Association of abnormality of liver enzymes and metabolic syndrome in patients with nonalcoholic fatty liver disease

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To investigate the changes of liver enzymes in the patients with nonalcoholic fatty liver disease (NAFLD) and to analyze the association between liver enzymes and metabolic syndrome (MS). 318 non-diabetic subjects with NAFLD underwent anthropometry (height, weight, waist and hip circumference, and blood pressure), laboratory tests, including alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), gamma-glutamyltransferase (GGT), serum lipid, fasting and 2 hour plasma glucose, and insulin after 75 g glucose load, and abdominal ultrasonography. Metabolic syndrome was diagnosed according to the National Cholesterol Education Program Adult Treatment Panel III criteria. 174 of the 318 NAFLD patients (54.7%) showed 1 to more abnormal liver enzymes. 123 of the 318 NAFLD patients (38.7%) were diagnosed as with MS, among which 48.8% of those with abnormal liver enzymes were diagnosed as with MS, a percentage significantly higher than that of those without normal liver enzyme (28.6%, P < 0.001). The levels of the 4 liver enzymes were all higher in the group with MS than in the group without MS (all P < 0.05). With the increase of the number of elevated MS components the serum levels of ALT, AST, and GGT were elevated accordingly. The risk of abnormality of liver enzyme levels significantly increased with the number of MS components after adjustment for age and sex [OR (95% CI): ALT 1.78 (1.37 approximately 2.32), AST 1.65 (1.19 approximately 2.29), GGT 1.81 (1.35 approximately 2.43)]. Most patients with NAFLD have abnormal liver enzymes, and the percentage of MS is higher in the abnormal liver enzyme group. The risk of abnormality of liver enzyme levels significantly increases with the number of MS components which suggested the components of MS might be the risk factor of increase of liver enzymes' levels.