title: γ-glutamyl transpeptidase in men and alanine aminotransferase in women are the most suitable parameters among liver function tests for the prediction of metabolic syndrome in nonviral hepatitis and nonfatty liver in the elderly.
abstract: OBJECTIVE
  Nonalchoholic fatty liver disease (NAFLD) has been reported as a hepatic manifestation of metabolic syndrome (MetS); it is common and accounts for 80% of the cases with abnormal liver function tests (LFTs). In addition, several studies have proved that there is a correlation between abnormal LFTs and MetS. Therefore, LFTs may represent the abnormal metabolic status of livers in the patients with MetS. To identify the early state of metabolic dysfunction, we investigate the value of LFTs for the future MetS development in the relatively healthy (non-NAFLD) elderly.
  
  
  METHODS
  A total of 16,912 subjects met the criteria for analysis. In the first stage of this study, subjects were enrolled in the cross-sectional study in order to find out the optimal cutoff value in different LFTs with higher chances to have MetS. In the second stage of the present study, subjects with MetS at baseline were excluded from the same study group, and a median 5.6-year longitudinal study was conducted on the rest of the group.
  
  
  RESULTS
  Among all LFTs, only aspartate aminotransferase in both genders and the α-fetal protein in women failed to show the significance in distinguishing subjects with MetS by the receiver operating characteristic curve. In the Kaplan-Meier plot, only γ-glutamyl transpeptidase (γ-GT) in men and the alanine aminotransferase (ALT) in women could be used to successfully separate subjects with higher risk of developing the MetS from those with lower risk. Finally, in the multivariant Cox regression model, similar results were identified. Still, the hazard ratio (HR) to have future MetS, γ-GT in men, and ALT in women showed significance (HR = 1.511 in men and 1.504 in women).
  
  
  CONCLUSIONS
  Among all the different LFTs, γ-GT (>16 U/L) in male and ALT (>21 U/L) in female were the best predictors for the development of MetS in healthy elderly. These two liver markers could be an ancillary test in predicting future MetS development/diagnosis. Elevation of the LFTs without underlying liver diseases should be treated as a warning sign of the possible MetS development in the elderly.
authors.forename: Dee
authors.initials: D
authors.lastname: Pei
authors.forename: Te-Lin
authors.initials: TL
authors.lastname: Hsia
authors.forename: Ting-Ting
authors.initials: TT
authors.lastname: Chao
authors.forename: Jiunn-Diann
authors.initials: JD
authors.lastname: Lin
authors.forename: Chun-Hsien
authors.initials: CH
authors.lastname: Hsu
authors.forename: Chung-Ze
authors.initials: CZ
authors.lastname: Wu
authors.forename: Chang-Hsun
authors.initials: CH
authors.lastname: Hsieh
authors.forename: Yao-Jen
authors.initials: YJ
authors.lastname: Liang
authors.affiliation: Department of Pathology, Cardinal Tien Hospital, School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan.
authors.forename: Yen-Lin
authors.initials: YL
authors.lastname: Chen
mesh_terms: D000368:Aged; D000410:Alanine Transaminase / Q000378:metabolism*; D001219:Aspartate Aminotransferases / Q000378:metabolism; D015415:Biomarkers / Q000378:metabolism; D015992:Body Mass Index; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006505:Hepatitis / Q000201:enzymology* / Q000503:physiopathology; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging / Q000201:enzymology* / Q000503:physiopathology; D008111:Liver Function Tests; D008137:Longitudinal Studies; D008297:Male; D024821:Metabolic Syndrome / Q000201:enzymology* / Q000503:physiopathology / Q000517:prevention & control; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000201:enzymology* / Q000503:physiopathology; D014463:Ultrasonography; D000509:alpha-Fetoproteins / Q000378:metabolism; D005723:gamma-Glutamyltransferase / Q000378:metabolism*
chemical_list: D015415:Biomarkers; D000509:alpha-Fetoproteins; D005723:gamma-Glutamyltransferase; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase