Serum Gamma-glutamyltransferase Levels and the Risks of Impaired Fasting Glucose in Healthy Men: A 2-year Follow-up

건강한 남성에서 혈중 감마지티피 수준과 공복혈당장애 (IFG)의 발생 위험도: 2년 추적 연구

  • Shin, Joo-Youn (Gwangju Regional Labor Office, Ministry of Labor) ;
  • Lim, Jong-Han (Department of Occupational and Environmental Medicine, Inha University Hospital) ;
  • Koh, Dai-Ha (Department of Preventive Medicine, College of Medicine, Chonbuk National University) ;
  • Kwon, Keun-Sang (Department of Preventive Medicine, College of Medicine, Chonbuk National University) ;
  • Kim, Yong-Kyu (Industrial Medical Center, The Catholic University of Korea) ;
  • Kim, Hwan-Chul (Department of Occupational and Environmental Medicine, Inha University Hospital) ;
  • Lee, Yeui-Cheol (Department of Occupational and Environmental Medicine, Inha University Hospital) ;
  • Lee, Ju-Hyoung (Department of Preventive Medicine, College of Medicine, Chonbuk National University) ;
  • Nam, Moon-Suk (Department of Internal Medicine, Inha University Hospital) ;
  • Hong, Sung-Bin (Department of Internal Medicine, Inha University Hospital) ;
  • Park, Shin-Goo (Department of Occupational and Environmental Medicine, Inha University Hospital)
  • 신주연 (노동부 광주지방노동청) ;
  • 임종한 (인하대학교 의과대학 부속병원 산업의학과) ;
  • 고대하 (전북대학교 의과대학 예방의학교실) ;
  • 권근상 (전북대학교 의과대학 예방의학교실) ;
  • 김용규 (가톨릭대학교 의과대학 산업의학센터) ;
  • 김환철 (인하대학교 의과대학 부속병원 산업의학과) ;
  • 이의철 (인하대학교 의과대학 부속병원 산업의학과) ;
  • 이주형 (전북대학교 의과대학 예방의학교실) ;
  • 남문석 (인하대학교 의과대학 부속병원 내과) ;
  • 홍성빈 (인하대학교 의과대학 부속병원 내과) ;
  • 박신구 (인하대학교 의과대학 부속병원 산업의학과)
  • Published : 2006.07.31

Abstract

Objectives: An increase in the serum gamma-glutamyltransferase (GGT) concentration has been regarded as a marker of alcohol drinking or liver disease. Some reports, however, have suggested that the serum GGT may be a sensitive and early biomarker for the development of prediabetes and diabetes. In this study we investigated whether serum GGT is a reliable predictor of the incident impaired fasting glucose (IFG), including diabetes. Methods: We performed a prospective study for two years (2002-2004). We analyzed the periodic health examination data from a total of 4,711 men. The examinations were done in the years 2002 and 2004. The analyzed data included a self-questionnaire, a physical examination and the laboratory results. Both IFG and diabetes were defined as a serum fasting glucose concentration of more than 100 mg/dL and 126 mg/dL, respectively. Results: A total of 738 cases (15.7%) of incident IFG and 13 cases (0.3%) of diabetes occurred. The mean serum GGT concentrations were quite different between the normal (38.0 IU) and incident IFG groups (50.3 IU), and the incident diabetes group (66.0 IU) (p<0.001). After multivariable adjustment, the relative risks for incident IFG or diabetes across the baseline GGT categories (<10th, 10th-20th, 30th-40th, 50th-60th, 70th-80th and >90th percentile) were 1.0, 1.172 (0.769-1.785), 1.107 (0.725-1.689), 1.444 (0.934-2.232), 2.061 (1.401-3.031) and 2.545 (1.784-3.631) (p-value for trend: <0.001). The risks significantly increased with increasing levels of GGT for 2 years; when comparing the increased groups (<10%, 10-20%, >20%) versus the decreased over 20% group of GGT, the risks for IFG or diabetes were 1.334 (1.002-1.776), 1.613 (1.183-2.199) and 1.399 (1.092-1.794). Conclusions: Our findings suggest that serum GGT concentrations within its normal range may be an early predictor of the development of IFG and diabetes. As serum GGT is a relatively inexpensive test and a reliable marker, it might have important implications in public health promotion.

