Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Abnormal liver function test results are related to metabolic syndrome and BMI in Taiwanese adults without chronic hepatitis B or C

International Journal of Obesity volume 33, pages 1309–1317 (2009)Cite this article

Abstract

Background:

Metabolic syndrome (MS) is considered a cause of abnormal deposition of fat into hepatocytes, which might be associated with hepatic steatosis or abnormal liver function.

Objective:

The aim of this study was to explore the factors associated with MS and the relationship between MS and abnormal aspartate aminotransferase (AST), alanine aminotransferase (ALT) and γ-glutamyl transferase (GGT) levels in Taiwanese subjects without chronic hepatitis B (CHB) or C (CHC).

Subjects:

We enrolled 2539 Taiwanese adults without CHB or CHC (age range: 16–88 years old) and investigated the factors related to MS using the NCEP-ATP (National Cholesterol Education Program-Adult Treatment Panel) III criteria; body mass index (BMI) was measured using Asia-Pacific criteria.

Results:

The prevalence rate of MS in Taiwanese adults without CHB or CHC was 16.9% using the modified ATP III criteria and 15.4% using the International Diabetes Federation criteria. Males had a significantly higher prevalence rate than females (P<0.001), and subjects with MS were significantly older and had significantly higher BMI values and AST, ALT and GGT levels (all P<0.001). In univariate analyses, the abnormality of liver function test results were related to gender, level of fasting sugar, systolic blood pressure, triglyceride, high-density lipoprotein, BMI and MS (all P<0.05). Multivariate analysis showed that the male gender, a higher BMI value and MS were related to abnormal liver function test results. The cutoff value for ALT in relation to MS is 31 IU l−1 for male and 18 IU l−1 for female.

Conclusion:

The prevalence of MS in Taiwanese adults without hepatitis B or C was found to be high, and MS and BMI were identified as being related to abnormal liver function test results in these adults.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1

Similar content being viewed by others

References

  1. Isomaa B, Almgren P, Tuomi T, Forsen B, Lahti K, Nissen M et al. Cardiovascular morbidity and mortality associated with the metabolic syndrome. Diabetes Care 2001; 24: 683–689.

    Article  CAS  PubMed  Google Scholar 

  2. Lakka HM, Laaksonen DE, Lakka TA, Niskanen LK, Kumpusalo E, Tuomilehto J et al. The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men. JAMA 2002; 288: 2709–2716.

    Article  PubMed  Google Scholar 

  3. Hanson RL, Imperatore G, Bennett PH, Knowler WC . Components of the ‘metabolic syndrome’ and incidence of type 2 diabetes. Diabetes 2002; 51: 3120–3127.

    Article  CAS  PubMed  Google Scholar 

  4. Boyko EJ, de Courten M, Zimmet PZ, Chitson P, Tuomilehto J, Alberti KG . Features of the metabolic syndrome predict higher risk of diabetes and impaired glucose tolerance: a prospective study in Mauritius. Diabetes Care 2000; 23: 1242–1248.

    Article  CAS  PubMed  Google Scholar 

  5. Wilson PW, D'Agostino RB, Parise H, Sullivan L, Meigs JB . Metabolic syndrome as a precursor of cardiovascular disease and type 2 diabetes mellitus. Circulation 2005; 112: 3066–3072.

    Article  CAS  PubMed  Google Scholar 

  6. Grundy SM . Metabolic syndrome: a multiplex cardiovascular risk factor. J Clin Endocrinol Metab 2007; 92: 399–404.

    Article  CAS  PubMed  Google Scholar 

  7. Gami AS, Witt BJ, Howard DE, Erwin PJ, Gami LA, Somers VK et al. Metabolic syndrome and risk of incident cardiovascular events and death: a systematic review and meta-analysis of longitudinal studies. J Am Coll Cardiol 2007; 49: 403–414.

    Article  CAS  PubMed  Google Scholar 

  8. Laaksonen DE, Lakka HM, Niskanen LK, Kaplan GA, Salonen JT, Lakka TA . Metabolic syndrome and development of diabetes mellitus: application and validation of recently suggested definitions of the metabolic syndrome in a prospective cohort study. Am J Epidemiol 2002; 156: 1070–1077.

    Article  PubMed  Google Scholar 

  9. National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation 2002; 106: 3143–3421.

    Article  Google Scholar 

  10. Grundy SM . Hypertriglyceridemia, insulin resistance, and the metabolic syndrome. Am J Cardiol 1999; 83 (9B): 25F–29F.

