Molecular Mechanism Research

Serum Gamma-Glutamyl Transferase as a Predictive Biomarker for Metabolic Syndrome and Insulin Resistance: Implications for Early Risk Assessment and Preventive Healthcare

Tasnim Shamrin

Department of Microbiology, City Dental College and Hospital, Bangladesh

Mohamed NurMohamed

Department of Public Health, World University of Bangladesh (WUB), Bangladesh

Abu BakarSiddik

Department of Microbiology, Jagannath University, Bangladesh

Sadia Islam

Department of Laboratory Medicine, Bangladesh Specialized Hospital, Bangladesh

Nayem Sarker

Department of Biochemistry & Cell Biology, Bangladesh University of Health Sciences (BUHS), Bangladesh

Sajib Halder

Department of Biochemistry & Cell Biology, Bangladesh University of Health Sciences (BUHS), Bangladesh

Tanzila Akter

Department of Virology, National Institute of Laboratory Medicine & Referral Center, Bangladesh

Md. AshiqurRahman

Department of Laboratory Medicine, Novus Clinical Research Services Limited (NCRSL), Bangladesh

DOI: https://doi.org/mmr.v2i2.6959

Keywords: Metabolic Syndrome (MetS); Gamma-Glutamyl Transferase; HOMO-IR; Insulin resistance

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Abstract

Background: Metabolic syndrome (MetS) is a significant global public health concern. Each component of MetS is linked to various non-communicable chronic diseases, including type 2 diabetes mellitus (T2DM), coronary artery disease (CAD), cerebrovascular disease, and non-alcoholic fatty liver disease (NAFLD), which collectively are major causes of mortality worldwide. Aims: This study aimed to investigate the association between serum gamma-glutamyl transferase (GGT) levels and the risk of MetS and insulin resistance (IR) in a sample of adults, exploring how GGT levels correlate with MetS components and IR markers. Additionally, we examined whether these associations vary by gender. Methods: A total of 440 participants were selected for this study, including 196 individuals diagnosed with MetS and 244 without. Participants were selected based on predefined criteria from those attending the outpatient department of a biochemistry clinic in Dhaka, Bangladesh. Logistic regression analysis was conducted, adjusting for potential confounders, including age, sex, body mass index (BMI), alanine aminotransferase (ALT), uric acid, and low-density lipoprotein cholesterol (LDL-C), to assess the odds ratios (95% CI) for MetS across GGT tertiles. Results: Logistic regression analysis indicated that, after adjusting for confounders, the odds ratios for MetS increased significantly across GGT tertiles (1, 1.22 (0.36-4.12), p=0.738; 5.09 (2.06-12.58), p

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References

1.Scott, R., Donoghoe, M., Watts, G.F., O'Brien, R., Pardy, C., Taskinen, M.R., Davis, T.M., Colman, P.G., Manning, P., Fulcher, G. and Keech, A.C., 2011. Impact of metabolic syndrome and its components on cardiovascular disease event rates in 4900 patients with type 2 diabetes assigned to placebo in the FIELD randomised trial. Cardiovascular Diabetology, 10(1), p.102.

2.International Diabetes Federation, 2006. The IDF consensus worldwide definition of the metabolic syndrome. IDF Communications, pp.1-23.

3.Park, Y.W., Zhu, S., Palaniappan, L., Heshka, S., Carnethon, M.R. and Heymsfield, S.B., 2003. The metabolic syndrome: prevalence and associated risk factor findings in the US population from the Third National Health and Nutrition Examination Survey, 1988-1994. Archives of Internal Medicine, 163(4), pp.427-436.

4.Kavsak, P., 2017. Tietz Textbook of Clinical Chemistry and Molecular Diagnostics, edited by Nader Rifai, Andrea Rita Horvath and Carl T. Wittwer,6th edn, Elsevier, St. Louis, Missouri, USA.

5.Nestel, P., Lyu, R., Low, L.P., Sheu, W.H.H., Nitiyanant, W., Saito, I. and Tan, C.E., 2007. Metabolic syndrome: recent prevalence in East and Southeast Asian populations. Asia Pacific Journal of Clinical Nutrition, 16(2), pp.362-367.

