is little evidence of health risks and some evidence of health benefits. However, some groups, including people with hypertension, children, adolescents, and the elderly, may be more vulnerable to the adverse effects of caffeine. In addition, currently available evidence suggests that it may be prudent for pregnant women to limit coffee consumption to 3 cups/d providing no more than 300 mg/d of caffeine to exclude any increased probability of spontaneous abortion or impaired fetal growth.

Southern Europe as an example of interaction between various environmental factors: a systematic review of the epidemiologic evidence

Hepatitis B virus (HBV), hepatitis C virus (HCV) and alcohol consumption are major causes of hepatocellular carcinoma (HCC) worldwide. We performed a systematic review of epidemiologic studies carried out on HCC aetiology in Southern Europe, an area with an intermediate-high prevalence of these agents as well as of putative risk factors such as tobacco smoking, diabetes and obesity. To retrieve the articles, we performed a Medline search for titles and abstracts of articles. After the Medline search, we reviewed the papers and reference lists to identify additional articles. A synergism between HCV infection and HBV infection, overt (hepatitis B virus antigen (HbsAg) positivity) or occult (HBsAg negativity with presence of HBV DNA in liver or serum), is suggested by the results of some studies. The pattern of the risk for HCC due to alcohol intake shows a continuous dose-effect curve without a definite threshold, although most studies found that HCC risk increased only for alcohol consumption above 40-60 g of ethanol per day. Some evidence supports a positive interaction of alcohol intake probably with HCV infection and possibly with HBV infection. A few studies found that coffee has a protective effect on HCC risk due to various risk factors. Some data also support a role of tobacco smoking, diabetes and obesity as single agents or preferably co-factors in causing HCC. In countries with a relatively high alcohol consumption and intermediate levels of HCV and HBV infections (1-3% of population infected by each virus), such as Mediterranean countries, the three main risk factors together account for about 85% of the total HCC cases, leaving little space to other known risk factors, such as haemochromatosis, and to new, still unrecognised, factors as independent causes of HCC.

An Inverse Association between Serum Gamma Glutamyl Transpeptidase Activity and Breslow's Lifestyle Index; Its Practical Application for Screening of Subjects with Unhealthy Lifestyles

We examined whether serum gammaGTP activity (gammaGTP) is associated with Breslow's lifestyle index and whether it could be used as a tool to detect subjects with unhealthy lifestyles. To that effect, 724 male Japanese workers excluding patients suffering from hepatitis virus infection, autoimmune liver diseases and apparently active bile duct diseases were cross-sectionally examined. gammaGTP was inversely associated with the total score of Breslow's index for all subjects (lambda=30.643) and in subjects aged 40 or more (lambda=37.073). The association was consistent even after adjustments of subjects' ages and levels of triglycerides, total cholesterol and uric acid (p=0.0001). Among the seven lifestyle factors comprising Breslow's index, improper habits of drinking (p<0.0001), smoking (p=0.0204), exercise (p=0.0189) and body weight control (p<0.0001), were associated with increased gammaGTP. Even in a survey in which subjects who had proper habits of drinking and body weight control were selectively examined, improper habits of smoking and exercise still tended to be associated with increased gammaGTP. Receiver operating characteristic curves indicated that gammaGTP was beneficial for detecting subjects who scored two or less on Breslow's index, at least in subjects aged 40 or more. gammaGTP was associated with insulin resistance level estimated by the homeostasis model assessment (p<0.0001), which was inversely associated with Breslow's index (p=0.0040). gammaGTP could be used as an objective substitute of Breslow's index, allowing us to identify subjects with low scores on Breslow's index, at least after sorting subjects properly. Such screening would enable interventions to correct subjects' unhealthy lifestyles, helping to solve lifestyle-related disease issues.

Hepatic markers and development of type 2 diabetes in middle aged men and women: a three-year follow-up study. The D.E.S.I.R. Study (Data from an Epidemiological Study on the Insulin Resistance syndrome)

AIM

It has been shown, mainly in men, that gamma-glutamyltransferase (gammaGT) and alanine-aminotransferase (ALT) predict the development of type 2 diabetes. This study investigates the association between hepatic markers and the 3-year risk of diabetes.

METHODS

Incident diabetes was studied in 2071 men and 2130 women without diabetes at baseline from the D.E.S.I.R. cohort.

