Comparison between multiple logistic regression and machine learning methods in prediction of abnormal thallium scans in type 2 diabetes.

BACKGROUND: The prevalence of type 2 diabetes (T2D) has been increasing dramatically in recent decades, and 47.5% of T2D patients will die of cardiovascular disease. Thallium-201 myocardial perfusion scan (MPS) is a precise and non-invasive method to detect coronary artery disease (CAD). Most previous studies used traditional logistic regression (LGR) to evaluate the risks for abnormal CAD. Rapidly developing machine learning (Mach-L) techniques could potentially outperform LGR in capturing non-linear relationships. AIM: To aims were: (1) Compare the accuracy of Mach-L methods and LGR; and (2) Found the most important factors for abnormal TMPS. METHODS: 556 T2D were enrolled in the study (287 men and 269 women). Demographic and biochemistry data were used as independent variables and the sum of stressed score derived from MPS scan was the dependent variable. Subjects with a MPS score ≥ 9 were defined as abnormal. In addition to traditional LGR, classification and regression tree (CART), random forest, Naïve Bayes, and eXtreme gradient boosting were also applied. Sensitivity, specificity, accuracy and area under the receiver operation curve were used to evaluate the respective accuracy of LGR and Mach-L methods. RESULTS: Except for CART, the other Mach-L methods outperformed LGR, with gender, body mass index, age, low-density lipoprotein cholesterol, glycated hemoglobin and smoking emerging as the most important factors to predict abnormal MPS. CONCLUSION: Four Mach-L methods are found to outperform LGR in predicting abnormal TMPS in Chinese T2D, with the most important risk factors being gender, body mass index, age, low-density lipoprotein cholesterol, glycated hemoglobin and smoking.

High normotension is associated with future metabolic syndrome but not cardiovascular disease: A 10-year longitudinal study.

Hypertension and prehypertension can increase the risk of developing cardiovascular disease (CVD) and diabetes. However, whether the harmful effects of high blood pressure (BP) are also seen with high normotension remains unknown. This 10-year longitudinal follow-up study aimed to investigate the relationships among normal-range BP, metabolic syndrome (MetS), and CVD.A total of 9133 nonmedicated normotensive participants, 4634 males and 4499 females, aged 60 years or older were enrolled in a standard health examination program at 2 academic hospitals and a health screening center in Taiwan. The study subjects were divided into 3 groups according to their BP. The systolic BP (SBP) ranges of groups 1, 2, and 3 were 91 to 100, 101 to 110, and 111 to 119 mmHg, whereas the diastolic BP (DBP) ranges of groups 1, 2, and 3 were 51 to 60, 61 to 70, and 71 to 79 mmHg, respectively.In the SBP3 group, both sexes had a higher odds ratio (OR) for having MetS or abnormal MetS components, except for triglycerides. Females in the DBP3 group had a higher OR for having MetS at baseline. After the follow-up period, the SBP3 group had a significantly higher hazard ratio (HR) for developing MetS. Males in the DBP3 group and females in the DBP2 and DBP3 groups had a significantly higher HR for developing MetS. Neither the SBP3 group nor the DBP3 group had a higher HR for developing nonfatal CVD. In the Kaplan-Meier analysis, SBP and DBP in both sexes showed statistical significance as predictors of MetS, but not of nonfatal CVD.High normotensive elderly individuals have an elevated risk of developing MetS at baseline and within 10 years of follow-up, but they are not at increased risk of CVD. Preventive interventions, such as life-style modification, should be offered early even to the apparently healthy elderly.

The differences of metabolic syndrome in elderly subgroups: A special focus on young-old, old-old and oldest old.

BACKGROUND: Metabolic syndrome (MetS) is known to be correlated to future diabetes and cardiovascular disease. Due to the aging society, the increasing prevalence of MetS in the elderly is an important health issue. However, there were few studies focusing in this field. We investigated the changes of MetS components in the subgroups of the elderly. METHODS: Subjects aged above 65 years old who underwent routine health checkups in Taiwan (N=18916) were divided into three groups (young-old: ≧65 and <75, old-old: ≧75 and <85 and oldest-old ≧85). By using multiple logistic regressions, the odds ratio (OR) of subjects with abnormal MetS components to have MetS were evaluated. RESULTS: For men, the systolic blood pressure (SBP) and high-density lipoprotein cholesterol increased as the age got older. On the contrary, the diastolic blood pressure and triglycerides (TG) decreased. In women, the waist circumference and SBP increased significantly from the young-old to the oldest-old groups. The highest percentage having MetS was 35% in old-old men and 62% in oldest-old women. Finally, subjects with high TG had the highest and BP had the lowest ORs for having MetS in both genders except oldest-old women. CONCLUSIONS: In the elderly, the MetS and its components have different patterns not only in young-, old- and oldest-old groups but also in men and women. Moreover, among the five components, hypertension was always the most prevalent one. Finally, subjects had high TG had the highest ORs to have MetS compared to other components.

