title: Fatty liver index, gamma-glutamyltransferase, and early carotid plaques.
abstract: An association between fatty liver and carotid atherosclerosis has been established; however, it is not clear whether this relationship is a consequence of shared conventional risk factors or whether it is determined by specific circulating factors originating from liver or adipose tissue. To identify the factors possibly linking fatty liver and atherosclerosis, we assessed, in 1,012 subjects free of confounding diseases (e.g., hypertension, diabetes, cardiovascular diseases, and dyslipidemia) and metabolic syndrome, the relationship between the presence of early plaques at carotid bifurcation and fatty liver index (FLI; a validated surrogate marker of fatty liver), as well as the associations between carotid plaque presence and established atherosclerotic risk factors, family history of cardiovascular disease (FH-CVD) or diabetes, insulin sensitivity, serum liver enzymes, adipokines, fatty free acids, and high-sensitivity C-reactive protein (hsCRP). A total of 55 of 1,012 subjects (5.4%) had small plaque at carotid bifurcation. Subjects with plaque were older and had higher prevalence of FLI ≥60 and FH-CVD, higher blood pressure, plasma low-density lipoprotein cholesterol, glucose, gamma-glutamyltransferase (GGT), and hsCRP, as compared to subjects without plaques (P < 0.05). In a logistic regression model, adjusted for sex, liver transaminase, and alcohol consumption, the independent predictors of plaque presence were age (P < 0.0005), FLI ≥60 (P < 0.0005), and current smoking (P < 0.05). When FLI in the model was replaced by variables used in its equation (e.g., body mass index, waist circumference, plasma triglycerides, and GGT), the independent determinants of plaque presence were age (P < 0.001), GGT (P = 0.001), and current smoking (P < 0.05).
  
  
  CONCLUSIONS
  Our cross-sectional study suggests that subjects with FLI ≥60 are at higher risk of atherosclerotic lesions, independently of established risk factors, and that serum GGT may represent a link between fatty liver and the development of early atherosclerosis.
authors.affiliation: Department of Internal Medicine, University of Pisa, Pisa, Italy. m.kozakova@in.med.unipi.it
authors.forename: Michaela
authors.initials: M
authors.lastname: Kozakova
authors.forename: Carlo
authors.initials: C
authors.lastname: Palombo
authors.forename: Marco Paterni
authors.initials: MP
authors.lastname: Eng
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Dekker
authors.forename: Allan
authors.initials: A
authors.lastname: Flyvbjerg
authors.forename: Asimina
authors.initials: A
authors.lastname: Mitrakou
authors.forename: Amalia
authors.initials: A
authors.lastname: Gastaldelli
authors.forename: Ele
authors.initials: E
authors.lastname: Ferrannini
mesh_terms: D000328:Adult; D017677:Age Distribution; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000201:enzymology / Q000453:epidemiology*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005234:Fatty Liver / Q000175:diagnosis* / Q000201:enzymology / Q000453:epidemiology*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007333:Insulin Resistance; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D058226:Plaque, Atherosclerotic / Q000453:epidemiology* / Q000473:pathology; D015995:Prevalence; D011379:Prognosis; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D015996:Survival Rate; D014463:Ultrasonography; D055105:Waist Circumference; D005723:gamma-Glutamyltransferase / Q000097:blood*
chemical_list: D005723:gamma-Glutamyltransferase