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Hepatic fat content-independent association of the serum level of gamma-glutamyltransferase with visceral adiposity, but not subcutaneous adiposity
diabetes research and clinical practice 79 (2008) e13–e14
available at www.sciencedirect.com
journal homepage: www.elsevier.com/locate/diabres
Letter to the Editor Hepatic fat content-independent association of the serum level of gamma-glutamyltransferase with visceral adiposity, but not subcutaneous adiposity
article info
abstract
Article history:
We investigated the association between the serum level of gamma-glutamyltransferase
Received 25 June 2007
(GGT) and parameters of adiposity and lipid profile, including the serum triglyceride (TG), HDLcholesterol (HDL-C) and LDL-cholesterol (LDL-C) levels in Japanese patients with type 2 diabetes mellitus and non-diabetic subjects. A total of 257 Japanese subjects (169 patients
Keywords Gamma-glutamyltransferase Adiposity Visceral fat area Subcutaneous fat area Triglyceride
with type 2 diabetes and 88 non-diabetic subjects) were enrolled in the study. To assess the hepatic fat content, the ratio of the CT attenuation value of the liver to that of the spleen (L/S ratio) was calculated. Serum GGT was significantly correlated with the waist circumference, BMI, visceral fat area (VFA), L/S ratio and TG, but not with the subcutaneous fat area (SFA). The serum GGT was still correlated with the VFA and TG, but not with the SFA, after adjustment for the four variables of age, gender, serum HbA1c and the L/S ratio. Our finding that the serum GGT is specifically associated with the VFA, but not with the SFA, suggests that the serum GGT may be useful as a convenient indicator of VFA in the clinical treatment of obesity. # 2007 Elsevier Ireland Ltd. All rights reserved.
To the Editor, It have been reported that serum gamma-glutamyltransferase (GGT) was significantly associated with the waist circumference, the waist/hip ratio and metabolic syndrome [1,2], however, it is still unknown whether the serum GGT is specifically associated with visceral or subcutaneous fat accumulation. Moreover, VFA-specific clinical indicators have not yet been identified. Therefore, we investigated the association between parameters of adiposity and the serum GGT, and lipid profile. We evaluated the clinical characteristics of patients who were admitted to our hospital. A total of 257 Japanese subjects (139 men and 118 postmenopausal women; age, 57.8 13.9 years; body mass index, 25.7 4.6 kg/m2; GGT, 55.3 53.3 IU/l; VFA, 122.9 65.9 cm2; SFA 173.8 83.1 cm2; 169 type 2 diabetic patients and 88 non-diabetic subjects) were evaluated. Persons with a history of alcohol intake of 20 g/day were excluded from the study. The degree of liver steatosis and SFA, intraabdominal VFA was measured by previously described procedure [3,4].
The serum GGT was significantly correlated with the waist circumference ( p = 0.0408, r = 0.127), BMI ( p = 0.0147, r = 0.159), L/S ratio as a marker of the hepatic fat content ( p = 0.0019, r = 0.193), VFA ( p = 0.0008, r = 0.207) and TG ( p = 0.0007, r = 0.211), but not with the SFA ( p = 0.546, r = 0.038), in the entire population. In the 228 subjects with serum GGT < 100 IU/l, who accounted for about 90% of the entire subject population, the serum GGT was significantly correlated with the waist circumference, BMI, L/S ratio, VFA, SFA, TG, and LDL-C. Even after adjustment for four variables (age, gender, serum HbA1c and L/S ratio), the serum GGT was still correlated significantly with the VFA and TG, but not with the SFA (Table 1). In the subgroup of subjects with serum GGT < 100 IU/l, the serum GGT was still correlated significantly with the VFA, but not with the SFA. Thus, after adjustment for the hepatic fat content, the serum GGT was specifically associated with the VFA. In conclusion, the serum GGT was associated with visceral adiposity, but not subcutaneous adiposity, independent of the hepatic fat content. We propose that the serum GGT may be
Abbreviations: GGT, gamma-glutamyltransferase; VFA, visceral fat area; TG, triglyceride; SFA, subcutaneous fat area; L/S ratio, ratio of the CT attenuation value of the liver to that of the spleen
e14
diabetes research and clinical practice 79 (2008) e13–e14
Table 1 – Relationships between parameters of adiposity, the serum lipid profile, degree of insulin resistance and the clinical background factors evaluated by multiple regression analysis Dependent variables
Independent variables Standard regression coefficient (P-value) Regression analysis R2 (P-value)
Waist circumference BMI VFA SFA HDL-C TG LDL-C
0.181 0.265 0.200 0.255 0.202 0.184 0.077
(<0.0001) (<0.0001) (<0.0001) (<0.0001) (<0.0001) (<0.0001) (0.0014)
Age 0.194 0.306 0.007 0.255 0.227 0.145 0.008
(0.0022) (<0.0001) (0.9132) (<0.0001) (0.0003) (0.0214) (0.9088)
useful as a convenient indicator of visceral adiposity in the clinical treatment of obesity.
