Comparison of the combined marker GGT-CDT and the conventional laboratory markers of alcohol abuse in heavy drinkers, moderate drinkers and abstainers

AIMS: A combined index based on gamma-glutamyltransferase (GGT) and carbohydrate-deficient transferrin (CDT) measurements (GGT-CDT) has been recently suggested to improve the detection of excessive ethanol consumption. The aim of this work was to compare GGT-CDT with the conventional markers of alcohol abuse in individuals with a wide variety of alcohol consumption. METHODS: A cross-sectional and follow-up analysis was conducted in a sample of 165 heavy drinkers, consuming 40-540 g of ethanol per day, and 86 reference individuals who were either moderate drinkers (n = 51) or abstainers (n = 35). RESULTS: GGT-CDT (5.35 +/- 1.08) in the heavy drinkers was significantly higher than in the reference individuals (3.30 +/- 0.37). The sensitivity of GGT-CDT (90%) in correctly classifying heavy drinkers exceeded that of CDT (63%), GGT (58%), mean corpuscular volume (MCV) (45%), aspartate aminotransferase (AST) (47%), and alanine aminotransferase (ALT) (50%), being also essentially similar for alcoholics with (93%) or without (88%) liver disease. When comparing the data using either moderate drinkers or abstainers as reference population, the sensitivity of GGT-CDT, CDT, and ALT remained unchanged whereas the sensitivity of GGT, MCV, and AST was found to show variation. CONCLUSIONS: GGT-CDT improves the sensitivity of detecting excessive ethanol consumption as compared with the traditional markers of ethanol consumption. These findings should be considered in the assessment of patients with alcohol use disorders.     

Additive effects of moderate drinking and obesity on serum gamma-glutamyl transferase activity

BACKGROUND: Gamma-glutamyl transferase (GGT) is a widely used index of liver induction and a marker of alcohol overconsumption. Obesity has also been suggested to elevate serum GGT activities. OBJECTIVE: The aim was to examine the links between moderate ethanol consumption, obesity, and GGT activities. DESIGN: GGT values were recorded from 2490 persons (1184 men and 1306 women) who reported either no alcohol use (abstainers) or 1-40 g ethanol consumption per day (moderate drinkers). The study population was additionally classified according to body mass index (BMI; in kg/m2) as follows: < 19 (underweight), > or = 19 and < 25 (normal weight), > or = 25 and < 30 (overweight), and 30 (obese). RESULTS: Significant main effects of sex (P < 0.0001), drinking habits (P < 0.01), and BMI (P < 0.001) on serum GGT activities were observed. The values were higher in the men than in the women and higher in those with higher BMIs. The highest activities were found to occur in persons with moderate drinking combined with overweight or obesity. A significant positive correlation between GGT and BMI (P < 0.0001) was observed, which was stronger for the men (r = 0.24) than for the women (r = 0.15, P < 0.05 for the difference between correlations). CONCLUSION: The data indicate that serum GGT activities may respond to moderate drinking and overweight in an additive manner; this should be considered in the clinical use of GGT measurements and when defining normal GGT values in health care.     

Body weight, alcohol consumption and liver enzyme activity--a 4-year follow-up study

BACKGROUND: This prospective study was performed in order to investigate the effect of baseline body mass index (BMI), BMI changes, baseline alcohol consumption, and changes in alcohol consumption on liver enzyme activity. METHODS: This study population consisted of 6846 male workers in a steel manufacturing company who had undergone health examinations in 1994 and 1998. RESULTS: The risk for elevated both aspartate aminotransferase (AST) and alanine aminotransferase (ALT) values over the four years increased with the baseline BMI and BMI changes, but not with alcohol consumption. Compared with the subject BMI < 20, the adjusted odds ratios (OR) for those with baseline BMI 20-21.9, 22-24.9, 25- were 1.2, 1.6, 1.7 in AST and 1.4, 2.4, 2.8 in ALT, respectively. Compared with subjects who either lost or maintained their weight, the adjusted OR for men with slight, moderate, and heavy weight gain were 1.7, 2.6, 6.8 in AST and 2.4, 3.9, 11.3 in ALT, respectively. However gamma-glutamyl transferase (GGT) was associated with BMI changes and baseline alcohol consumption, not with baseline BMI and changes in alcohol consumption. Compared with subjects who lost or maintained weight, the adjusted OR for men with slight, moderate, and heavy weight gain were 2.4, 4.4 and 8.5, respectively. In comparison with non-drinkers, the adjusted OR for light, moderate and heavy drinkers were 1.8, 2.1 and 5.8, respectively. CONCLUSION: These data suggest that body weight, rather than alcohol consumption, may be the major factor in determining the serum level of liver enzymes. Even when body weight was not generally considered to be overweight, slight to moderate gains in weight were associated with increases in serum liver enzymes.     

