Skip to main content
Top
Published in: BMC Endocrine Disorders 1/2008

Open Access 01-12-2008 | Research article

Association of liver enzymes with incident type 2 diabetes: A nested case control study in an Iranian population

Authors: Maryam Tohidi, Hadi Harati, Farzad Hadaegh, Yadolladh Mehrabi, Fereidoun Azizi

Published in: BMC Endocrine Disorders | Issue 1/2008

Login to get access

Abstract

Background

To investigate the association of Aspartate aminotransferase (AST), Alanin aminotranferase (ALT) and Gamma glutamyl transferase (GGT) with incident type 2 diabetes.

Methods

In a nested case-control study, AST, ALT, GGT as well as classic diabetes risk factors, insulin and C-reactive protein (CRP) were measured in 133 non-diabetic subjects at baseline of which 68 were cases and 65 were controls. Incident diabetes was defined by the WHO 1999 criteria. Conditional logistic regression was used to calculate the odds ratio (OR) of incident diabetes associated with different hepatic markers. We used factor analysis for clustering of classic diabetes risk factors.

Results

In Univariate analysis both ALT and GGT were associated with diabetes with ORs of 3.07(1.21–7.79) and 2.91(1.29–6.53) respectively. After adjustment for CRP and insulin, ALT and GGT were still predictive of incident diabetes. When the model was further adjusted for anthropometric, blood pressure and metabolic factors, only ALT was independently associated with diabetes [OR = 3.18 (1.02–9.86)]. No difference was found between the area under the receiver operating characteristic curves of the models with and without ALT (0.820 and 0.802 respectively, P = 0.4)

