Association between liver function and metabolic syndrome in Chinese men and women

Evaluation of elevated serum liver enzymes and metabolic syndrome in the PERSIAN Guilan cohort study population

Objective

The purpose of this study is to evaluate the association between elevated serum liver enzymes and Metabolic Syndrome (MetS) in Prospective Epidemiological Research Studies of the Iranian Adults (PERSIAN) Guilan Cohort Study (PGCS) population.

Methods

This cross-sectional study involved 10,519 individuals between the ages of 35 and 70 enrolled in the PGCS. The gathered data encompassed demographic information, anthropometric measurements, blood pressure, and biochemical indicators. MetS was defined by the National Cholesterol Education Program-Adult Treatment Panel III criteria (NCEP-ATP III). The associations between elevated liver enzymes and MetS were examined using logistic regression analysis. Odds ratio (OR) and 95 % confidence interval (CI) were calculated.

Results

The prevalence of MetS was 41.8 %, and the prevalence of elevated alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT), and alkaline phosphatase (ALP) were 19.4, 4.6, 11.6, and 5.1 %, respectively. In the unadjusted model, elevated ALT, AST, and GGT were associated with increased odds of MetS (OR = 1.55, 95 % CI: 1.41-1.71; OR = 1.29, 95 % CI: 1.07-1.55, and OR = 1.90, 95 % CI: 1.69-2.14, respectively). These associations remained significant for ALT and GGT after adjustment for some demographic and clinical characteristics (aOR = 1.31, 95 % CI: 1.17-1.46 and aOR = 1.30, 95 % CI: 1.14-1.49, respectively). In addition, the odds of MetS increased with the number of elevated liver enzymes, up to almost 1.32-fold among subjects with three/four elevated liver enzymes.

Conclusion

The higher incidence of elevated liver enzymes was associated with an increased likelihood of MetS. Including liver markers in diagnosing and predicting MetS holds promise and is considered a possible approach.

Establishment and validation of a predictive nomogram for severe pleural effusion in liver cancer patients after hepatectomy

This study aims to develop and validate a predictive nomogram for severe postoperative pleural effusion (SPOPE) in patients undergoing hepatectomy for liver cancer. A total of 536 liver cancer patients who underwent hepatectomy at the Department of Hepatobiliary Surgery I of the Affiliated Hospital of North Sichuan Medical College from January 1, 2018, to December 31, 2022, were enrolled in a retrospective observational study and comprised the training dataset. Lasso regression and logistic regression analyses were employed to construct a predictive nomogram. The nomogram was internally validated using Bootstrapping and externally validated with a dataset of 203 patients who underwent liver cancer resection at the Department of General Surgery III of the same hospital from January 1, 2020, to December 31, 2022. We evaluated the nomogram using the receiver operating characteristic curve, calibration curve, and decision curve analysis. Variables such as drinking history, postoperative serum albumin, postoperative total bilirubin, right hepatectomy, diaphragm incision, and intraoperative blood loss were observed to be associated with SPOPE. These factors were integrated into our nomogram. The C-index of the nomogram was 0.736 (95% CI: 0.692-0.781) in the training set and 0.916 (95% CI: 0.872-0.961) in the validation set. The nomogram was then evaluated using sensitivity, specificity, positive predictive value, negative predictive value, calibration curve, and decision curve analysis. The nomogram demonstrates good discriminative ability, calibration, and clinical utility.

Association between liver enzymes and metabolic syndrome: a study in Bangladeshi adults

BACKGROUND

This study aimed to investigate the association between serum liver enzymes and the presence of metabolic syndrome (MetS) among Bangladeshi adults.

RESEARCH DESIGN AND METHODS

A total of 602 participants (424 males and 178 females) were enrolled in this cross-sectional study. Serum levels of liver enzymes (ALT, AST, GGT and ALP) and other biochemical parameters were measured by standard colorimetric methods. The relationship between liver enzymes and MetS was assessed by multivariable logistic regression models.

RESULTS

Overall, the prevalence of MetS was 34.9% among the participants. Of the four liver enzymes, the mean levels of serum ALT and GGT were significantly higher among subjects with MetS than those without MetS (p < 0.01). When liver enzyme levels were categorized into normal and elevated ranges, MetS and its component's prevalence was higher in the elevated group except for ALP. Serum ALT and GGT showed a significant relationship with the maximum components of MetS. According to the logistic regression analysis, elevated levels of ALT and GGT were significantly associated with the prevalence of MetS (p < 0.01 and p < 0.001, respectively).

CONCLUSIONS

This study showed that elevated ALT and GGT levels were independently associated with MetS and its components.

Vitamin D improves hepatic alterations in ACE1 and ACE2 expression in experimentally induced metabolic syndrome

Metabolic Syndrome (MetS) is a term used to describe a cluster of pathophysiological, biochemical, and metabolic criteria; including high Blood Pressure (BP), high cholesterol, dyslipidaemia, central obesity and Insulin Resistance (IR). The Renin Angiotensin System (RAS) has a regulatory function in BP, hydroelectrolyte balance, and cardiovascular function. RAS is composed of angiotensinogen (AGT), (Ang I), (Ang II), (ACE1), (ACE2), (AT1R), (AT2R), and (Ang 1-7). Vitamin D had been proved to act as a protective factor against MetS. Therefore, the study is pursued to explore vitamin D supplementation roles on hepatic RAS in MetS experimental model. At first, 36 males Albino rats were separated into 4 groups and induced to MetS under controlled circumstances for 3 months. Then, data were collected from blood samples, whereas RNA extracted from liver were analyzed using biochemical and statistical analysis tests. As a result, the major finding was proving that vitamin D can balance the expression of ACE1 and ACE2. Also, confirming that it can improve MetS components by elevating HDL and insulin levels while reducing the levels of BP, cholesterol, LDL, TG, GLU, ALT, AST, and IR. These outcomes may give a new insight into the RAS pathways associated with MetS.

