1
|
Ghotbi S, Joukar F, Orang Goorabzarmakhi M, Shahdkar M, Maroufizadeh S, Mojtahedi K, Asgharnezhad M, Naghipour M, Mansour-Ghanaei F. Evaluation of elevated serum liver enzymes and metabolic syndrome in the PERSIAN Guilan cohort study population. Heliyon 2024; 10:e32449. [PMID: 38961895 PMCID: PMC11219353 DOI: 10.1016/j.heliyon.2024.e32449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 06/01/2024] [Accepted: 06/04/2024] [Indexed: 07/05/2024] Open
Abstract
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.
Collapse
Affiliation(s)
- Saideh Ghotbi
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Farahnaz Joukar
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | | | - Milad Shahdkar
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Saman Maroufizadeh
- Department of Biostatistics, School of Health, Guilan University of Medical Sciences, Rasht, Iran
| | - Kourosh Mojtahedi
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Mehrnaz Asgharnezhad
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Mohammadreza Naghipour
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Fariborz Mansour-Ghanaei
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| |
Collapse
|
2
|
Raya-Cano E, Molina-Luque R, Vaquero-Abellán M, Molina-Recio G, Jiménez-Mérida R, Romero-Saldaña M. Metabolic syndrome and transaminases: systematic review and meta-analysis. Diabetol Metab Syndr 2023; 15:220. [PMID: 37899468 PMCID: PMC10614379 DOI: 10.1186/s13098-023-01200-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/24/2023] [Indexed: 10/31/2023] Open
Abstract
BACKGROUND Metabolic syndrome (MetS) is a group of metabolic abnormalities characterised by hypertension, central obesity, dyslipidaemia and dysregulation of blood glucose, associated with the risk of diabetes, cardiovascular disease and overall mortality. The presence of elevated liver enzymes may precede the development of MetS, with alterations of the liver being observed that are directly related to metabolic problems. The study aims to provide the best evidence on the association between liver enzymes (ALT, AST, GGT) and MetS by determining the effect size of these biomarkers. METHODS A systematic review and meta-analysis of studies indexed in PubMed and Scopus databases were performed. Study quality was assessed using the STROBE tool. The Grade Pro tool was used to evaluate the evidence, and the quantitative synthesis was performed using RevMan (Cochrane Collaboration). RESULTS Seventeen articles comparing liver enzyme concentrations between 76,686 with MetS (MetS+) and 201,855 without MetS (MetS-) subjects were included. The concentration of ALT, AST and GGT in the MetS + subjects was significantly higher than in the control group 7.13 IU/L (CI95% 5.73-8.54; p < 0.00001; I2 = 96%), 2.68 IU/L (CI95% 1.82-3.54; p < 0.00001; I2 = 96%) and 11.20 IU/L (CI95% 7.11-15.29; p < 0.00001; I2 = 96%), respectively. CONCLUSIONS The evaluation of the relationship of liver enzymes in the pathophysiological process of MetS could lead to new insights into early diagnosis.
Collapse
Affiliation(s)
- Elena Raya-Cano
- Faculty of Medicine and Nursing, University of Córdoba, Avd. Menéndez Pidal N/N, Córdoba, 14004, Spain
| | - Rafael Molina-Luque
- Faculty of Medicine and Nursing, University of Córdoba, Avd. Menéndez Pidal N/N, Córdoba, 14004, Spain.
- Lifestyles, Innovation and Health (GA-16), Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba, Spain.
| | - Manuel Vaquero-Abellán
- Faculty of Medicine and Nursing, University of Córdoba, Avd. Menéndez Pidal N/N, Córdoba, 14004, Spain
| | - Guillermo Molina-Recio
- Faculty of Medicine and Nursing, University of Córdoba, Avd. Menéndez Pidal N/N, Córdoba, 14004, Spain
- Lifestyles, Innovation and Health (GA-16), Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba, Spain
| | - Rocío Jiménez-Mérida
- Faculty of Medicine and Nursing, University of Córdoba, Avd. Menéndez Pidal N/N, Córdoba, 14004, Spain
| | - Manuel Romero-Saldaña
- Faculty of Medicine and Nursing, University of Córdoba, Avd. Menéndez Pidal N/N, Córdoba, 14004, Spain
- Lifestyles, Innovation and Health (GA-16), Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba, Spain
| |
Collapse
|
3
|
Liu L, Shao Y, Feng E, Shao Z, Xing D. Individual and combined associations of alanine aminotransferase and hemoglobin with metabolic syndrome in the elderly in Qingdao, China. Front Med (Lausanne) 2023; 10:1152747. [PMID: 37621460 PMCID: PMC10445138 DOI: 10.3389/fmed.2023.1152747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 07/17/2023] [Indexed: 08/26/2023] Open
Abstract
Background and aims Combined associations of alanine aminotransferase (ALT) and hemoglobin (Hb) with metabolic syndrome (MetS) have not been assessed yet. The current study investigated the independent and combined relationships between ALT, Hb, and MetS in the elderly. Methods The 37,966 elderly participants aged 65 years and older were recruited from community centers in Qingdao, China. The sampled elderly population visited the health centers once a year where they were offered a free health checkup. Based on a combination of ALT and Hb levels categorized by tertile, participants were grouped into nine groups (Group 1-9). Logistic regression models were used to analyze the individual and combined associations of ALT and Hb with MetS. Results ALT and Hb were both independently related to MetS in both genders. With the elevation of ALT or Hb levels, risks for MetS and its components increased. Compared to the reference group (the 1st tertiles of both ALT and Hb levels), respective odds ratio of combined ALT and Hb for MetS in Group 2-9 ranged from 1.32-3.38 and 1.14-2.31 in men and women after adjusting for age, sex, education, married status, current smoking, current drinking, physical activity, and diet habit. Conclusion ALT and Hb were both independently related to MetS and its components. Combined ALT and Hb levels could increase risks of MetS and its components than an elevation in ALT or Hb alone.
