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Aminotransferase and gamma-glutamyl transpeptidase levels in obesity are associated with insulin resistance and the metabolic syndrome

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Abstract

Fatty liver at ultrasounds, with/without raised plasma levels of hepatic enzymes, is common in obesity. In most cases, it is the hallmark of non-alcoholic fatty liver disease (NAFLD), a potentially progressive disease associated with insulin resistance and the metabolic syndrome (MS). We tested the hypothesis that insulin resistance per se might be associated with hepatocellular necrosis. Alanine and aspartate aminotransferases (ALT and AST; no.=799) and gamma-glutamyltranspeptidase (GGT; no.=459) were analyzed in a group of treatment-seeking obese patients recruited in 12 Italian medical centers. Insulin resistance was calculated by the homeostasis model assessment method (HOMA-IR; no.=522). Median ALT and AST increased with increasing obesity class (p=0.001 and p=0.005) and exceeded normal limits in 21.0% of cases. Also HOMA-IR increased with the obesity class (p<0.0001), and was higher in subjects with elevated ALT (median, 4.93 vs 2.89; p<0.0001). A significant correlation was observed between HOMA-IR and ALT (R2=0.208; p<0.0001), as well as between HOMA-IR and AST or GGT (R2=0.112 and R2=0.080; p<0.0001). The correlation was maintained when cases with elevated enzyme levels were omitted from analysis. Diabetes and hypertriglyceridemia were the features of the MS most commonly associated with raised liver enzymes. In logistic regression, after correction for age, gender, BMI and features of the MS, HOMA-IR maintained a highly predictive value for raised ALT, AST and GGT. We conclude that in obesity insulin resistance is a risk factor for raised liver enzyme levels, possibly related to NAFLD.

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Authors and Affiliations

  1. Metabolic Unit, Department of Internal Medicine and Gastroenterology, “Alma Mater Studiorum” University of Bologna, Bologna

    G. Marchesini MD

  2. Unit of Dietetics and Clinical Nutrition, “San Giovanni Battista” Hospital, Turin

    S. Avagnina

  3. Metabolic Rehabilitation, “San Giuseppe” Hospital, Piancavallo, Verbania

    E. G. Barantani

  4. Department of Endocrinology and Metabolism, University of Pisa, Pisa

    A. M. Ciccarone

  5. Department of Internal Medicine, University of Messina, Messina

    F. Corica

  6. Center for Diabetes and Obesity, University of Parma, Parma

    E. Dall’Aglio

  7. Medical Department, “Villa Garda” Hospital, Garda, Verona

    R. Dalle Grave

  8. Institute of Endocrine Sciences, “Maggiore” Hospital-IRCCS, University of Milan, Milan

    P. S. Morpurgo

  9. Unit of Dietetics and Clinical Nutrition, “S. Anna” Hospital, Ferrara

    F. Tomasi

  10. Diabetes Unit, University of Chieti, Pescara, Italy

    E. Vitacolonna

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  1. G. Marchesini MD
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  2. S. Avagnina
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  3. E. G. Barantani
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  4. A. M. Ciccarone
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Correspondence to G. Marchesini MD.

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Marchesini, G., Avagnina, S., Barantani, E.G. et al. Aminotransferase and gamma-glutamyl transpeptidase levels in obesity are associated with insulin resistance and the metabolic syndrome. J Endocrinol Invest 28, 333–339 (2005). https://doi.org/10.1007/BF03347199

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  • DOI: https://doi.org/10.1007/BF03347199

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