Serum gamma-glutamyl transferase in alcoholics, moderate drinkers and abstainers: effect on gt reference intervals at population level

AIMS: To clarify in the association between amount of ethanol consumption and serum gamma-glutamyl transferase (GT) levels. METHODS: GT values were measured from 195 individuals with a wide variety of well-documented ethanol consumption assessed by detailed personal interviews using a time-line follow-back technique. These included 103 heavy drinkers (90 men, 13 women) and 92 healthy volunteers (54 men, 38 women) who were either abstainers (n = 30) or moderate drinkers (n = 62). For comparisons, data were collected from GT measurements for establishing GT reference intervals from 2485 healthy volunteers including 1156 abstainers and 1329 moderate drinkers. RESULTS: GT values in the individuals whose mean ethanol consumption exceeded 40 g of ethanol per day were significantly higher than those in the moderate drinkers with a mean consumption of 1-40 g/day (P < 0.001) or in abstainers (P < 0.001). The GT values in the group of moderate drinkers also exceeded those of the abstainers (P < 0.001). The upper normal GT limits obtained from the data from abstainers were markedly lower (men 45 U/l, women 35 U/l) than those obtained from the population of moderate drinkers (men 66 U/l, women 40 U/l). CONCLUSIONS: Serum GT concentrations may respond to relatively low levels of ethanol consumption, which should be considered when defining GT reference intervals. The continuous increase in alcohol consumption at population level may lead to increased GT cut-off limits and hamper the detection of alcohol problems and liver affection in their early phase.     

Elevated liver enzyme activity in construction workers: prevalence and impact on early retirement and all-cause mortality

Background: Gamma-glutamyl transferase (GGT), alanine transaminase (ALT), and aspartate transaminase (AST) are widely used as markers of hepatobiliary disorders in occupational health surveillance. Little is known, however, about the prevalence and occupational and non-occupational determinants of elevated levels of these enzymes in specific occupational groups or about the prognostic value of elevated levels with respect to long-term outcomes such as all-cause mortality and vocational disability. Methods: A cohort study was conducted among 8,043 male construction workers aged 25–64 years who had undergone occupational health examinations in 6 centers in southern Germany from 1986 to 1988 and had been followed until 1994. The prevalence of elevated levels of GGT, ALT, and AST, depending on the sociodemographic and medical characteristics determined at the baseline examination and the risk of vocational disability and all-cause mortality in relation to elevated liver enzyme activity at baseline were assessed. Covariates considered in multivariate analysis included age, nationality, occupation, body mass index (BMI), smoking, and alcohol consumption. Results: The baseline prevalence of elevated activity levels of GGT (>28 U/l at 25 °C), ALT (>22 U/l), and AST (>18 U/l) was 32%, 22%, and 12%, respectively. Factors most strongly related to elevated serum activity levels for all three enzymes were self-reported alcohol consumption, diabetes, and hypertension. BMI was strongly associated with elevations in GGT and ALT but not in AST. Elevated levels of AST and GGT were strongly related to early retirement and all-cause mortality. Men with AST levels exceeding 18 U/l had a 2-fold risk of early retirement and a 3 times higher risk of all-cause mortality as compared with men with lower AST levels. No significant association was observed between ALT and either of the long-term outcomes. Conclusions: Our findings suggest that screening for elevated GGT and AST levels, which are a common finding among construction workers, may be a␣powerful tool for the identification of individuals at increased risk of early retirement and preterm mortality and may be helpful in targeting of prevention efforts. Received: 8 December 1997 / Accepted: 28 March 1998     

