J Korean Endocr Soc.  2008 Dec;23(6):404-412. 10.3803/jkes.2008.23.6.404.

Alanine Aminotransferase as a Predictor of Metabolic Syndrome in Koreans

• Kwon JH
• An YS
• Kang YH
• Son SM
• Kim IJ
• Kim YK

• KMID: 1965993
• DOI: http://doi.org/10.3803/jkes.2008.23.6.404

Abstract

AIMS: Alanine aminotransferase (ALT) is associated with insulin resistance, and is independent of the general metabolic measures. Gamma-glutamyltransferase (GGT) is regarded as a predictor of diabetes mellitus. We analyzed which of ALT or GGT is better tool to preestimate the development of metabolic syndrome. METHOD: A total of 1203 Koreans who visited the Institute of Health in Pusan National University Hospital from January 2005 to August 2006 were enrolled in this cross-sectional study. Their median age was 51 years old, and the prevalence of metabolic syndrome was 16.4% (n = 197). We excluded the subjects with diabetes mellitus, hypertension and viral hepatitis or those subjects with a level of alanine aminotransferase (ALT) or gamma-glutamyltransferase (r-GGT) > 80 IU/L.
RESULTS
For all the patients in the metabolic syndrome group, the median homeostatic assessment of insulin resistance (HOMA-IR), the waist circumference, the fasting blood glucose level, the systolic and diastolic blood pressure were all associated with the ALT level (P < 0.05). For the nonmetabolic syndrome group, all the metabolic risk factors were associated with the ALT level (P < 0.05). On logistic regression analysis, after correction for age, alcohol intake, HOMA-IR and body mass index, the logALT maintained a highly predictive value for metabolic syndrome, and this was better than the logGGT [odds ratio (OR) of logALT: 18.489, odds ratio of logGGT: 2.024] (P < 0.001). The risk of developing metabolic syndrome was significantly higher in the above 50 percentile and the above 75 percentile of ALT than in the lowest quartile. [for men - OR: 3.6; 95% confidence interval (CI), 2.2-5.9; OR: 6.9; 95% CI: 4.3-10.9] [for women - OR: 2.7; 95% CI: 1.5-4.7; OR: 6.5; 95% CI: 3.8-11] (P < 0.001). The cut-off value of ALT by the ROC curve was 24 IU/L for men (sensitivity: 64.3%, specificity: 66%, negative predictive value: 99.5%) and 20 IU/L for women (sensitivity: 78.9%, specificity: 61.4%, negative predictive value: 84.9%).
CONCLUSIONS
Even although patients can have an ALT level that's included within the upper normal level, we may consider the probability that these patients will have metabolic syndrome. Furthermore, in our analysis, the ALT level is a better predictor of metabolic syndrome than the GGT level.

Keyword

alanine aminotransferase; gamma-glutamyltransferase; metabolic syndrome

MeSH Terms

Alanine
Alanine Transaminase
Blood Glucose
Blood Pressure
Body Mass Index
Cross-Sectional Studies
Diabetes Mellitus
Fasting
Female
gamma-Glutamyltransferase
Hepatitis
Humans
Hypertension
Insulin Resistance
Logistic Models
Male
Odds Ratio
Prevalence
Risk Factors
ROC Curve
Waist Circumference
Alanine
Alanine Transaminase
Blood Glucose
gamma-Glutamyltransferase

Figure

• 

  Fig. 1–1. Cut-off value of ALT according to sex (A: men, B: women) to preestimate the incidence of metabolic syndrome. A. MEN The cut-off value of ALT about metabolic syndrome is above 24 IU/L. The sensitivity is 64.29% (95% confidence interval 55.3∼72.6%) and the specificity is 66% (61.7∼70.1%). The negative predictive value is 99.5% and AUC (area under the ROC curve) is 0.701 (95% confidence interval 0.664∼0.737) (P = 0.0001). B. WOMEN The cut-off value of ALT about metabolic syndrome is above 20 IU/L. The sensitivity is 78.87% (95% confidence interval 67.6∼87.7%) and the specificity is 61.43% (57∼65.7%). The negative predictive value is 84.9% and AUC is 0.747 (0.709∼0.782) (P = 0.0001).

• 

  Fig. 1–2. Cut-off value of GGT according to sex (A: men, B: women) to preestimate the incidence of metabolic syndrome. A. MEN The cut-off value of GGT about metabolic syndrome is above 36 IU/L. The sensitivity is 58.82% (95% confidence interval 33∼81.5%) and the specificity is 83.3% (80.1∼86.2%). The negative predictive value is 98.6% and AUC (area under the ROC curve) is 0.71 (95% confidence interval 0.673∼0.745) (P = 0.0033). B. WOMEN The cut-off value of GGT about metabolic syndrome is above 26 IU/L. The sensitivity is 61.11% (95% confidence interval 53.6∼68.3%) and the specificity is 63.71% (58.7∼68.5%). The negative predictive value is 78.2% and AUC is 0.655 (0.614∼0.694) (P = 0.0001).

Reference

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