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Choi, Bae, Lee, Cho, Lee, Choi, and Kim: Relationship between Serum Gamma-glutamyltransferase Levels within Reference Intervals and the Prevalence of Metabolic Syndrome and Diabetes Mellitus in Adults

Abstract

Background

This study was conducted to establish reference intervals (RIs) for serum gamma-glutamyltransferase (GGT), and to evaluate the association between serum GGT levels within RIs and the prevalence of metabolic syndrome (MetS) and type 2 diabetes mellitus (DM) in men and women.

Methods

A total of 363 healthy adults (137 men and 226 women) were enrolled for establishing the RIs of serum GGT. A cross-sectional study was conducted with 919 individuals (519 men and 400 women) to evaluate the associations between gender-specific serum GGT RI quartiles and prevalence of MetS and DM.

Results

The RIs for serum GGT levels (central 95th percentile ranges) were 9.0–70.6 IU/L and 4.0–31.3 IU/L in men and women, respectively. In men, the odds ratios (ORs) and 95% confidence intervals (CIs) for the prevalence of MetS in 4 serum GGT quartiles (lowest to highest) were 1.0 (reference), 3.6 (0.7–18.0), 8.8 (2.0–39.1), and 17.4 (4.0–75.3), respectively, while the ORs (95% CIs) for the prevalence of DM were 1.0 (reference), 1.0 (0.3–3.0), 1.7 (0.6–4.6), and 2.6 (1.0–6.6), respectively. In women, the corresponding ORs (95% CIs) were 1.0 (reference), 3.3 (0.6–16.6), 5.8 (1.2–27.3), and 18.8 (4.3–82.2) for MetS, respectively, and 1.0 (reference), 1.6 (0.3–9.7), 1.6 (0.3–9.9), and 8.0 (1.7–36.7) for DM, respectively. These significant relationships persisted after adjusting for age, alcohol intake, body mass index, and smoking.

Conclusions

Serum GGT levels, even within RIs, were proportionally associated with prevalence of metabolic syndrome and DM in both men and women. Serum GGT level may be an independent predictor for chronic degenerative diseases.

References

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Table 1.
Clinical and biochemical characteristics of the subjects selected for establishing the reference intervals for serum GGT levels
Characteristics Men Women P value by t-test
Number of subjects 137 226  
Age (yr) 43.5±9.5 43.3±10.8 0.823
Systolic BP (mmHg) 1 120.0±8.0 110.6±10.8 <0.001
Diastolic BP (mmHg) 76.0±7.7 70.8±8.8 <0.001
Height (cm) 1 170.3±5.7 158.9±5.5 <0.001
Weight (kg) 70.1±10.1 57.1±6.9 <0.001
BMI (kg/m2) 24.1±3.0 22.6±2.6 <0.001
Total cholesterol (mg/dL) 1 183.4±31.5 181.9±31.4 0.659
HDL-cholesterol (mg/dL) 46.9±10.7 54.1±12.5 <0.001
LDL-cholesterol (mg/dL) 1 123.0±30.9 114.8±31.2 0.015
Triglyceride (mg/dL) 1 120.8±67.4 88.7±47.0 <0.001
Fasting glucose (mg/dL) 87.5±9.4 84.6±8.4 0.002
GGT (IU/L) 28.3±16.0 13.2±6.0 <0.001
AST (IU/L) 22.8±6.1 19.0±4.9 <0.001
ALT (IU/L) 24.0±11.7 14.6±6.2 <0.001
Uric acid (mg/dL) 6.0±1.0 4.2±0.8 <0.001
GGT (central 95th percentile, IU/L) 9.0–70.6 4.0–31.3  

Data are expressed as mean±S.D.

Abbreviations: GGT, gamma-glutamyltransferase; BP, blood pressure; BMI, body mass index; HDL, high-density lipoprotein; LDL, low-density lipoprotein; AST, aspartate aminotransferase; ALT, alanine aminotransferase.