Liver function assessment in workers exposed to vinyl chloride

Objective: To investigate liver function in vinyl chloride workers and assess its relation with current/past occupational exposure to vinyl chloride monomer (VCM). Methods: A medical examination including the execution of liver function tests (LFTs) and liver ultrasonography was executed in a group of 757 workers with a long-standing service in the production of VCM/polyvinylchloride (PVC). Cumulative and maximum VCM exposures were calculated. History of viral hepatitis and alcohol intake were carefully investigated. Regression analysis explored the association between abnormal LFTs and a group of possible determinants (VCM cumulative and maximum exposure, BMI, age, history of viral hepatitis, alcohol and triglyceride levels). Also, synergistic effect between VCM and a history of hepatitis was analysed, as well as the possible association between VCM exposure and aspartate aminotransferase/alanine amino transferase (AST/ALT) ratio >1. Distribution of abnormal LFTs was also assessed in relation to the results provided by liver ultrasonography. Results: The most frequently abnormal serum parameters were, in decreasing order: total cholesterol (27.3%), triglycerides (12.2%), total bilirubin (9.1%), gamma glutamil transpeptidase (GGT; 9.0%) and ALT (8.2%). The AST/ALT ratio >1 was present in 28.1% of workers. Abnormal LFTs were not found to be associated with current or past VCM exposure. High ALT resulted positively associated with BMI, AST with alcohol intake, GGT with alcohol intake and triglycerides. No synergistic effect on LFTs of exposure to VCM and a history of hepatitis was observed. The AST/ALT ratio >1 was not found to be associated with VCM exposure. The prevalence of abnormal LFTs was higher in case of liver steatosis (ALT) or periportal fibrosis (GGT), but not in case of pure hepatomegaly, as documented by ultrasonography. Conclusions: Liver function assessment only including LFTs is not able to detect VCM-induced liver damage, but reveals alterations due to non-occupational factors, such as dietary and/or metabolic disfunctions. The LFTs are however of importance to detect conditions that could recommend avoidance of exposure to VCM and are useful for medical counselling and health promotion purposes.     

Liver enzymes as mediators of association between obesity and diabetes: the Guangzhou Biobank Cohort Study

PurposeTo assess the proportion of the association between obesity and diabetes mediated by liver enzymes such as gamma-glutamyltransferase (GGT), alanine transaminase (ALT), and aspartate transaminase (AST).MethodsMediation analysis was used with adjustment for age, education, physical activity, smoking, and alcohol use.ResultsA total of 9748 participants from Phase III of the Guangzhou Biobank Cohort Study were recruited in 2006–2008. For women, the association of body mass index (BMI) and waist circumference (WC) with glucose was partially mediated by GGT, 30% (95% confidence interval 23%–40%) and 28% (23%–34%) and by ALT, 15% (14%–25%) and 14% (10%–18%), respectively; for men, the proportion mediated by GGT was 16% (9%–26%) and 23% (12%–36%), respectively, and by ALT 12% (4%–22%) for BMI and for WC. The association of BMI and WC with glucose was not mediated by AST for women or men. Additionally, considering of mediation by lipids did not change the mediation by GGT and ALT.ConclusionsThe effect of obesity on diabetes is partly mediated by GGT and ALT but not AST. There is no evidence of the mediation effect by lipids. Our results may provide opportunities to identify new targets for diabetes interventions.     

Probiotics restore bowel flora and improve liver enzymes in human alcohol-induced liver injury: a pilot study

