Metabolic syndrome is linked to a mild elevation in liver aminotransferases in diabetic patients with undetectable non-alcoholic fatty liver disease by ultrasound

Abstract

BackgroundDespite ongoing findings on the relationship between elevated levels of alanine and aspartate aminotransferases (ALT and AST) and metabolic syndrome (MetS), this association in diabetic patients without a known cause for liver enzymes elevation other than diabetes, per se, remains unclear. In this study, we aimed to assess the relationship between circulating liver enzymes and MetS in a relatively large sample of patients with diabetes.MethodsA total of 670 diabetic patients, without known causes of hepatocellular injury, were enrolled. Patients with ultrasonographic signs of fatty liver disease were not included. Fasting blood samples were obtained and biochemical characteristics were measured. MetS was defined according to the international diabetes federation criteria.ResultsSerum ALT and AST were significantly higher in patients with MetS (p < 0.001). High waist circumference and low HDL-cholesterol were significantly associated with elevated ALT (OR = 2.56 and 2.0, respectively) and AST (OR = 2.23 and 2.21, respectively). ALT and AST were significantly associated with MetS (OR = 2.17 and 2.31, respectively). These associations remained significant after multiple adjustments for age, sex, BMI, diabetes duration, HbA1c and medications. There was a significant (p < 0.01) positive association between the number of the MetS features and the level of ALT or AST.ConclusionIn diabetic patients without ultrasonographic evidence of fatty liver, elevated aminotransferases are independently associated with MetS. Despite negative ultrasound results in diabetic patients with MetS, the serum level of liver aminotransferases may be elevated and should be more thoroughly monitored.

Composite prognostic models across the non-alcoholic fatty liver disease spectrum: Clinical application in developing countries

“…Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels are commonly elevated in patients with this condition, and increased ALT reliably predicts the development of adverse cardiac events and cardiovascular mortality [22,23] . Although used to determine eligibility for further diagnostic work-up and imaging, liver enzymes may however remain normal in up to 80% of NAFLD cases [24] . In addition, while elevated gamma glutamyl-transferase (GGT) has greater specificity for hepatosteatosis and is a sensitive marker for early IR, it is clear that no single biochemical test is considered ideal for confirming a suspected diagnosis of NAFLD.…”

Correlation of Alt/Ast Ratio With Insulin Resistance in Metabolic Syndrome.

“…In another study from China, both ALT and GGT concentrations were linearly correlated with HOMA-IR and independently associated with HOMA-IR [23]. To the contrary, in a study by Esteghamati et al, both Serum ALT and AST were significantly higher in patients with MS [24].…”

Biphasic insulin Aspart 30 vs. NPH plus regular human insulin in type 2 diabetes patients; a cost-effectiveness study

“…Serum concentrations of two-hour post-prandial glucose (PPG) were assessed using a glucose analyzer (YSI 2700 Select, YSI, Inc., Yellow Springs, OH). Percentage of glycated hemoglobin A1c (HbA1c) was measured using the high performance liquid chromatography (HPLC) method [ 22 ]. Serum concentrations of total cholesterol, high-density lipoprotein cholesterol (HDL), low density lipoprotein cholesterol (LDL), and triglycerides were determined using enzymatic methods with available commercial kits (Pars Azmun, Karaj, Iran) in a Hitachi 704 automatic analyzer (Tokyo, Japan) [ 23 ].…”