Collapse
Affiliation(s)
- Li Liu
- Cancer Institute, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, Shandong, China
- Qingdao Cancer Institute, Qingdao, Shandong, China
- Qingdao Municipal Center for Disease Control and Prevention, Qingdao, Shandong, China
- Qingdao Institute of Preventive Medicine, Qingdao, Shandong, China
| | - Yuhan Shao
- Qingdao Municipal Center for Disease Control and Prevention, Qingdao, Shandong, China
- Qingdao Institute of Preventive Medicine, Qingdao, Shandong, China
| | - Enqiang Feng
- Qingdao Municipal Center for Disease Control and Prevention, Qingdao, Shandong, China
- Qingdao Institute of Preventive Medicine, Qingdao, Shandong, China
| | - Zhugang Shao
- Shandong Muhua Medical Technology Co., Ltd., Qingdao, Shandong, China
| | - Dongming Xing
- Cancer Institute, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, Shandong, China
- Qingdao Cancer Institute, Qingdao, Shandong, China
- School of Life Sciences, Tsinghua University, Beijing, China
| |
Collapse
|
4
|
Chu LM, Karunanayake C, Aich P, Hecker M, Pahwa P. Association between liver enzymes and metabolic syndrome in Canadian adults: results from the Canadian health measures survey - cycles 3 &4. J Diabetes Metab Disord 2022; 21:1699-1708. [PMID: 36404860 PMCID: PMC9672191 DOI: 10.1007/s40200-022-01124-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 09/06/2022] [Indexed: 10/14/2022]
Abstract
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.
Collapse
Affiliation(s)
- Luan Manh Chu
- Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, Canada
| | - Chandima Karunanayake
- Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, Canada
| | - Palok Aich
- School of Biological Sciences, National Institute of Science Education and Research (NISER), HBNI, PO Jatni, Khurda, Odisha 752050 India
| | - Markus Hecker
- School of Environment & Sustainability & Toxicology Centre, University of Saskatchewan, Saskatoon, Canada
| | - Punam Pahwa
- Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, Canada
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Canada
| |
Collapse
|
5
|
Aliabadi PK, Sohrab M, Hessami A, Afshari M, Kashi Z, Kheradmand M, Hedayatizadeh-Omran A, Alizadeh-Navaei R, Moosazadeh M. Association between liver enzymes and metabolic syndrome: results of the enrollment phase of Tabari cohort. Ir J Med Sci 2022; 191:1201-1208. [PMID: 34170477 DOI: 10.1007/s11845-021-02694-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 05/06/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND The association between liver enzymes and metabolic syndrome (MetS) has been evaluated in several studies with different results. The purpose of this study is to determine the association between the serum levels of these liver enzymes and MetS in Tabari cohort population. METHOD In this case-control study, data collected from the enrolment phase of the Tabari cohort population have been used. MetS was defined based on IDF (international diabetes federation) standards. Then, 476 patients with MetS (case group) and 476 age-sex matched controls were selected randomly. RESULTS Mean aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels were higher in case group than control group (20.59 vs. 19.99 respectively, p = 0.339 and 24.64 vs. 20.16 respectively, p < 0.001). The chance of having MetS, high triglyceride, and fasting blood glucose (FBG) was significantly higher in people with ALT ≥ 40 (1.63, 2.35, and 2.02, respectively). The chance of having MetS in people with AST ≥ 40 was 1.45 times higher than that among those with normal AST level (p > 0.05). CONCLUSION This study showed that there is an association between liver enzymes and MetS as well as some of its components. Liver enzymes, especially ALT, can be used as an early indicator of MetS in the at risk population.