The Relationship between Elevated Homocysteine and Metabolic Syndrome in a Community-Dwelling Middle-Aged and Elderly Population in Taiwan

(1) Background: Metabolic syndrome has become a serious health problem in society. Homocysteine is a biomarker for cardiovascular disease. We investigated the relationship between homocysteine levels and metabolic syndrome. (2) Methods: A total of 398 middle-aged and elderly individuals were included in our study. First, we divided the participants into two groups: the metabolic syndrome group and the nonmetabolic syndrome group. Second, according to tertiles of homocysteine levels from low to high, the participants were divided into first, second, and third groups. Pearson's correlation was then calculated for homocysteine levels and metabolic factors. Scatterplots are presented. Finally, the risk of metabolic syndrome in the second and third groups compared with the first group was assessed by multivariate logistic regression. (3) Results: In our study, the metabolic syndrome group had higher homocysteine levels, and the participants in the third group were more likely to have metabolic syndrome. Multivariate logistic regression revealed that the third group, which had the highest homocysteine level, was associated with metabolic syndrome with an odds ratio of 2.32 compared with the first group after adjusting for risk factors. (4) Conclusions: We concluded that high plasma homocysteine levels were independently associated with MetS in our study population.

Association between liver enzymes and metabolic syndrome in Canadian adults: results from the Canadian health measures survey - cycles 3 &4

Background

The relationship between liver enzymes and Metabolic Syndrome (MetS) in different populations, including Canadians, is not consistent and well understood. We used the Canadian Health Measures Survey data (Cycles 3 and 4) to examine the cross-sectional relationships between select liver biomarkers and MetS in the adult Canadian population. The biomarkers selected were gamma-glutamyl transferase (GGT), aspartate aminotransferase (AST), and alkaline phosphatase (ALKP).

Methods

Fasting blood samples (FBS) were collected from adults above the age of 20 years for Cycle 3 and Cycle 4 (n = 3003). MetS was diagnosed if the subjects had three or more risk determinants according to the Joint Interim Statement criteria. Primary risk factors included quartile cut-offs for each of the biomarkers ALKP, AST, GGT for males and females separately. A multivariable logistic regression technique based on a maximum likelihood approach was used to evaluate the association between quartiles of ALKP, AST, and GGT, other individual and contextual factors, and the prevalence of MetS.

Results

MetS was prevalent in 32.3% of subjects. BMI was an effect modifier in the relationship between GGT and MetS prevalence, while sex was an effect modifier in the relationship between ALKP and MetS prevalence; and age was an effect modifier in the relationship between AST and MetS prevalence.

Conclusions

Since the mechanisms to underpin the associations between the liver enzymes activity and MetS are unknown, further epidemiologic investigations using longitudinal designs are necessary to understand these associations.

Can Gamma-glutamyl Transferase Predict Unhealthy Metabolic Phenotypes Among Healthcare Workers in Azar Cohort Study?

Background: Although various studies have assessed the correlation between gamma-glutamyl transferase (GGT) and cardiometabolic risk factors in obesity, no research has differentiated among metabolically-healthy obese (MHO) and metabolically unhealthy obese (MUHO), metabolically-healthy lean (MHL), and metabolically-unhealthy lean (MUHL). Objectives: Accordingly, this study evaluated the correlation between GGT and cardiometabolic phenotypes among healthcare workers. Methods: In this study, there were anthropometric measurements as well as the measurements of fasting blood sugar (FBS), GGT, cholesterol, triglyceride (TG), high lipoprotein density (HDL), and blood pressure in 1458 healthcare workers enrolled in the Azar Cohort Study. Metabolic syndrome (MetS) was defined according to the National Cholesterol Education Program Adult Treatment Panel III (ATP III). Accordingly, the participants were divided into four cardiometabolic phenotypes. Results: In this cross-sectional study, there was a significant difference in the prevalence of cardiometabolic phenotypes regarding the GGT tertiles (P ≤ 0.001). The highest prevalence of MHO was observed in the third GGT tertile. The mean waist circumference, TG, FBS, HDL, and systolic and diastolic blood pressure levels increased in the MHO, MUHO, and MHL groups in a dose dependent manner with an increase in the GGT tertiles (P < 0.05). In comparing the highest and lowest GGT tertile, the risk of MHO and MUHO increased by 2.84 (95%CI 2.01 - 4.01) and 9.12 (95%CI 5.54 - 15), respectively. However, the correlation between the GGT tertile and MUHL did not reveal a similar trend. The ROC curve shows the cutoff value of 18.5 U/L for GGT, which allowed us to distinguish between the MUHO and MHO individuals. Conclusions: The findings revealed that GGT can indicate the risk of MetS as such, it can be used to detect at-risk MHO individuals and administer proper interventions.

Metabolic dysfunction and obesity-related cancer: Beyond obesity and metabolic syndrome

OBJECTIVES

The metabolic dysfunction driven by obesity, including hyperglycemia and dyslipidemia, increases risk for developing at least 13 cancer types. The concept of "metabolic dysfunction" is often defined by meeting various combinations of criteria for metabolic syndrome. However, the lack of a unified definition of metabolic dysfunction makes it difficult to compare findings across studies. This review summarizes 129 studies that evaluated variable definitions of metabolic dysfunction in relation to obesity-related cancer risk and mortality after a cancer diagnosis. Strategies for metabolic dysfunction management are also discussed.

METHODS

A comprehensive search of relevant publications in MEDLINE (PubMed) and Google Scholar with review of references was conducted.

RESULTS

Metabolic dysfunction, defined as metabolic syndrome diagnosis or any number of metabolic syndrome criteria out of clinical range, inflammatory biomarkers, or markers of metabolic organ function, has been associated with risk for, and mortality from, colorectal, pancreatic, postmenopausal breast, and bladder cancers. Metabolic dysfunction associations with breast and colorectal cancer risk have been observed independently of BMI, with increased risk in individuals with metabolically unhealthy normal weight or overweight/obesity compared with metabolically healthy normal weight.

CONCLUSION

Metabolic dysfunction is a key risk factor for obesity-related cancer, regardless of obesity status. Nonetheless, a harmonized definition of metabolic dysfunction will further clarify the magnitude of the relationship across cancer types, enable better comparisons across studies, and further guide criteria for obesity-related cancer risk stratification.

