Combined Associations of Liver Enzymes and Obesity With Diabetes Mellitus Prevalence: The Tohoku Medical Megabank Community-based Cohort Study.

Fumi Itabashi,Shinichi Kuriyama,Ichiro Tsuji,Nobuyuki Takanashi,Junichi Sugawara,Naoki Nakaya,Kozo Tanno,Kiyomi Sakata,Shigeo Kure,Takumi Hirata,Ryohei Sasaki,Atsushi Hozawa,Akira Narita,Naho Tsuchiya,Mana Kogure,Tomohiro Nakamura

doi:10.2188/jea.je20200384

Abstract

BackgroundAlanine aminotransferase (ALT) and gamma-glutamyl transferase (GGT) are enzymes associated with diabetes mellitus (DM) prevalence. However, limited information is available regarding the association of liver enzymes and DM consistently present in obese and non-obese individuals. We examined whether the combination of ALT and GGT enzymes is associated with the prevalence of DM, regardless of obesity, in a general Japanese population.MethodsWe conducted a cross-sectional study of 62,786 participants aged ≥20 years who lived in Miyagi and Iwate, Japan. We divided all the participants into eight groups according to the ALT level (low: <30 IU/L and high: ≥30 IU/L), GGT level (low: <50 IU/L and high: ≥50 IU/L), and the presence of obesity. We calculated odds ratios (ORs) and 95% confidence intervals (CIs) using multivariable logistic regression analysis, adjusting for potential confounders, to determine associations of the combination of ALT and GGT levels and obesity with DM prevalence.ResultsOverall, 6,008 participants (9.6%) had DM. Compared to non-obese individuals with low ALT and GGT levels, the participants with high ALT and GGT levels had high ORs for DM in both obese (OR 4.06; 95% CI, 3.61–4.56) and non-obese groups (OR 2.19; 95% CI, 1.89–2.52). The obese group had high ORs for DM, even at low ALT and GGT levels.ConclusionHigh ALT and GGT levels are associated with DM prevalence in obese and non-obese participants. This finding suggests that correcting ALT and GGT levels and controlling obesity are important for the prevention of DM.

Highlights

Obesity is a well-known risk factor for the development of diabetes mellitus (DM).[1,2,3] screening for obesity is an appropriate approach to distinguish between the participants with high and low risk
The prevalence of DM was highest in the group with high ALT and gamma-glutamyl transferase (GGT) levels, compared to the group with both low ALT and GGT levels
The proportions of current smokers and current drinkers were higher among the high GGT level groups, regardless of obesity

Summary

Introduction

Obesity is a well-known risk factor for the development of diabetes mellitus (DM).[1,2,3] screening for obesity is an appropriate approach to distinguish between the participants with high and low risk. Previous epidemiological studies in the Asian and Japanese populations have reported that the prevalence of DM is increasing even in non-obese individuals.[4,5,6] screening for obesity alone may overlook people at high risk of DM. Previous epidemiological studies in the Japanese population have reported that fatty liver is associated with the development of DM, regardless of obesity.[7,8] we considered it appropriate to first screen non-obese individuals with fatty liver to detect the risk of DM. Fatty liver is commonly diagnosed by ultrasonography and liver biopsy These diagnostic evaluations are expensive, time-consuming, and have a higher risk of complications. We examined whether the combination of ALT and GGT enzymes is associated with the prevalence of DM, regardless of obesity, in a general Japanese population

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