Obesity Surgery

, Volume 28, Issue 5, pp 1363–1371 | Cite as

γ-Glutamyltransferase Fractions in Obese Subjects with Type 2 Diabetes: Relation to Insulin Sensitivity and Effects of Bariatric Surgery

  • Maria Franzini
  • Veronica Musetti
  • Daniela Guarino
  • Laura Caponi
  • Aldo Paolicchi
  • Michele Emdin
  • Ele Ferrannini
  • Monica Nannipieri
Original Contributions



Gamma-glutamyltranspeptidase (GGT) levels are an independent risk marker for the development of type 2 diabetes (T2DM). We investigated the relationship between the newly identified serum GGT fractions and glucose metabolism in obese subjects before and after bariatric surgery.


Twenty-nine T2DM subjects, wait-listed for Roux-en-Y gastric bypass (RYGB; n = 21) or laparoscopic sleeve gastrectomy (LSG; n = 8), received a 5-h mixed meal test before (T0), 15 days (T15), and 1 year after surgery (T365). Insulin sensitivity was assessed by the OGIS index and β-cell function by C-peptide analysis; fractional GGT (b-, s-, m-, and f-GGT) analysis was performed by gel-filtration chromatography.


At T15, total GGT activity decreased by 40% after LSG (p = 0.007) but remained unchanged after RYGB. At T365, all patients showed a reduction in total GGT, in particular b-GGT (≥ 60%) and m-GGT (≥ 50%). In patients with biopsy-proven steatohepatitis (n = 10), total, b-, s-, and m-GGT fractions at T0 were significantly higher than in patients with low-grade steatosis (p = 0.016, 0.0003, and 0.005, respectively); at T365, there was a significant fall in total GGT as well as in each fraction in both groups. In a multiple regression model, b-GGT was the only fraction related to insulin sensitivity (p = 0.016; β coeff. = − 14.0) independently of BMI, fasting glucose, and triglycerides.


While GGT activity is generally associated with impaired glucose metabolism, fractional GGT analysis showed that the b-GGT fraction specifically and independently tracks with insulin resistance.


Insulin sensitivity Gamma-glutamyltransferase B-GGT fraction NASH 



The study was supported by an EMIF grant (IMI JU GA 115372-2).

Compliance with Ethical Standards

Competing Interests

The authors declare that they have no competing interests.

Studies with Human Participants

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent Statement

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  1. 1.Department of Translational ResearchUniversity of PisaPisaItaly
  2. 2.Department of Clinical and Experimental MedicineUniversity of PisaPisaItaly
  3. 3.Sant’Anna School of Advanced Study – Pisa and CNR Institute of Clinical PhysiologyPisaItaly
  4. 4.Fondazione Toscana G. MonasterioPisaItaly
  5. 5.CNR Institute of Clinical PhysiologyPisaItaly

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