6.Mainuddin, A.K.M., Choudhury, K.N., Ahmed, K.R., Akter, S., Islam, N. and Masud, J.H.B., 2013. The metabolic syndrome: comparison of newly proposed IDF, modified ATP III and WHO criteria and their agreements. Cardiovascular Journal, 6(1), pp. 17-22.

7.Chowdhury, M.Z.I., Anik, A.M., Farhana, Z., Bristi, P.D., Al Mamun, B.A., Uddin, M.J., Fatema, J., Akter, T., Tani, T.A., Rahman, M. and Turin, T.C., 2018. Prevalence of metabolic syndrome in Bangladesh: a systematic review and meta-analysis of the studies. BMC Public Health, 18(1), p.308.

8.Borai, A., Livingstone, C. and Ferns, G.A., 2007. The biochemical assessment of insulin resistance. Annals of Clinical Biochemistry, 44(4), pp.324-342.

9.Singh, B. and Saxena, A., 2010. Surrogate markers of insulin resistance: A review. World Journal of Diabetes, 1(2), p.36.

10.Burtis, C.A. and Bruns, D.E., 2014. Tietz fundamentals of Clinical Chemistry and Molecular Diagnostics, 7th edn, Elsevier, St. Louis, Missouri, USA.

11.Meisinger, C., Döring, A., Schneider, A. and Löwel, H., 2006. Serum γ-glutamyltransferase is a predictor of incident coronary events apparently healthy men from the general population. Atherosclerosis, 189(2), pp.297-302.

12.Mason, J.E., Starke, R.D. and Van Kirk, J.E., 2010. Gamma‐Glutamyl transferase: a novel cardiovascular risk BioMarker. Preventive Cardiology, 13(1), pp.36-41.

13.Hotamisligil, G.S., 2003. Inflammatory pathways and insulin action. International Journal of Obesity, 27(S3), p.S53.

14.Lee, D.H., Blomhoff, R. and Jacobs, D.R., 2004. Review is serum gamma glutamyltransferase a marker of oxidative stress. Free Radical Research, 38(6), pp.535-539.

15.Nakanishi, N., Suzuki, K. and Tatara, K., 2004. Serum γ-glutamyltransferase and risk of metabolic syndrome and type 2 diabetes in middle-aged Japanese men. Diabetes Care, 27(6), pp.1427-1432.

16.Kim, J.Y., Dhananjay, D., Ahn, S.V., Koh, S.B., Son, J.W., Lee, J.W., Youn, Y.J., Ahn, M.S., Ahn, S.G., Yoo, B.S. and Lee, S.H., 2016. Ps 11-70 A Prospective study Of serum γ-glutamyltransferase levels and incident of Metabolic Syndrome: The Arirang Study. Journal of Hypertension, 34, p.352.

17.Marchesini, G., Avagnina, S., Barantani, E.G., Ciccarone, A.M., Corica, F., Dall’Aglio, E., Dalle Grave, R., Morpurgo, P.S., Tomasi, F. and Vitacolonna, E., 2005. Aminotransferase and gamma-glutamyl transpeptidase levels in obesity are associated with insulin resistance and the metabolic syndrome. Journal of Endocrinological Investigation, 28(6), pp.333-339.

18.Kawamoto, R., Kohara, K., Tabara, Y., Miki, T. and Otsuka, N., 2009. Serum gamma-glutamyltransferase levels are associated with metabolic syndrome in community-dwelling individuals. Journal of Atherosclerosis and Thrombosis, 16(4), pp.355-362.

19.Xie, J., Zhang, S., Yu, X., Yang, Y., Liu, Z., Yuan, G. and Hu, S., 2018. Association between liver Enzymes with metabolically unhealthy obese phenotype. Lipids in Health and Disease, 17(1), p.198.

20.Lawlor, D.A., Sattar, N., Smith, G.D. and Ebrahim, S., 2005. The associations of physical activity and adiposity with alanine aminotransferase and gamma-glutamyltransferase. American Journal of Epidemiology, 161(11), pp.1081-1088.