Associations between Circulating SELENOP Level and Disorders of Glucose and Lipid Metabolism: A Meta-Analysis

Selenoprotein P (SELENOP) is an extracellular antioxidant, selenium transporter, and hepatokine interfering with glucose and lipid metabolism. To study the association between the circulating SELENOP concentration and glucose and lipid metabolic diseases (GLMDs), including gestational diabetes (GD), metabolic syndrome (MetS), non-alcoholic fatty liver disease, obesity, and type 2 diabetes, as well as the individual markers, a meta-analysis was conducted by searching multiple databases from their establishment through March 2022 and including 27 articles published between October 2010 and May 2021, involving 4033 participants. Participants with GLMDs had higher levels of SELENOP than those without GLMDs (standardized mean difference = 0.84, 95% CI: 0.16 to 1.51), and the SELENOP levels were positively correlated with the markers of GLMDs (pooled effect size = 0.09, 95% CI: 0.02 to 0.15). Subgroup analyses showed that the SELENOP concentrations were higher in women with GD and lower in individuals with MetS than their counterparts, respectively. Moreover, SELENOP was positively correlated with low-density lipoprotein cholesterol, but not with the other markers of GLMDs. Thus, the heterogenicity derived from diseases or disease markers should be carefully considered while interpreting the overall positive association between SELENOP and GLMDs. Studies with a larger sample size and advanced design are warranted to confirm these findings.

12-Month Post-Discharge Liver Function Test Abnormalities Among Patients With COVID-19: A Single-Center Prospective Cohort Study

Objective

The longitudinal effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on the liver are unknown. This study aimed to characterize dynamic changes in liver function test abnormalities in patients with COVID-19 at the acute phase and recovery phase.

Methods

A prospective cohort study involved patients with COVID-19 who were admitted to Shenzhen Third People’s Hospital between January 11, 2020, and April 27, 2020. Patients underwent liver function tests at hospitalization and at the outpatient visit at the 1-month, 3-month, 6-month, and 12-month follow-ups.

Results

Among 461 patients, 28.4% of patients had any kind of liver function tests abnormality at admission, manifested as elevated ALT (13.0%), AST (17.6%), and GGT (15.8%) levels. The trajectory analysis indicated a marked improvement in liver function after discharge, with any kind of liver function test abnormalities of 25.1% at 1 month, 13.2% at 3 months, 16.7% at 6 months, and 13.2% at 12 months after discharge. Persistent liver function abnormalities were observed in patients with pre-existing conditions during follow-up. A significantly higher prevalence of ultrasound determined fatty liver disease was found in those patients with more frequent LFT abnormalities at follow-up.

Conclusion

In this study of patients with COVID-19, liver damage in COVID-19 was usually temporary and could return to normal at the end of the 12-month follow-up.

Alanine aminotransferase to aspartate aminotransferase ratio and hepatitis B virus on metabolic syndrome: a community-based study

BACKGROUND

The serum aminotransferase elevation in metabolic syndrome (MetS) reflected hepatosteatosis, but there is a conflict with the coexistence of viral hepatitis, especially for the hepatitis B virus (HBV). Thus, this study aimed to investigate the relationship between the alanine aminotransferase (ALT)/aspartate aminotransferase (AST) ratio, MetS, and HBV infection in a rural Taiwanese population.

METHODS

We conducted a cross-sectional analysis in southern Taiwan between March and December 2019. Multivariable logistic regression analyses adjusted for demographics, education, dietary behaviors, irregular exercise, substance use, and viral markers were performed to investigate the association between the ALT/AST ratio and MetS.

RESULTS

Altogether, 2,416 participants (891 men and 1,525 women; mean age, 64.1 ± 14.9 years) were enrolled. Of the participants, 22.7% (n = 519) were seropositive for viral hepatitis. In the multivariable analysis, age [odds ratio (OR) 1.02, 95% CI 1.01-1.03, p < 0.001], ALT/AST ratio >1 (OR 2.63, 95% CI 2.15-3.21, p < 0.001), education (OR 0.96, 95% CI 0.94-0.98, p < 0.001), and HBV seropositivity (OR 0.70, 95% CI 0.52-0.95, p = 0.021) were associated with the risk of MetS. The area under the curve of the ALT/AST ratio was 0.62 (95% CI 0.60-0.64, p < 0.001), and the cutoff value was >0.852 for the Youden index.

CONCLUSION

An ALT/AST ratio >1 could be a simple index for MetS prediction during community checkups. In contrast to age and betel nut chewing, HBV seropositivity and higher education might be inversely associated with MetS. Aggressive health promotion for MetS prevention has emerged as essential in participants without HBV and with lower education levels. Further large-scale, longitudinal studies are needed to unlink these correlations.

The Association between Anthropometry Indices and Serum Concentrations of Gamma-Glutamyl Transferase, Alkaline Phosphatase, Alanine Aminotransferase, and Aspartate Aminotransferase

Background

Nowadays, metabolic syndrome (MetS) has become a great public health crisis that threatens too many lives worldwide. Many previous studies have been investigated the association between MetS and anthropometric indices. This study is aimed at investigating the association between anthropometric indices with gamma-glutamyl transferase (GGT), alkaline phosphatase (ALP), alanine aminotransferase (ALT), and aspartate aminotransferase (AST). We were using data from a large population-based cohort of seemingly healthy women and men.

Methods

A total of 7216 participants were included in this study. The serum levels of GGT, ALP, ALT, and AST with bioimpedance measures were obtained at the time of enrollment. Multiple regression analysis was performed to assess the relationship between anthropometric indices and serum levels of the aforementioned laboratory tests.

Results

Serum levels of GGT, ALP, ALT, and AST significantly correlated with body mass index (BMI). Only ALP had a significant association with visceral fat area (VFA). AST, ALT, and ALP levels had a positive correlation with 50 kHz whole-body phase.

Conclusion

From the findings of this study, body mass index consistently appeared a good predictor of elevated hepatic enzymes and triglycerides. Thus, it can be helpful in clinical settings to identify patients at risk of nonalcoholic fatty liver disease, which is closely related to metabolic syndrome.

Sulforaphane Ameliorates the Liver Injury of Traumatic Hemorrhagic Shock Rats

BACKGROUND

The protective effects of sulforaphane on liver injury induced by high-fat diet and sodium valproate were previously reported. The present study preliminarily investigated the effect of sulforaphane on liver injury induced by traumatic hemorrhagic shock.