γ-glutamyl transpeptidase in men and alanine aminotransferase in women are the most suitable parameters among liver function tests for the prediction of metabolic syndrome in nonviral hepatitis and nonfatty liver in the elderly.

BACKGROUND/AIMS: Nonalchoholic fatty liver disease (NAFLD) has been reported as a hepatic manifestation of metabolic syndrome (MetS); it is common and accounts for 80% of the cases with abnormal liver function tests (LFTs). In addition, several studies have proved that there is a correlation between abnormal LFTs and MetS. Therefore, LFTs may represent the abnormal metabolic status of livers in the patients with MetS. To identify the early state of metabolic dysfunction, we investigate the value of LFTs for the future MetS development in the relatively healthy (non-NAFLD) elderly. PATIENTS AND METHODS: A total of 16,912 subjects met the criteria for analysis. In the first stage of this study, subjects were enrolled in the cross-sectional study in order to find out the optimal cutoff value in different LFTs with higher chances to have MetS. In the second stage of the present study, subjects with MetS at baseline were excluded from the same study group, and a median 5.6-year longitudinal study was conducted on the rest of the group. RESULTS: Among all LFTs, only aspartate aminotransferase in both genders and the α-fetal protein in women failed to show the significance in distinguishing subjects with MetS by the receiver operating characteristic curve. In the Kaplan-Meier plot, only γ-glutamyl transpeptidase (γ-GT) in men and the alanine aminotransferase (ALT) in women could be used to successfully separate subjects with higher risk of developing the MetS from those with lower risk. Finally, in the multivariant Cox regression model, similar results were identified. Still, the hazard ratio (HR) to have future MetS, γ-GT in men, and ALT in women showed significance (HR = 1.511 in men and 1.504 in women). CONCLUSION: Among all the different LFTs, γ-GT (>16 U/L) in male and ALT (>21 U/L) in female were the best predictors for the development of MetS in healthy elderly. These two liver markers could be an ancillary test in predicting future MetS development/diagnosis. Elevation of the LFTs without underlying liver diseases should be treated as a warning sign of the possible MetS development in the elderly.

Accurate method to estimate insulin resistance from multiple regression models using data of metabolic syndrome and oral glucose tolerance test.

AIMS/INTRODUCTION: How to measure insulin resistance (IR) accurately and conveniently is a critical issue for both clinical practice and research. In the present study, we tried to modify the ß-cell function, insulin sensitivity, and glucose tolerance test (BIGTT) in patients with normal glucose tolerance (NGT) and abnormal glucose tolerance (AGT) by oral glucose tolerance test (OGTT) and metabolic syndrome (MetS) components. MATERIALS AND METHODS: There were 327 participants enrolled and divided into NGT or AGT. Data from 75% of the participants were used to build the models, and the remaining 25% were used for external validation. Steady-state plasma glucose (SSPG) concentration derived from the insulin suppression test was regarded as the standard measurement for IR. Five models were built from multiple regression: model 1 (MetS model with sex, age and MetS components); model 2 (simple OGTT model with sex, age, plasma glucose, and insulin concentrations at 0 and 120 min during OGTT); model 3 (full OGTT model with sex, age, and plasma glucose and insulin concentrations at 0, 30, 60, 90, 120, and 180 min during OGTT); model 4 (simple combined model): model 1 and model 2; and model 5 (full model): model 1 and 3. RESULTS: In general, our models had higher r (2) compared with surrogates derived from OGTT, such as homeostasis model assessment-insulin resistance and quantitative insulin sensitivity check index. Among them, model 5 had the highest r (2) (0.505 in NGT, 0.556 in AGT, respectively). CONCLUSIONS: Our modified BIGTT models proved to be accurate and easy methods for estimating IR, and can be used in clinical practice and research.

Estimation of the disposition index based on components of metabolic syndrome.

