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Title: Opposite associations between alanine aminotransferase and γ-glutamyl transferase levels and all-cause mortality in type 2 diabetes: Analysis of the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study
Austin Authors: Williams, Kathryn H;Sullivan, David R;Nicholson, Geoffrey C;George, Jacob;Jenkins, Alicia J;Januszewski, Andrzej S;Gebski, Val J;Manning, Patrick;Tan, Yong Mong;Donoghoe, Mark W;Ehnholm, Christian;Young, Simon;O'Brien, Richard C ;Buizen, Luke;Twigg, Stephen M;Keech, Anthony C
Affiliation: Austin Health, Heidelberg, Victoria, Australia
Sydney Medical School, University of Sydney, Sydney, NSW, Australia
Royal Prince Alfred Hospital, Sydney, NSW, Australia
National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
Rural Clinical School, University of Queensland, Brisbane, Queensland, Australia
Storr Liver Unit, Westmead Millennium Institute, Westmead Hospital, Sydney, NSW, Australia
Department of Medical and Surgical Sciences, Dunedin School of Medicine, Dunedin, New Zealand
Townsville Diabetes and Endocrine Unit, Townsville Hospital, Townsville, Queensland, Australia
Biomedicum Helsinki, Helsinki, Finland
Diabetes Clinic, Northshore Hospital, Auckland, New Zealand
Issue Date: May-2016
Date: 2016-12-21
Publication information: Metabolism 2016; 65(5): 783-793
Abstract: AIMS: Reported associations between liver enzymes and mortality may not hold true in type 2 diabetes, owing to a high prevalence of non-alcoholic fatty liver disease, which has been linked to cardiovascular disease and mortality in its own right. Our study aimed to determine whether alanine aminotransferase (ALT) or γ-glutamyl transferase (GGT) levels predict mortality in type 2 diabetes, and to examine possible mechanisms. METHODS: Data from the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study were analyzed to examine the relationship between liver enzymes and all-cause and cause-specific mortality over 5years. RESULTS: Over 5years, 679 (6.9%) individuals died. After adjustment, for every standard deviation increase in ALT (13.2U/L), the HR for death on study was 0.85 (95% CI 0.78-0.93), p<0.001. Conversely, GGT >70U/L, compared with GGT ≤70U/L, had HR 1.82 (1.48-2.24), p<0.001. For cause-specific mortality, lower ALT was associated with a higher risk of cardiovascular death only, whereas GGT >70U/L was associated with higher risks of death due to cardiovascular disease, cancer and non-cancer/non-cardiovascular causes. The relationship for ALT persisted after adjustment for indirect measures of frailty but was attenuated by elevated hsCRP. CONCLUSIONS: As in the general population, ALT has a negative, and GGT a positive, correlation with mortality in type 2 diabetes when ALT is less than two times the upper limit of normal. The relationship for ALT appears specific for death due to cardiovascular disease. Links of low ALT with frailty, as a potential mechanism for relationships seen, were neither supported nor conclusively refuted by our analysis and other factors are also likely to be important in those with type 2 diabetes.
DOI: 10.1016/j.metabol.2015.12.008
Journal: Metabolism
PubMed URL:
Type: Journal Article
Subjects: Mortality
Alanine aminotransferase
γ-Glutamyl transferase
Non-alcoholic fatty liver disease
Diabetes mellitus
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