RESULTS

Adjusting on age, only gammaGT was predictive of diabetes in both sexes, whereas ALT and aspartate-aminotransferase (AST) were only predictive in men, and bilirubin was not predictive. After adjustment on classical confounding factors and on ALT activity, the odds ratios (OR) for incident diabetes increased across baseline gammaGT quartiles: 1, 3.1, 2.6, 5.0 in men (P<0.0003) and 1, 0.9, 3.2, 3.5 in women (P<0.01). The relations with ALT and AST were not significant after adjusting on gammaGT. Additional adjustment on markers of insulin resistance, BMI or fasting plasma glucose attenuated the risk associated with gammaGT in both sexes, and it remained significantly predictive only in the men. Pooling men and women, those with gammaGT above the median had adjusted ORs of developing diabetes of 13.7 (1.8-99.8) if WHR > =0.85 and 1.7 (0.6-4.8) if WHR<0.85 (interaction P<0.007).

CONCLUSION

gammaGT was the main hepatic risk marker for type-2 diabetes in both sexes, especially in subjects with central adiposity.

Coffee and tea consumption are associated with a lower incidence of chronic liver disease in the United States

BACKGROUND & AIMS

Coffee drinking has been suggested to protect against liver injury, but it is uncertain whether this is of clinical significance. We examined the relationship of coffee and tea consumption with the incidence of hospitalization or death from chronic liver disease (CLD).

METHODS

Participants in the population-based, first National Health and Nutrition Examination Survey, 1971-1975, were asked about coffee and tea consumption, which was categorized as <1 cup (mean, 0.2 cups), 1 to 2 cups, and >2 cups per day (mean, 4.0 cups). A second analysis included persons who, in 1982-1984, were asked more detailed questions on coffee and tea drinking. Participants were followed through 1992-1993 for a hospital or death certificate diagnosis of CLD or cirrhosis (ICD-9-CM 571). Hazard rate ratios for CLD according to coffee and tea intake were calculated using Cox proportional hazards analysis.

RESULTS

Among 9849 persons followed for a median of 19.0 years (range, 0.02-22.1), the cumulative incidence of CLD was 1.4%. In multivariate analysis, participants who drank >2 cups per day had less than half the rate of CLD as those who drank <1 cup per day (hazard ratio, 0.43, 95% confidence interval: 0.24-0.78). Protection by coffee and tea was limited to persons at higher risk for liver diseases from heavier alcohol intake, overweight, diabetes, or high iron saturation. Among 9650 participants who provided detailed drink information in 1982-1984, intake of regular ground coffee and of caffeine was associated with lower incidence of CLD.

CONCLUSIONS

Coffee and tea drinking decreases the risk of clinically significant CLD.

Body fat distribution, liver enzymes, and risk of hypertension: evidence from the Western New York Study

Gamma-glutamyltransferase (GGT) has been associated with hypertension (HTN); however, the nature of this association remains unclear. GGT is a marker of alcohol consumption, but it is also related to the infiltration of fat in the liver (fatty liver). The association between GGT and HTN was examined in a 6-year longitudinal investigation among 1455 men and women who returned for the follow-up visit. Baseline variables included serum GGT, blood pressure, and anthropometric measures. Incident HTN was defined as blood pressure > or =140/90 or on antihypertensive medication at the follow-up visit. To eliminate individuals with potential liver pathology, analyses focused only on individuals with GGT within its normal range (n=897). Participants were divided in quintiles (Q) based on their baseline GGT levels. Multiple logistic regression analyses [odds ratio (95% confidence intervals)] revealed a significant association of GGT with incident hypertension [2.1 (1.1 to 4.0) Q5 versus Q1]. In subgroup analyses, GGT and HTN were significantly associated among both noncurrent and current drinkers, but only for participants above the median of anthropometric measures [eg, body mass index >26.4, 2.3 (0.9 to 5.7), waist circumference >86.1 cm, 3.7 (1.4 to 9.9), and abdominal height >19.8 cm, 3.1 (1.2 to 8.5), for Q5 versus Q1, in fully adjusted models]. These findings suggest that the association between GGT and hypertension is not caused solely by alcohol consumption and indicate that serum GGT, within its normal range, may predict hypertension among individuals with increased central fat distribution, suggesting that fatty liver may represent an important underlying mechanism for this association.

Association of Working Conditions and Lifestyle with Increased Serum Gamma-Glutamyltransferase: A Follow-up Study

BACKGROUND

This study investigated the association of working conditions and lifestyle with the development of increased serum gamma-glutamyltransferase (GGT) in Japanese workers.

METHODS

A follow-up study was carried out on workers of a telecommunication enterprise who received their first annual health check-up between 1992 and 1996, when they were between 40 and 54 years of age. Workers who had high serum GGT (> or =60 IU/L in males, > or =30 IU/L in females), a past history of disease, or current illness at their first check-up were excluded from the analysis. In total, the study included 15,586 workers. The association between working conditions and lifestyle and development of increased serum GGT (> or =60 IU/L in males, > or =30 IU/L in females) was investigated by pooled logistic regression analyses.

RESULTS

In males, body mass index, consumption of alcohol (<2 times/week, 2-5 times/week, >5 times/week), smoking (<20 cigarettes/day, > or =20 cigarettes/day), rarely taking three meals a day, marked preference for salty meals, and little preference for vegetables were positively associated with the development of increased serum GGT. Preferences for fatty meals (marked, moderate) were negatively associated with the development of increased serum GGT. In females, age and BMI were positively associated with the development of increased serum GGT.

CONCLUSIONS

Applying a new statistical analysis to this retrospective cohort study of 5 years, we revealed the health influences of alcohol consumption, smoking and eating habits on increased serum GGT. On the other hand, this study indicated that shift work or other working conditions are not significant risk factors for increased serum GGT.

Coffee and caffeine consumption reduce the risk of elevated serum alanine aminotransferase activity in the United States

BACKGROUND & AIMS

Based on experimental and epidemiologic studies, we investigated whether coffee and caffeine consumption reduced the risk of elevated alanine aminotransferase (ALT) activity in persons at high risk for liver injury in a national, population-based study.

METHODS

Participants were 5944 adults in the Third US National Health and Nutrition Examination Survey, 1988-1994, with excessive alcohol consumption, viral hepatitis, iron overload, overweight, or impaired glucose metabolism. Liver injury was indicated by abnormal serum ALT activity (>43 U/L).

RESULTS

Elevated ALT activity was found in 8.7% of this high-risk population. In unadjusted analysis, lower ALT activity was associated with increasing consumption of coffee ( P = .001) and caffeine ( P = .001). Multivariate logistic regression analyses showed that the risk of elevated ALT activity declined with increasing intake of coffee ( P for trend = .034) and caffeine ( P < .001). Comparing persons who drank more than 2 cups per day with noncoffee drinkers, the odds ratio was .56 (95% confidence interval, .31-1.0). Comparing persons in the highest caffeine quintile with the lowest, the odds ratio was .31 (95% confidence interval, .16-.61). These relationships were consistent across subgroups at risk for liver injury and were relatively unchanged when analyses included the entire population or when limited to persons without impaired liver function or right upper quadrant pain. Fasting insulin concentrations did not mediate the effects.

CONCLUSIONS

In this large, national, population-based study, among persons at high risk for liver injury, consumption of coffee and especially caffeine was associated with lower risk of elevated ALT activity.

Coffee intake and mortality from liver cirrhosis

PURPOSE

The aim of the study was to evaluate the association between coffee consumption and mortality from liver cirrhosis.

METHODS

We conducted a mortality follow-up of 51,306 adults who underwent screening for cardiovascular disease from 1977 to 1983. During the subsequent 17 years, the total number of deaths from all causes in the studied cohort was 4207. Fifty-three had the diagnosis of cirrhosis mentioned on the death certificate; of these, 36 had alcoholic cirrhosis.

RESULTS

The relative risk of liver cirrhosis mentioned on the death certificate associated with an increase of two cups of coffee, adjusted for sex, age, alcohol use and other major cardiovascular risk factors was 0.6 (95% confidence interval, 0.5-0.8). For alcoholic cirrhosis the results were identical. When studying cirrhosis as the underlying cause of death, the inverse relationship becomes somewhat stronger.

CONCLUSIONS

The present study confirms the existence of an inverse association between coffee consumption and liver cirrhosis.

Erratum to "Sex differences in gamma-glutamyltransferase in people aged 40-42 years in two Norwegian counties"

Gamma-glutamyltransferase (GGT) is widely used as a marker of alcohol intake, although it is documented that other factors are also associated with serum levels of GGT. The total population of men and women aged 40-42 years in two Norwegian counties was invited to participate in a health survey program. GGT was measured in 8116 men and 8689 women--67 % of the eligible population. In sex-specific multiple regression analyses, GGT showed a positive association with body mass index (BMI), cholesterol, ln triglycerides, systolic blood pressure, and number of drinks per 2 weeks for both men and women. Glucose and 'years of smoking' were significant in women only. Cups of boiled coffee per day and physical activity in spare time were inversely associated with GGT level for both men and women. A significant positive interaction between alcohol intake and BMI was observed for men but not for women. The use of GGT as a marker of alcohol consumption in middle-aged persons should take into account sex, BMI and drinking of boiled coffee.

Sex differences in gamma-glutamyltransferase in people aged 40-42 years in two Norwegian counties

Gamma-glutamyltransferase (GGT) is widely used as a marker of alcohol intake, although it is documented that other factors are also associated with serum levels of GGT. The total population of men and women aged 40-42 years in two Norwegian counties was invited to participate in a health survey program. GGT was measured in 8116 men and 8689 women--67 % of the eligible population. In sex-specific multiple regression analyses, GGT showed a positive association with body mass index (BMI), cholesterol, ln triglycerides, systolic blood pressure, and number of drinks per 2 weeks for both men and women. Glucose and 'years of smoking' were significant in women only. Cups of boiled coffee per day and physical activity in spare time were inversely associated with GGT level for both men and women. A significant positive interaction between alcohol intake and BMI was observed for men but not for women. The use of GGT as a marker of alcohol consumption in middle-aged persons should take into account sex, BMI and drinking of boiled coffee.

Coffee, caffeine, and the risk of liver cirrhosis

PURPOSE

To evaluate the effect of the consumption of caffeine-containing beverages on the risk of symptomatic liver cirrhosis (LC).

METHODS

From 1994 to 1998, all the consecutive cirrhotic inpatients admitted in 19 collaborative hospitals for signs of liver decompensation in whom the diagnosis of liver cirrhosis was made for the first time (274 cases) and one or two gender, age, and place of residence pair matched individuals (458 controls) were recruited. Data on years of education, lifetime cigarette use, lifetime intake of alcohol- and caffeine-containing beverages, usual consumption of 180 food items, and on markers of hepatitis B and C viral infection were collected.

RESULTS

A statistically significant trend toward lowered cirrhosis risk with increasing exposure to coffee was observed. The LC odds ratios decreased from 1.0 (reference category: lifetime abstainers from coffee) to 0.47 (95% confidence interval: 0.20, 1.10), 0.23 (0.10, 0.53), 0.21 (0.06, 0.74), and 0.16 (0.05, 0.50) in 1, 2, 3, and 4 or more cups of coffee drinkers, respectively. There was no convincing evidence that coffee consumption modifies the effects of the known risk factors of liver cirrhosis (alcohol intake and viruses infection).

CONCLUSIONS

These findings support the hypothesis that coffee, but not other beverages containing caffeine, may inhibit the onset of alcoholic and nonalcoholic liver cirrhosis.

Coffee consumption and serum aminotransferases in middle-aged Japanese men

We investigated the relation between coffee drinking and serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) concentrations among 7313 Japanese men receiving a health examination, excluding former alcohol drinkers and men with a history of chronic liver disease. Serum AST > 40 and/or ALT > 40 U/L was defined as liver inflammation. Adjustment was made for alcohol use, smoking, body mass index, serum marker for hepatitis virus infection, and other possible confounders. Adjusted odds ratios of liver inflammation were 1.00 (reference), 0.80, 0.69, and 0.61 for men drinking < 1, 1-2, 3-4, and > or = 5 cups of coffee daily, respectively. Among 6898 men without liver inflammation, serum AST and ALT were inversely associated with coffee consumption, and alcohol-related rise in AST was attenuated with coffee drinking. These findings suggest coffee may have an effect of suppressing the rise of serum aminotransferase, partly by inhibiting the alcohol-related elevation. Studies regarding biological mechanism are warranted.

