Correlation of liver enzymes with diabetes and pre-diabetes in middle-aged rural population in China

The Glycemic Curve during the Oral Glucose Tolerance Test: Is It Only Indicative of Glycoregulation?

The shape of the glycemic curve during the oral glucose tolerance test (OGTT), interpreted in the correct context, can predict impaired glucose homeostasis. Our aim was to reveal information inherent in the 3 h glycemic trajectory that is of physiological relevance concerning the disruption of glycoregulation and complications beyond, such as components of metabolic syndrome (MS).

METHODS

In 1262 subjects (1035 women, 227 men) with a wide range of glucose tolerance, glycemic curves were categorized into four groups: monophasic, biphasic, triphasic, and multiphasic. The groups were then monitored in terms of anthropometry, biochemistry, and timing of the glycemic peak.

RESULTS

Most curves were monophasic (50%), then triphasic (28%), biphasic (17.5%), and multiphasic (4.5%). Men had more biphasic curves than women (33 vs. 14%, respectively), while women had more triphasic curves than men (30 vs. 19%, respectively) (p < 0.01). Monophasic curves were more frequent in people with impaired glucose regulation and MS compared to bi-, tri-, and multiphasic ones. Peak delay was the most common in monophasic curves, in which it was also most strongly associated with the deterioration of glucose tolerance and other components of MS.

CONCLUSION

The shape of the glycemic curve is gender dependent. A monophasic curve is associated with an unfavorable metabolic profile, especially when combined with a delayed peak.

Obesity, insulin resistance and their interaction on liver enzymes

Introduction

To investigate weight status, insulin resistance assessed by HOMA-IR, and their interaction on liver function in non-diabetic Chinese adults.

Methods and results

A total of 7066 subjects were included, and divided into normal weight (n = 3447), overweight (n = 2801), and obese (n = 818) groups. Data including weight, height, waist circumference, fasting blood glucose, fasting insulin, total cholesterol, triglycerides, y-glutamyl transferase (GGT), aspartate aminotransferase (AST), and alanine aminotransferase (ALT) were acquired. In multi-linear regression analysis for liver enzymes as dependent variables, insulin resistance emerged as a determinant of ALT (β = 0.165, P<0.001), AST (β = 0.040, P<0.001) and GGT (β = 0.170, P<0.001) after adjusting for age, sex, body mass index, triglyceride, and cholesterol. Interactions between insulin resistance and weight status by body mass index were observed in ALT (P<0.001), AST (P<0.001) and GGT (P = 0.0418).

Conclusion

Insulin resistance had significant associations with greater risk of elevated ALT, AST and GGT level in non-diabetic Chinese adults, especially among those who were overweight/ obese.

Relationship Between Serum Gamma-Glutamyl Transferase Level and Impaired Fasting Glucose Among Chinese Community-Dwelling Adults: A Follow-Up Observation of 6 Years

Objective: We aimed to investigate the relationship between serum gamma-glutamyl transferase (GGT) and fasting blood glucose (FBG) levels, as well as the cumulative risk of impaired fasting glucose (IFG) regulation in the Chinese adult population after 6 years of follow-up. Methods: A total of 1360 apparently healthy Chinese men and women who completed a community-based health examination survey and did not have IFG in central China in 2010 and 2016 were included in this study. The patients were divided into four groups according to their baseline GGT (in quartiles). The relationship between GGT levels and FBG levels was examined using general linear regression models. The effect of the GGT level on the risk of IFG was analyzed using multivariate logistic regression. The first quartile group of GGT levels was set as the dummy variable in the model, and the odds ratios and 95% confidence intervals of the remaining quartile groups relative to the first quartile group were obtained. Results: After 6 years of follow-up, 16.4% (188/1148) of participants were diagnosed with IFG. The cumulative incidence of IFG in the four groups according to their baseline GGT levels (in quartiles) was 7.7%, 16.1%, 15.8%, and 26.8%, respectively. Based on the Cox multiple regression, the hazard ratio for IFG increased by 28.9% for each unit of increase in the baseline GGT level after adjusting for the confounding factors. The GGT levels of participants in the first quartile were used as the reference group. The relative risks of IFG in the second, third, and fourth quartiles of GGT were 1.70, 1.55, and 2.46, respectively (P = 0.005). Conclusions: GGT was positively associated with the risk of IFG and can be used as an indicator to assess whether a patient may develop prediabetes.

Serum γ-glutamyltransferase as an independent predictor for incident type 2 diabetes in middle-aged and older adults: Findings from the KoGES over 12 years of follow-up

BACKGROUNDS AND AIMS

Limited evidence is available on whether serum γ-glutamyltransferase (GGT) has value as a predictor of type 2 diabetes in East Asian populations. We investigated the causal relationship between serum GGT level and incident type 2 diabetes in Korean adults.

METHODS AND RESULTS

A total of 7739 nondiabetic adults aged 40-69 years from the Korean Genome and Epidemiology Study were studied. We divided the population into four groups according to sex-specific quartiles by serum GGT levels. Hazard ratios (HRs) with 95% Confidence intervals (CIs) for incident type 2 diabetes were prospectively analyzed using multivariate Cox proportional hazards regression models. A total of 1432 (18.5%) participants developed type 2 diabetes over 12 years of follow-up. The higher the serum GGT group quartile, the higher the cumulative type 2 diabetes incidence over 12 years with significance in both sexes (log-rank test P < 0.001). HRs (95% CIs) for incident type 2 diabetes for the highest quartile versus referent lowest quartile for serum GGT levels were 2.55 (1.86-3.51) for men and 1.90 (1.40-2.58) for women after adjusting for confounding variables.

