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Clinical Chemistry 53: 1092-1098, 2007. First published May 3, 2007; 10.1373/clinchem.2006.079814
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(Clinical Chemistry. 2007;53:1092-1098.)
© 2007 American Association for Clinical Chemistry, Inc.

Lipids, Lipoproteins, and Cardiovascular Risk Factors

A Strong Interaction between Serum {gamma}-Glutamyltransferase and Obesity on the Risk of Prevalent Type 2 Diabetes: Results from the Third National Health and Nutrition Examination Survey

Ji-Sun Lim1, Duk-Hee Lee1,a, Joo-Yun Park1, Soo-Hee Jin1 and David R. Jacobs, Jr2,3

1 Department of Preventive Medicine and Health Promotion Research Center, School of Medicine, Kyungpook National University, Daegu, Korea.
2 Department of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, MN.
3 Department of Nutrition, University of Oslo, Oslo, Norway.

aAddress correspondence to this author at: Department of Preventive Medicine, School of Medicine, Kyungpook University, 101 Dongin-dong, Jung-gu, Daegu 700-422, Korea. Fax 82-53-425-2447; e-mail lee_dh{at}knu.ac.kr.

Background: Some studies have found an association of obesity with type 2 diabetes only among individuals with high normal serum {gamma}-glutamyltransferase (GGT) activity, not in those with low serum GGT. If this interaction reflected pathophysiology, it would have scientific and clinical importance. The findings failed to reach statistical significance, however, and no articles have focused on the topic. We investigated possible interactions between serum GGT and body mass index (BMI) and their effects on the risk of prevalent type 2 diabetes and homeostasis model assessment (HOMA) insulin resistance.

Methods: We analyzed 4011 adults ≥40 years old who participated in the 3rd US National Health and Nutrition Examination Survey.

Results: BMI was associated with prevalent diabetes only among persons with high normal serum GGT activity (P for interaction = 0.002). In the highest serum GGT quartile, adjusted odds ratios for BMI 25–29.9, 30–34.5, and ≥35 kg/m2 compared with BMI<25 kg/m2 were 3.1, 5.1, and 6.2, respectively (P for trend <0.001). In the lowest serum GGT quartile, BMI was not associated with diabetes; corresponding adjusted odds ratios were 1.0, 0.9, 1.8, and 0.8 (P for trend = 0.551). After prevalent diabetes was excluded, there was a parallel interaction with HOMA levels (P for interaction <0.001).

Conclusions: BMI was not associated with prevalent type 2 diabetes when GGT was low normal, suggesting that obesity itself may not be a sufficient risk factor for type 2 diabetes. Practically, this interaction can be useful in clinical settings to identify individuals at high risk for type 2 diabetes.




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