Table 2.
Clinical and biochemical characteristics of all subjects with serum GGT levels within the reference intervals
Characteristics Men Women P value by t-test
Number of subjects 519 400  
Age (yr) 47±10.7 47.1±12.2 0.940
Systolic BP (mmHg) 124.5±13.9 116.3±15.5 <0.001
Diastolic BP (mmHg) 77.8±9.6 73.1±10.3 <0.001
Height (cm) 170.3±5.7 158.2±5.8 <0.001
Weight (kg) 70.6±9.7 57.5±7.9 <0.001
BMI (kg/m2) 24.3±2.8 23.0±3.0 <0.001
Total cholesterol (mg/dL) 183.6±32.5 181.2±32.6 0.258
HDL-cholesterol (mg/dL) 45.0±10.6 52.4±12.2 <0.001
LDL-cholesterol (mg/dL) 122.5±32.0 114.9±32.3 <0.001
Triglyceride (mg/dL) 137.2±79.9 97.1±64.4 <0.001
Fasting glucose (mg/dL) 92.7±19.7 88.8±20.7 0.004
GGT (IU/L) 30.5±15.1 13.6±6.0 <0.001
AST (IU/L) 23.6±8.6 20.2±6.0 <0.001
ALT (IU/L) 24.4±13.5 15.9±7.8 <0.001
Uric acid (mg/dL) 6.0±1.1 4.3±0.9 <0.001
Metabolic syndrome (%) 9.2 10.5 0.527
Type 2 DM (%) 7.5 5. 0.114

Data are expressed as mean±S.D, unless otherwise stated.

Abbreviations: GGT, gamma-glutamyltransferase; BP, blood pressure; BMI, body mass index; HDL, high-density lipoprotein; LDL, low-density lipoprotein; AST, aspartate aminotransferase; ALT, alanine aminotransferase; DM, diabetes mellitus.

Table 3.
Clinical and biochemical characteristics of male and female subgroups according to the quartiles of sex-specific serum GGT reference intervals
Quartiles (Q) of serum GGT
Men (N=519) P value by ANOVA Women (N=400) P value by ANOVA
Q1 (<19 IU/L) Q2 (20–26 IU/L) Q3 (27–41 IU/L) Q4 (42–70 IU/L) Q1 (<9 IU/L) Q2 (10–12 IU/L) Q3 (13–17 IU/L) Q4 (18–31 IU/L)
Number of subjects 140 122 133 124   107 102 100 91  
Age (yr) 47.4±13.4 46.9±10.7 46.9±9.4 46.7±8.6 0.956 44.9±12.2 46.2±11.6 47.1±12.0 50.6±12.5 0.007
BMI (kg/m2) 23.0±2.5 24.0±2.5 24.7±2.7 25.8±2.9 <0.001 21.9±2.5 22.8±2.7 23.3±2.9 24.1±3.4 <0.001
Current smoker (%) 13.6 17.2 18.1 23.4 0.041 0.0 1.0 1.0 3.3 0.209
Drinker (>1 time/month) (%) 59.3 61.5 72.9 71.0 0.043 21.5 23.5 23.0 24.2 0.974
Hypertension (%) 17.1 28.7 28.6 28.2 0.073 10.3 10.8 20.0 28.6 0.001
Metabolic syndrome (%) 1.4 4.9 11.3 20.2 <0.001 1.9 5.9 10.0 26.4 <0.001
Type 2 DM (%) 5.0 4.9 8.3 12.1 0.098 1.9 2.9 3.0 13.2 0.001
Total cholesterol (mg/dL) 1 172.7±31.9 178.8±30.8 189.1±31.0 194.9±31.8 <0.001 176.5±33.4 176.0±29.2 182.0±30.3 191.7±35.5 0.002
HDL-cholesterol (mg/dL) 45.9±10.7 46.3±11.0 44.4±10.3 43.4±10.3 0.105 55.3±14.5 52.7±10.0 53.2±12.2 47.8±10.2 <0.001
LDL-cholesterol (mg/dL) 1 113.2±30.1 118.1±30.0 128.0±33.6 131.3±31.2 <0.001 109.9±31.7 109.0±28.1 115.5±29.5 126.6±37.4 <0.001
Triglyceride (mg/dL) 1 106.1±50.3 124.2±65.9 144.5±88.6 177.5±91.6 <0.001 76.1±28.2 91.2±41.7 96.5±51.9 128.9±104.5 <0.001
Fasting glucose (mg/dL) 89.0±13.8 90.8±17.7 93.6±22.2 97.9±23.7 0.002 83.7±7.8 85.9±11.6 89.0±26.3 97.9±28.3 <0.001
GGT (IU/L) 14.7±3.3 22.9±1.9 32.9±4.4 53.0±8.1 <0.001 7.4±1.6 10.9±0.8 14.9±1.4 22.6±4.2 <0.001
AST (IU/L) 20.6±4.7 23.2±11.4 23.4±5.9 27.5±9.6 <0.001 18.8±4.9 18.9±4.3 20.3±4.8 23.3±8.4 <0.001
ALT (IU/L) 17.6±5.8 21.4±9.7 25.3±10.5 33.8±19.3 <0.001 13.1±4.8 13.9±4.9 16.3±5.8 21.0±11.9 <0.001
Uric acid (mg/dL) 5.58±1.18 5.94±0.96 6.08±1.07 6.24±1.12 <0.001 4.1±0.8 4.2±0.9 4.4±1.0 4.4±0.9 0.010

Data are expressed as mean±S.D, unless otherwise stated.