MATERIALS AND METHODS

After a traumatic hemorrhagic shock model was established in rats, the survival of rats during the first 24 hours was analyzed by Kaplan-Meier analysis. The serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TB), tumor necrosis factor α (TNF-α), and interleukin 1β (IL-1β) were measured using a biochemical analyzer or enzyme-linked immunosorbent assay (ELISA). The cell apoptosis and histopathology of liver tissues were examined by TUNEL and hematoxylin-eosin (HE) staining. The mRNA and protein expressions of B-cell lymphoma-2 (Bcl-2), Bcl2 associated X (Bax), Caspase-3, TNF-α, IL-1β, Cyclooxygenase-2 (COX-2), nitric oxide synthase (iNOS), nuclear factor E2-related factor 2 (Nrf2), and heme oxygenase 1 (HO-1) in the liver tissues were determined by immunohistochemical staining, quantitative reverse transcription PCR (qRT-PCR) or western blot.

RESULTS

Sulforaphane promoted the health of the animal, reduced liver cell apoptosis and ameliorated the histopathological damage in the liver of rats with traumatic hemorrhagic shock. Sulforaphane downregulated the expressions of liver function-related factors (ALT, AST, TB), inflammation-related factors (TNF-α, IL-1β, COX-2, iNOS), and apoptosis-related factors (Bax, Caspase-3) and upregulated the expressions of factors related to apoptosis (Bcl-2) and Nrf2/HO-1 pathway (Nrf2, HO-1).

CONCLUSION

Sulforaphane protected the liver against traumatic hemorrhagic shock through ameliorating the apoptosis and inflammation of the liver via activating the Nrf2/HO-1 pathway.

Liver Enzymes and Their Association with Some Cardiometabolic Diseases: Evidence from a Large Kurdish Cohort

Objective

According to reports, liver enzymes might play a role in the incidence and development of cardiometabolic diseases such as metabolic syndrome (MetS), hypertension (HTN), and cardiovascular diseases (CVD). We conducted a study to investigate this hypothesis among the Iranian Kurdish population.

Methods

We analyzed data from the baseline phase of the Ravansar noncommunicable disease (RaNCD) cohort. The association between liver enzymes (ALT, AST, ALT/AST ratio, GGT, and ALP) with cardiometabolic disease risk factors was investigated by multiple linear regression. The odds ratio of cardiometabolic diseases in each quartile category of liver enzyme concentration was estimated using multivariable logistic regression.

Results

The mean age of participants was 47.3 ± 4.1 years (48.1 years in males and 51.8 years in females). In the adjusted model, all enzymes were positively associated with MetS, HTN, and CVD risk factors except for the ALT/AST ratio with SBP and DBP. In the adjusted model, subjects in the fourth quartile for GGT, ALT/AST ratio, ALT, ALP, and AST had 3.29-, 2.94-, 2.45-, 2.00-, and 1.19-fold increased risk for MetS compared with subjects in the first quartile. Increased levels of GGT and ALP were positively associated with the risk of HTN (ORs = 1.33, 95%CI = 1.03-1.71 for GGT; ORs = 1.32, 95%CI = -1.68 for ALP). An increased GGT level was significantly associated with CVD (ORs = 1.54, 95%CI = 1.03-1.68). Within the normal range quartile, ALT had a significant correlation with the incidence of MetS.

Conclusion

According to the present study, the levels of liver enzymes could be considered for early diagnosis of MetS, HTN, and CVD.

Gegen Qinlian Decoction Ameliorates Nonalcoholic Fatty Liver Disease in Rats via Oxidative Stress, Inflammation, and the NLRP3 Signal Axis

Gegen Qinlian Decoction (GQD), a classic Chinese herbal formula, has been widely used in Chinese clinic for centuries and is well defined in treating nonalcoholic fatty liver disease (NAFLD). However, the mechanism action of GQD on NAFLD is still rarely evaluated. The present study aims to investigate the effect of GQD on treatment of NAFLD in rats and to further explore the underlying mechanism. The rat NAFLD model established by high-fat-diet feeding was used in the research. Our results exhibited the liver lesions and steatosis was significantly alleviated in NAFLD rats treated with GQD via Oil Red O and H&E staining. Body weight and liver index in GQD groups were reduced significantly (P < 0.05). Moreover, the biochemical analyzer test results showed that GQD significantly decreased blood lipid levels total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), and liver injury indicators alanine aminotransferase (ALT), aspartate aminotransferase (AST), and alkaline phosphatase (ALP), while it increased the level of high-density lipoprotein cholesterol (HDL-C) (P < 0.05). The levels of interferon-β (IFN-β), tumor necrosis factor-α (TNF-α), and malondialdehyde (MDA) after the GQD treatment were significantly lower, and then interleukin-2 (IL-2), superoxide dismutase (SOD), and glutathione peroxidase (GSH-Px) levels were lifted significantly (P < 0.05). Further, GQD blocked the expression of NLRP3, ASC, caspase-1 mRNA, and proteins in the liver tissues significantly (P < 0.05). These findings indicated that GQD can ameliorate the hepatic steatosis and injury of NAFLD. Its possible mechanism involves the modulation of inflammatory cytokines and antioxidative stress and the inhibition of NLRP3 signal axis activation. The results support that GQD may be a promising candidate in the treatment of NAFLD.

Risk of gastrointestinal cancer in patients with an elevated level of gamma-glutamyltransferase: A nationwide population-based study

Emerging evidence that an elevated serum gamma-glutamyltransferase (GGT) level is associated with an increased risk of gastrointestinal cancer, but still controversial. The aim of this study to assess the relationship between GGT level and risk of gastrointestinal cancer, and the contribution of the interaction of hyperglycemia with elevated GGT level to the incidence of gastrointestinal cancer by the stratified analysis. A total of 8,120,665 Koreans who received medical checkups in 2009 were included. Subjects were classified according to the quartile of GGT level for women and men. The incidence rates of gastrointestinal cancer for each group were analyzed using Cox proportional hazards models. During follow-up, 129,853 cases of gastrointestinal cancer newly occurred (esophagus, 3,792; stomach, 57,932; and colorectal, 68,789 cases). The highest GGT quartile group showed an increased risk of gastrointestinal cancer (esophagus, hazard ratio = 2.408 [95% confidence interval, 2.184–2.654]; stomach, 1.121 [1.093–1.149]; and colorectal, 1.185 [1.158–1.211]). The risk increased significantly with the rise in GGT quartile level, regardless of the site of cancer. The stratified analysis according to glycemic status showed that the effect of elevated GGT was predominant in the risk of esophageal cancer. The effect of elevated GGT further increased the risk of stomach and colorectal cancers in diabetic patients. An elevated level of GGT was associated with an increased risk of gastrointestinal cancer, regardless of the site of cancer. The effect of the increase in GGT level on the risk of gastrointestinal cancer depended on the type of cancer and glycemic status.