Conclusion

ALT is associated with incident type 2 diabetes independent of classic risk factors. However, its addition to the classic risk factors does not improve the prediction of diabetes.
Literature
1.
go back to reference Schindhelm RK, Diamant M, Dekker JM: Alanine aminotransferase as a marker of non-alcoholic fatty liver disease in relation to type 2 diabetes mellitus and cardiovascular disease. Diabetes Metab Res Rev. 2006, 22: 437-43. 10.1002/dmrr.666.CrossRefPubMed Schindhelm RK, Diamant M, Dekker JM: Alanine aminotransferase as a marker of non-alcoholic fatty liver disease in relation to type 2 diabetes mellitus and cardiovascular disease. Diabetes Metab Res Rev. 2006, 22: 437-43. 10.1002/dmrr.666.CrossRefPubMed
2.
go back to reference Marchesini G, Brizi M, Bianchi G, Tomassetti S: Nonalcoholic fatty liver disease: a feature of the metabolic syndrome. Diabetes. 2001, 50: 1844-50. 10.2337/diabetes.50.8.1844.CrossRefPubMed Marchesini G, Brizi M, Bianchi G, Tomassetti S: Nonalcoholic fatty liver disease: a feature of the metabolic syndrome. Diabetes. 2001, 50: 1844-50. 10.2337/diabetes.50.8.1844.CrossRefPubMed
3.
go back to reference Marchesini G, Bugianesi E, Forlani G: Nonalcoholic fatty liver, steatohepatitis, and the metabolic syndrome. Hepatology. 2003, 37: 917-23. 10.1053/jhep.2003.50161.CrossRefPubMed Marchesini G, Bugianesi E, Forlani G: Nonalcoholic fatty liver, steatohepatitis, and the metabolic syndrome. Hepatology. 2003, 37: 917-23. 10.1053/jhep.2003.50161.CrossRefPubMed
4.
go back to reference Dixon JB, Bhathal PS, O'Brien PE: Nonalcoholic fatty liver disease: predictors of nonalcoholic steatohepatitis and liver fibrosis in the severely obese. Gastroenterology. 2001, 121: 91-100. 10.1053/gast.2001.25540.CrossRefPubMed Dixon JB, Bhathal PS, O'Brien PE: Nonalcoholic fatty liver disease: predictors of nonalcoholic steatohepatitis and liver fibrosis in the severely obese. Gastroenterology. 2001, 121: 91-100. 10.1053/gast.2001.25540.CrossRefPubMed
5.
go back to reference Mulhall BP, Ong JP, Younossi ZM: Non-alcoholic fatty liver disease: an overview. J Gastroenterol Hepatol. 2002, 17: 1136-43. 10.1046/j.1440-1746.2002.02881.x.CrossRefPubMed Mulhall BP, Ong JP, Younossi ZM: Non-alcoholic fatty liver disease: an overview. J Gastroenterol Hepatol. 2002, 17: 1136-43. 10.1046/j.1440-1746.2002.02881.x.CrossRefPubMed
6.
go back to reference Angulo P, Lindor KD: Non-alcoholic fatty liver disease. J Gastroenterol Hepatol. 2002, 17 (Suppl): S186-90. 10.1046/j.1440-1746.17.s1.10.x.CrossRefPubMed Angulo P, Lindor KD: Non-alcoholic fatty liver disease. J Gastroenterol Hepatol. 2002, 17 (Suppl): S186-90. 10.1046/j.1440-1746.17.s1.10.x.CrossRefPubMed
7.
go back to reference André P, Balkau B, Born C: Hepatic markers and development of type 2 diabetes in middle aged men and women: a three-year follow-up study. The D.E.S.I.R. Study. Diabetes Metab. 2005, 31: 542-50.PubMed André P, Balkau B, Born C: Hepatic markers and development of type 2 diabetes in middle aged men and women: a three-year follow-up study. The D.E.S.I.R. Study. Diabetes Metab. 2005, 31: 542-50.PubMed
8.
go back to reference Nakanishi N, Suzuki K, Tatara K: Serum gamma-glutamyltransferase and risk of metabolic syndrome and type 2 diabetes in middle-aged Japanese men. Diabetes Care. 2004, 27: 1427-32. 10.2337/diacare.27.6.1427.CrossRefPubMed Nakanishi N, Suzuki K, Tatara K: Serum gamma-glutamyltransferase and risk of metabolic syndrome and type 2 diabetes in middle-aged Japanese men. Diabetes Care. 2004, 27: 1427-32. 10.2337/diacare.27.6.1427.CrossRefPubMed
9.
go back to reference Vozarova B, Stefan N, Lindsay RS: High alanine aminotransferase is associated with decreased hepatic insulin sensitivity and predicts the development of type 2 diabetes. Diabetes. 2002, 51: 1889-95. 10.2337/diabetes.51.6.1889.CrossRefPubMed Vozarova B, Stefan N, Lindsay RS: High alanine aminotransferase is associated with decreased hepatic insulin sensitivity and predicts the development of type 2 diabetes. Diabetes. 2002, 51: 1889-95. 10.2337/diabetes.51.6.1889.CrossRefPubMed
10.