Gender 0.065 0.072 0.172 0.340 0.200 0.031 0.223
(0.2810) (0.2333) (0.0004) (<0.0001) (0.0009) (0.6016) (0.0006)
HbA1c 0.151 0.099 0.163 0.088 0.145 0.176 0.036
(0.0105) (0.0893) (0.0055) (0.1172) (0.0133) (0.0031) (0.5646)
L/S ratio 0.298 0.324 0.331 0.274 0.229 0.264 0.149
(<0.0001) (<0.0001) (<0.0001) (<0.0001) (0.0002) (<0.0001) (0.0246)
GGT 0.065 0.069 0.126 0.021 0.055 0.164 0.124
(0.2874) (0.2551) (0.0387) (0.7147) (0.3599) (0.0077) (0.0569)
Tomoyuki Iwasaki Department of Endocrinology and Metabolism, Yokohama City University Graduate School of Medicine, Yokohama, Japan
Acknowledgements This work was supported in part by the Yokohama City University Center of Excellence Program and a grant for the 2006 Strategic Research Project (K18005) of Yokohama City University.
Conflict of interest
Masato Yoneda Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Japan Satsuki Kawasaki Department of Endocrinology and Metabolism, Yokohama City University Graduate School of Medicine, Yokohama, Japan
The authors state that they have no conflict of interest.
references
[1] S. Stranges, J.M. Dorn, P. Muti, J.L. Freudenheim, E. Farinaro, M. Russell, et al., Body fat distribution, relative weight, and liver enzyme levels: a population-based study, Hepatology 39 (2004) 754–763. [2] Y.H. Kang, H.K. Min, S.M. Son, I.J. Kim, Y.K. Kim, The association of serum gamma glutamyltransferase with components of the metabolic syndrome in the Korean adults, Diabetes Res. Clin. Pract. 77 (2007) 306–313. [3] T. Iwasaki, A. Nakajima, M. Yoneda, Y. Yamada, K. Mukasa, K. Fujita, et al., Serum ferritin is associated with visceral fat area and subcutaneous fat area, Diabetes Care 28 (2005) 2486–2491. [4] T. Iwasaki, A. Nakajima, M. Yoneda, Y. Terauchi, Relationship between the serum concentrations of Creactive protein and parameters of adiposity and insulin resistance in patients with type 2 diabetes mellitus, Endocri. J. 53 (2006) 345–356.
Koji Fujita Atsushi Nakajima Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Japan Yasuo Terauchi* Department of Endocrinology and Metabolism, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan *Corresponding author. Tel.: +81 45 787 2639; fax: +81 45 784 3012 E-mail address: [email protected] (Y. Terauchi) 0168-8227/$ – see front matter # 2007 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.diabres.2007.06.014
available at www.sciencedirect.com
journal homepage: www.elsevier.com/locate/diabres
Letter to the Editor Hepatic fat content-independent association of the serum level of gamma-glutamyltransferase with visceral adiposity, but not subcutaneous adiposity
article info
abstract
Article history:
We investigated the association between the serum level of gamma-glutamyltransferase
Received 25 June 2007
(GGT) and parameters of adiposity and lipid profile, including the serum triglyceride (TG), HDLcholesterol (HDL-C) and LDL-cholesterol (LDL-C) levels in Japanese patients with type 2 diabetes mellitus and non-diabetic subjects. A total of 257 Japanese subjects (169 patients
Keywords Gamma-glutamyltransferase Adiposity Visceral fat area Subcutaneous fat area Triglyceride
with type 2 diabetes and 88 non-diabetic subjects) were enrolled in the study. To assess the hepatic fat content, the ratio of the CT attenuation value of the liver to that of the spleen (L/S ratio) was calculated. Serum GGT was significantly correlated with the waist circumference, BMI, visceral fat area (VFA), L/S ratio and TG, but not with the subcutaneous fat area (SFA). The serum GGT was still correlated with the VFA and TG, but not with the SFA, after adjustment for the four variables of age, gender, serum HbA1c and the L/S ratio. Our finding that the serum GGT is specifically associated with the VFA, but not with the SFA, suggests that the serum GGT may be useful as a convenient indicator of VFA in the clinical treatment of obesity. # 2007 Elsevier Ireland Ltd. All rights reserved.
To the Editor, It have been reported that serum gamma-glutamyltransferase (GGT) was significantly associated with the waist circumference, the waist/hip ratio and metabolic syndrome [1,2], however, it is still unknown whether the serum GGT is specifically associated with visceral or subcutaneous fat accumulation. Moreover, VFA-specific clinical indicators have not yet been identified. Therefore, we investigated the association between parameters of adiposity and the serum GGT, and lipid profile. We evaluated the clinical characteristics of patients who were admitted to our hospital. A total of 257 Japanese subjects (139 men and 118 postmenopausal women; age, 57.8 13.9 years; body mass index, 25.7 4.6 kg/m2; GGT, 55.3 53.3 IU/l; VFA, 122.9 65.9 cm2; SFA 173.8 83.1 cm2; 169 type 2 diabetic patients and 88 non-diabetic subjects) were evaluated. Persons with a history of alcohol intake of 20 g/day were excluded from the study. The degree of liver steatosis and SFA, intraabdominal VFA was measured by previously described procedure [3,4].