Collapse
Affiliation(s)
| | - Mehrnoush Sohrab
- Diabetes Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Amirhossein Hessami
- Student Research Committee, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mahdi Afshari
- Pediatric Gastroenterology and Hepatology Research Center, Zabol University of Medical Sciences, Zabol, Iran
| | - Zahra Kashi
- Diabetes Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Motahareh Kheradmand
- Health Sciences Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | | | - Reza Alizadeh-Navaei
- Gastrointestinal Cancer Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mahmood Moosazadeh
- Gastrointestinal Cancer Research Center, Mazandaran University of Medical Sciences, Sari, Iran.
| |
Collapse
|
6
|
Musa NI, Safwat E, Abdelhakam SM, Farid AM, Hetta WM. Noninvasive tool for the diagnosis of NAFLD in association with atherosclerotic cardiovascular risk. EGYPTIAN LIVER JOURNAL 2019. [DOI: 10.1186/s43066-019-0002-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Abstract
Background
Whether the severity of liver histology in non-alcoholic fatty liver disease (NAFLD) is associated with more pronounced cardiovascular disease is unsettled. There is a need to develop a noninvasive tool to help its diagnosis in association with atherosclerotic cardiovascular disease. We aimed to evaluate the diagnostic performance of NAFLD-liver fat score (NAFLD-LFS) and carotid intima-media thickness (CIMT) in magnetic resonance imaging-proved NAFLD. The study comprised 60 patients with NAFLD during the period from October 2015 to June 2017, diagnosed by clinical features, laboratory tests, and magnetic resonance study. Thirty healthy subjects served as controls. All included individuals were subjected to anthropometric measurements and measurement of NAFLD-LFS and CIMT.
Results
On doing ultrasonography, 30 cases showed mild, 24 showed moderate, and 6 cases showed severe steatosis. NAFLD-LFS at a cutoff value of − 1.628 showed a sensitivity of 96.7%, specificity 100%, positive predictive value 100%, negative predictive value 93.8%, and accuracy 97.8%. CIMT at a cutoff value of 0.6 had a sensitivity of 70%, specificity 53.3%, positive predictive value 75%, negative predictive value 47.1%, and accuracy 64.4%. The combination of CIMT at cutoff 0.7 and NAFLD-LFS at cutoff − 1.628 showed sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of 100%.
Conclusion
CIMT combined with NAFLD-LFS can produce a simple noninvasive tool for diagnosis of NAFLD.
Collapse
|
7
|
Abstract
The prevalence of nonalcoholic fatty liver disease (NAFLD) has increased substantially in the past two decades and NAFLD has now become the most common cause of chronic liver disease in children and adolescents. NAFLD is a broad clinicopathologic spectrum ranging from simple steatosis to varying degrees of necroinflammation called nonalcoholic steatohepatitis (NASH), leading to fibrosis and subsequently to cirrhosis. Despite the increasing prevalence and progressive nature of NAFLD even among children, therapy for NAFLD in both adults and children are limited. Weight loss remains the only consistently effective therapy for NAFLD. Pharmacologic options are even more limited in children than in adults with NAFLD. Vitamin E has been shown to be effective in improving histology in children with NASH. Few pharmacologic options such as metformin, probiotics, omega-3 fatty acids, and cysteamine bitartrate have been studied in children, with limited beneficial effects. However, these studies are limited by small sample size and heterogeneity of outcome assessment after treatment. Recent studies show promising results with bariatric surgery with regards to weight loss and improvement in liver histology in adolescents with NAFLD. In this review article, we discuss epidemiology, pathophysiology, and extrahepatic comorbidities of pediatric NAFLD and review existing therapeutic options for children with NAFLD. We also review novel therapeutic strategies studied in adults that could potentially be studied in children in the future.