Association of total bilirubin and indirect bilirubin content with metabolic syndrome among Kazakhs in Xinjiang

BACKGROUND

Some studies have shown that a high level of bilirubin is a protective factor against metabolic syndrome (MS), while a high level of transaminase is a risk factor for MS. However, the existing results are inconsistent and few cohort studies have been published.

METHODS

Using an ambispective cohort study, 565 Kazakhs from Xinjiang, China were selected as the study subjects. The baseline serum bilirubin and transaminase levels of the subjects were divided into quartiles and the relationship between these values and the incidence of MS was analyzed. The definition of MS was based on the Joint Interim Statement (JIS) diagnostic criteria.

RESULTS

The average follow-up time for the subjects was 5.72 years. The cumulative incidence of MS was 36.11% (204 of the 565 subjects), and the incidence density was 63.10/1000 person-years. Multivariate Cox regression analysis showed that the levels of total bilirubin (TBIL) and indirect bilirubin (IBIL) were negatively correlated with the occurrence of MS, Compared to the lowest quartile level (Q1), the hazard ratios of MS the TBIL levels at the Q2-Q4 quartiles were: 0.47 (0.31-0.71), 0.53 (0.35-0.79), and 0.48 (0.32-0.72), respectively, while IBIL levels at the Q2-Q4 quartiles showed an MS hazard ratio of 0.48 (0.32-0.72), 0.54(0.36-0.81), and 0.52 (0.35-0.77), respectively, all at a 95% confidence level. However, no relationship was found between transaminase levels and the incidence of MS.

CONCLUSION

Serum TBIL and IBIL levels were negatively correlated with the incidence of MS in a Kazakh population in China.

Associations of iron markers with type 2 diabetes mellitus and metabolic syndrome: Results from the prospective SHIP study

AIMS

To assess the role of serum ferritin and transferrin with prevalent and incident type 2 diabetes mellitus (T2DM) and metabolic syndrome (MetS) and whether these associations are independent of inflammatory markers and hepatic enzymes.

METHODS

We analyzed data from 3,232 participants aged 20-81 years of the population-based Study of Health in Pomerania (SHIP) from Northeast Germany with a median follow-up time of 10.6 years. Logistic and Cox regression analyses were performed.

RESULTS

Serum ferritin concentrations were associated with a higher prevalence of T2DM (total population OR: 1.16 [95% CI: 1.07, 1.26]; men OR: 1.18 [95% CI: 1.08, 1.30) and MetS (total population OR: 1.27 [95% CI: 1.16, 1.38]; men OR: 1.26 [95% CI: 1.15, 1.38]) in the total population and men independently of inflammatory markers and hepatic enzymes. In longitudinal analyses, baseline ferritin concentrations were associated with a higher risk of incident T2DM in women (HR: 1.38 [95% CI: 1.10, 1.71]), but not in men or in the total population and also with a higher risk of incident MetS (HR: 1.09 [95% CI: 1.01, 1.17]) in the total population. These longitudinal associations attenuated considerably after adjustment for hepatic enzymes but not inflammatory markers. Transferrin was not associated with any of the outcomes.

CONCLUSIONS

Our results suggest a link between ferritin and T2DM and MetS, which might be partially explained by hepatic dysfunction.

Predicting Metabolic Syndrome With Machine Learning Models Using a Decision Tree Algorithm: Retrospective Cohort Study

Background

Metabolic syndrome is a cluster of disorders that significantly influence the development and deterioration of numerous diseases. FibroScan is an ultrasound device that was recently shown to predict metabolic syndrome with moderate accuracy. However, previous research regarding prediction of metabolic syndrome in subjects examined with FibroScan has been mainly based on conventional statistical models. Alternatively, machine learning, whereby a computer algorithm learns from prior experience, has better predictive performance over conventional statistical modeling.

Objective

We aimed to evaluate the accuracy of different decision tree machine learning algorithms to predict the state of metabolic syndrome in self-paid health examination subjects who were examined with FibroScan.

Methods

Multivariate logistic regression was conducted for every known risk factor of metabolic syndrome. Principal components analysis was used to visualize the distribution of metabolic syndrome patients. We further applied various statistical machine learning techniques to visualize and investigate the pattern and relationship between metabolic syndrome and several risk variables.

Results

Obesity, serum glutamic-oxalocetic transaminase, serum glutamic pyruvic transaminase, controlled attenuation parameter score, and glycated hemoglobin emerged as significant risk factors in multivariate logistic regression. The area under the receiver operating characteristic curve values for classification and regression trees and for the random forest were 0.831 and 0.904, respectively.

Conclusions

Machine learning technology facilitates the identification of metabolic syndrome in self-paid health examination subjects with high accuracy.

No obvious association exists between red blood cell distribution width and thyroid function

Aim: We aimed to explore gender impacts on the associations between red blood cell distribution width (RDW) and thyroid function in the Chinese population. Methods/results: Gender impacts on the associations between RDW and thyroid function in 8424 males and 5198 females were investigated. RDW was found significantly lower in males than in females. An increasing trend of RDW along with aging was demonstrated in males. For females, an obvious decrease was shown during menopause period. From binary logistic regression, RDW displayed negative relationship with hypothyroidism in both genders as a single factor. However, if RDW was analyzed as a categorical variable (in RDW width quartiles) and as a continuous variable in models with covariates, all the odds ratios were negative, except for a weak-negative relationship with hypothyroidism in women in a continuous RDW model. Conclusion: The current study suggests that anisocytosis could be a contributing factor in thyroid dysfunction.

