Ggt for metabolic syndrome.ggt for metabolic syndrome

Use of ggt as early marker

1. GAMMA GLUTAMYL TRANSFERASE(GGT) AS AN EARLY DIAGNOSTIC MARKER OF METABOLIC SYNDROME. DR THAMATAPU APOORVA (Medicine Pg 2nd year) Guide:DR SWAMY MIRYALA(HOD and Professor,Department of General Medicine ) Kamineni Academy of Medical Sciences and Research Centre,Hyderabad

2. INTRODUCTION The metabolic syndrome (syndrome X, insulin resistance syndrome) consists of a constellation of metabolic abnormalities that confer increased risk of cardiovascular disease (CVD) and cerebrovascular Disease .The major features of the metabolic syndrome include central obesity, hypertriglyceridemia, low high-density lipoprotein (HDL) cholesterol, hyperglycaemia, and hypertension. The rise in the prevalence of obesity in India is threatening to increase the burden of atherosclerotic cardiovascular disease (ASCVD). The prevalence of metabolic syndrome worldwide is 20-25% (IDF) 2, 3. Among the complications, cardiovascular events produce the greatest morbidity and mortality. A significant portion of the latter occurs in persons in whom obesity precedes type II diabetes. But diabetes is only one of several conditions that associate strongly with obesity. Others include dyslipidemia, hypertension, systemic inflammation, and a thrombotic tendency. This syndrome does not include, but is strongly associated with, other complications of obesity, for example, fatty liver, cholesterol gallstones, obstructive sleep apnoea, and poly cystic ovarian syndrome. The current definition generally regards hyperglycaemia in the range of type II diabetes to be one of the components of metabolic syndrome.

3. There has been a consistent effort to evaluate biochemical markers to predict an early onset of metabolic syndrome and subsequently intervene appropriately by means of lifestyle changes and drug therapy and thereby reduce cardiovascular morbidity and mortality. Markers like adiponectin have been studied as a measure of increased adipose tissue but have not proven to be cost effective and easily available. Gamma Glutamyl Transferase (GGT) is one such marker which is cost effective, easily available and performed as part of liver function tests. High levels of GGT have been associated in populations with increased risk of atherosclerotic cardiovascular disease (ASCVD) 2. Several prospective studies reported that baseline serum GGT concentration was an independent risk factor for the development of coronary artery disease (CAD), diabetes mellitus, stroke and hypertension].The purpose of this study is to evaluate the utility of GGT as an early diagnostic marker of metabolic syndrome.

4. MATERIAL AND METHODS This is a hospital based cross-sectional study undertaken in 140 patients ( Patients attending the medicine outpatient & inpatient services at Kamineni Academy of Medical Sciences and Research Center in one year duration from May 2022 to May 2023 ) BMI calculated in: - wt in kg/ht in m2 . Blood pressures recorded after at least 5 minutes of rest in both arms sitting/supine position . Waist circumference- measured in a horizontal plane midway between the inferior margin of the ribs and superior border of the iliac crest. Liver function tests(including GGT) , Fasting lipid profile , Fasting plasma glucose,Post prandial glucose , HbA1C , Thyroid profile , Renal function tests were estimated . USG Abdomen was done to check for Fatty liver.

5. INCLUSION CRITERIA Patients aged above 18 years with Central obesity – defined as waist circumference>=90cm for men and>=80cm for women( Indian population) plus two of the following four factors:- a) Raised TG level> = 150 mg/dl or specific treatment for this lipid abnormality b) Reduced HDL cholesterol < 40 mg/dl or specific treatment for this lipid abnormality c) Raised B.P systolic>=130 diastolic>=85 or treatment for diagnosed hypertension. d) Raised FPG>= 100 mg/dl or previously diagnosed type 2 diabetics. EXCLUSION CRITERIA Patients with Hypothyroidism , Malignant diseases , Severe renal insufficiency , Acute and chronic liver disease , Chronic alcohol consumption , Drugs - antiepileptics, Oral contraceptive agents, trimethoprim, sulphamethoxazole , erythromycin, cimetidine

6. DISCUSSION 180 subjects were recruited comprising 90 cases of metabolic syndrome and 90 age and sex matched controls. The mean age in the study Group was 54.1±5.895 year and 52.8±12.4 years in the control group. There were 60% males and sixth decade of life 40% females in the study group whereas 45% males and 55% females in the control group. The mean values of alanine ami transferase (AST) and no transferase (ALT), aspartate GGT levels were statistically signi fi amino cantly higher in MS group. The mean values of liver enzymes, for female/ male subjects in MS group, AST; ALT and GGT , were; 20.5/19.7 U/l; 25.9/28.5 U/l; 35.9/42.1 U/l respectively. increase in GGT is positively correlated with increased MS prevalence.

7. A high GGT was positively associated with CVD prevalance (odds ratio: 2.011, 95% CI 1.10-4.57) compared to low GGT group independent of age, sex and smoking habits. GGT values when compared with the respective parameters of metabolic syndrome showed the following results. 1.Out of 51 patients with SBP>130mmHg 36 had GGT levels above the reference range comprising 40% of the study population. 2.Among 60 patients with FPG>100, 41(46%) had higher GGT levels. 3.Among 56 cases with HDL<40 for males and <50 for females, 37(41%) had GGT values above the reference range. 4.Among 68 patients with hypertriglyceridemia, 47 had higher GGT levels comprising 52% of the study population.

8. CONCLUSION An elevated level of GGT is found to be associated with metabolic syndrome and is a strong predictor of cardiovascular risk. GGT correlated well with all the parameters of Metabolic Syndrome especially with hypertriglyceridemia with which it is the highest. GGT was found to be significantly higher in patients with cardiovascular disease. It is also noted that there was a clustering of patients in the range of upper limit of normal values for GGT indicating the possible need for considering even such values in the context of metabolic syndrome and CVD risk. The sensitivity of the test to diagnose MS was better in females; but specificity had no gender bias. Considering the CVD risk primary prevention may be emphasized in patients of metabolic syndrome with high GGT values. Hence GGT probably has a position in algorithms for the evaluation of metabolic syndrome and CVD risk assessment.

9. SUMMARY In this dissertation undertaken in Kamineni Academy of Medical Sciences and Research Center, the primary objective was to assess the utility of Gamma Glutamyl Transferase as a diagnostic marker of metabolic syndrome and compute its sensitivity . GGT levels were attained for all patients along with other metabolic parameters and all patients were assessed for preexisting cardiovascular disease.Elevated levels of GGT were found to be associated with metabolic syndrome. GGT had the highest correlation with hypertriglycerdemia. It was also found that GGT is a strong predictor of cardiovascular disease. The sensitivity and specificity was found to be 67% and 100% and 94% and 98% in males and females respectively. Considering all the observations made in the study GGT values should probably find a position in algorithms for evaluation of patients with metabolic syndrome.