The serum GGT was significantly correlated with the waist circumference ( p = 0.0408, r = 0.127), BMI ( p = 0.0147, r = 0.159), L/S ratio as a marker of the hepatic fat content ( p = 0.0019, r = 0.193), VFA ( p = 0.0008, r = 0.207) and TG ( p = 0.0007, r = 0.211), but not with the SFA ( p = 0.546, r = 0.038), in the entire population. In the 228 subjects with serum GGT < 100 IU/l, who accounted for about 90% of the entire subject population, the serum GGT was significantly correlated with the waist circumference, BMI, L/S ratio, VFA, SFA, TG, and LDL-C. Even after adjustment for four variables (age, gender, serum HbA1c and L/S ratio), the serum GGT was still correlated significantly with the VFA and TG, but not with the SFA (Table 1). In the subgroup of subjects with serum GGT < 100 IU/l, the serum GGT was still correlated significantly with the VFA, but not with the SFA. Thus, after adjustment for the hepatic fat content, the serum GGT was specifically associated with the VFA. In conclusion, the serum GGT was associated with visceral adiposity, but not subcutaneous adiposity, independent of the hepatic fat content. We propose that the serum GGT may be
Abbreviations: GGT, gamma-glutamyltransferase; VFA, visceral fat area; TG, triglyceride; SFA, subcutaneous fat area; L/S ratio, ratio of the CT attenuation value of the liver to that of the spleen
e14
diabetes research and clinical practice 79 (2008) e13–e14
Table 1 – Relationships between parameters of adiposity, the serum lipid profile, degree of insulin resistance and the clinical background factors evaluated by multiple regression analysis Dependent variables
Independent variables Standard regression coefficient (P-value) Regression analysis R2 (P-value)
Waist circumference BMI VFA SFA HDL-C TG LDL-C
0.181 0.265 0.200 0.255 0.202 0.184 0.077
(<0.0001) (<0.0001) (<0.0001) (<0.0001) (<0.0001) (<0.0001) (0.0014)
Age 0.194 0.306 0.007 0.255 0.227 0.145 0.008
(0.0022) (<0.0001) (0.9132) (<0.0001) (0.0003) (0.0214) (0.9088)
useful as a convenient indicator of visceral adiposity in the clinical treatment of obesity.
Gender 0.065 0.072 0.172 0.340 0.200 0.031 0.223
(0.2810) (0.2333) (0.0004) (<0.0001) (0.0009) (0.6016) (0.0006)
HbA1c 0.151 0.099 0.163 0.088 0.145 0.176 0.036
(0.0105) (0.0893) (0.0055) (0.1172) (0.0133) (0.0031) (0.5646)
L/S ratio 0.298 0.324 0.331 0.274 0.229 0.264 0.149
(<0.0001) (<0.0001) (<0.0001) (<0.0001) (0.0002) (<0.0001) (0.0246)
GGT 0.065 0.069 0.126 0.021 0.055 0.164 0.124
(0.2874) (0.2551) (0.0387) (0.7147) (0.3599) (0.0077) (0.0569)
Tomoyuki Iwasaki Department of Endocrinology and Metabolism, Yokohama City University Graduate School of Medicine, Yokohama, Japan
Acknowledgements This work was supported in part by the Yokohama City University Center of Excellence Program and a grant for the 2006 Strategic Research Project (K18005) of Yokohama City University.
Conflict of interest
Masato Yoneda Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Japan Satsuki Kawasaki Department of Endocrinology and Metabolism, Yokohama City University Graduate School of Medicine, Yokohama, Japan
The authors state that they have no conflict of interest.
references
[1] S. Stranges, J.M. Dorn, P. Muti, J.L. Freudenheim, E. Farinaro, M. Russell, et al., Body fat distribution, relative weight, and liver enzyme levels: a population-based study, Hepatology 39 (2004) 754–763. [2] Y.H. Kang, H.K. Min, S.M. Son, I.J. Kim, Y.K. Kim, The association of serum gamma glutamyltransferase with components of the metabolic syndrome in the Korean adults, Diabetes Res. Clin. Pract. 77 (2007) 306–313. [3] T. Iwasaki, A. Nakajima, M. Yoneda, Y. Yamada, K. Mukasa, K. Fujita, et al., Serum ferritin is associated with visceral fat area and subcutaneous fat area, Diabetes Care 28 (2005) 2486–2491. [4] T. Iwasaki, A. Nakajima, M. Yoneda, Y. Terauchi, Relationship between the serum concentrations of Creactive protein and parameters of adiposity and insulin resistance in patients with type 2 diabetes mellitus, Endocri. J. 53 (2006) 345–356.
Koji Fujita Atsushi Nakajima Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Japan Yasuo Terauchi* Department of Endocrinology and Metabolism, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan *Corresponding author. Tel.: +81 45 787 2639; fax: +81 45 784 3012 E-mail address: [email protected] (Y. Terauchi) 0168-8227/$ – see front matter # 2007 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.diabres.2007.06.014