CONCLUSIONS

Higher serum GGT levels preceded and positively associated with incident type 2 diabetes among community-dwelling middle-aged and older Korean adults.

Association of liver enzymes levels with fasting plasma glucose levels in Southern China: a cross-sectional study

OBJECTIVE

According to several studies, liver enzymes levels are associated with fasting plasma glucose (FPG) levels. However, the association stratified by body mass index (BMI) remains to be elucidated, especially in Southern China. Therefore, the aim of this study was to investigate the correlation between liver enzymes levels and FPG levels stratified by BMI in Southern China.

DESIGN

Cross-sectional study.

PARTICIPANTS AND SETTING

3056 individuals participated in real-time interviews and blood tests in Southern China. Participants were divided into three groups (underweight, normal weight and overweight or obesity) based on BMI cut-offs.

MAIN OUTCOME MEASURED

Partial correlation analysis was performed to investigate the relationship between FPG levels and liver tests. Multivariate logistic regression analyses were applied to calculate the adjusted ORs for FPG levels based on liver enzymes levels.

RESULTS

There was no association between liver enzymes and FPG either in the underweight group or in the normal weight group; however, a significant correlation was observed in the overweight or obesity group (alanine transaminase (ALT), p<0.01; aspartate aminotransferase (AST), p<0.05). After adjusting for confounding factors, the highest tertiles of ALT still remained significantly positively related to FPG levels in the overweight or obesity group, with an OR of 2.205 (95% CI 1.442 to 3.371) for the 5.56≤FPG<7.00 mmol/L vs the FPG<5.56 mmol/L group and with an OR of 2.297 (95% CI 1.017 to 5.187) for the FPG≥7.00 mmol/L vs the FPG<5.56 mmol/L group, but this correlation was not found for AST.

CONCLUSIONS

The association of liver enzymes levels with FPG levels differed based on different BMI cut-offs. ALT levels were significantly positively associated with FPG levels in the overweight or obesity group, but not in the other two groups; AST levels were not associated with FPG levels in any group.

Is Acupuncture Effective for Improving Insulin Resistance? A Systematic Review and Meta-analysis

This study aimed to evaluate the clinical efficacy of acupuncture for intervening insulin resistance (IR) by meta-analysis of related randomized controlled trials (RCTs). Studies published prior to 31 January 2018 were searched on Pubmed, Medline, Cochrane Library, Embase databases and Chinese databases. Only RCTs, which examined acupuncture as the sole or adjunctive treatment for IR-related diseases, were included. The primary outcome was homeostasis model assessment for insulin resistance (HOMA-IR). The secondary outcomes consisted of fasting blood glucose (FBG), fasting insulin (FINS) and 2-h postprandial blood glucose (2h-PBG). The differences between groups were reported as mean differences (MD). All statistical analyses were performed using RevMan software 5.3. After carefully screening relevant studies, 9 RCTs involving 562 patients (279 in experimental group and 283 in control group) were enrolled in this study. The pooled results showed that acupuncture had significant effects on HOMA-IR (MD 0.70, 95% CI 0.04 to 1.35, P=0.04<0.05), FINS (MD 3.35 mU/L, 95% CI 1.99 to 4.7, P<0.001) and 2h-PBG (MD 1.03 mmol/L, 95% CI 0.25 to 1.82, P=0.01). However, the differences in FBG were not significant (MD 0.28 mmol/L, 95% CI-0.28 to 0.84, P=0.32>0.05). The present meta-analysis indicated that acupuncture can help to improve IR to a certain extent, which remains to be confirmed by further high-quality RCTs.

High Liver Enzyme Concentrations are Associated with Higher Glycemia, but not with Glycemic Variability, in Individuals without Diabetes Mellitus

BACKGROUND

Elevated concentrations of liver enzymes have been associated with an increased risk of developing type 2 diabetes mellitus. However, it remains unclear to which specific aspects of diurnal glucose metabolism these associate most. We aimed to investigate the associations between liver enzyme concentrations and 24 h-glucose trajectories in individuals without diabetes mellitus from three independent cohorts.

METHODS

This cross-sectional study included 436 participants without diabetes mellitus from the Active and Healthy Aging Study, the Switchbox Study, and the Growing Old Together Study. Fasting blood samples were drawn to measure gamma-glutamyltransferase (GGT), alanine transaminase, and aspartate transaminase. Measures of glycemia (e.g., nocturnal and diurnal mean glucose levels) and glycemic variability (e.g., mean amplitude of glucose excursions) were derived from continuous glucose monitoring. Analyses were performed separately for the three cohorts; derived estimates were additionally meta-analyzed.

RESULTS

After meta-analyses of the three cohorts, elevated liver enzyme concentrations, and specifically elevated GGT concentrations, were associated with higher glycemia. More specific, participants in the highest GGT tertile (GGT ≥37.9 U/L) had a 0.39 mmol/L (95% confidence interval: 0.23, 0.56) higher mean nocturnal glucose (3:00 to 6:00 a.m.) and a 0.23 mmol/L (0.10, 0.36) higher diurnal glucose (6:00 to 0:00 a.m.) than participants in the lowest GGT tertile (GGT <21.23 U/L). However, elevated liver enzyme concentrations were not associated with a higher glycemic variability.

CONCLUSION

Though elevated liver enzyme concentrations did not associate with higher glycemic variability in participants without diabetes mellitus, specifically, elevated GGT concentrations associated with higher glycemia.