Decreased insulin sensitivity (IS) and impaired insulin secretion are major pathological features of type 2 diabetes (T2DM). The product of these factors is the disposition index (DI). We aimed to develop an equation for predicting DI. We enrolled 167 participants in our study. We randomly assigned 126 (75%) of the participants to the study group, whose data would be used to build the equation for estimating the DI. The remaining 41 participants comprised the external validation group. A frequently sampled intravenous glucose-tolerance test was performed for all participants, and the IS, the glucose sensitivity, the acute insulin response to the glucose load, and the DI were determined. Three factors were selected from multiple linear regression analysis, and we constructed the equation log (DI) = 2.449 - 0.113 × fasting plasma glucose + 0.046 × body mass index - 0.612 × high-density lipoprotein cholesterol. Using this equation, the calculated log (DI) significantly correlated with the measured log (DI) in the external validation group (r = 0.428, p = 0.007). By using the equation based on the demographic data and measurements of metabolic syndrome components, the DI could be predicted with acceptable accuracy (r = 0.428). Because of the relationships between the MetS and demographic parameters, this method of predicting DI may help further clinicians' understanding of the underlying pathological mechanisms in T2DM.

The effect of chromium on inflammatory markers, 1st and 2nd phase insulin secretion in type 2 diabetes.

OBJECTIVE: Impaired insulin sensitivity (SI) and ß-cell function are the two main causes of type 2 diabetes (T2D) and are related to low-grade inflammation status. Trivalent chromium has shown to improve SI in our previous study. This might be due to the ability of decreasing interleukin-6 (IL-6) and tumor necrosis factor α (TNF-α) shown in animal studies. In the current study, we measured SI, ß-cell function, and plasma levels of IL-6 and TNF-α after treatment of chromium chloride (GaCr) in T2D. RESEARCH DESIGN AND METHODS: Sixty-six patients were randomly assigned to the 20 g of GaCr milk powder studying group or the milk powder placebo group. Oral glucose tolerance test was performed before and after the treatment. The SI and the ß-cell function were measured as well. RESULTS: The SI was significantly improved. At the same time, the static insulin responsivity index (Φs) was significantly higher after the treatment (p = 0.003). On the other hand, the dynamic insulin responsivity index (Φd) remained unchanged. Interestingly, a significant decrease in the IL-6 level after the treatment (p = 0.015) was noted. Although there was a trend of decreasing in TNF-α, it was not statistically significant. Finally, there was no significant correlation between the δ-IL-6, SI, and Φd after GaCr treatment. CONCLUSIONS: In conclusion, other than the improvement of SI, GaCr could also improve the second phase of insulin responsivity (Φs) and IL-6. However, δ-IL-6 was correlated with neither δ-SI nor δ-Φs which indicated that the improvement of SI and Φs might involve mechanisms other than lower inflammatory effect.

The adipokines and inflammatory marker in young type 2 diabetics with metabolic syndrome: A pilot study.

OBJECTIVE: The purpose of the metabolic syndrome (MetS) concept was to early identify subjects having risk for developing cardiovascular diseases and diabetes, which of both are involved in low grade inflammation and obesity. We wish to explore the role of adipokines and inflammatory marker in young type 2 diabetics (YDM) with MetS. METHODS: Forty-eight YDM patients were divided to 2 and 3 groups according to the presence of the MetS (MetS+ and MetS-), and the numbers of MetS component (MetS-2 to MetS-4 with 1-2, 3, and 4-5 components) respectively. Plasma adipokines (tumor necrosis factor-α; TNF-α and adiponectin) and C-reactive protein (CRP) were measured and compared among groups. RESULTS: Blood pressure (BP), body mass index (BMI), and plasma triglyceride (TG) levels were higher in the group with MetS+ than that of MetS-. Except for diastolic BP, BMI, waist, and plasma TG levels, which were generally lower in the MetS-2 group, the rest demographic characteristics were not different among these three groups. Finally, the plasma adiponectin, CRP and TNF-αlevels were not different between both groups with or without MetS; and also among these three groups regardless the component numbers they had. CONCLUSION: YDM with MetS might have non-significant lower adiponectin and higher CRP levels compared to subjects without MetS. It needs prospective study with larger scale to explicit the role of cytokines and inflammatory markers in YDM with MetS.

Variability in hemoglobin A1c predicts all-cause mortality in patients with type 2 diabetes.