The effects of chronic alcohol consumption on the bowel flora and the potential therapeutic role of probiotics in alcohol-induced liver injury have not previously been evaluated. In this study, 66 adult Russian males admitted to a psychiatric hospital with a diagnosis of alcoholic psychosis were enrolled in a prospective, randomized, clinical trial to study the effects of alcohol and probiotics on the bowel flora and alcohol-induced liver injury. Patients were randomized to receive 5 days of Bifidobacterium bifidum and Lactobacillus plantarum 8PA3 versus standard therapy alone (abstinence plus vitamins). Stool cultures and liver enzymes were performed at baseline and again after therapy. Results were compared between groups and with 24 healthy, matched controls who did not consume alcohol. Compared to healthy controls, alcoholic patients had significantly reduced numbers of bifidobacteria (6.3 vs. 7.5 log colony-forming unit [CFU]/g), lactobacilli (3.15 vs. 4.59 log CFU/g), and enterococci (4.43 vs. 5.5 log CFU/g). The mean baseline alanine aminotransferase (ALT), aspartate aminotransferase (AST), and γ-glutamyl transpeptidase (GGT) activities were significantly elevated in the alcoholic group compared to the healthy control group (AST: 104.1 vs. 29.15 U/L; ALT: 50.49 vs. 22.96 U/L; GGT 161.5 vs. 51.88 U/L), indicating that these patients did have mild alcohol-induced liver injury. After 5 days of probiotic therapy, alcoholic patients had significantly increased numbers of both bifidobacteria (7.9 vs. 6.81 log CFU/g) and lactobacilli (4.2 vs. 3.2 log CFU/g) compared to the standard therapy arm. Despite similar values at study initiation, patients treated with probiotics had significantly lower AST and ALT activity at the end of treatment than those treated with standard therapy alone (AST: 54.67 vs. 76.43 U/L; ALT 36.69 vs. 51.26 U/L). In a subgroup of 26 subjects with well-characterized mild alcoholic hepatitis (defined as AST and ALT greater than 30 U/L with AST-to-ALT ratio greater than one), probiotic therapy was associated with a significant end of treatment reduction in ALT, AST, GGT, lactate dehydrogenase, and total bilirubin. In this subgroup, there was a significant end of treatment mean ALT reduction in the probiotic arm versus the standard therapy arm. In conclusion, patients with alcohol-induced liver injury have altered bowel flora compared to healthy controls. Short-term oral supplementation with B. bifidum and L. plantarum 8PA3 was associated with restoration of the bowel flora and greater improvement in alcohol-induced liver injury than standard therapy alone.     

High AST/ALT ratio may indicate advanced alcoholic liver disease rather than heavy drinking

AIMS: To assess the place of AST/ALT ratio (the ratio of serum aspartate aminotransferase to serum alanine aminotransferase) as a diagnostic marker in medical populations. METHODS: Laboratory tests were viewed retrospectively in three groups of patients: 313 patients with alcohol dependence, consecutively admitted to an alcohol and drug treatment unit for treatment of withdrawal (W) symptoms, 78 patients with alcohol abuse or dependence consecutively admitted to surgical or medical wards with various primary somatic (S) diagnoses (e.g. respiratory, gastrointestinal and metabolic), and 48 consecutive patients with alcohol abuse or dependence admitted to surgical or medical wards for treatment of alcohol-related liver cirrhosis and its complications (C). Comparison between groups was made of the pattern of patients' AST/ALT ratios using, for Groups S and C, laboratory data from patients' first admission for their condition. RESULTS: There was a significant rise in the AST/ALT ratio from the W to the S patients, and from the S to the C patients. In the W group, the ratio was < or = 1.0 in 64% of the patients, and only exceptionally > or = 2. In the C group, 69% had a ratio > or = 2, and 8% a ratio < or = 1.0. The mean ratio was midway in the S group. In the C group, there was a progressive decline in aspartate (AST/ALT) ratios after admission. CONCLUSIONS: Most patients with high alcohol consumption but without severe liver disease do not have an AST/ALT ratio above 1. High AST/ALT ratio suggests advanced alcoholic liver disease.     

Effects of coffee consumption against the development of liver dysfunction: a 4-year follow-up study of middle-aged Japanese male office workers

The association of coffee consumption with the development of increased serum aspartate aminotransferase (AST) and/or alanine aminotransferase (ALT) activities over 4 years was studied in 1221 liver dysfunction-free (serum AST and ALT < or = 39 IU/l and no medical care for or no past history of liver disease) Japanese male office workers aged 35 to 56 years. From the analysis using the Kaplan-Meier method, the estimated incidence of serum AST and/or ALT > or = 40 IU/l, > or = 50 IU/l, and > or = 60 IU/l decreased with an increase in coffee consumption. From the Cox proportional hazards model, coffee drinking was independently inversely associated with the development of serum AST and/or ALT > or = 40 IU/l (p = 0.019 by test for tendency), > or = 50 IU/l (p = 0.002), and > or = 60 IU/l (p = 0.007), controlling for age, body mass index, alcohol intake, and cigarette smoking. These results suggest that coffee may be protectively against the liver dysfunction in middle-aged Japanese men.     

Gamma-glutamyltransferase, alcohol, and blood pressure. A four year follow-up study

PURPOSE: We performed this study to see: 1) whether gamma-glutamyltransferase (GGT) was a predictor for hypertension irrespective of amount of alcohol consumption; and 2) whether the relationship between alcohol consumption and blood pressure (BP) was different depending on GGT. METHODS: This study included 8170 healthy male workers in a steel manufacturing company who had undergone health examinations in both 1994 and 1998. RESULTS: The adjusted relative risk (RR) for hypertension over four years among those with GGT >or=30 U/L at baseline was 1.6 (95% confidence interval (CI): 1.1-2.4), compared to those with GGT < 30 U/L. This relationship was shown only in drinkers. Among subjects with GGT < 30U/L, no matter how much the subjects drank, the risk of hypertension in drinkers was similar with that of non-drinkers. However, among those with GGT >or=30 U/L, adjusted RRs for light, moderate, and heavy drinkers compared to non-drinkers were 1.4 (95% CI: 0.5-4.5), 5.2 (95% CI: 1.5-18.0), and 5.3 (95% CI: 1.0-27.6). CONCLUSIONS: This study showed that elevated GGT could be a predictor for hypertension in drinkers and the relationship between alcohol consumption and hypertension was shown only among those with GGT >or= 30 U/L at baseline. These findings suggest that increased serum GGT levels may reflect individual susceptibility to the blood pressure raising effect of alcohol.     

Blood pressure, levels of serum lipids, liver enzymes and blood glucose by aldehyde dehydrogenase 2 and drinking habit in Japanese men

Objectives The association of blood pressure and levels of serum lipids, liver enzymes, blood glucose and aldehyde dehydrogenase 2 (ALDH2) with drinking habit was examined in Japanese men. Methods The subjects were 264 men aged 39 to 80 years who were classified into the ALDH2 deficiency or sufficiency group using the ethanol patch test and the Tokyo University ALDH2 Phenotype Screening Test. A self-administered questionnaire including drinking habit was used. Blood pressure and the levels of biochemical markers in groups with ALDH2 sufficiency, ALDH2 deficiency and drinking habit were compared using multiple regression models for adjusting age, smoking habit, physical exercising habit and body mass index. Results The levels of serum high-density lipoprotein cholesterol, triglycerides, aspartate aminotransferase (AST) and gamma-glutamyl transpeptidase (γ-GTP) were significantly higher in current drinkers of 20 g of ethanol or more per day than in nondrinkers of the ALDH2 sufficiency group. The levels of serum AST and γ-GTP in current drinkers of 20 g of ethanol or more per day, and fasting blood sugar in current drinkers of less than 20 g of ethanol per day were significantly higher than those in nondrinkers of the ALDH2 deficiency group. Conclusions These results suggest that alcohol consumption increases the levels of serum lipids and liver enzymes in ALDH2-sufficient individuals and liver enzymes and blood glucose levels in ALDH2-deficient individuals.     