Association between platelet distribution width and serum uric acid in Chinese population

Platelet distribution width (PDW) is a simple and inexpensive parameter, which could predict activation of coagulation efficiently. And it has been confirmed to have a significant role in many diseases. We aimed to explore the association between PDW and hyperuricemia in a large Chinese cohort. This cross-sectional study recruited 61,091 ostensible healthy participants (29,259 males and 31,832 females) after implementing exclusion criteria. Clinical data of the enrolled population included anthropometric measurements and serum parameters. Database was sorted by gender, and the association between PDW and hyperuricemia was analyzed after dividing PDW into quartiles. Crude and adjusted odds ratios of PDW for hyperuricemia with 95% confidence intervals were analyzed using binary logistic regression models. We found no significant difference in PDW values between the genders. Males showed significantly higher incidence of hyperuricemia than females. From binary logistic regression models, significant hyperuricemia risks only were demonstrated in PDW quartiles 2 and 3 in males (P < 0.05). This study displayed close association between PDW and hyperuricemia as a risk factor. It is meaningful to use PDW as a clinical risk predictor for hyperuricemia in males. © 2019 BioFactors, 45(3):326-334, 2019.

The relationship between red blood cell distribution width and metabolic syndrome in elderly Chinese: a cross-sectional study

OBJECTIVE

Metabolic syndrome (MS) is a group of risk factors which includes hypertension, hyperglycemia, abnormal cholesterol levels, and obesity. Red blood cell distribution width (RDW) is a parameter that reflects the heterogeneity of erythrocyte volume. But the relationship between MS and RDW is intricate and remains poorly understood. We hypothesized that high RDW was associated with MS via inflammation. Our study aimed to investigate the association between RDW and MS in Chinese elderly large cohort. If RDW had a strong correlation with MS, RDW could become a predictor of MS?

METHODS

We recruited 10,887 ostensibly healthy participants aged from 60 to 93 (5795 male, 5092 female). Associations between RDW and other variables were assessed by Pearson correlation. Crude and adjusted odds ratio for MS with 95% confidence intervals was calculated by binary logistic regression models.

RESULTS

In elderly Chinese, RDW was significantly higher in males than in females. The prevalence of both men and women decreased with the rise of RDW. For both sexes, RDW demonstrated positive correlations with age, systolic blood pressure (0.070 in males,0.058 in females), high density lipoprotein(0.027in males,0.064 in females), negative correlations with triglycerides (- 0.120 in males,-0.074 in females) and fasting glucose (- 0.048 in males,-0.016 in females). Notably, we detected the associated reduced risks at the the third and fourth quartile of RDW in males. In women, there was no statistical significance.

CONCLUSION

We found the adjusted odds ratios of MS was lower at the third and fourth quartile of RDW in males.

Serum bilirubin is negatively associated with white blood cell count

OBJECTIVE

Bilirubin is considered an important antioxidant, anti-inflammatory factor and immunomodulator. The current investigation aimed to explore the association between bilirubin and white blood cell (WBC) count in a large Chinese cohort.

METHODS

A total of 61091 participants (29259 males, 31832 females) were recruited from a Chinese tertiary hospital. Data were sorted by sex, and the association between bilirubin and WBC count was analyzed after dividing bilirubin levels into quartiles.

RESULTS

Most parameters (including age, body mass index, systolic blood pressure, diastolic blood pressure, alanine aminotransferase, total bilirubin, blood urea nitrogen, creatinine, uric acid, triglycerides and WBC count) were significantly higher in men than in women. Bilirubin displayed significant negative relationships with most other measured variables. Linear logistic regression analysis further indicated their negative relationships. Females showed a significantly higher frequency of leucopenia than males. Significant associations of leucopenia with high bilirubin quartiles were shown in binary logistic regression models for both sexes, with a much closer association in men than in women. For instance, for men with bilirubin levels in quartile 4, the adjusted likelihood of leucopenia was 1.600-times higher than that of men with values in quartile 1. For women with bilirubin levels in quartile 4, the adjusted likelihood of leucopenia was 1.135-times higher than that of women with values in quartile 1.

CONCLUSION

Bilirubin is negatively related to WBC count. Significant associations exist between leucopenia and high bilirubin quartiles, and these associations are more obvious in men than in women.

Potential impact of the joint association of total bilirubin and gamma-glutamyltransferase with metabolic syndrome

BACKGROUND

Metabolic syndrome is characterized by the clustering of different metabolic abnormalities. Total bilirubin and gamma-glutamyltransferase (GGT) levels have been reported to be associated with this condition. However, the extent to which the interaction between these parameters affects metabolic syndrome is unknown. Therefore, we examined the association of total bilirubin and GGT levels with metabolic syndrome, and investigated the combined effect of the two parameters.

METHODS

In this retrospective cohort study, we analyzed 8992 middle-aged Japanese subjects (4586 men, 4406 women; mean age, 44.8 ± 9.3 years) without metabolic syndrome from a cohort of employees undergoing annual health examinations. They were divided into four groups according to median total bilirubin and GGT levels: both-low, GGT-high, total bilirubin-high, and both-high. The incident of metabolic syndrome was evaluated during a follow-up of 2.8 ± 1.2 years.

RESULTS

The incident rate of metabolic syndrome during the follow-up was 4.6% in the both-low group, 12.1% in the GGT-high group, 2.7% in the total bilirubin-high group, and 10.6% in the both-high group. Total bilirubin and GGT have an interaction effect on the risk of incident metabolic syndrome (p = 0.0222). The both-low [hazard ratio (HR), 1.37; 95% confidence interval (CI) 1.002-1.89], GGT-high (HR, 1.88; 95% CI 1.42-2.52), and both-high (HR, 2.07; 95% CI 1.56-2.80) groups showed an increased adjusted HR for incident metabolic syndrome after adjusting for covariates compared with the total bilirubin-high group.

CONCLUSIONS

The simultaneous presence of high total bilirubin and low GGT levels may be associated with a lower incidence of metabolic syndrome.