BACKGROUND: To evaluate the relationship between hemoglobin A1c variability and all-cause mortality in type 2 diabetic patients. METHODS: This was a retrospective cohort study in type 2 diabetic patients followed for at least 2 years between 2003 and 2009. A1C variability was determined from the standard deviation or coefficient of variation of serial A1C values (A1C(SD) or A1C(CV)). Subjects were categorized into either the high or low A1C variability group according to their A1C(CV) median. Hazard ratios (HRs) of various factors for all-cause mortality were determined from Cox's proportional hazard models. RESULTS: A total of 881 subjects (422 men, 459 women) were included and 73 (8.3%) died during follow-up. The follow-up period was 4.7 ± 2.3 years. All-cause mortality was higher in subjects with high A1C(CV) (11.0% vs. 5.4%, p=0.002). In the Kaplan-Meier failure curve, subjects with higher A1C(CV) demonstrated a trend of higher mortality (p=0.1). In multivariate Cox's proportional hazards models, A1C(SD) and A1C(CV) significantly predicted all-cause mortality with an HR of 1.987 (p=0.02) and 1.062 (p=0.013), respectively, after adjusting for age, gender, body mass index, duration of diabetes, mean systolic blood pressure, use of antihypertensives and statins, mean LDL-cholesterol, smoking status, chronic kidney disease, and mean A1C values (A1C(MEAN)). The ability of A1C(SD) and A1C(CV) to predict all-cause mortality was more evident in subjects with relatively low A1C(MEAN.) CONCLUSIONS: A1C variability is an important risk factor for all-cause mortality in type 2 diabetic patients.

The importance of cyclooxygenase 2-mediated oxidative stress in obesity-induced muscular insulin resistance in high-fat-fed rats.

AIM: This study was undertaken to examine the effect of cyclooxygenase (COX) 2 inhibition on the development of muscular insulin resistance in high-fat-induced obese rats. MAIN METHODS: The rats were on a regular chow diet (C) or high-fat enriched diet (HFD) energy-restrictedly (HFr), or ad libitum (HFa) for 12weeks. The rats fed HFD ad libitum were further divided into 3 groups: oral gavage with vehicle (HFa), selective COX-2 inhibitors-celecoxib (HFa+C) or nimesulid (HFa+N), 30mg/kg/day, respectively. KEY FINDINGS: Increased fasting plasma insulin, triglyceride and 8-isoprostane levels in HFa were significantly suppressed in those of HFa+C and HFa+N. The whole body insulin resistance of HFa indicated by the increased fasting plasma insulin levels and the elevated area under curve of insulin obtained from the oral glucose tolerance test were significantly reversed in those combined with celecoxib and nimesulid administration compared with those in HFr. The gene expression of COX-2 was significantly increased in epididymal fat but not in soleus muscle in HFa and the enhanced adipose COX-2 expression in high-fat fed rats was suppressed by those with drug treatment. Both selective COX-2 inhibitors reversed the diminished insulin-stimulated glucose uptake and GLUT4 translocation in skeletal muscles of HFa. Obesity-induced oxidative stress indicated by the elevated plasma 8-isoprostane,the decreased ratio of GSH/GSSG and increased TBARS in soleus muscle were significantly reversed by COX-2 inhibition. SIGNIFICANCE: The results suggest that COX-2 inhibition might suppress the muscular insulin resistance indirectly through decreasing the COX-2-mediated systemic oxidative stress in this diet-induced obese model.

The relationship between thyroid function and bone mineral density in euthyroid healthy subjects in Taiwan.

INTRODUCTION: It has been reported that low normal circulating thyrotropin (TSH) levels correlate with lower bone mineral density (BMD) in the Korean postmenopausal female. The goal of this study is to evaluate this relationship in different sex and age groups in a Chinese population. MATERIALS AND METHODS: A total of 2,957 subjects in Taiwan, 1,343 males and 1,614 females, aged from 45 to 64 years, were enrolled in this study. They were divided into four groups: group 1 was males aged between 45 and 50 years (young male, YM); group 2 was females aged between 45 and 50 years (young female, YF); group 3 was males older than 50 years (old male, OM); and group 4 was females older than 50 years (old female, OF). Plasma total thyroxine (T4) and TSH were measured. BMD was quantified at the wrist using dual energy X-ray absorptiometry. RESULTS: YM had the highest BMD whereas OF had the lowest BMD. Among the four groups, no significant correlation between TSH level and BMD was found in the four groups, but a significant negative correlation existed between T4 and BMD in OF (r = -0.089, p = 0.005) and YM (r = -0.109, p = 0.018). CONCLUSION: Our study did not find significant correlations between TSH and BMD in both men and women with normal thyroid function in Taiwan. Weak negative correlations existed between T4 and BMD in postmenopausal women and young men. Further studies with measurement of FT4 and TSH and with a longitudinal design may shed light on this population difference.

