title: No effect modification of serum bilirubin or coffee consumption on the association of gamma-glutamyltransferase with glycated hemoglobin in a cross-sectional study of Japanese men and women.
abstract: BACKGROUND
  Oxidative stress has been implicated in the development of type 2 diabetes mellitus. Bilirubin is a potent endogenous antioxidant, and coffee is a major source of exogenous antioxidants. Serum gamma-glutamyltransferase (GGT), a marker of oxidative stress, is a strong predictor of the risk of type 2 diabetes mellitus. This study evaluated the effect modification of bilirubin and coffee consumption on the association of serum GGT with glycated hemoglobin (HbA1c) and the combined effect of bilirubin and coffee on HbA1c concentrations.
  
  
  METHODS
  The subjects were 4492 men and 6242 women aged 49-76 years who participated in the baseline survey of an on-going cohort study on lifestyle-related diseases in Fukuoka, Japan. Geometric means of HbA1c were examined according to quartile categories of GGT, with stratification by serum total bilirubin (≥ 0.6 mg/dL versus less in men and ≥ 0.5 mg/dL versus less in women) and coffee consumption (< 1, 1-3 and ≥ 4 cups of per day). Statistical adjustment was made for age, smoking, alcohol use and body mass index by using analysis of covariance.
  
  
  RESULTS
  HbA1 concentrations increased progressively with increasing levels of GGT in both men and women. The increasing trend of HbA1c concentrations associated with GGT did not differ by either bilirubin status or coffee consumption. Both men and women with high bilirubin had consistently lower concentrations of HbA1c across the GGT quartiles. Higher coffee consumption was associated with lower concentrations of HbA1c in women with low bilirubin (trend P = 0.04), but not with high bilirubin (trend P = 0.37). There was no such association between coffee and HbA1c in men with either low or high bilirubin levels.
  
  
  CONCLUSIONS
  Bilirubin is possibly protective against deterioration of glucose metabolism. Further studies are needed regarding the combined effect of bilirubin and coffee on glucose metabolism.
authors.affiliation: Department of Preventive Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan. skono@phealth.med.kyushu-u.ac.jp.
authors.forename: Zhenjie
authors.initials: Z
authors.lastname: Wang
authors.forename: Christopher
authors.initials: C
authors.lastname: McMonagle
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Yoshimitsu
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Budhathoki
authors.forename: Makiko
authors.initials: M
authors.lastname: Morita
authors.forename: Kengo
authors.initials: K
authors.lastname: Toyomura
authors.forename: Keizo
authors.initials: K
authors.lastname: Ohnaka
authors.forename: Ryoichi
authors.initials: R
authors.lastname: Takayanagi
authors.forename: Suminori
authors.initials: S
authors.lastname: Kono