Collapse
|
8
|
Zheng J, Zhou Y, Zhang K, Qi Y, An S, Wang S, Zhao X, Tang YD. Association between nonalcoholic fatty liver disease and subclinical atherosclerosis: a cross-sectional study on population over 40 years old. BMC Cardiovasc Disord 2018; 18:147. [PMID: 30012085 PMCID: PMC6048911 DOI: 10.1186/s12872-018-0877-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 06/27/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Nonalcoholic fatty liver disease (NAFLD) refers to fatty infiltration of liver in the absence of excessive alcohol abuse. However, the problem that whether NAFLD is correlated with subclinical atherosclerosis assessed by carotid intima-media thickness (CIMT) and brachial-ankle pulse wave velocity (ba-PWV) remains a source of controversy. This can be attributed to the differences in diagnosis methods, population ethnicity, sampling size and bias. This study aimed to further investigate the association of NAFLD with subclinical atherosclerosis. METHODS A cross-sectional study was carried out in the current study on population aged over 40 years derived from Kailuan community-based prospective study among Chinese adults from June 2010 to June 2011. NAFLD was evaluated through ultrasonography and histories of alcohol consumption. Clinical parameters and medical histories of patients were collected in the manner of interview performed by trained investigators using the standardized questionnaires. The biochemical parameters were analyzed at the central laboratory. CIMT and ba-PWV of each patient were measured. Multivariate logistic regression was used to analyze the associations of NAFLD with subclinical atherosclerosis assessed by CIMT or ba-PWV. RESULTS A total of 4112 participants aged over 40 years were enrolled from Kailuan cohort, including 2229 men and 1883 women. The overall prevalence of NAFLD was 38.2% in the total population. Statistically significant differences were found in CIMT (P < 0.0001) and ba-PWV (P = 0.0007) according to the presence of NAFLD. It is notably that the multivariate logistic regression revealed NAFLD was independently associated with elevated CIMT after adjusting the conventional cardiovascular and metabolic risk factors (OR = 1.663, 95% CI = 1.391-1.989, P < 0.0001). In addition, NAFLD was also found to be positively associated with elevated ba-PWV after adjusting age, gender, BMI, current smoking and regular exercising (OR = 1.319, 95% CI = 1.072-1.624, P = 0.0089). CONCLUSIONS Our findings suggest that NAFLD is remarkably correlated with subclinical atherosclerosis, which should be strongly advised to engage in the preventive strategies for cardiovascular diseases (CVDs).
Collapse
Affiliation(s)
- Jilin Zheng
- Department of Internal Medicine, Coronary Heart Disease Center State, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Beijing, 100037, China
| | - Yong Zhou
- Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Kuo Zhang
- Department of Internal Medicine, Coronary Heart Disease Center State, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Beijing, 100037, China
| | - Yu Qi
- Department of Internal Medicine, Coronary Heart Disease Center State, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Beijing, 100037, China
| | - Shimin An
- Department of Internal Medicine, Coronary Heart Disease Center State, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Beijing, 100037, China
| | - Siyuan Wang
- Department of Internal Medicine, Coronary Heart Disease Center State, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Beijing, 100037, China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, China.
| | - Yi-Da Tang
- Department of Internal Medicine, Coronary Heart Disease Center State, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Beijing, 100037, China.
| |
Collapse
|
9
|
Liu CF, Zhou WN, Lu Z, Wang XT, Qiu ZH. The associations between liver enzymes and the risk of metabolic syndrome in the elderly. Exp Gerontol 2018; 106:132-136. [PMID: 29499373 DOI: 10.1016/j.exger.2018.02.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Revised: 10/28/2017] [Accepted: 02/25/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Studies have demonstrated that liver enzymes are associated with metabolic syndrome (MetS). However, little information is available regarding these relationships in elderly populations. Our present study aimed to explore the associations between liver enzymes and the risk of MetS in elderly populations. METHODS This cross-sectional study included 1444 elder participants (970 men and 474 women) who attended annual physical examinations. Univariate and multivariate logistic regressions were performed to estimate the associations between liver enzymes and the risk of MetS and its components according to quartiles of the concentration of each liver enzyme. RESULTS The prevalence of MetS and its components increased remarkably with increasing quartiles of alanine aminotransferase (ALT), gamma-glutamyltransferase (GGT) and alkaline phosphatase (ALP) but not with aspartate aminotransferase (AST) in the elderly. Compared with subjects in the bottom quartile, the adjusted odds ratio for MetS in the highest ALT, GGT and ALP quartiles were 1.78 (95% CI 1.21-2.61), 2.58 (95% CI 1.77-3.78) and 1.85 (95%CI 1.27-2.70) respectively. No statistically significant increases in the odds ratio for MetS according to increased quartiles of AST were found in either the univariate or multivariate logistic regression analyses. CONCLUSIONS Elevated liver enzymes levels (mainly ALT, GGT and ALP but not AST) are positively associated with the prevalence of MetS in elderly populations.
Collapse
Affiliation(s)
- Cun-Fei Liu
- Department of Cardiology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200336, China; Department of Cardiology, Linyi People's Hospital, Linyi, Shandong 276000, China
| | - Wei-Ning Zhou
- Department of Pathology, East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Zheng Lu
- Department of Cardiology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200336, China
| | - Xue-Ting Wang
- Department of Cardiology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200336, China
| | - Zhao-Hui Qiu
- Department of Cardiology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200336, China.