Abbreviations: GGT, gamma-glutamyltransferase; BP, blood pressure; BMI, body mass index; HDL, high-density lipoprotein; LDL, low-density lipoprotein; AST, aspartate aminotransferase; ALT, alanine aminotransferase; DM, diabetes mellitus.

Table 4.
Odds ratios and 95% confidence intervals for the prevalence of metabolic syndrome according to quartiles of sex-specific serum GGT RIs in men and women
  Quartiles (Q) of serum GGT P trend
Q1 Q2 Q3 Q4
Men (<19 IU/L) (20–26 IU/L) (27–41 IU/L) (42–70 IU/L)  
Number of subjects (N=519) 140 122 133 124  
GGT (IU/L) (mean±SD) 14.7±3.3 22.9±1.9 32.9±4.4 53.0±8.1  
Odds ratio (95% CI)          
Model 1 1 3.6 (0.7–18.0) 8.8 (2.0–39.1) 17.4 (4.0–75.3) <0.001
Model 2 1 3.9 (0.8–20.1) 10 (2.2–45.6) 20.6 (4.7–90.9) <0.001
Model 3 1 3.3 (0.6–17.4) 7.6 (1.6–35.3) 12.6 (2.8–57.3) <0.001
Women (<9 IU/L) (10–12 IU/L) (13–17 IU/L) (18–31 IU/L)  
Number of subjects (N=400) 107 102 100 91  
GGT (IU/L) (mean±SD) 7.41±1.6 10.9±0.8 14.9±1.3 22.6±4.2  
Odds ratio (95% CI)          
Model 1 1 3.3 (0.6–16.6) 5.8 (1.2–27.3) 18.8 (4.3–82.2) <0.001
Model 2 1 3.2 (0.6–16.3) 5.5 (1.2–26.0) 15.8 (3.6–69.8) <0.001
Model 3 1 2.2 (0.4–11.4) 3.1 (0.6–15.2) 8.5 (1.9–39.1) 0.001

Model 1, crude odds ratio; Model 2, model 1 plus adjustment for age; Model 3, model 2 plus adjustment for body mass index, alcohol intake, and smoking.

Abbreviations: CI, confidence intervals; GGT, gamma-glutamyltransferase.

Table 5.
Odds ratios and 95% confidence intervals for the prevalence of diabetes mellitus according to quartiles of sex-specific serum GGT reference intervals in men and women
  Quartiles (Q) of serum GGT P trend
Q1 Q2 Q3 Q4
Men (<19 IU/L) (20–26 IU/L) (27–41 IU/L) (42–70 IU/L)  
Number of subjects (N=519) 140 122 133 124  
GGT (IU/L) (mean±SD) 14.7±3.3 22.9±1.9 32.9±4.4 53.0±8.1  
Odds ratio (95% CI)          
Model 1 1 1.0 (0.3–3.0) 1.7 (0.6–4.6) 2.6 (1.0–6.6) 0.099
Model 2 1 1.2 (0.4–3.6) 2.2 (0.8–6.0) 3.5 (1.3–9.3) 0.033
Model 3 1 1.2 (0.4–3.6) 2.2 (0.8–6.0) 3.5 (1.3–9.3) 0.033
Women (<9 IU/L) (10–12 IU/L) (13–17 IU/L) (18–31 IU/L)  
Number of subjects (N=400) 107 102 100 91  
GGT (IU/L) (mean±SD) 7.41±1.6 10.9±0.8 14.9±1.3 22.6±4.2  
Odds ratio (95% CI)          
Model 1 1 1.6 (0.3–9.7) 1.6 (0.3–9.9) 8.0 (1.7–36.7) 0.001
Model 2 1 1.6 (0.2–10.0) 1.4 (0.2–9.3) 6.1 (1.3–29.8) 0.012
Model 3 1 1.6 (0.2–10.0) 1.4 (0.2–9.3) 6.1 (1.3–29.8) 0.012

Model 1, crude odds ratio; Model 2, model 1 plus adjustment for age; Model 3, model 2 plus adjustment for body mass index, alcohol intake, and smoking.

Abbreviations: CI, confidence intervals; GGT, gamma-glutamyltransferase.

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