Association between raised blood pressure and elevated serum liver enzymes among active-duty Royal Thai Army personnel in Thailand

Lifestyle factors modified the mediation role of liver fibrosis in the association between occupational physical activity and blood pressure

Objectives

The study aimed to estimate the role of liver fibrosis in the association between occupational physical activity (OPA) and blood pressure (BP), which is modified by lifestyle factors.

Methods

The questionnaire survey and physical examination were completed among 992 construction workers in Wuhan, China. Associations between OPA or lifestyle factors and liver fibrosis indices and blood pressure were assessed using generalized additive models. The mediation analysis was used to evaluate the role of liver fibrosis in the association between OPA and lifestyle factors and BP.

Results

Moderate/high OPA group workers had an increased risk of liver fibrosis [odds ratio (OR) = 1.69, 95% confidence intervals (CI): 1.16-2.47, P < 0.05] compared with low OPA group workers. Smoking or drinking alcohol was related to liver fibrosis (aspartate aminotransferase to platelet ratio index: OR = 2.22, 95% CI: 1.07-4.62 or OR = 2.04, 95% CI: 1.00-4.15; P < 0.05). Compared with non-drinkers, drinkers were related to a 2.35-mmHg increase in systolic blood pressure (95% CI: 0.09-4.61), and a 1.60-mmHg increase in diastolic blood pressure (95% CI: 0.08-3.13; P < 0.05). We found a significant pathway, "OPA → liver fibrosis → blood pressure elevation," and lifestyle factors played a regulatory role in the pathway.

Conclusion

OPA or lifestyle factors were associated with liver fibrosis indices or BP in construction workers. Furthermore, the association between OPA and BP may be partially mediated by liver fibrosis; lifestyle factors strengthen the relationship between OPA and BP and the mediation role of liver fibrosis in the relationship.

The relationship between liver enzymes, prehypertension and hypertension in the Azar cohort population

BACKGROUND

The incidence of hypertension (HTN) as a worldwide health problem is rising rapidly. Early identification and management of pre-HTN before HTN development can help reduce its related complications. We evaluated the relationship between liver enzymes levels and pre-HTN/HTN in the Azar cohort population.

METHOD

This cross-sectional study was based on data from the large Azar cohort study and a total of 14,184 participants were included. Pre-HTN and HTN were defined based on the American Heart Association guideline. Serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT) levels were measured by Pars Azmoon kits. The relationship between pre-HTN/HTN and liver enzyme levels was evaluated by logistic regression.

RESULTS

Of 14,184 participants, 5.7% and 39.6% had pre-HTN and HTN, respectively. In the adjusted model, AST levels of 19-23 IU/l were associated with an elevated risk of pre-HTN (OR [95% CI]: 1.24 [1.04-1.48]). A dose-response increase was seen in pre-HTN in relation to ALT, with the highest OR in the third tertile (1.34 [1.09-1.63]). The odds of pre-HTN also increased with GGT in the third tertile (1.25[1.03-1.52]). In addition, the odds of HTN increased with increased levels of AST, ALT, ALP, and GGT, such that the highest ORs were recorded in the third tertile (OR 1.22 [1.09-1.37], 1.51 [1.35-1.70], 1.19 [1.07-1.34], and 1.68 [1.49-1.89], respectively). Among these enzymes, GGT had the highest OR regarding HTN.

CONCLUSION

This study indicates that AST, ALT, ALP and GGT levels were associated with pre-HTN (except for ALP) and HTN, independent of known risk factors. Hence, it may be possible to use liver enzymes to predict the incidence of pre-HTN and HTN, empowering primary care providers to make the necessary interventions promptly.

Associations of triglyceride-glucose index with hyperuricemia among Royal Thai Army personnel

BACKGROUND

Hyperuricemia has placed an immense burden on the global healthcare system. Studies have discovered a close correlation between serum uric acid (SUA) and insulin resistance (IR). The objective of this investigation is to examine the association between the triglyceride-glucose (TyG) index, a simple surrogate for IR, and the presence of hyperuricemia.

METHODS

Between 2017 and 2021, an epidemiologic study was conducted on Royal Thai Army (RTA) personnel aged 35-60 years, involving a total of 231,286 participants. In the study, hyperuricemia was defined as a SUA level of 7 mg/dL and 6 mg/dL among male and female participants, respectively. Using linear regression analysis and logistic regression analysis, the association between the TyG index and SUA was determined.

RESULTS

A positive relationship was demonstrated between the TyG index and the SUA. Overall, SUA increased by 0.32 per unit of TyG index growth (95% CI: 0.31-0.32). In comparison with the first quartile, employees in the fourth TyG quartile had a greater likelihood of having hyperuricemia [adjusted odds ratio (AOR): 2.45, 95% CI: 2.38-2.52]. Effect modification by obesity on the association between the TyG index and SUA was observed (P-interaction < 0.001). Among individuals with obesity, compared with the first TyG index quartile, the AOR for hyperuricemia was 2.15 (95% CI: 2.06-2.25) and 2.14 (95% CI: 1.81-2.53) for the fourth quartile of the TyG index for males and females, respectively. However, for nonobese personnel, in comparison to the top quartile of the TyG index, the AOR for hyperuricemia was 2.73 (95% CI:2.61-2.84) and 5.03 (95% CI: 4.03-6.29) for the fourth quartile of the TyG index for males and females, respectively. Personnel in the fourth TyG index quartile revealed that the prevalence of hyperuricemia reached 44.2%.

CONCLUSION

A robust positive association between the TyG index and SUA was illustrated among active-duty RTA personnel. Obesity was identified as a modifier influencing this relationship. Furthermore, individuals in the fourth quarter of the TyG index, regardless of their obesity status, could be considered appropriate candidates for screening SUA levels.

Relationship between triglyceride-glucose index and aminotransferase among Royal Thai Army personnel 2017-2021: a serial cross-sectional study

BACKGROUND

Insulin resistance (IR) is a major pathogenesis of nonalcoholic fatty liver disease (NAFLD). The triglyceride-glucose (TyG) index has recently gained popularity to assess IR and NAFLD due to its simplicity and low cost. The aim of the current study was to evaluate the relationship between the TyG index and aminotransferase.

METHODS

A serial cross-sectional study was conducted among 232,235 Royal Thai Army (RTA) personnel aged 35-60 years from 2017-2021. Elevated aminotransferase was defined as ≥ 40 U/L and ≥ 35 U/L among males and females, respectively. A linear regression analysis between the TyG index and log-transformed aminotransferase was performed. High- and low-TyG index groups were divided according to Youden's index cut point for predicting elevated aminotransferase. Multivariable logistic analysis was also utilized to investigate the association between the TyG index and elevated aminotransferase.

RESULTS

The TyG index revealed a dose‒response relationship with log-transformed aminotransferase in both sexes and all age groups. The TyG index was positively associated with the prevalence of elevated aminotransferases. In comparison with the first TyG quartile (< 8.37), participants in the fourth quartile (> 9.23) had a higher chance for elevated ALT (AOR: 2.81, 95% CI: 2.71-2.90 for males and AOR: 4.01, 95% CI: 3.50-4.60 for females, P < 0.001 for both). In the fourth TyG quartile, the prevalence of elevated ALT was 47.8% and 40.2% in the participants aged 35-44 and male participants, respectively.

CONCLUSION

A high TyG index is a novel risk factor for elevated aminotransferase among RTA personnel. Those with a high TyG index should be screened for elevated aminotransferase, particularly males aged 35-44 years.