| |
Collapse
|
10
|
Gill C, Vatcheva KP, Pan JJ, Smulevitz B, McPherson DD, Fallon M, McCormick JB, Fisher-Hoch SP, Laing ST. Frequency of Nonalcoholic Fatty Liver Disease and Subclinical Atherosclerosis Among Young Mexican Americans. Am J Cardiol 2017; 119:1717-1722. [PMID: 28395890 DOI: 10.1016/j.amjcard.2017.03.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 03/01/2017] [Accepted: 03/01/2017] [Indexed: 02/08/2023]
Abstract
Nonalcoholic fatty liver disease (NAFLD) is considered as the hepatic manifestation of the metabolic syndrome, whose criteria are risk factors for atherosclerotic cardiovascular disease. We aimed to evaluate the prevalence of NAFLD, its association with subclinical atherosclerosis, and factors that may account for this association in Mexican Americans. In a population-based cross-sectional sample drawn from the Cameron County Hispanic Cohort in Texas, carotid intima media thickness (cIMT), an indicator of subclinical atherosclerosis, was measured. Abnormal carotid ultrasound study was defined as mean cIMT >75th percentile for age and gender and/or plaque presence. NAFLD was defined as steatosis by ultrasound in the absence of other causes of liver disease. Multivariable weighted regression analyses were performed to evaluate associations between NAFLD and cIMT. Mean age was 50.4 ± 1.2 years with 58.3% women. Mean body mass index was 31.0 ± 0.4 kg/m2, and 54.0% had the metabolic syndrome. NAFLD was highly prevalent (48.80%); subjects with NAFLD had greater body mass index, central obesity, fasting glucose levels, and dyslipidemia and were more likely to have the metabolic syndrome. Nearly 1/3 of subjects with NAFLD also had evidence of subclinical atherosclerosis (31.2%). After adjusting for covariates, there was an independent association between NAFLD and increased cIMT only in younger subjects <45 years (p = 0.0328). Subjects with both abnormal liver and carotid ultrasound studies tended to be obese, diabetic and have the metabolic syndrome. In conclusion, NAFLD is highly prevalent in this Mexican American cohort, with an independent association between NAFLD and subclinical atherosclerosis among younger subjects; clustering of diabetes, obesity, and metabolic syndrome in this health disparity cohort increases the risk of both liver disease and early atherosclerosis in young adults.
Collapse
|
11
|
Selvakumar PKC, Kabbany MN, Nobili V, Alkhouri N. Nonalcoholic Fatty Liver Disease in Children: Hepatic and Extrahepatic Complications. Pediatr Clin North Am 2017; 64:659-675. [PMID: 28502444 DOI: 10.1016/j.pcl.2017.01.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Nonalcoholic fatty liver disease (NAFLD) is considered the hepatic manifestation of metabolic syndrome and has become the most common form of chronic liver disease in children and adolescents. The histologic spectrum of NAFLD is broad ranging, from the relatively benign form of simple steatosis to the aggressive form of nonalcoholic steatohepatitis, eventually leading to fibrosis and cirrhosis. NAFLD has also been recognized as an independent risk factor for extrahepatic complications, such as cardiovascular disease, type 2 diabetes mellitus, sleep disorders, and osteoporosis. In this review, we discuss both the hepatic and extrahepatic complications of NAFLD in children.
Collapse
Affiliation(s)
| | - Mohammad Nasser Kabbany
- Department of Pediatric Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, USA
| | - Valerio Nobili
- Liver Unit, IRCCS Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Naim Alkhouri
- Department of Pediatric Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic Cleveland, Cleveland Clinic Main Campus, Mail Code A111, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| |
Collapse
|
12
|
Alkhouri N, Hanouneh IA, Zein NN, Lopez R, Kelly D, Eghtesad B, Fung JJ. Liver transplantation for nonalcoholic steatohepatitis in young patients. Transpl Int 2017; 29:418-24. [PMID: 26402655 DOI: 10.1111/tri.12694] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 06/29/2015] [Accepted: 09/18/2015] [Indexed: 01/01/2023]
Abstract
Nonalcoholic steatohepatitis (NASH) is the hepatic manifestation of obesity and insulin resistance. The aim of this study was to determine the frequency of NASH as an indication for liver transplantation (LT) in children and young adults and to characterize patient and graft survival. The study included all children and young adult patients (up to the age of 40 years) who underwent LT in the United States for NASH cirrhosis from the 1987 to 2012 United Network for Organ Sharing (UNOS) database. Kaplan-Meier analysis was used to assess patient and graft survival. A total of 330 patients were included, 68% were Caucasian, and the mean BMI was 33.6 ± 6.3. Age at time of LT ranged between 4 and 40 years (mean 33.9 ± 6.6 years). Fourteen subjects were <18 years of age at time of LT and 20 were between the ages of 18 and 25 years. Median follow-up after 1st LT was 45.8 months [10.7, 97.3]. During this time, 30% of subjects (n = 100) died and 11.5% (n = 38) were retransplanted including 13 for NASH recurrence. In conclusion, NASH can progress to end-stage liver disease requiring LT in childhood and early adulthood. A significant number of young patients transplanted for NASH cirrhosis required retransplantation.