    Article  CAS  PubMed  Google Scholar 

  11. Unwin N . The metabolic syndrome. J R Soc Med 2006; 99: 457–462.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Miyatake N, Matsumoto S, Makino H, Numata T . Comparison of hepatic enzymes between Japanese men with and without metabolic syndrome. Acta Med Okayama 2007; 61: 31–34.

    CAS  PubMed  Google Scholar 

  13. Wannamethee SG, Shaper AG, Lennon L, Whincup PH . Hepatic enzymes, the metabolic syndrome, and the risk of type 2 diabetes in older men. Diabetes Care 2005; 28: 2913–2918.

    Article  CAS  PubMed  Google Scholar 

  14. Nannipieri M, Gonzales C, Baldi S, Posadas R, Williams K, Haffner SM et al. Liver enzymes, the metabolic syndrome, and incident diabetes: the Mexico City diabetes study. Diabetes Care 2005; 28: 1757–1762.

    Article  CAS  PubMed  Google Scholar 

  15. Hsiao PJ, Kuo KK, Shin SJ, Yang YH, Lin WY, Yang JF et al. Significant correlations between severe fatty liver and risk factors for metabolic syndrome. J Gastroenterol Hepatol 2007; 22: 2118–2123.

    Article  CAS  PubMed  Google Scholar 

  16. Tsai CH, Li TC, Lin CC . Metabolic syndrome as a risk factor for nonalcoholic fatty liver disease. South Med J 2008; 101: 900–905.

    Article  PubMed  Google Scholar 

  17. Lai SW, Liao KF, Li TC, Lin HF, Lin WY, Lin CH . Metabolic syndrome in older people in Taiwan: a hospital-based study. Intern Med J 2006; 36: 648–651.

    Article  PubMed  Google Scholar 

  18. Hwang LC, Bai CH, Chen CJ . Prevalence of obesity and metabolic syndrome in Taiwan. J Formos Med Assoc 2006; 105: 626–635.

    Article  PubMed  Google Scholar 

  19. [Revised Diagnostic Criteria of Metabolic Syndrome for adults aged more or equal 20 years old in Taiwan, 2006]. In: Bureau of Health Promotion. Department of Health: Taipei, ROC (Taiwan).

  20. Jia WP, Xiang KS, Chen L, Lu JX, Wu YM . Epidemiological study on obesity and its comorbidities in urban Chinese older than 20 years of age in Shanghai, China. Obes Rev 2002; 3: 157–165.

    Article  CAS  PubMed  Google Scholar 

  21. Gill TP . Cardiovascular risk in the Asia-Pacific region from a nutrition and metabolic point of view: abdominal obesity. Asia Pac J Clin Nutr 2001; 10: 85–89.

    Article  CAS  PubMed  Google Scholar 

  22. Alberti KG, Zimmet P, Shaw J . The metabolic syndrome—a new worldwide definition. Lancet 2005; 366: 1059–1062.

    Article  PubMed  Google Scholar 

  23. Chang CJ, Wu CH, Chang CS, Yao WJ, Yang YC, Wu JS et al. Low body mass index but high percent body fat in Taiwanese subjects: implications of obesity cutoffs. Int J Obes Relat Metab Disord 2003; 27: 253–259.

    Article  PubMed  Google Scholar 

  24. Saito T, Misawa K, Kawata S . 1. Fatty liver and non-alcoholic steatohepatitis. Intern Med 2007; 46: 101–103.

    Article  PubMed  Google Scholar 

  25. Schindhelm RK, Diamant M, Dekker JM, Tushuizen ME, Teerlink T, Heine RJ . Alanine aminotransferase as a marker of non-alcoholic fatty liver disease in relation to type 2 diabetes mellitus and cardiovascular disease. Diabetes Metab Res Rev 2006; 22: 437–443.

    Article  CAS  PubMed  Google Scholar 

  26. Younossi ZM, McCullough AJ, Ong JP, Barnes DS, Post A, Tavill A et al. Obesity and non-alcoholic fatty liver disease in chronic hepatitis C. J Clin Gastroenterol 2004; 38: 705–709.

    Article  PubMed  Google Scholar 

  27. Kawai N, Kawai T, Kawai K . Ultrasonic and laboratory studies on fatty liver in white-collar workers. Nippon Shokakibyo Gakkai Zasshi 1995; 92: 1058–1065.

    CAS  PubMed  Google Scholar 

  28. Lonardo A, Bellini M, Tartoni P, Tondelli E . The bright liver syndrome. Prevalence and determinants of a ‘bright’ liver echo pattern. Ital J Gastroenterol Hepatol 1997; 29: 351–356.

    CAS  PubMed  Google Scholar 

  29. Ionescu DL . Microvesicular steatosis. Rev Med Chir Soc Med Nat Iasi 2002; 107: 268–272.

    CAS  PubMed  Google Scholar 

  30. De Luis DA, Aller R, Izaola O, Gonzalez Sagrado M, Conde R, Gonzalez Hernandez JM . Influence of insulin resistance in obese patients on elevated serum alanine aminotransferase. Eur Rev Med Pharmacol Sci 2007; 11: 21–25.

    CAS  PubMed  Google Scholar 

  31. Kim WR, Flamm SL, Di Bisceglie AM, Bodenheimer HC . Serum activity of alanine aminotransferase (ALT) as an indicator of health and disease. Hepatology 2008; 47: 1363–1370.

    Article  CAS  PubMed  Google Scholar 

  32. Keeffe EB, Dieterich DT, Han SH, Jacobson IM, Martin P, Schiff ER et al. A treatment algorithm for the management of chronic hepatitis B virus infection in the United States: an update. Clin Gastroenterol Hepatol 2006; 4: 936–962.

    Article  CAS  PubMed  Google Scholar 

  33. Prati D, Taioli E, Zanella A, Della Torre E, Butelli S, Del Vecchio E et al. Updated definitions of healthy ranges for serum alanine aminotransferase levels. Ann Intern Med 2002; 137: 1–10.

    Article  CAS  PubMed  Google Scholar 

  34. Lok AS, McMahon BJ . Chronic hepatitis B. Hepatology 2007; 45: 507–539.

    Article  CAS  PubMed  Google Scholar 

  35. Yuen MF, Yuan HJ, Wong DK, Yuen JC, Wong WM, Chan AO et al. Prognostic determinants for chronic hepatitis B in Asians: therapeutic implications. Gut 2005; 54: 1610–1614.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Lai M, Hyatt BJ, Nasser I, Curry M, Afdhal NH . The clinical significance of persistently normal ALT in chronic hepatitis B infection. J Hepatol 2007; 47: 760–767.

    Article  CAS  PubMed  Google Scholar 

  37. Michelle Lai BH . Role of liver biopsy in patients with normal ALT and high HBV DNA. Hepatology 2005; 42 (Suppl 1): 720A.

    Google Scholar 

  38. Alberti A, Noventa F, Benvegnu L, Boccato S, Gatta A . Prevalence of liver disease in a population of asymptomatic persons with hepatitis C virus infection. Ann Intern Med 2002; 137: 961–964.

    Article  PubMed  Google Scholar 

  39. Kim HC, Nam CM, Jee SH, Han KH, Oh DK, Suh I . Normal serum aminotransferase concentration and risk of mortality from liver diseases: prospective cohort study. BMJ 2004; 328: 983.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Wang Z, Hall SD, Maya JF, Li L, Asghar A, Gorski JC . Diabetes mellitus increases the in vivo activity of cytochrome P450 2E1 in humans. Br J Clin Pharmacol 2003; 55: 77–85.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

This study was supported by grants from the Taiwan Liver Research Foundation, the Department of Preventive Medicine, Chung-Ho Memorial Hospital, Kaohsiung Medical University and the Health Examination Center, Kaohsiung Municipal Hsiaokang Hospital, Taiwan.

Author information

Authors and Affiliations

  1. Department of Occupational Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan

    M-H Hsieh & W-Y Lin

  2. Department of Occupational and Environmental Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan

    C-K Ho, C-L Wang & C-Y Dai

  3. Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan

    N-J Hou, M-Y Hsieh, J-F Huang, C-Y Dai, W-L Chuang & M-L Yu

  4. Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan

    N-J Hou, J-F Huang & C-L Wang

  5. Department of Preventive Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan

    W-Y Lin, J-F Yang, C-C Chiu, N-C Chang & M-L Yu

  6. Faculty of Internal Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

    C-Y Dai, W-L Chuang & M-L Yu

Authors
  1. M-H Hsieh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C-K Ho
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. N-J Hou
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M-Y Hsieh
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. W-Y Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. J-F Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. C-C Chiu
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. J-F Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. N-C Chang
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. C-L Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. C-Y Dai
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. W-L Chuang
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. M-L Yu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to C-Y Dai.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hsieh, MH., Ho, CK., Hou, NJ. et al. Abnormal liver function test results are related to metabolic syndrome and BMI in Taiwanese adults without chronic hepatitis B or C. Int J Obes 33, 1309–1317 (2009). https://doi.org/10.1038/ijo.2009.172

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ijo.2009.172

Keywords

This article is cited by

Search

Advanced search

Quick links