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

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Abstract

Background/Objectives

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.

Subjects/Methods

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.

Results

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.

Conclusions

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.

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Acknowledgements

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

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Author notes

  1. Maria Franzini and Veronica Musetti contributed equally to this work.

Authors and Affiliations

  1. Department of Translational Research, University of Pisa, Pisa, Italy

    Maria Franzini, Veronica Musetti, Laura Caponi & Aldo Paolicchi

  2. Department of Clinical and Experimental Medicine, University of Pisa, Via Savi 8, 56126, Pisa, Italy

    Daniela Guarino & Monica Nannipieri

  3. Sant’Anna School of Advanced Study – Pisa and CNR Institute of Clinical Physiology, Pisa, Italy

    Michele Emdin

  4. Fondazione Toscana G. Monasterio, Pisa, Italy

    Michele Emdin

  5. CNR Institute of Clinical Physiology, Pisa, Italy

    Ele Ferrannini

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  1. Maria Franzini
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Correspondence to Monica Nannipieri.

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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.

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Franzini, M., Musetti, V., Guarino, D. et al. γ-Glutamyltransferase Fractions in Obese Subjects with Type 2 Diabetes: Relation to Insulin Sensitivity and Effects of Bariatric Surgery. OBES SURG 28, 1363–1371 (2018). https://doi.org/10.1007/s11695-017-3017-7

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