21.Masilamani, V., Gopinath, P., Kandasamy, S. and Kumar, A., 2016. Association of Gamma-glutamyl transferase with Metabolic syndrome. Medicine and Healthcare, 3(100), pp.5498-5502

22.Sakugawa, H., Nakayoshi, T., Kobashigawa, K., Nakasone, H., Kawakami, Y., Yamashiro, T., Maeshiro, T., Tomimori, K., Miyagi, S., Kinjo, F. and Saito, A., 2004. Metabolic syndrome is directly associated with gamma glutamyl transpeptidase elevation in Japanese women. World Journal of Gastroenterology, 10(7), p.1052.

23.Gorter, P.M., Olijhoek, J.K., van der Graaf, Y., Algra, A., Rabelink, T.J., Visseren, F.L. and SMART Study Group, 2004. Prevalence of the metabolic syndrome in patients with coronary heart disease, cerebrovascular disease, peripheral arterial disease or abdominal aortic aneurysm. Atherosclerosis, 173(2), pp.361-367.

24.Kolovou, G.D., Anagnostopoulou, K.K. and Cokkinos, D.V., 2005. Pathophysiology of dyslipidaemia in the metabolic syndrome. Postgraduate Medical Journal, 81(956), pp.358-366.

25.Kang, Y.H., Min, H.K., Son, S.M., Kim, I.J. and Kim, Y.K., 2007. The association of serum gamma glutamyltransferase with components of the metabolic syndrome in the Korean adults. Diabetes Research and Clinical Practice, 77(2), pp.306-313.

26.Inoue, K., Hirohara, J., Nakano, T., Seki, T., Sasaki, H., Higuchi, K., Ohta, Y., Onji, M., Muto, Y. and Moriwaki, H., 1995. Prediction of prognosis of primary biliary cirrhosis in Japan. Liver, 15(2), pp.70-77.

27.Whitfield, J.B., 2001. Gamma glutamyl transferase. Critical Reviews in Clinical Laboratory Sciences, 38(4), pp.263-355.

28.Lee, D.H., Ha, M.H., Kim, J.H., Christiani, D.C., Gross, M.D., Steffes, M., Blomhoff, R. and Jacobs, D.R., 2003. Gamma-glutamyltransferase and diabetes—a 4 year follow-up study. Diabetologia, 46(3), pp.359-364.

29.Chanda M, Biswas T, Roy MN, Sampa SR, Saha P, Sharna RJ, Islam S, Mahbub A, Rahman MA. Association of Liver Enzymes and Lipid Profile in Adults at Tertiary Level Hospitalin Bangladesh. J Natl Inst Lab Med Ref Bangladesh. 2021;1(1):17-24.

30.Marchesini, G., Brizi, M., Bianchi, G., Tomassetti, S., Bugianesi, E., Lenzi, M., McCullough, A.J., Natale, S., Forlani, G. and Melchionda, N., 2001. Nonalcoholic fatty liver disease: a feature of the metabolic syndrome. Diabetes, 50(8), pp.1844-1850.

31.Kerner, A., Avizohar, O., Sella, R., Bartha, P., Zinder, O., Markiewicz, W., Levy, Y., Brook, G.J. and Aronson, D., 2005. Association between elevated liver enzymes and C-reactive protein: possible hepatic contribution to systemic inflammation in the metabolic syndrome. Arteriosclerosis, Thrombosis, and Vascular biology, 25(1), pp.193-197.

32.Islam S, Hossen MA, Rahman MA, Lubaba MI, Akram A. Serum uric acid level among type-2 diabetes subjects attending in a tertiary hospital of Bangladesh. World Journal of Biology Pharmacy and Health Sciences. 2022;12(1):081-5.

33.Mazidi M, Toth PP, Banach M. C-reactive protein is associated with prevalence of the metabolic syndrome, hypertension, and diabetes mellitus in US adults. Angiology. 2018 May;69(5):438-42.