Collapse
Affiliation(s)
- Naim Alkhouri
- Department of Gastroenterology and Hepatology and Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ibrahim A Hanouneh
- Department of Gastroenterology and Hepatology and Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Nizar N Zein
- Department of Gastroenterology and Hepatology and Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Rocio Lopez
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Dympna Kelly
- Department of Gastroenterology and Hepatology and Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Bijan Eghtesad
- Department of Gastroenterology and Hepatology and Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA
| | - John J Fung
- Department of Gastroenterology and Hepatology and Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA
| |
Collapse
|
13
|
Zhang L, Ma X, Jiang Z, Zhang K, Zhang M, Li Y, Zhao X, Xiong H. Liver enzymes and metabolic syndrome: a large-scale case-control study. Oncotarget 2016; 6:26782-8. [PMID: 26449189 PMCID: PMC4694952 DOI: 10.18632/oncotarget.5792] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 08/29/2015] [Indexed: 12/28/2022] Open
Abstract
Previous studies suggested that elevated liver enzymes could be used as potential novel biomarkers of Metabolic syndrome (MetS) and its clinical outcomes, although the results were inconsistent and the conclusions were underpowered. A case-control study with 6,268 MetS subjects and 6,330 frequency-matched healthy controls was conducted to systematically evaluated levels of four liver enzymes (ALT, AST, GGT and ALP), both in overall populations and in subjects with normal liver enzymes, with MetS risk using both quartiles and continuous unit of liver enzymes. We found significant associations were detected for all above analyses. Compared with quartile 1 (Q1), other quartiles have significant higher MetS risk, with ORs ranging from 1.15 to 18.15. The highest effected was detected for GGT, for which the OR value for the highest versus lowest quartile was 18.15 (95% CI: 15.7-20.9). Mutual adjustment proved the independence of the relations for all four liver enzymes. Sensitivity analyses didn’t materially changed the trend. To the best of our knowledge, this study should be the largest, which aimed at evaluating the association between liver enzymes measures and MetS risk. The results can better support that liver enzyme levels could be used as clinical predictors of MetS.
Collapse
Affiliation(s)
- Lu Zhang
- Department of Epidemiology, College of Preventive Medicine, Third Military Medical University, Chongqing, China.,Division of Scientific Research, Third Military Medical University, Chongqing, China
| | - Xiangyu Ma
- Department of Epidemiology, College of Preventive Medicine, Third Military Medical University, Chongqing, China
| | - Zhi Jiang
- Health Care Center of Southwest Hospital, The First Affiliated Hospital of The Third Military Medical University, Chongqing, China
| | - Kejun Zhang
- Department of Clinical Laboratory, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Mengxuan Zhang
- Department of Epidemiology, College of Preventive Medicine, Third Military Medical University, Chongqing, China
| | - Yafei Li
- Department of Epidemiology, College of Preventive Medicine, Third Military Medical University, Chongqing, China
| | - Xiaolan Zhao
- Health Care Center of Southwest Hospital, The First Affiliated Hospital of The Third Military Medical University, Chongqing, China
| | - Hongyan Xiong
- Department of Epidemiology, College of Preventive Medicine, Third Military Medical University, Chongqing, China
| |
Collapse
|
14
|
Nobili V, Alisi A, Newton KP, Schwimmer JB. Comparison of the Phenotype and Approach to Pediatric vs Adult Patients With Nonalcoholic Fatty Liver Disease. Gastroenterology 2016; 150:1798-810. [PMID: 27003600 PMCID: PMC4887388 DOI: 10.1053/j.gastro.2016.03.009] [Citation(s) in RCA: 113] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 02/29/2016] [Accepted: 03/08/2016] [Indexed: 02/06/2023]
Abstract
Nonalcoholic fatty liver disease (NAFLD) is one of the main chronic noncommunicable diseases in Westernized societies; its worldwide prevalence has doubled during the last 20 years. NAFLD has serious health implications not only for adults, but also for children. However, pediatric NAFLD is not only an important global problem in itself, but it is likely to be associated with increases in comorbidities, such as metabolic syndrome and cardiovascular diseases. There are several differences between NAFLD in children and adults, and it is not clear whether the disease observed in children is the initial phase of a process that progresses with age. The increasing prevalence of pediatric NAFLD has serious implications for the future adult population requiring appropriate action. Studies of NAFLD progression, pathogenesis, and management should evaluate disease phenotypes in children and follow these over the patient's lifetime. We review the similarities and differences of NAFLD between children and adults.