go back to reference Sattar N, Scherbakova O, Ford I: Elevated alanine aminotransferase predicts new-onset type 2 diabetes independently of classical risk factors, metabolic syndrome, and C-reactive protein in the west of Scotland coronary prevention study. Diabetes. 2004, 53: 2855-60. 10.2337/diabetes.53.11.2855.CrossRefPubMed Sattar N, Scherbakova O, Ford I: Elevated alanine aminotransferase predicts new-onset type 2 diabetes independently of classical risk factors, metabolic syndrome, and C-reactive protein in the west of Scotland coronary prevention study. Diabetes. 2004, 53: 2855-60. 10.2337/diabetes.53.11.2855.CrossRefPubMed
11.
go back to reference Hanley AJ, Williams K, Festa A: Elevations in markers of liver injury and risk of type 2 diabetes: the insulin resistance atherosclerosis study. Diabetes. 2004, 53: 2623-32. 10.2337/diabetes.53.10.2623.CrossRefPubMed Hanley AJ, Williams K, Festa A: Elevations in markers of liver injury and risk of type 2 diabetes: the insulin resistance atherosclerosis study. Diabetes. 2004, 53: 2623-32. 10.2337/diabetes.53.10.2623.CrossRefPubMed
12.
go back to reference Perry IJ, Wannamethee SG, Shaper AG: Prospective study of serum gamma-glutamyltransferase and risk of NIDDM. Diabetes Care. 1998, 21: 732-7. 10.2337/diacare.21.5.732.CrossRefPubMed Perry IJ, Wannamethee SG, Shaper AG: Prospective study of serum gamma-glutamyltransferase and risk of NIDDM. Diabetes Care. 1998, 21: 732-7. 10.2337/diacare.21.5.732.CrossRefPubMed
13.
go back to reference Azizi F, Rahmani M, Emami H: Cardiovascular risk factors in an Iranian urban population: Tehran lipid and glucose study (phase 1). Soz Praventivmed. 2002, 47: 408-26.CrossRefPubMed Azizi F, Rahmani M, Emami H: Cardiovascular risk factors in an Iranian urban population: Tehran lipid and glucose study (phase 1). Soz Praventivmed. 2002, 47: 408-26.CrossRefPubMed
14.
go back to reference Greenland S, Schwartzbaum JA, Finkle WD: Problems due to small samples and sparse data in conditional logistic regression analysis. Am J Epidemiol. 2000, 151: 531-9.CrossRefPubMed Greenland S, Schwartzbaum JA, Finkle WD: Problems due to small samples and sparse data in conditional logistic regression analysis. Am J Epidemiol. 2000, 151: 531-9.CrossRefPubMed
15.
go back to reference Peduzzi P, Concato J, Kemper E: A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol. 1996, 49: 1373-9. 10.1016/S0895-4356(96)00236-3.CrossRefPubMed Peduzzi P, Concato J, Kemper E: A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol. 1996, 49: 1373-9. 10.1016/S0895-4356(96)00236-3.CrossRefPubMed
16.
go back to reference Marjorie Pett, Eleanor J, Sullivan Lackey: Making Sense of Factor Analysis. 2003, Sage Publications. California, USA Marjorie Pett, Eleanor J, Sullivan Lackey: Making Sense of Factor Analysis. 2003, Sage Publications. California, USA
17.
go back to reference DeLong ER, DeLong DM, Clarke-Pearson DL: Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics. 1988, 44: 837-844. 10.2307/2531595.CrossRefPubMed DeLong ER, DeLong DM, Clarke-Pearson DL: Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics. 1988, 44: 837-844. 10.2307/2531595.CrossRefPubMed
18.
go back to reference Lee DH, Silventoinen K, Jacobs DR: gamma-Glutamyltransferase, obesity, and the risk of type 2 diabetes: observational cohort study among 20,158 middle-aged men and women. J Clin Endocrinol Metab. 2004, 89: 5410-4. 10.1210/jc.2004-0505.CrossRefPubMed Lee DH, Silventoinen K, Jacobs DR: gamma-Glutamyltransferase, obesity, and the risk of type 2 diabetes: observational cohort study among 20,158 middle-aged men and women. J Clin Endocrinol Metab. 2004, 89: 5410-4. 10.1210/jc.2004-0505.CrossRefPubMed
19.
go back to reference Lee DH, Ha MH, Kim JH: Gamma-glutamyltransferase and diabetes–a 4 year follow-up study. Diabetologia. 2003, 46: 359-64. 10.1007/s00125-003-1226-1.CrossRefPubMed Lee DH, Ha MH, Kim JH: Gamma-glutamyltransferase and diabetes–a 4 year follow-up study. Diabetologia. 2003, 46: 359-64. 10.1007/s00125-003-1226-1.CrossRefPubMed
20.
