Elevated liver transaminases and their association with metabolic syndrome in type 2 diabetic patients attending tertiary care hospital of Nepal

Figures & data

Table 1. Socio-demographic and health risk factors.

	Poor glycaemic control n (366) (HbA1c ≥ 7.0%)	Good glycaemic control n (174) (HbA1c < 7.0%)	p
Age (years) 40–54 55−0	210 (57.4%) 156 (42.6%)	75 (43.1%) 99 (56.9%)	0.05
Sex Male Female	183 (50%) 183 (50%)	99 (56.9%) 75 (43.1%)	0.24
Duration since diagnosis of diabetes Previously diagnosed (>10 years) Recently diagnosed (<10 years)	204 (55.7%) 162 (44.3%)	69 (39.6%) 105 (60.4%)	0.03
Habit of exercise Low adherence High adherence	286 (78.1%) 80 (21.9%)	81 (46.5%) 93 (53.5%)	0.00
Number of medications ≤3 >3	192 (52.5%) 174 (47.5%)	85 (49.3%) 89 (50.7%)	0.10
Following meal plan Low adherence High adherence	325 (88.9%) 41 (11.1%)	88 (49.3%) 86 (49.4%)	0.00

Note: Bold represents statistically significant values (p < 0.05).

HbA_1c, glycated haemoglobin.

Figure 1. Distribution of metabolic components in diabetic population.

Table 2. Baseline characteristics based on glycaemic status of the study population.

	Poor glycaemic control (HbA1c ≥ 7.0%)	Good glycaemic control (HbA1c < 7.0%)
Parameters	(mean ± SD)	(mean ± SD)	p
Age (years)	53.7 ± 12.3	50.5 ± 13.4	0.118
SBP (mmHg)	128.6 ± 14.1	124.4 ± 12.5	0.52
DBP (mmHg)	81.4 ± 7.2	80.9 ± 7.0	0.696
BMI (kg/m^2)	26.2 ± 4.6	25.8 ± 4.0	0.601
WC (cm)	95.0 ± 10.1	94.6 ± 10.1	0.786
FBS (mg/dL)	155 ± 67	113 ± 15	0.000
PPBS (mg/dL)	215 ± 85	141 ± 22	0.000
TC (mg/dL)	176 ± 52	149 ± 47	0.001
TG (mg/dL)	165 ± 70	135 ± 46	0.003
HDL-C (mg/dL)	41.0 ± 15	49 ± 11	0.001
LDL-C (mg/dL)	85 ± 44	91 ± 44	0.351
AST (U/L)	36 ± 12	35 ± 10	0.821
ALT (U/L)	37 ± 16	29 ± 18	0.005
GGT (U/L)	38 ± 14	30 ± 15	0.000

Note: Bold represents statistically significant values (p < 0.05).

Abbreviations: SBP, systolic blood pressure; DBP, diastolic blood pressure; BMI, body mass index; WC, waist circumference; FBS, fasting blood sugar; PPBS, postprandial blood sugar; TC, total cholesterol; TG, triglycerides; HDL-C, high-density lipoprotein-cholesterol; LDL-C, low-density lipoprotein-cholesterol; AST, aspartate aminotransferase; ALT, alanine aminotransferase; GGT, gamma glutamyl transferase.

Table 3. Association of metabolic components with liver enzyme activity in the study population.

	AST (U/L)		ALT(U/L)		GGT (U/L)
	mean ± SD	p	mean ± SD	p	mean ± SD	p
Obesity Obese (BMI ≥ 25 kg/m^2) Non-obese (BMI < 25 kg/m^2)	36 ± 14 30 ± 10	0.001	39 ± 15 23 ± 15	0.000	38 ± 16 31 ± 14	0.002
Central obesity (NCEPATP III criteria) Present Absent	36 ± 13 32 ± 13	0.036	40 ± 14 27 ± 17	0.000	38 ± 15 33 ± 16	0.036
Hypertension Present (≥130/85 mmHg) Absent (≥130/85 mmHg)	36 ± 13 33 ± 13	0.166	42 ± 12 26 ± 17	0.000	41 ± 16 31 ± 14	0.000
Dyslipidaemia Present (TG≥ 150 mg/dL) Absent (TG< 150 mg/dL)	40 ± 12 30 ± 13	0.000	38 ± 15 30 ± 17	0.001	37 ± 15 35 ± 16	0.34
HDL-C status Low HDL	31 ± 13 32 ± 13	0.56	42 ± 11 27 ± 17	0.000	39 ± 15 32 ± 16	0.004
(≤40 mg/dL for males, ≤ 50 mg/dL for females) High HDL (>40 mg/dL for males, > 50 mg/dL for females)
Duration since diagnosis of diabetes >10 years <10 years	34 ± 14 34 ± 13	0.92	36 ± 16 31 ± 17	0.081	37 ± 16 34 ± 15	0.10

Note: Bold represents statistically significant values (p < 0.05).