Gamma glutamyl transferase

Serum gamma-glutamyl transferase (GGT) has been widely used as an index of liver dysfunction and marker of alcohol intake. The last few years have seen improvements in these areas and advances in understanding of its physiological role in counteracting oxidative stress by breaking down extracellular glutathione and making its component amino acids available to the cells. Conditions that increase serum GGT, such as obstructive liver disease, high alcohol consumption, and use of enzyme-inducing drugs, lead to increased free radical production and the threat of glutathione depletion. However, the products of the GGT reaction may themselves lead to increased free radical production, particularly in the presence of iron. There have also been important advances in the definition of the associations between serum GGT and risk of coronary heart disease, Type 2 diabetes, and stroke. People with high serum GGT have higher mortality, partly because of the association between GGT and other risk factors and partly because GGT is an independent predictor of risk. This review aims to summarize the knowledge about GGT's clinical applications, to present information on its physiological roles, consider the results of epidemiological studies, and assess how far these separate areas can be combined into an integrated view.

Association of carbohydrate-deficient transferrin (CDT) and gamma-glutamyl-transferase (GGT) with serum lipid profile in the Finnish population

BACKGROUND

Moderate consumption of alcohol may reduce mortality from vascular diseases. The beneficial effects of alcohol may partly be mediated by its effects on lipoprotein metabolism. We studied the connection between alcohol consumption and the serum lipid profile from a well-documented national health program study.

METHODS AND RESULTS

Carbohydrate-deficient transferrin (CDT) and gamma-glutamyl-transferase (GGT) were used as biochemical markers for alcohol consumption. The laboratory analyses were carried out on 5675 subjects (3097 males and 2578 females). The subjects were divided into quartiles on the basis of CDT or GGT value. The highest CDT quartile and the lowest GGT quartile seemed to be associated with a favorable lipid profile and the lowest CDT quartile and the highest GGT quartile were associated with an unfavorable lipid profile. Serum high density lipoprotein (HDL) cholesterol values were significantly higher and triglycerides lower with increasing serum CDT concentrations for both men and women. Increasing serum GGT was associated with higher serum total cholesterol and higher triglycerides in both men and women and lower HDL cholesterol in men.

CONCLUSIONS

CDT and GGT seem to detect different populations of subjects in regard to lipid metabolism. These observations may lead to a better understanding of the effects of alcohol consumption on lipids as well as mechanisms behind favorable and detrimental effects of alcohol on vascular diseases.

CONDENSED ABSTRACT

Carbohydrate-deficient transferrin (CDT) and gamma-glutamyl-transferase (GGT) were used as biochemical markers for alcohol consumption. A total of 3097 males and 2578 females were divided into quartiles on the basis of their CDT or GGT values. The highest CDT quartiles had higher HDL and lower triglycerides, whereas the highest GGT quartiles appeared to be associated with higher total cholesterol and triglycerides in both genders and lower HDL in men. CDT and GGT seem to detect different populations of subjects in regard to lipid metabolism. These observations may have important clinical and public health implications.

Lifestyle and the development of increased serum gamma-glutamyltransferase in middle-aged Japanese men

To identify the lifestyle factors responsible for increases in serum gamma-glutamyltransferase (GGT), 1014 hepatobiliary dysfunction-free (no medication for and no past history of liver disease, < or = 39 U/L of serum aspartate and/or alanine aminotransferase, and < or = 59 U/L of serum GGT) Japanese male office workers aged 35-55 years were examined annually over five successive years (average period 4.5 years, SD 1.11 years). From the Cox proportional hazards model without serum GGT at entry, significant correlates with the incidence of increased (> or = 60 U/L) serum GGT levels were the slope of body mass index (BMI), alcohol intake, cigarette smoking and coffee drinking (negative). In the model including serum GGT at entry, the slope of BMI and coffee drinking (negative) remained as significant factors for the incidence of increased serum GGT levels. From stepwise regression analyses for the slope of log serum GGT at entry, not including serum GGT in the model, significant correlates with the slope of serum GGT were, in order of relative importance, the slope of BMI, alcohol intake and coffee drinking (negative). In the model with serum GGT at entry, the slope of BMI and coffee drinking (negative) remained as statistically significant. Our results indicate that an increase in body weight is the strongest determinant for increases in serum GGT and that coffee drinking may be associated with a reduced risk of the development of increased serum GGT levels.