Gender- and Age-Specific Differences in the Association of Hyperuricemia and Hypertension: A Cross-Sectional Study

OBJECTIVE

Both hyperuricemia and hypertension have important clinical implications, but their relationship in terms of gender and age is still a matter of debate. In this study, we aimed to explore gender- and age-specific differences in this association between hyperuricemia and hypertension in a Chinese population.

METHODS

A total of 78596 ostensibly healthy subjects (47781 men and 30815 women) were recruited. The association between hyperuricemia and hypertension was analyzed by multivariate logistic regression, and the analyses were stratified by gender and age.

RESULTS

Overall prevalence of hypertension and hyperuricemia was significantly higher in males than in females. Increasing trends of hypertension prevalence in both genders as well as hyperuricemia prevalence in females were found along with aging. However, males showed a reduced trend in hyperuricemia prevalence with aging. Higher hypertension and hyperuricemia prevalence was found in young and middle-aged men than in women, but not in elderly people older than 70 years. Significantly increased risk of hypertension from hyperuricemia was found only in men with an adjusted odds ratio of 1.131 (P < 0.01), especially in the middle-aged male participants. However, such significant results were not found in women. Similarly, hyperuricemia was also an independent risk factor of increased systolic blood pressure and diastolic blood pressure in males, but not in females.

CONCLUSION

We observed significantly higher overall prevalence of hyperuricemia and hypertension in men than in women. Men with hyperuricemia (particularly in middle age) had a significantly increased susceptibility of hypertension, while this significant association was not observed in women.

Gender-Specific Differences on the Association of Hypertension with Subclinical Thyroid Dysfunction

OBJECTIVE

Both hypertension and subclinical thyroid dysfunction (STD) have high prevalence and clinical importance, but their relationship is still a matter of debate. We aimed to explore gender-specific difference on the association between hypertension and STD in Chinese.

METHODS

We recruited 13,380 ostensible healthy participants (8,237 men and 5,143 women). The associations between hypertension and STD were analyzed on a gender-based setting after dividing STD into subclinical hypothyroidism, subclinical hyperthyroidism and further subgrouped euthyroidism. Crude and adjusted odds ratios of STD for hypertension were analyzed by binary logistic regression.

RESULTS

An increasing trend of hypertension prevalence was found along with aging in both genders. Yet, higher male hypertension prevalence was found until 65 years, and then it intersected with female hypertension prevalence. Women had significantly higher propensity for STD than men. Yet, in elderly participants, this gender-specific difference became less obvious. We displayed detrimental effects for subclinical hypothyroidism in both genders after multiple-covariate adjustments, yet no such effects were shown for subclinical hyperthyroidism. Moreover, females with subclinical hypothyroidism were more likely to be associated with hypertension than males, and the corresponding odds ratios were 1.619 (P < 0.01) and 1.557 (P < 0.01) and 1.557 (P < 0.01) and 1.557 (P < 0.01) and 1.557 (P < 0.01) and 1.557 (P < 0.01) and 1.557 (.

CONCLUSION

We demonstrate that hypertension is associated with subclinical hypothyroidism, but not with subclinical hyperthyroidism. Moreover, females with subclinical hypothyroidism are more likely to be associated with hypertension than males.

Gender impact on the correlations between Graves' hyperthyroidism and hyperuricemia in Chinese

OBJECTIVE

An increased level of serum uric acid (SUA) can be observed in patients with hypothyroidism. Nonetheless, data on the relationship between hyperuricemia and hyperthyroidism was still controversial. Thus, we aimed to analyze the association between Graves' hyperthyroidism and hyperuricemia in Chinese men and women.

METHODS

We recruited 103 male and 254 female patients with Graves' hyperthyroidism, as well as the same number of control subjects. Anthropometric measurements and fasting blood tests were collected and analyzed statistically by binary logistic regressions to determine the risk of developing hyperuricemia in hyperthyroidism.

RESULTS

SUA levels in males were significantly higher than that in females in both patients and controls. SUA levels were also significantly increased in hyperthyroid patients compared to in controls in both genders. The incidence of hyperuricemia rose significantly in subjects with hyperthyroidism with a higher prevalence in males than in females. SUA was negatively correlated with age and fasting glucose in male hyperthyroid patients, while it was positively correlated with body height, body weight, free triiodothyronine, and free thyroxine in female patients. Hyperthyroidism was a risk factor for hyperuricemia with an odd ratio of 4.536 for men and 2.730 for women.

CONCLUSIONS

For hyperuricemia, hyperthyroidism was an important risk factor that should not be neglected, especially for men.

No associations exists between red blood cell distribution width and serum uric acid in both sexes

The aim of this study was to determine whether there was a significant association between red blood cell distribution width (RDW) and uric acid (UA) in a large Chinese population.This was a cross-sectional study with an enrollment of 80,298 ostensibly healthy participants (48,971 males, 31,327 females) during the period from 2011 to 2015. In the study, database was grouped by sex and the association between RDW and UA was analyzed by quartiles of RDW.UA values between different sexes and RDW subgroups were analyzed by 2-way analysis of variance and Bonferroni t tests. Prevalence of hyperuricemia in different sexes was calculated. The relationship between risks of hyperuricemia and RDW level was analyzed by binary logistic regression with or without adjustment for age and body mass index.UA values were not all the same between different sexes and RDW subgroups. Males had significantly higher hyperuricemia prevalence than females (20.00% vs 6.48%, P < .01). In addition, hyperuricemia prevalence in males decreased slightly across RDW quartiles, but was stable in females. No significant association between hyperuricemia risk and RDW was found in both sexes according to the results of multivariate logistic regression analysis. Similarly, negative results were also observed in multivariate linear analysis when both RDW and UA were considered as continuous variable.We could not find any significant relationship between RDW and UA in both sexes.

