Liver function test changes in centrally obese youth with metabolic syndrome in a Serbian population

Homocysteine is the confounding factor of metabolic syndrome-confirmed by siMS score

BACKGROUND

Abdominal adiposity has a central role in developing insulin resistance (IR) by releasing pro-inflammatory cytokines. Patients with metabolic syndrome (MS) have higher values of homocysteine. Hyperhomocysteinemia correlates with IR, increasing the oxidative stress. Oxidative stress causes endothelial dysfunction, hypertension and atherosclerosis. The objective of the study was to examine the correlation of homocysteine with siMS score and siMS risk score and with other MS co-founding factors.

METHODS

The study included 69 obese individuals (age over 30, body mass index [BMI] >25 kg/m2), classified into two groups: I-with MS (33 patients); II-without MS (36 patients). Measurements included: anthropometric parameters, lipids, glucose regulation parameters and inflammation parameters. IR was determined by homeostatic model assessment for insulin resistance (HOMA-IR). ATP III classification was applied for diagnosing MS. SiMS score was used as continuous measure of metabolic syndrome.

RESULTS

A significant difference between groups was found for C-reactive protein (CRP) (p<0.01) apolipoprotein (Apo) B, HOMA-IR and acidum uricum (p<0.05). siMS risk score showed a positive correlation with homocysteine (p=0.023), while siMS score correlated positively with fibrinogen (p=0.013), CRP and acidum uricum (p=0.000) and homocysteine (p=0.08). Homocysteine correlated positively with ApoB (p=0.036), HbA1c (p=0.047), HOMA-IR (p=0.008) and negatively with ApoE (p=0.042).

CONCLUSIONS

Correlation of siMS score with homocysteine, fibrinogen, CRP and acidum uricum indicates that they are co-founding factors of MS. siMS risk score correlation with homocysteine indicates that hyperhomocysteinemia increases with age. Hyperhomocysteinemia is linked with genetic factors and family nutritional scheme, increasing the risk for atherosclerosis.

Positive Effect of Fermented Camel Milk on Liver Enzymes of Adolescents with Metabolic Syndrome: a Double Blind, Randomized, Cross-over Trial

Background:

Metabolic syndrome (MetS) has several health consequences. Liver enzymes elevation is among them.

Aim:

This study aimed to assess the effects of fermented Camel milk (FCM), as a functional food and dairy, on some features of MetS in adolescents including liver enzymes status, serum lipids and anthropometric measures.

Methods:

Overweight/obese adolescents with MetS were randomly assigned to FCM 250 cc per day for 8 weeks, a 4-week washout, and then to diluted Cow’s yogurt (DCY) 250 cc per day for 8 weeks, or the reverse sequence. Anthropometric measures, liver enzymes and serum lipids were measured just before and after each one of the four periods. A three-day food record and physical activity questionnaire were completed before each period. Statistical analyses were done using Minitab and SPSS soft-wares considering the significance level of 0.05.

Results:

Twenty-four participants with a mean age (SD) of 13.77 (1.87) years (range: 10.45-16.25) (58% girls) completed the study. It resulted significant mean reduction of aspartate aminotransferase (AST) (-3.75 U/L [95% CI: -7.06; -0.43]; p=0.042) and alanine aminotransferase (ALT) (-2.54 U/L [95% CI: -3.33; -2.24], and p=0.006) and AST/ALT ratio (-0.16 U/L [95% CI: -0.28; -0.05]; p= 0.029) by FCM consumption in comparison to DCY. Non-significant favorable effects on anthropometric measures and serum lipids were seen as well.

Conclusion:

According to the observed favorable effects of fermented camel milk on liver enzymes, its consumption may be considered as a functional food supplement in related circumstances.

γ-glutamyl transpeptidase in men and alanine aminotransferase in women are the most suitable parameters among liver function tests for the prediction of metabolic syndrome in nonviral hepatitis and nonfatty liver in the elderly

BACKGROUND/AIMS

Nonalchoholic fatty liver disease (NAFLD) has been reported as a hepatic manifestation of metabolic syndrome (MetS); it is common and accounts for 80% of the cases with abnormal liver function tests (LFTs). In addition, several studies have proved that there is a correlation between abnormal LFTs and MetS. Therefore, LFTs may represent the abnormal metabolic status of livers in the patients with MetS. To identify the early state of metabolic dysfunction, we investigate the value of LFTs for the future MetS development in the relatively healthy (non-NAFLD) elderly.

PATIENTS AND METHODS

A total of 16,912 subjects met the criteria for analysis. In the first stage of this study, subjects were enrolled in the cross-sectional study in order to find out the optimal cutoff value in different LFTs with higher chances to have MetS. In the second stage of the present study, subjects with MetS at baseline were excluded from the same study group, and a median 5.6-year longitudinal study was conducted on the rest of the group.

RESULTS

Among all LFTs, only aspartate aminotransferase in both genders and the α-fetal protein in women failed to show the significance in distinguishing subjects with MetS by the receiver operating characteristic curve. In the Kaplan-Meier plot, only γ-glutamyl transpeptidase (γ-GT) in men and the alanine aminotransferase (ALT) in women could be used to successfully separate subjects with higher risk of developing the MetS from those with lower risk. Finally, in the multivariant Cox regression model, similar results were identified. Still, the hazard ratio (HR) to have future MetS, γ-GT in men, and ALT in women showed significance (HR = 1.511 in men and 1.504 in women).

CONCLUSION

Among all the different LFTs, γ-GT (>16 U/L) in male and ALT (>21 U/L) in female were the best predictors for the development of MetS in healthy elderly. These two liver markers could be an ancillary test in predicting future MetS development/diagnosis. Elevation of the LFTs without underlying liver diseases should be treated as a warning sign of the possible MetS development in the elderly.

Can "healthy" normal alanine aminotransferase levels identify the metabolically obese phenotype? Findings from the Korea national health and nutrition examination survey 2008-2010

BACKGROUND

There is no established parameter with which to screen metabolically obese phenotypes.

AIM

The aim of the study was to revise the upper limit of normal (ULN) of serum alanine aminotransferase (ALT) and to investigate the predictive value of updated ALT levels for metabolic obese phenotype stratified according to body mass index (BMI).

METHODS

We analyzed a nationally representative data from the Fourth Korea National Health and Nutrition Examination Survey. This cross-sectional study included 2,416 healthy people aged 33.9 ± 0.3 years. The ULN of healthy ALT level was set at the 95th percentile of the healthy population. A metabolic obese phenotype was defined as having insulin resistance or metabolic syndrome. A logistic regression analysis was performed to assess the odds ratio for a metabolic obese phenotype according to the healthy ALT level.

RESULTS

The revised ULN of serum ALT level in healthy participants were 30 IU/L and 22 IU/L for males and females, respectively. Serum ALT level was higher in individuals with metabolic obesity compared with those without metabolic obesity in both genders, stratified according to BMI. After adjusting for age, BMI, smoking, alcohol drinking, and regular physical activity, unhealthy normal ALT levels (males 30-40 IU/L, females 22-40 IU/L) were significantly associated with metabolic obesity, especially in both obese and non-obese women.

CONCLUSIONS

A newly revised threshold for ALT is proposed as a simple clinical metabolic parameter that can identify a metabolic obese phenotype. We suggest that people with unhealthy normal ALT levels may need further investigation for the presence of metabolic obesity.