Coffee consumption and decreased serum gamma-glutamyltransferase: a study of middle-aged Japanese men

The potential inverse association between coffee intake and serum gamma-glutamyltransferase (GGT) was examined in a cross-sectional study involving 1353 Japanese male office workers aged 35-59 years in Osaka, Japan. Those who had serum aminotransferases exceeding the normal range and/or who had been administered medical care for, or had a past history of, liver disease were excluded. Multiple linear regression analysis and analysis of covariance were used to control for confounding variables (age, body mass index, alcohol use, and cigarette smoking) and to examine possible interactions. From the linear regression analysis, coffee intake was inversely related to serum GGT levels independently of age, body mass index, alcohol intake, and cigarette smoking. All of the latter variables were also independently and positively associated with serum GGT levels. When the interactions between coffee and each of four covariates on serum GGT were evaluated by adding each interaction term to the above regression model, significant negative interactions were observed for age and cigarette smoking. From the analysis of covariance, lower levels of serum GGT associated with coffee consumption were more evident in the older age group and at the higher levels of cigarette smoking. These findings suggest that coffee consumption is inversely related to serum GGT and that coffee may inhibit the inducing effects of aging and possibly of smoking on serum GGT in the liver.

Coffee drinking and serum gamma-glutamyltransferase: an extended study of Self-Defense Officials of Japan

PURPOSE

To examine the effect of coffee drinking on serum gamma-glutamyltransferase (GGT) level in relation to alcohol drinking, smoking, and degree of obesity in middle-aged Japanese men.

METHODS

From 1986 to 1994, a total of 7,637 male officials of the Self-Defense Forces of Japan aged 48-59 years received a preretirement health examination. Coffee drinking was ascertained by a self-administered questionnaire, and serum GGT level was measured. After excluding 1,360 men with a possible pathologic condition influencing liver enzyme levels and 182 former alcohol drinkers, effect of coffee drinking on serum GGT was examined by a multiple linear regression model and analysis of variance adjusting for alcohol drinking, smoking, and body mass index (BMI).

RESULTS

The adjusted percentage of difference in serum GGT was -4.3 (95% CI = -5.0; -3.5) per cup of coffee. The inverse coffee-GGT relation was most prominent among men drinking > or = 30 ml of ethanol and smoking > or = 15 cigarettes daily; and positive associations of alcohol and smoking with GGT were attenuated by coffee drinking, more clearly among men with BMI > or = 25.00 kg/m2. Adjusted percentages of difference in serum GGT were -2.6% (p = 0.0003) per cup of brewed coffee, and -5.1% (p = 0.0001) per cup of instant coffee, independently of each other.

CONCLUSIONS

The present study suggests that coffee consumption may weaken GGT-induction by alcohol, and possibly by smoking. These effect modifications by coffee may differ according to the degree of obesity.

Carbohydrate-deficient transferrin and gamma-glutamyltransferase are inversely associated with lipid markers of cardiovascular risk

BACKGROUND

A variety of epidemiological studies have suggested a U-shaped association between alcohol consumption and atherosclerosis progression and incidence events. Moderate intake of alcohol is considered beneficial, whereas heavy drinking increases cardiovascular disease risk.

METHODS

Alcohol and cardiovascular risk-related laboratory tests were carried out in 70 consecutive male employees in connection with an occupational health survey in 1996. Carbohydrate-deficient transferrin (CDT) and gamma-glutamyltransferase (GGT) were used as markers for alcohol consumption. The subjects were divided into quartiles on the basis of CDT or GGT value.

RESULTS

The highest CDT quartile had significantly higher serum high-density lipoprotein (HDL)-cholesterol (P < 0.05) than the lowest quartile. The highest GGT quartile had significantly higher serum total cholesterol (P < 0. 01), lower serum HDL-cholesterol (P < 0.05), higher serum low-density lipoprotein (LDL)-cholesterol (P < 0.01) and higher serum triglyceride (P < 0.01) than the lowest quartile.

CONCLUSIONS

An explanation for the findings is that high alcohol consumption without significant liver induction increases the level of HDL-cholesterol, whereas high alcohol consumption with induction of liver may have adverse effects on lipoprotein metabolism. The results were interpreted to indicate that CDT and GGT detect different populations of drinkers in regard to cardiovascular lipid risk factors.

The cholesterol-raising factor from coffee beans

Some coffee brewing techniques raise the serum concentration of total and low-density-lipoprotein cholesterol in humans, whereas others do not. The responsible factors are the diterpene lipids cafestol and kahweol, which make up about 1% (wt:wt) of coffee beans. Diterpenes are extracted by hot water but are retained by a paper filter. This explains why filtered coffee does not affect cholesterol, whereas Scandinavian "boiled," cafetiere, and Turkish coffees do. We describe the identification of the cholesterol-raising factors, their effects on blood levels of lipids and liver function enzymes, and their impact on public health, based on papers published up to December 1996.