Relationship between mean platelet volume and metabolic syndrome in Chinese patients

Mean platelet volume (MPV) is a determinant of activation and variability of platelets (PLT). The focus of this study was to to investigate MPV values in patients with and without metabolic syndrome (MS). It also evaluates the association between them. There are close connections among MPV, MS, and cardiometabolic risk. We compiled age, body mass index, blood cell counts, MPV, and other data of 59976 self-reported healthy volunteers (28428 male, 31548 female), 24.65% of who have MS. The mean age of the group was 48.21 years old. The data was grouped by sex and values of data between men and women groups were analyzed by independent sample’s t-test. The relationship between sex and MS was evaluated by chi-square tests. Crude odd ratios of MS between MPV quartiles and 95% confidence intervals were analyzed by binary logistic regression in this study. We found women had higher levels of MPV (10.09 vs. 9.98, P < 0.01) and PLT (228.68 vs. 212.11, P < 0.01) than men. In females, the prevalence of MS was higher in low MPV group than in high MPV groups. The odds of having MS were significantly lower in higher MPV quartiles compared with MPV Quartile 1 in women (Adjusted OR < 1, P < 0.01). This study indicated that MS was inversely associated with MPV in females only.

The association between total bilirubin and serum triglyceride in both sexes in Chinese

OBJECTIVE

Dyslipidemia can cause some chronic diseases. Bilirubin is reported to have anti-inflammatory and anti-oxidant properties. We aimed to explore the relationship between triglyceride and total bilirubin (TB) in a large Chinese cohort.

METHODS

A total of 80,298 healthy Chinese (48,971 male, 31,327 female) enrolled in this cross-sectional study. Clinical data were collected from participants. Database was divided according to sex and age. The relationship between triglyceride and TB was analyzed by quartiles of TB. Levels of triglyceride were compared in different TB subgroups by one-way analysis of variance and independent sample's t-test. Crude and adjusted odds ratios of triglyceride for TB with 95% confidence intervals were analyzed by binary logistic regression models.

RESULTS

Overall, men showed higher levels of TB and triglyceride than women. In people older than 60 years, women had higher triglyceride levels than men. Linear logistic regression analyses showed a negative relationship between triglyceride and TB in both genders. Men showed significantly higher overall incidence of high triglyceride than women. Men less than 60 years old showed a higher incidence of high triglyceride. For women older than 60 years, the incidence of high triglyceride was higher. However, high TB showed no protective effects on both genders from high TG in the binary logistic regression models. TB showed a detrimental effect on high TG in model 2 which included TB as a covariate. But that effect disappeared after other confounding factors were included.

CONCLUSIONS

Our findings showed no association between TB and triglyceride in Chinese.

Waist Circumference and Subclinical Thyroid Dysfunction in a Large Cohort of Chinese Men and Women

OBJECTIVE

The association between subclinical thyroid dysfunction and waist circumference (WC) is still controversial, especially from the perspective of sex differences. We aimed to explore the impact of sex on this relationship in a large Chinese cohort.

METHODS

This cross-sectional study recruited 13,505 healthy participants (8,346 males, 5,159 females) who were enrolled in a health check program. Clinical data were collected. The association between subclinical thyroid dysfunction and WC of both sexes was analyzed separately after dividing WC into quartiles. Odds ratios (ORs) were calculated by binary logistic regression models, and linear regression analysis was also performed.

RESULTS

The prevalence rates of subclinical hyper-and hypothyroidism were significantly lower in males. Binary logistic regression models showed that WC in females with subclinical hypothyroidism had a detrimental effect with an OR of 1.011, but the effect disappeared when we included other covariates. The other ORs indicated no significant effects. The weak negative relationship between WC and thyrotropin was also indicated by linear regression analyses with very low R² values.

CONCLUSION

The current research did not show WC as a risk factor for subclinical thyroid dysfunction in either sex. Regional and ancestral origin differences may account for the variations with other studies.

ABBREVIATIONS

ALT = alanine aminotransferase; BMI = body mass index; FT3 = free triiodothyronine; FT4 = free thyroxine; TG = triglycerides; TSH = thyroid-stimulating hormone; UA = uric acid; WC = waist circumference.

Association between Serum Liver Enzymes and Metabolic Syndrome in Korean Adults

The purpose of this study was to evaluate the association between alanine aminotransferase (ALT) and aspartate aminotransferase (AST), and metabolic syndrome (MS) in the Korean population. A total of 11,587 adults ≥30 years of age and with complete data were selected from Korea National Health and Nutrition Examination Survey VI conducted from 2013 to 2015. Normal ALT and AST levels were divided into quartiles, and their associations with MS were assessed by logistic regression analysis. Elevated levels of ALT [adjusted odds ratio (aOR) = 7.90, 95% confidence interval (CI) = 6.50–9.60] and AST (aOR = 3.81, 95% CI = 3.10–4.74) were both significantly associated with a higher prevalence of MS. The quartile group containing the highest levels of ALT and AST within the normal range also showed an increased risk of MS and its components. Elevated levels of ALT and AST, even within the normal range, were associated with prevalence of MS.

Infectious mononucleosis and hepatic function

Abnormal hepatic function is common in infectious mononucleosis (IM). However, it remains unknown why increased transferase levels are more common than bilirubin abnormalities in IM. The current study aimed to investigate these associations in the Chinese population. A total of 95 patients with IM (47 males and 48 females) were enrolled in the current study, as well as 95 healthy controls. Patients were sorted by sex. A receiver operating characteristic (ROC) curve was used to determine cut-off values for IM diagnosis and prediction. Crude and adjusted odds ratios (OR) for IM were analyzed using binary logistic regression. It was determined that alanine aminotransferase (ALT), aspartate aminotransferase (AST) and γ-glutamyl transferase (GGT) levels were significantly higher in patients with IM compared with controls; however, total bilirubin (TB) levels were significantly lower in patients with IM. ROCs demonstrated that, if ALT, AST and GGT concentrations were higher than, or if TB was lower than, cut-off values, they were predictive of IM. Binary logistic regression identified that the risk of IM in patients exhibiting high levels of transferases was significantly increased, particularly in males. Crude ORs in ALT quartile 4 were 21.667 and 10.111 for males and females, respectively and adjusted ORs were 38.054 and 9.882, respectively. A significant IM risk of IM was evident in patients with low bilirubin levels and females appeared to be particularly susceptible. For example, crude ORs in quartile 1 were 8.229 and 8.257 for males and females, respectively and adjusted ORs were 8.883 and 10.048, respectively. Therefore, the current study identified a positive association between transferase levels and IM and a negative association between TB and IM. Therefore, the results of the current study indicate that high transferases are suggestive of IM, particularly in males, whereas low TB is suggestive for IM, particularly in females.