Glycated albumin is independently associated with estimated glomerular filtration rate in nondiabetic patients with chronic kidney disease.

BACKGROUND: Glycated albumin (GA) may contribute to diabetic nephropathy, but the clinical significance of GA in patients with chronic kidney disease (CKD) is unknown. METHODS: Patients were classified with the NKF/DOQI classification system as mild (stage I, II), moderate (stage III), or advanced CKD (stage IV). Those undergoing dialysis or with CKD stage V were excluded. GA was measured using the Lucica TM GA-L assay kit. The relationship between GA and renal dysfunction was analyzed in patients with or without diabetes. RESULTS: A total of 187 subjects were enrolled. GA values in those with normal, mild, moderate and advanced CKD were 18.4 ± 1.4%, 18.4 ± 3.1%, 19.0 ± 3.8%, 20.4 ± 6.4%, respectively, in diabetic patients (N=67, p=0.5), and were 14.1 ± 1.9%, 14.2 ± 2.2%, 15.9 ± 1.9%, 15.0 ± 1.7%, respectively, in nondiabetic patients (N=120, p=0.004). GA value was negatively correlated to eGFR in nondiabetic patients (r=-0.35, p<0.001) but not in diabetic patients (r=-0.11, p=0.39). In the adjusted model, GA is independently correlated to eGFR only in nondiabetic subjects. CONCLUSIONS: Increased GA concentrations are independently associated with renal dysfunction in nondiabetic patients with CKD.

Comparison of insulin sensitivity, glucose sensitivity, and first phase insulin secretion in patients treated with repaglinide or gliclazide.

The traditional sulfonylureas with long half-lives have sustained stimulatory effects on insulin secretion compared to the short-acting insulin secretagogue. In this study, we used the frequently sampled intravenous glucose tolerance test (FSIGT) to evaluate the insulin sensitivity (IS), glucose sensitivity (SG), and acute insulin response after glucose load (AIRg) after 4 months treatment with either gliclazide or repaglinide. The design of study was randomizedcrossover. We enrolled 20 patients with new-onset type 2 diabetes (mean age, 49.3 years). Totally three FSIGTs were performed, one before and one after each of the two treatment periods as aforementioned. No significant differences in fasting plasma glucose, insulin, body mass index, blood pressure, glycated hemoglobin, or lipids were noted between the two treatments. After the repaglinide treatment, higher AIRg, lower IS, and lower SG were noted, but they did not reach statistical significance. The disposal index (DI) was also not significantly different between the two treatments. In conclusion, since non-significantly higher DI, AIRg, lower IS and SG were noted after repaglinide treatment, it might be a better treatment for diabetes, relative to gliclazide.

Comparison of oral glucose insulin sensitivity with other insulin sensitivity surrogates from oral glucose tolerance tests in Chinese.

INTRODUCTION: There is no single method of measuring insulin resistance that is both accurate and can be easily performed by general researchers. We validate the accuracy of oral glucose insulin sensitivity (OGIS) in the Chinese by comparing the OGIS120 and OGIS180, homeostasis model assessment of insulin resistance (HOMA-IR), and quantitative insulin sensitivity check index (OUICKI) with steady-state plasma glucose (SSPG) in different glucose tolerance subjects. MATERIALS AND METHODS: We enrolled 515 subjects, aged between 20 and 75 years old, during routine health evaluations. All subjects were divided into normal, obese, impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and type 2 diabetes (T2D) groups. Participants had a 3-hour oral glucose tolerance test (OGTT) and SSPG with an insulin suppression test. The relationships between SSPG and OGIS120, OGIS180, HOMA-IR, and QUICKI were evaluated. RESULTS: The normal group had the highest OGIS120, OGIS180 and lowest SSPG as compared with the other 4 groups. OGIS180, HOMA-IR and QUICKI in all 5 groups were significantly related to SSPG (r = 0.397-0.621, all P <0.05). OGIS120 in all 5 groups was not significantly related to SSPG (r = 0.003-0.226). Additionally, the r value of OGIS180 against SSPG was not higher than the other 2 insulin sensitivity surrogates from OGTT. CONCLUSIONS: Although OGIS180 was more accurate in estimating insulin sensitivity than OGIS120 in the Chinese, it was not superior to the traditional surrogates such as HOMA-IR or QUICKI.