Table 4. Metabolic syndrome and individual components associated with risk of elevated liver enzyme activity.

Bivariate analysis	High ALT COR (95%CI)	High AST COR (95%CI)	High GGT COR (95%CI)
Time since diagnosis (>10 years)	0.262 (0.140–0.491)^a	0.359 (0.194–0.666)^b	1.308 (0.706–2.423)^c
Male gender	0.942 (0.520–1.708)^c	4.022 (2.146–7.536)^a	2.084 (1.115–3.896)^b
BMI (>25 kg/m^2)	1.695 (0.926–3.103)^c	1.124 (0.616–2.054)^c	0.701 (0.377–1.307)^c
Glycosylated haemoglobin (>7.5%)	1.679 (0.785–3.591)^c	1.491 (0.727–3.061)^c	0.727 (0.333–1.586)^c
Waist circumference > 102 cm (M) or > 88 cm (F)	0.195 (0.102–0.373)^a	0.288 (0.154–0.539)^a	2.652 (1.403–5.013)^b
Waist circumference >94 cm (M) or >80 cm (F)	0.366 (0.175–0.762)^b	0.347 (0.153–0.787)^b	1.745 (0.840–3.623)^c
Arterial pressure ≥130/85 mmHg	0.389 (0.198–0.763)^b	0.622 (0.332–1.162)^c	2.495 (1.222–5.095)^b
Triglycerides ≥150 mg/dL	0.243 (0.128–0.463)^a	0.341 (0.185–0.629)^a	3.478 (1.786–6.771)^a
HDL cholesterol < 40 mg/dL (M) or <50 mg/dL (F)	0.218 (0.115–0.413)^a	0.623 (0.343–1.132)^c	4.111 (2.118–7.980)^a
Metabolic syndrome + (defined by NCEPATP III criteria)	13.776 (4.064–46.701)^a	2.860 (1.402–5.834)^b	0.244 (0.096–0.618)^b
Metabolic syndrome + (defined by IDF criteria)	12.304 (2.825–53.586)^a	1.867 (2.825–4.159)^c	0.180 (0.052–0.621)^b
Metabolic syndrome + (Harmonizing criteria)	0.168 (0.502–0.760)^b	0.629 (0.425–0.932)^c	0.701 (0.577–0.852)^b
Multivariate analysis
Covariates	High ALT AOR (95%CI)	High AST AOR (95%CI)	High GGT AOR (95%CI)
Time since diagnosis (>10 years)	2.874 (1.368–6.037)^a	2.622 (1.249 −5.505)^a	–
Male gender	–	0.203 (0.095 – 0.435)^b	0.225 (0.098 – 0.519)^b
Waist circumference >102 cm (M) or > 88 cm (F)	4.172 (1.583 – 10.992)^a	2.795 (1.044 – 7.477)^a	0.245 (0.097 – 0.621)^a
Waist circumference >94 cm (M) or >80 cm (F)	0.949 (0.352 – 2.558)^c	0.710 (0.235 −2.147)^c	–
Arterial pressure ≥130/85 mmHg	1.056 (0.414 – 2.696)^c	1.039 (0.486 – 2.220)^c	0.633 (0.239 – 1.679)^c
Triglycerides ≥150 mg/dL	2.268 (0.937–5.491)^c	4.946 (1.927–12.695)^a	0.339 (0.136–0.845)^a
HDL cholesterol < 40 mg/dL (M) or < 50 mg/dL (F)	2.860 (1.235 – 6.622)^a	–	0.226 (0.094 – 0.545)^a
Metabolic syndrome + (defined by NCEPATP III criteria)	0.116 (0.033–0.410)^a	0.353 (0.155–0.808)^a	2.704 (0.989–7.391)^a
Metabolic syndrome + (defined by IDF criteria)	0.195 (0.041–0.932)^a	–	3.317 (0.874–12.589)^c
Metabolic syndrome+ (Harmonized criteria)	0.145 (0.033–0.650)^c	–	5.050 (1.127–22.612)^c

COR, crude odds ratio (bivariate analysis); AOR, adjusted odds ratio (multivariate analysis); M, male; F, female.

^ap < 0.001, ^bp< 0.005.

^cNon-significant.

NCEPATP III, National Cholesterol Education program Adult Treatment Panel III; IDF, International Diabetes Federation.