Blood alcohol is the best indicator of hazardous alcohol drinking in young adults and working-age patients with trauma

AIMS: To determine the most effective marker of hazardous alcohol drinking in trauma patients. METHODS: A prospective study of 349 trauma patients aged 16-49 years admitted into a general hospital trauma centre. Information on the amount and pattern of alcohol drinking was obtained by interview. Blood or breath alcohol concentration (BAC), serum gammaglutamyl transferase (GGT), aspartate aminotransferase (AST), carbohydrate-deficient transferrin (CDT) and the mean corpuscular volume (MCV) of erythrocytes were measured as markers of alcohol consumption. RESULTS: In this series, 8% of all trauma patients were found to be dependent drinkers, while 61% were frequent binge drinkers, 17% infrequent binge drinkers, 8% light-to-moderate drinkers and 6% nondrinkers. On admission, the BAC test was positive in 68% of the hazardous drinkers (i.e. dependent drinkers or frequent binge drinkers). Using a cut-off level of >0 mg/dl, the sensitivity and specificity of the BAC test for identifying hazardous drinking were 68% (95% confidence intervals [CI], 61-73%) and 94% (95% CI, 87-97%), respectively, and the positive predictive value was 96% (95% CI, 92-98%). GGT, MCV, CDT and AST were less accurate indicators of hazardous drinking. BAC was the least expensive marker. CONCLUSIONS: Two-thirds of trauma patients were hazardous drinkers, and blood alcohol on admission was an accurate indicator of this. BAC should be systematically used in trauma centres if patients are to be selected for an alcohol intervention.     

Predictors of non-alcoholic fatty liver disease in obese children

OBJECTIVE: To evaluate predictors of non-alcoholic fatty liver disease (NAFLD) in obese children. DESIGN: Cross-sectional study. SUBJECTS: Two hundred and sixty-eight obese children not consuming alcohol and without hepatitis B or C were consecutively studied at an auxology clinic. MEASUREMENTS: Alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl-transferase (GGT), cholesterol, high-density lipoprotein (HDL)-cholesterol, low-density lipoprotein (LDL)-cholesterol, triglycerides, uric acid, glucose, glucose during oral glucose tolerance testing (OGTT), insulin, insulin during OGTT, insulin resistance as estimated by homeostasis model assessment (HOMA), C-reactive protein (CRP), and systolic and diastolic blood pressure were measured. Fatty liver was diagnosed by ultrasonography using standard criteria. Univariable and multivariable logistic regression was used to evaluate predictors of NAFLD. All predictors except gender and pubertal status were modeled as continuous variables. RESULTS: NAFLD was detected in 44% of obese children. At univariable analysis, male gender, Z-score of body mass index (BMI) (Z-BMI), ALT, AST, GGT, triglycerides, uric acid, glucose, glucose during OGTT, insulin, insulin during OGTT, HOMA, CRP and systolic blood pressure were predictors of NAFLD, whereas HDL-cholesterol and late-pubertal status were predictors of the normal liver. At multivariable analysis, however, only Z-BMI, ALT, uric acid, glucose during OGTT and insulin during OGTT were independent predictors of NAFLD. CONCLUSION: Z-BMI, ALT, uric acid, glucose during OGTT and insulin during OGTT are independent predictors of NAFLD in Italian obese children, with most of the prediction explained by ALT and Z-BMI.     

Abnormal liver function in workers exposed to low levels of ethylene dichloride and vinyl chloride monomer

We investigated whether exposure to ethylene dichloride (EDC) and vinyl chloride monomer (VCM) resulted in increased risk of liver damage. Epidemiological information, including occupational, medical, smoking, and drinking history, was obtained by interview from 251 male workers. Serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma-glutamyltransferase (GGT) were used as indicators of liver damage. Exposure to moderate or low levels of ECD and VCM resulted in a higher risk of developing abnormal ALT levels than did exposure to lower levels of the chemicals. Results were similar for AST. GGT was not associated with EDC or VCM exposure. Combined exposure to EDC and VCM showed a dose-response relationship in association with abnormal ALT levels. We concluded that relatively low concentrations of VCM and EDC cause liver damage.     

Coffee drinking and serum gamma-glutamyltransferase: an extended study of Self-Defense Officials of Japan

PURPOSE: To examine the effect of coffee drinking on serum gamma-glutamyltransferase (GGT) level in relation to alcohol drinking, smoking, and degree of obesity in middle-aged Japanese men. METHODS: From 1986 to 1994, a total of 7,637 male officials of the Self-Defense Forces of Japan aged 48-59 years received a preretirement health examination. Coffee drinking was ascertained by a self-administered questionnaire, and serum GGT level was measured. After excluding 1,360 men with a possible pathologic condition influencing liver enzyme levels and 182 former alcohol drinkers, effect of coffee drinking on serum GGT was examined by a multiple linear regression model and analysis of variance adjusting for alcohol drinking, smoking, and body mass index (BMI). RESULTS: The adjusted percentage of difference in serum GGT was -4.3 (95% CI = -5.0; -3.5) per cup of coffee. The inverse coffee-GGT relation was most prominent among men drinking > or = 30 ml of ethanol and smoking > or = 15 cigarettes daily; and positive associations of alcohol and smoking with GGT were attenuated by coffee drinking, more clearly among men with BMI > or = 25.00 kg/m2. Adjusted percentages of difference in serum GGT were -2.6% (p = 0.0003) per cup of brewed coffee, and -5.1% (p = 0.0001) per cup of instant coffee, independently of each other. CONCLUSIONS: The present study suggests that coffee consumption may weaken GGT-induction by alcohol, and possibly by smoking. These effect modifications by coffee may differ according to the degree of obesity.     

不同体质量指数世居藏族大学生移居平原初期肝脏功能变化

  目的  探讨不同体质量指数(BMI)的世居高原藏族大学生移居平原初期肝脏功能变化规律,为世居高原藏族脱适应研究提供科学依据和理论基础。  方法  选取从高原(西藏)初入平原(陕西)的3 035名藏族大学生为研究对象,进行脱适应症状筛查。将受试者分为体重偏轻、体重正常、超重及肥胖4组,分别于初入平原3,6,9 d检测肝脏功能指标。采用χ2检验比较各组肝功能指标异常率,采用二元Logistic回归分析BMI与肝功能指标异常的关系。  结果  超重藏族男生与肥胖藏族男女生的丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、γ-谷氨酰转肽酶(GGT),超重藏族男生和肥胖藏族女生的总胆汁酸(TBA)在脱适应初期均高于体重正常组(P值均 < 0.05)。在脱适应3,6,9 d,指标总体呈上升趋势的包括超重组男、女生直接胆红素(DBIL)、肥胖组女生血清总蛋白(TP)、球蛋白(GLOB)(P值均 < 0.05)。超重组男生ALT(13.9%),肥胖组男、女生ALT(34.3%,26.7%)、GGT(11.4%,13.3%)和女生AST(10.0%)肝功能指标异常率高于体重偏轻(2.8%,3.5%,0,1.0%,1.5%)、正常组(3.5%,3.4%,0.9%,3.6%,4.1%)(χ2值分别为48.07,20.55,20.55,17.93,10.23,P值均 < 0.05)。二元Logistic回归分析显示,在校正年龄和性别因素后,超重与ALT(OR=2.10,95%CI=1.20~3.62)异常呈正相关,肥胖与ALT(OR=5.50,95%CI=4.23~7.40)、GGT(OR=4.10,95%CI=2.03~6.74)异常均呈正相关(P值均 < 0.05)。  结论  世居高原藏族大学生移居平原初期,肝脏功能指标变化与BMI相关。超重肥胖者肝功能损伤指标异常率较高。肥胖高危人群从高原移居平原地区时需进行健康检查及医务监督。     

Consumption of fructose- but not glucose-sweetened beverages for 10 weeks increases circulating concentrations of uric acid, retinol binding protein- 4, and gamma-glutamyl transferase activity in overweight/obese humans