Keywords

References

  1. Whitfield JB. Gamma glutamyl transferase. Crit Rev Clin Lab Sci 2001; 38(4): 263-355 https://doi.org/10.1080/20014091084227
  2. Yi KN, Kwon OH. Cinical Pathology File, 3rd Ed. Seoul, Eui-Hak Publishing & Printing Co; 2000. p. 367-370 (Korean)
  3. Wannamethee G, Ebrahim S, Shaper AG. Gamma-glutamyltransferase: determinants and association with from ischemic heart disease and all causes. Am J Epidemiol 1995; 142(7): 699-708 https://doi.org/10.1093/oxfordjournals.aje.a117699
  4. Pintus F, Mascia P. Distribution and population determinants of gamma-glutamyltransferase in a random sample of Sardinian inhabitants. 'ATSSARDEGNA' Research Group. Eur J Epidemiol 1996; 12(1): 71-76 https://doi.org/10.1007/BF00144431
  5. Whitehead TP, Robinson D, Allaway SL. The effects of cigarette smoking and alcohol consumption on serum liver enzyme activities: a dose-related study in men. Ann Clin Biochem 1996; 33(6): 530-535 https://doi.org/10.1177/000456329603300607
  6. Kim KY, Kam S, Lee JH, Ha YA, Lee KE. A cross-sectional study on gamma-GTP and its related factors in male workers. Korean J Prev Med 2002; 35(2): 169-174 (Korean)
  7. Kim SH, Lee JN, Hong YC. Effect of commuting time on male workers' serum gamma-glutamyltransferase level. Korea J Occup Environ Med 2002; 14(4): 418-425 (Korean)
  8. Yamada Y, Noborisaka Y, Suzuki H, Ishizaki M, Yamada S. Alcohol consumption, serum gamma-glutamyltransferase levels, and coronary risk factors in a middle-aged occupational population. J Occup Health 2003; 45(5): 293-299 https://doi.org/10.1539/joh.45.293
  9. Stranges S, Dom JM, Muti P, Freudenheim JL, Farinaro E, Russell M, Nochajski TH, Trevisan M. Body fat distribution, relative weight, and liver enzyme levels: a population-based study. Hepatology 2004; 39(3): 754-763 https://doi.org/10.1002/hep.20149
  10. Shin JY, Kim YK, Park SG, Lee JN, Kim HC, Lee JH, Hong YC The clinical importance of an increase in serum gamma-glutamyltransferase concentration. Korea J Occup Environ Med 2005; 17(1): 1-9 (Korean)
  11. Lim JS, Yang JH, Chun BY, Kam S, Jacobs DR Jr, Lee DH. Is serum gammaglutamyltransferase inversely associated with serum antioxidants as a marker of oxidative stress? Free Radic Biol Med 2004; 37(7): 1018-1023 https://doi.org/10.1016/j.freeradbiomed.2004.06.032
  12. Bhatia S, Shukla R, Venkata Madhu S, Kaur Gambhir J, Madhava Prabhu K. Antioxidant status, lipid peroxidation and nitric oxide end products of type 2 diabetes mellitus with nephropathy. Clin Biochem 2003; 36(7): 557-562 https://doi.org/10.1016/S0009-9120(03)00094-8
  13. Atli T, Keven K, Avci A, Kutlay S, Turkcapar N, Varli M, Aras S, Ertug E, Canbolat O. Oxidative stress and antioxidant status in elderly diabetes mellitus and glucose intolerance patients. Arch Gerontol Geriatr 2004; 39(3): 269-275 https://doi.org/10.1016/j.archger.2004.04.065
  14. Delles C, Schneider MP, Oehmer S, Fleischmann I, Fleischmann EF, Schmieder RE. Increased response of renal perfusion to the antioxidant vitamin C in type 2 diabetes. Nephrol Dial Transplant 2004; 19(10): 2513-2518
  15. Lee DH, Ha MH, Kim JH, Christiani DC, Gross MD, Steffes M, Blomhoff R, Jacobs Dr Jr. Gannna-giutamyitransferase and diabetes--a 4 year follow-up study. Diobetologia 2003a; 46(3): 359-364 https://doi.org/10.1007/s00125-003-1036-5
  16. Lee DH, Jacobs DR Jr, Gross M, Kiefe CI, Roseman J, Lewis CE, Steffes M. Gammaglutamyltransferase is a predictor of incident diabetes and hypertension: the Coronary Artery Risk Development in Young Adults(CARDIA) study. Clin Chem 2003b; 49(8): 1358-1366 https://doi.org/10.1373/49.8.1358
  17. Nakanishi N, Nishina K, Li W, Sato M, Suzuki K, Tatara K. Serum gamma-glutamyltransferase and development of impaired fasting glucose or type 2 diabetes in middle-aged Japanese men. J Intern Med 2003; 254(3): 287-295 https://doi.org/10.1046/j.1365-2796.2003.01198.x
