title: Elevated liver function enzymes are related to the development of prediabetes and type 2 diabetes in younger adults: the Bogalusa Heart Study.
abstract: OBJECTIVE
  Elevations in alanine aminotransferase (ALT) and γ-glutamyl transferase (GGT), surrogate markers of liver dysfunction and nonalcoholic fatty liver, are considered as part of metabolic syndrome and related type 2 diabetes. However, information is limited regarding the long-term predictability of ALT and GGT in the development of prediabetes and type 2 diabetes.
  
  
  METHODS
  In this retrospective cohort study, normoglycemic (n = 874), prediabetic (n = 101), and diabetic (n = 80) adults aged 26-50 years (average age 41.3 years) were followed over an average period of 16 years since their young adulthood (aged 18-38 years, average age 25.1 years), with measurements of cardiometabolic risk factor variables including ALT and GGT.
  
  
  RESULTS
  The follow-up prevalence rate of adult diabetes status by quartiles of baseline ALT and GGT levels showed an adverse trend for both prediabetes (P < 0.05) and diabetes (P < 0.01). In a longitudinal multivariate logistic regression analysis that included anthropometric, hemodynamic, and metabolic variables, as well as alcohol consumption and smoking, individuals with elevated baseline ALT and GGT levels (per 1-SD increment) were 1.16 and 1.20 times, respectively, more likely to develop diabetes (P = 0.05 for ALT and P < 0.01 for GGT); no such associations were noted for prediabetes. Regarding the predictive value of ALT and GGT, the area under the receiver operating curve analysis yielded C values ranging from 0.70 to 0.82, with values significantly higher for diabetes compared with prediabetes.
  
  
  CONCLUSIONS
  These findings in younger adults suggest potential clinical utility of including ALT and GGT as biomarkers in diabetes risk assessment formulations.
authors.affiliation: Tulane Center for Cardiovascular Health, Tulane University, New Orleans, Louisiana, USA.
authors.forename: Quoc Manh
authors.initials: QM
authors.lastname: Nguyen
authors.forename: Sathanur R
authors.initials: SR
authors.lastname: Srinivasan
authors.forename: Ji-Hua
authors.initials: JH
authors.lastname: Xu
authors.forename: Wei
authors.initials: W
authors.lastname: Chen
authors.forename: Susan
authors.initials: S
authors.lastname: Hassig
authors.forename: Janet
authors.initials: J
authors.lastname: Rice
authors.forename: Gerald S
authors.initials: GS
authors.lastname: Berenson
mesh_terms: D050154:Adiposity; D000328:Adult; D000410:Alanine Transaminase / Q000032:analysis*; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000201:enzymology* / Q000453:epidemiology; D005234:Fatty Liver / Q000150:complications / Q000201:enzymology; D005260:Female; D006801:Humans; D008099:Liver / Q000201:enzymology*; D008107:Liver Diseases / Q000201:enzymology; D008137:Longitudinal Studies; D008145:Louisiana / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease; D011236:Prediabetic State / Q000201:enzymology* / Q000453:epidemiology; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D005723:gamma-Glutamyltransferase / Q000032:analysis*
chemical_list: D005723:gamma-Glutamyltransferase; D000410:Alanine Transaminase