Including abnormal liver function tests in the definition of metabolic syndrome could increase its predictive nature for cardiovascular disease
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The definition of metabolic syndrome does not include abnormal liver function tests (LFTs). Elevated LFTs, commonly observed in the presence of non-alcoholic fatty liver disease, may represent a surrogate of the recent lipotoxic effects of fat overflow. The aim of this study was twofold: 1) to assess the association between the five components of metabolic syndrome (ATP III criteria) and different LFTs, and 2) to assess the association between raised LFTs and prevalent cardiovascular disease (CVD). To this end, a total of 1,357 patients without alcoholism or known liver disease from rural Victoria, Australia, were randomly selected. Receiver operating characteristic (ROC) areas under the curve (AUC) were determined for the associations between ATP III components, and between LFTs and ATP III components. The range of ROC AUCs for ATP III diagnostic components was 0.60-0.77, with waist having the strongest, and blood pressure the weakest, association. The strength of association between ATP III components and gamma GT (GGT) was similar, with a lower association found for alanine transaminase and asparatate transaminase. When using a GTT cut-off of 27 IU for men and 20 IU for women, subjects with metabolic syndrome and elevated GGT had more CVD than those with metabolic syndrome and low GGT or those without metabolic syndrome. After adjusting for covariates, the odds ratio of CVD among patients with metabolic syndrome was 2.66 for a high GTT when compared to low GTT. Moreover, CVD was not more prevalent in subjects with metabolic syndrome and low GGT than in those without metabolic syndrome. Based on these study results, the authors suggest that including a raised GGT in the metabolic syndrome criteria could increase its predictive nature for CVD disease.
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