Collapse
Affiliation(s)
- V Nobili
- Hepato-metabolic Disease Unit and Liver Research Unit, Bambino Gesù Children’s Hospital and IRCCS, Rome, Italy
| | - A Alisi
- Hepato-metabolic Disease Unit and Liver Research Unit, Bambino Gesù Children’s Hospital and IRCCS, Rome, Italy
| | - Kimberly P. Newton
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California, San Diego School of Medicine, La Jolla, California,Department of Gastroenterology, Rady Children’s Hospital San Diego, San Diego, California
| | - Jeffrey B. Schwimmer
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California, San Diego School of Medicine, La Jolla, California,Department of Gastroenterology, Rady Children’s Hospital San Diego, San Diego, California,Liver Imaging Group, Department of Radiology, University of California, San Diego School of Medicine, San Diego, California
| |
Collapse
|
15
|
Suomela E, Oikonen M, Virtanen J, Parkkola R, Jokinen E, Laitinen T, Hutri-Kähönen N, Kähönen M, Lehtimäki T, Taittonen L, Tossavainen P, Jula A, Loo BM, Mikkilä V, Younossi Z, Viikari JSA, Juonala M, Raitakari OT. Prevalence and determinants of fatty liver in normal-weight and overweight young adults. The Cardiovascular Risk in Young Finns Study. Ann Med 2015; 47:40-6. [PMID: 25333756 DOI: 10.3109/07853890.2014.966752] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND AIMS Fatty liver may have different determinants in normal-weight and in obese individuals. We measured factors associated with fatty liver in 863 normal-weight (BMI < 25) and 1135 overweight/obese (BMI ≥ 25) young and middle-aged adults (45% male, age 34-49 years) in the population-based Cardiovascular Risk in Young Finns Study. METHODS AND RESULTS The prevalence of fatty liver detected with ultrasound was 29% in overweight/obese and 5% in normal-weight participants. In overweight/obese, the independent correlates were waist circumference (odds ratio for 1 standard deviation increase = 3.78), alanine transaminase (2.11), BMI (2.00), male sex (1.74), triglycerides (1.44), systolic blood pressure (1.31), fasting insulin (1.23), and physical activity (0.76). In normal weight, the independent correlates included alanine transaminase (3.05), smoking (2.56), systolic blood pressure (1.54), and alcohol intake (1.41). In normal-weight participants, the associations with fatty liver were stronger for alcohol intake and smoking, and weaker for triglycerides, than in overweight/obese participants (P for interaction < 0.05). CONCLUSION Prevalence of fatty liver was 29% in overweight/obese and 5% in normal-weight adults. Differences in factors associated with fatty liver were seen between these two groups: alcohol intake and smoking were more strongly and triglycerides more weakly associated in normal-weight than in overweight/obese participants.
Collapse
Affiliation(s)
- Emmi Suomela
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku , Turku , Finland
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Dalla Valle M, Laatikainen T, Kalliokoski T, Nykänen P, Jääskeläinen J. Childhood obesity in specialist care--searching for a healthy obese child. Ann Med 2015; 47:639-54. [PMID: 26575698 DOI: 10.3109/07853890.2015.1083118] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION One in three obese adults is classified as metabolically healthy, but there is less evidence in obese children. We studied the overall clinical presentation of Finnish obese children and the prevalence of cardiometabolic risk factors with child-specific cut-offs. MATERIAL AND METHODS This is a cross-sectional register-based study of 2-18-year-old children (n = 900) evaluated for obesity in three hospitals in 2005-2012. Clinical and metabolic data were related to sex, age, puberty, and obesity grade and analyzed using chi-square and non-parametric tests. RESULTS In 80% of cases at least one cardiovascular risk factor was present. Only 3% of subjects for whom complete metabolic data were available (n = 360) had no metabolic disorder. Systolic blood pressure was hypertensive in 50.2% and diastolic in 14.5% of the children. The youngest children had highest body mass index SD score. Obesity was more severe in boys than girls (p < 0.001). Hypertensive systolic blood pressure values (p = 0.012), prediabetes (p < 0.001), fatty liver (p < 0.001), and dyslipidemia (p = 0.025) were more prevalent in 15-18-year-old boys than girls. CONCLUSION Most obese children in specialist care have cardiovascular risk factors; this indicates that earlier intervention is needed.