ABSTRACT: BACKGROUND: Prospective studies in humans examining the effects of fructose consumption on biological markers associated with the development of metabolic syndrome are lacking. Therefore we investigated the relative effects of 10 wks of fructose or glucose consumption on plasma uric acid and RBP-4 concentrations, as well as liver enzyme (AST, ALT, and GGT) activities in men and women. METHODS: As part of a parallel arm study, older (age 40-72), overweight and obese male and female subjects (BMI 25-35 kg/m2) consumed glucose- or fructose-sweetened beverages providing 25% of energy requirements for 10 wks. Fasting and 24-h blood collections were performed at baseline and following 10 wks of intervention and plasma concentrations of uric acid, RBP-4 and liver enzyme activities were measured. RESULTS: Consumption of fructose, but not glucose, led to significant increases of 24-h uric acid profiles (P < 0.0001) and RBP-4 concentrations (P = 0.012), as well as plasma GGT activity (P = 0.04). Fasting plasma uric acid concentrations increased in both groups; however, the response was significantly greater in subjects consuming fructose (P = 0.002 for effect of sugar). Within the fructose group male subjects exhibited larger increases of RBP-4 levels than women (P = 0.024). CONCLUSIONS: These findings suggest that consumption of fructose at 25% of energy requirements for 10 wks, compared with isocaloric consumption of glucose, may contribute to the development of components of the metabolic syndrome by increasing circulating uric acid, GGT activity, suggesting alteration of hepatic function, and the production of RBP-4.     

Epidemiological study of gastrointestinal and liver effects of carbon disulfide

Summary In the framework of an extensive health survey, 119 viscose rayon workers exposed to carbon disulfide (CS₂) and 79 workers from other plants not exposed to any toxic agent in the working environment underwent a gastrointestinal examination including a self-administered questionnaire, abdominal palpation, percussion and a number of liver function tests. In the viscose rayon factory the working conditions have not changed since 1932. Personal monitoring performed in 17 jobs showed CS₂ exposures varying from 4 to 112 mg · m^–3. For each individual a cumulative CS₂ exposure index (CS₂ index) was calculated. Univariate analysis of the questionnaire findings showed significantly higher prevalences of anorexia (37.0% vs 11.4%, P<0.0001), vomiting (12.6% vs 3.8%, P = 0.04), and recent weight loss (10.9% vs 1.3%, P = 0.009) in the exposed than in the non-exposed workers. The exposed workers had a larger total number of gastrointestinal complaints and a larger proportion reported at least one complaint at least once a month than the non-exposed ones. Abdominal tenderness was very rare in both groups. In multiple logistic regression analysis, adjusting for alcohol intake, smoking, body mass index (BMI), coffee consumption, commuting time, stress at work, shift work, educational level, family history of ulcer disease and intake of medication, significant associations with exposure were found for anorexia (P = 0.0001), nausea (P = 0.009), vomiting (P = 0.002) and flatulence (P = 0.03). Stress at work was a determinant for quite a few digestive complaints, but shift work was not significantly associated with any of them. The exposed workers had significantly lower median values for aspartate aminotransferase (AST) and alanine aminotransferase (ALT) than the non-exposed (11.0 vs 13.5 mU/ml, P = 0.0008; 12.0 vs 13.0 mU/mL, P = 0.01, respectively. The values for liver size and -glutamyltransferase (GGT) were significantly higher in the exposed than in the non-exposed workers (72 vs 67 mm, P = 0.002; 13 vs 11 U/1, P = 0.0003, respectively). The alkaline phosphatase (AP) activity did not differ significantly between the two groups. In multiple linear regression, adjusting for alcohol, pharmaceuticals consumption and BMI, there was a slightly significant negative association between exposure and AST (P = 0.04) and positive association with liver size (P = 0.002) and GGT (P = 0.0001). Alcohol was positively associated with GGT, and BMI with ALT and GGT.     

Coffee consumption and serum aminotransferases in middle-aged Japanese men

We investigated the relation between coffee drinking and serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) concentrations among 7313 Japanese men receiving a health examination, excluding former alcohol drinkers and men with a history of chronic liver disease. Serum AST > 40 and/or ALT > 40 U/L was defined as liver inflammation. Adjustment was made for alcohol use, smoking, body mass index, serum marker for hepatitis virus infection, and other possible confounders. Adjusted odds ratios of liver inflammation were 1.00 (reference), 0.80, 0.69, and 0.61 for men drinking < 1, 1-2, 3-4, and > or = 5 cups of coffee daily, respectively. Among 6898 men without liver inflammation, serum AST and ALT were inversely associated with coffee consumption, and alcohol-related rise in AST was attenuated with coffee drinking. These findings suggest coffee may have an effect of suppressing the rise of serum aminotransferase, partly by inhibiting the alcohol-related elevation. Studies regarding biological mechanism are warranted.