One-hour post-load plasma glucose levels are associated with elevated liver enzymes

https://doi.org/10.1016/j.numecd.2011.02.002Get rights and content

Abstract

Background and aims

Glucose-tolerant subjects who have 1-h post-load glucose levels ≥155 mg dl−1 (normal glucose tolerance (NGT)-1h-high) are at an increased risk of developing type 2 diabetes. Prospectively conducted studies indicated that high levels of liver enzymes are predictors of a tendency to develop type 2 diabetes; however, it is unknown whether the NGT-1h-high subjects are at increased risk for secreting higher levels of liver biomarkers.

Methods and results

In this study, oral glucose tolerance tests (OGTTs) were performed in a cohort of 1000 non-diabetic Caucasians and levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST) and gamma-glutamyltransferase (GGT) were measured in these subjects. The NGT-1h-high subjects had increased levels of ALT and GGT, but not AST, as compared with the NGT-1h-low. Following adjustment for age and gender, the ALT, AST and GGT levels were all found to be significantly correlated with body mass index (BMI), waist circumference, blood pressure, triglycerides as well as fasting and post-challenge glucose and insulin levels. In a logistic regression analysis adjusted for age and gender, NGT-1h-high subjects were found to be at increased risk of having ALT levels in the highest quartile as compared with NGT-1h-low subjects (odds ratio (OR) = 1.71; 95% confidence interval (CI): 1.16–2.52). In addition, NGT-1 h-high subjects exhibited an increased risk for having GGT levels in the highest quartile (OR = 1.50; 95%CI: 1.02–2.17). These associations remained significant after adjustment for BMI, blood pressure and lipids, but were not significant following further adjustment for an insulin sensitivity index. NGT-1h-high subjects were at increased risk of having AST levels in the highest quartile as compared with NGT-1h-low subjects (OR = 1.51; 95%CI: 1.04–2.22). This association ceased to be significant following adjustment for BMI, blood pressure and lipids.

Conclusions

These data suggest that a 1hPG ≥ 155 mg dl−1 cut-off may facilitate the identification of NGT individuals at risk of developing liver abnormalities.

Section snippets

Methods

Subjects in this study consisted of 1000 Caucasian subjects participating to the CAtanzaro MEtabolic RIsk factors Study (CATAMERIS), an observational study for the identification of cardio-metabolic risk factors; the exclusion criteria have been described previously and comprised known history of diabetes mellitus, chronic gastrointestinal diseases or pancreatitis, history of any malignant disease or drug abuse, self-reported alcohol intake of three or more drinks per day and test positivity

Results

Among the 1000 subjects examined, 752 (75.2%) had NGT and 248 (24.8%) had IGT. Subjects with NGT were classified into two groups: 532 subjects with 1-h post-load PG level <155 mg dl−1 (NGT-1h-low) and 220 individuals with 1-h post-load PG level ≥155 mg dl−1 (NGT-1h-high). Table 1 presents the clinical characteristics and laboratory findings of the three study (2 NGT + 1 IGT) groups. Significant differences among these three groups were observed with regard to gender (higher prevalence of men

Discussion

Subjects with NAFLD are characterised by elevated levels of liver biomarkers such as ALT, AST and GGT, and it has been suggested that NAFLD is the most common cause of chronically elevated liver enzymes. Thus, these liver biomarkers, especially ALT, are useful surrogate measures of NAFLD for large-scale studies, and such application is also supported by data that show a significant correlation between liver biomarkers and direct measures of liver fat content [23]. A number of studies have

Acknowledgements

This work was supported, in part, by the Italian Ministry of Health (grant number RF-FSR-2007-631176) to Giorgio Sesti.

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