go back to reference Schindhelm RK, Dekker JM, Nijpels G: No independent association of alanine aminotransferase with risk of future type 2 diabetes in the Hoorn study. Diabetes Care. 2005, 28: 2812-10.2337/diacare.28.11.2812.CrossRefPubMed Schindhelm RK, Dekker JM, Nijpels G: No independent association of alanine aminotransferase with risk of future type 2 diabetes in the Hoorn study. Diabetes Care. 2005, 28: 2812-10.2337/diacare.28.11.2812.CrossRefPubMed
21.
go back to reference Nannipieri M, Gonzales C, Baldi S: Liver enzymes, the metabolic syndrome, and incident diabetes: the Mexico City diabetes study. Diabetes Care. 2005, 28: 1757-62. 10.2337/diacare.28.7.1757.CrossRefPubMed Nannipieri M, Gonzales C, Baldi S: Liver enzymes, the metabolic syndrome, and incident diabetes: the Mexico City diabetes study. Diabetes Care. 2005, 28: 1757-62. 10.2337/diacare.28.7.1757.CrossRefPubMed
22.
go back to reference Tiikkainen M, Bergholm R, Vehkavaara S: Effects of identical weight loss on body composition and features of insulin resistance in obese women with high and low liver fat content. Diabetes. 2003, 52: 701-7. 10.2337/diabetes.52.3.701.CrossRefPubMed Tiikkainen M, Bergholm R, Vehkavaara S: Effects of identical weight loss on body composition and features of insulin resistance in obese women with high and low liver fat content. Diabetes. 2003, 52: 701-7. 10.2337/diabetes.52.3.701.CrossRefPubMed
23.
go back to reference Day C, Saksena S: Non-alcoholic steatohepatitis: Definitions and pathogenesis. J Gastroenterol Hepatol. 2002, 17: S377-S384. 10.1046/j.1440-1746.17.s3.31.x.CrossRefPubMed Day C, Saksena S: Non-alcoholic steatohepatitis: Definitions and pathogenesis. J Gastroenterol Hepatol. 2002, 17: S377-S384. 10.1046/j.1440-1746.17.s3.31.x.CrossRefPubMed
24.
go back to reference Ceriello A, Motz E: Is oxidative stress the pathogenic mechanism underlying insulin resistance, diabetes, and cardiovascular disease? The common soil hypothesis revisited. Arterioscler Thromb Vasc Biol. 2004, 24: 816-23. 10.1161/01.ATV.0000122852.22604.78.CrossRefPubMed Ceriello A, Motz E: Is oxidative stress the pathogenic mechanism underlying insulin resistance, diabetes, and cardiovascular disease? The common soil hypothesis revisited. Arterioscler Thromb Vasc Biol. 2004, 24: 816-23. 10.1161/01.ATV.0000122852.22604.78.CrossRefPubMed
25.
go back to reference Lloyd-Jones DM, Liu K, Tian L, Greenland P: Narrative review: Assessment of C-reactive protein in risk prediction for cardiovascular disease. Ann Intern Med. 2006, 145: 35-42.CrossRefPubMed Lloyd-Jones DM, Liu K, Tian L, Greenland P: Narrative review: Assessment of C-reactive protein in risk prediction for cardiovascular disease. Ann Intern Med. 2006, 145: 35-42.CrossRefPubMed
26.
go back to reference Wannamethee SG, Shaper AG, Lennon L: Hepatic enzymes, the metabolic syndrome, and the risk of type 2 diabetes in older men. Diabetes Care. 2005, 28: 2913-8. 10.2337/diacare.28.12.2913.CrossRefPubMed Wannamethee SG, Shaper AG, Lennon L: Hepatic enzymes, the metabolic syndrome, and the risk of type 2 diabetes in older men. Diabetes Care. 2005, 28: 2913-8. 10.2337/diacare.28.12.2913.CrossRefPubMed
27.
go back to reference Gholamreza R, Shahryar S, Abbasali K: Seroprevalence of hepatitis B virus and its co-infection with hepatitis D virus and hepatitis C virus in Iranian adult population. Indian J Med Sci. 2007, 61: 263-8.CrossRefPubMed Gholamreza R, Shahryar S, Abbasali K: Seroprevalence of hepatitis B virus and its co-infection with hepatitis D virus and hepatitis C virus in Iranian adult population. Indian J Med Sci. 2007, 61: 263-8.CrossRefPubMed
Metadata
Title
Association of liver enzymes with incident type 2 diabetes: A nested case control study in an Iranian population
Authors
Maryam Tohidi
Hadi Harati
Farzad Hadaegh
Yadolladh Mehrabi
Fereidoun Azizi
Publication date
01-12-2008
Publisher
BioMed Central
Published in
BMC Endocrine Disorders / Issue 1/2008
Electronic ISSN: 1472-6823
DOI
https://doi.org/10.1186/1472-6823-8-5

Other articles of this Issue 1/2008

BMC Endocrine Disorders 1/2008 Go to the issue
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.