title: Liver enzymes as a predictor for incident diabetes in a Japanese population: the Hisayama study.
abstract: OBJECTIVE
  We studied the relationship between liver enzymes and the development of diabetes in a general Japanese population.
  
  
  METHODS
  A total of 1804 non-diabetic subjects 40 to 79 years of age were followed-up prospectively for a mean of 9.0 years.
  
  
  RESULTS
  During the follow-up, 135 subjects developed diabetes. In both sexes, the age-adjusted cumulative incidence of diabetes increased significantly with elevating quartiles of serum gamma-glutamyltransferase (GGT) and alanine aminotransferase (ALT) levels. This pattern was also observed in aspartate aminotransferase (AST) quartiles for men but not for women. In multivariate analyses after adjusting for comprehensive risk factors and other liver enzymes, the risk of developing diabetes was significantly higher in the highest GGT quartile than in the lowest quartile [odds ratio (OR), 2.54; 95% confidence interval (CI), 1.03 to 6.26 for men; OR, 5.73; 95% CI, 1.62 to 20.19 for women]. Similar results were observed in ALT quartiles (OR, 2.32; 95% CI, 0.91 to 5.92 for men; OR, 4.40; 95% CI, 1.38 to 14.06 for women) but not in AST quartiles in either sex. Significant positive associations of GGT and ALT with diabetes were seen within each stratified category of risk factors, namely fasting insulin, BMI, waist-to-hip ratio, high-sensitivity C-reactive protein, and alcohol consumption. In receiver operating characteristic analyses, the areas under the receiver operating characteristic curve of GGT and ALT were significantly larger than that of AST, fasting insulin, waist-to-hip ratio, or C-reactive protein.
  
  
  CONCLUSIONS
  Our findings suggest that serum GGT and ALT concentrations are strong predictors of diabetes in the general population, independent of known risk factors.
authors.affiliation: Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka 812-8582, Japan. doi@intmed2.med.kyushu-u.ac.jp
authors.forename: Yasufumi
authors.initials: Y
authors.lastname: Doi
authors.forename: Michiaki
authors.initials: M
authors.lastname: Kubo
authors.forename: Koji
authors.initials: K
authors.lastname: Yonemoto
authors.forename: Toshiharu
authors.initials: T
authors.lastname: Ninomiya
authors.forename: Masanori
authors.initials: M
authors.lastname: Iwase
authors.forename: Yumihiro
authors.initials: Y
authors.lastname: Tanizaki
authors.forename: Kentaro
authors.initials: K
authors.lastname: Shikata
authors.forename: Mitsuo
authors.initials: M
authors.lastname: Iida
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Kiyohara
mesh_terms: D000368:Aged; D000410:Alanine Transaminase / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000032:analysis; D003920:Diabetes Mellitus / Q000201:enzymology* / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008099:Liver / Q000201:enzymology*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D005723:gamma-Glutamyltransferase / Q000097:blood*
chemical_list: D000410:Alanine Transaminase; D015415:Biomarkers; D001786:Blood Glucose; D006442:Glycated Hemoglobin; D005723:gamma-Glutamyltransferase