Collapse
Affiliation(s)
- Marketta Dalla Valle
- a Department of Pediatrics , North Karelia Central Hospital , Joensuu , Finland ;,b Department of Pediatrics , University of Eastern Finland , Kuopio , Finland
| | - Tiina Laatikainen
- c Institute of Public Health and Clinical Nutrition, University of Eastern Finland , Kuopio , Finland ;,d Health Department , National Institute for Health and Welfare , Helsinki , Finland ;,e North Karelia Hospital District , Joensuu , Finland
| | - Tomi Kalliokoski
- f School of Medicine , University of Eastern Finland , Kuopio , Finland
| | - Päivi Nykänen
- g Department of Pediatrics , Mikkeli Central Hospital , Mikkeli , Finland
| | - Jarmo Jääskeläinen
- b Department of Pediatrics , University of Eastern Finland , Kuopio , Finland ;,h Department of Pediatrics , Kuopio University Hospital , Kuopio , Finland
| |
Collapse
|
17
|
Family history of premature coronary heart disease, child cardio-metabolic risk factors and left ventricular mass. Cardiol Young 2014; 24:938-40. [PMID: 24107484 DOI: 10.1017/s1047951113001571] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
In a prospective cohort of 181 individuals followed up since childhood--when aged 9, 12 and 15 years--patients with a family history of premature coronary heart disease (n=18) had higher left ventricular mass index in adulthood--at mean age of 31 years--compared with those without (mean±standard error 39.1±1.9 versus 34.6±0.7 g/m(2.7), p=0.04). The correlation between adult left ventricular mass index and child triglycerides (r=0.66, p=0.04 versus r=-0.03, p=0.75; p(diff)=0.02) and diastolic blood pressure (r=0.65, p=0.02 versus r=0.16, p=0.07; p(diff)=0.05) was stronger among those with a family history of coronary heart disease than in those without. Although preliminary, these data suggest that the higher left ventricular mass index among adults with a family history might be explained by their increased susceptibility to child cardio-metabolic risk factors.
Collapse
|
18
|
Liu H, Lu HY. Nonalcoholic fatty liver disease and cardiovascular disease. World J Gastroenterol 2014; 20:8407-8415. [PMID: 25024598 PMCID: PMC4093693 DOI: 10.3748/wjg.v20.i26.8407] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2013] [Revised: 01/04/2014] [Accepted: 04/09/2014] [Indexed: 02/06/2023] Open
Abstract
Nonalcoholic fatty liver disease (NAFLD) and cardiovascular disease (CVD) are two diseases that are common in the general population. To date, many studies have been conducted and demonstrate a direct link between NAFLD and CVD, but the exact mechanisms for this complex relationship are not well established. A systematic search of the PubMed database revealed that several common mechanisms are involved in many of the local and systemic manifestations of NAFLD and lead to an increased cardiovascular risk. The possible mechanisms linking NAFLD and CVD include inflammation, oxidative stress, insulin resistance, ectopic adipose tissue distribution, dyslipidemia, endothelial dysfunction, and adiponectin, among others. The clinical implication is that patients with NAFLD are at an increased risk of CVD and should undergo periodic cardiovascular risk assessment.
Collapse
|
19
|
|
20
|
Nuti M, Spontoni P, Grigoratos C, Dell'Omo G, Balbarini A, Pedrinelli R. Lack of a relationship between circulating gamma-glutamyltransferase levels and carotid intima media thickness in hypertensive and diabetic patients. Vasc Health Risk Manag 2012; 8:275-81. [PMID: 22661894 PMCID: PMC3363144 DOI: 10.2147/vhrm.s30747] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND By increasing the intracellular prooxidant burden, gamma-glutamyltransferase (GGT) may accelerate atherosclerotic vascular disease. That noxious influence may be reflected by circulating enzyme levels, a correlate of cardiovascular risk factors, and a predictor of incident events. To evaluate this hypothesis, we tested the association between circulating GGT and common carotid intima-media thickness (CIMT), a surrogate index of systemic atherosclerotic involvement, in a large and well-characterized group of patients at risk of cardiovascular disease (CVD). PATIENTS This study analyzed 548 patients with hypertension and/or diabetes and a widely prevalent history of CVD. Subjects with known hepatic disease and abnormal GGT values were excluded. METHODS CIMT (B-mode ultrasonography) values were the mean of four far-wall measurements at both common carotids. Metabolic syndrome (MetS) was diagnosed according to National Cholesterol Education Program-Adult Treatment Panel III criteria. Due to inherent sex-related differences in GGT levels, the data were analyzed separately in males and females in samples dichotomized by the median. RESULTS The age-adjusted CIMT values did not differ by GGT levels in males or females. In contrast, the carotid wall was consistently thicker in patients with a history of CVD and MetS independent of age and concurrent GGT values. In both sexes, GGT was associated with key components of the MetS such as triglycerides, fasting plasma glucose, and body mass index. CONCLUSION The data collected in this mixed group of hypertensive and/or diabetic patients with widely prevalent history of CVD do not support the concept of a direct pathophysiological link between GGT levels within reference limits and atherosclerotic involvement.
Collapse
Affiliation(s)
- Marco Nuti
- Dipartimento Cardio Toracico e Vascolare, Università di Pisa, Pisa, Italy
| | | | | | | | | | | |
Collapse
|