  18. Nakanishi N, Suzuki K, Tatara K. Serum gamma-glutamyltransferase and risk of metabolic syndrome and type 2 diabetes in middle-aged Japanese men. Diabetes C care 2004; 27(6): 1427-1432 https://doi.org/10.2337/diacare.27.6.1427
  19. Arndt V, Brenner H, Rothenbacher D, Zschenderlein B, Fraisse E. Elevated liver enzyme activity in construction workers: prevalence and impact on early retirement and all cause mortality. Int Arch Occup Environ Health 1998; 71(6): 405-412 https://doi.org/10.1007/s004200050299
  20. van der Vaart H, Postma DS, Timens W, ten Hacken NH. Acute effects of cigarette smoke on inflannnation and oxidative stress: a review. Thorax 2004; 59(8): 713-721 https://doi.org/10.1136/thx.2003.012468
  21. Moller P, Wallin H, Knudsen LE. Oxidative stress associated with exercise, psychological stress and life-style factors. Chem Biol Interact 1996; 102(1): 17-36 https://doi.org/10.1016/0009-2797(96)03729-5
  22. Lesgards JF, Durand P, Lassarre M, Stocker P, Lesgards G, Lanteaume A, Prost M, LehucherMichel MP. Assessment of lifestyle effects on the overall antioxidant capacity of healthy subjects. Environ Health Perspect 2002; 110(5): 479-486 https://doi.org/10.1289/ehp.02110479
  23. Park E, Kang MH. Smoking and high plasma triglyceride levels as risk factors for oxidative DNA damage in the korean population. Ann Nutr Metab 2004; 48(1): 36-42 https://doi.org/10.1159/000075083
  24. Scott JA, King GL. Oxidative stress and antioxidant treatment in diabetes. Ann N Y Acad Sci 2004; 1031: 204-213 https://doi.org/10.1196/annals.1331.020
  25. World Health Organization(WHO). Diabetes Programme. Available from: URL: http://www.who.int/diabetes/en/
  26. The Korea Geriatrics Society. Textbook of Geriatric Medicine, 2nd Ed. Seoul, Medical Publishing Co; 2005. p. 774-784 (Korean)
  27. Korea National Statistical Office. Statistics information system. Mortality statistics(1983-2004). Available from: http://wwwsearch.nso.go.kr
  28. Alexander CM, Landsman PB, Teutsch SM. Diabetes mellitus, impaired fasting glucose, atherosclerotic risk factors, and prevalence of coronary heart disease. Am J Cardiol 2000; 86(9): 897-902 https://doi.org/10.1016/S0002-9149(00)01118-8
  29. Chen KT, Chen CJ, Gregg EW, hnperatore G, Narayan KM. Impaired fasting glucose and risk of diabetes in Taiwan: follow-up over 3 years. Diabetes Res Clin Pract 2003; 60(3): 177-182 https://doi.org/10.1016/S0168-8227(03)00037-8
  30. Qiao Q, Jousilahti P, Eriksson J, Tuomilehto J. Predictive properties of impaired glucose tolerance for cardiovascular risk are not explained by the development of overt diabetes during follow-up. Diabetes Care 2003; 26(10): 2910-2914 https://doi.org/10.2337/diacare.26.10.2910
  31. Heldgaard PE, Olivarius Nde F, Hindsberger C, Henriksen JE. Impaired fasting glycemia resembles impaired glucose tolerance with regard to cardiovascular risk factors: population-based, cross-sectional study of risk factors for cardiovascular disease. Diabet Med 2004; 21(4): 303-304 https://doi.org/10.1111/j.1464-5491.2004.01232.x
  32. Soderberg S, Zimmet P, Tuomilehto J, de Courten M, Dowse GK, Chitson P, Stenlund H, Gareeboo H, Alberti KG, Shaw J. High incident of type 2 diabetes and increasing conversion rates from impaired fasting glucose and impaired glucose tolerance to diabetes in Mauritius. J Intern Med 2004; 256(1): 37-47 https://doi.org/10.1111/j.1365-2796.2004.01336.x
  33. Wang JJ, Yuan SY, Zhu LX, Fu HJ, Li HB, Hu G, Tuomilehto J. Effects of impaired fasting glucose and impaired glucose tolerance on predicting incident type 2 diabetes in a Chinese population with high post-prandial glucose. Diabetes Res Clin Pract 2004; 66(2): 183-191 https://doi.org/10.1016/j.diabres.2004.03.002