The first and second phase of insulin secretion in naive Chinese type 2 diabetes mellitus.

Impaired insulin secretion (ISEC) has been recognized as one of the most important pathophysiologies of type 2 diabetes mellitus. There are 2 phases of ISEC: the first phase (first ISEC) and second phase (second ISEC). This study aimed to evaluate the 2 phases of ISEC in newly diagnosed type 2 diabetes mellitus patients. Fifty-two drug-naive type 2 diabetes mellitus patients were given 2 tests: a modified low-dose graded glucose infusion (M-LDGGI) and frequent sample intravenous glucose tolerance test. The M-LDGGI is a simplified version of the Polonsky method. Two stages of intravenous infusion of glucose with different rates were given, starting from 2 mg/(kg min) and then followed by 6 mg/(kg min). Each stage was maintained for 80 minutes. The results were interpreted as the slope of the changes of plasma insulin against the glucose levels. The slope of these curves was regarded as the second ISEC and used as the criterion for grouping-the responders and nonresponders. The responders are older and had higher body mass index and log (homeostasis model assessment of beta-cell function) (log HOMA-beta) but lower fasting plasma glucose and hemoglobin A(1c) (HbA(1c)) than the nonresponders. Significant correlations were only noted between the second ISEC and first ISEC (r = 0.278, P = .046) and between the second ISEC and log HOMA-beta (r = 0.533, P = .000). Correlation between different parameters and HbA(1c) was also evaluated. Only second ISEC and log HOMA-beta were correlated significantly with HbA(1c) (r = -0.388, P = .015 and r = -0.357, P = .026, respectively). In type 2 diabetes mellitus, subjects with higher second ISEC are older and have higher body mass index. At the same time, second ISEC is the most important factor for determining glucose levels in naive Chinese type 2 diabetes mellitus patients. The first and second ISECs were only modestly correlated, which indicated that the deterioration of these 2 phases was not synchronized. Finally, we also recommend using the M-LDGGI for quantifying second ISEC. This practical method could be done in many centers without difficulty.

Relationship between white blood cell count and components of metabolic syndrome among young adolescents.

Components of metabolic syndrome (MetS) have been associated with several inflammatory factors, including white blood cell count (WBCC). In the present study, the relationships between WBCC and aspects of MetS in young adolescents were investigated. We enrolled 596 participants (328 males and 268 females) from 10 to 13 years of age and with normal WBCC in this study. They were divided into four quartiles according to WBCC (WBCC1-4, from lowest to highest WBCC). The mean values of MetS components for each group were compared in males and females separately. Multivariate linear regression analysis between the WBCC and the components of MetS after adjusted for age and body mass index (BMI) were also evaluated. In the male group, the BMI of WBCC1 and WBCC2 was significantly lower than WBCC4. The total cholesterol and low-density lipoprotein-cholesterol (LDL-C) of WBCC2 were significantly higher than WBCC1 and WBCC4. Triglyceride (TG) levels of WBCC1 were significantly lower than WBCC3 and WBCC4, and TG levels of WBCC2 were significantly lower than WBCC4. Alternatively, the BMI of WBCC1 and WBCC2 were significantly lower than WBCC3 in the female group. Finally, the TG and fasting plasma glucose (FPG) levels of WBCC1 were significantly lower than WBCC3 or WBCC4, respectively. After multivariate linear regression, WBCC was positively correlated to BMI and TG, but negatively correlated to FPG in males whereas in young adolescent females, WBCC was positively correlated to BMI and FPG. In conclusion BMI was positively correlated with WBCC in young adolescent females and males. Thus, BMI is the most important component of MetS in this age group. In addition, TG levels in males and FPG in females were significantly related to WBCC. These findings could be regarded an early indication for the future development of full-blown MetS or cardiovascular diseases.

Association of nonalcoholic fatty liver disease with abnormal aminotransferase and postprandial hyperglycemia.

GOALS: This study was conducted to explore the association between nonalcoholic fatty liver disease and glucose metabolism as well as insulin resistance using the homeostasis model assessment method (HOMA). STUDY: From July 2003 to June 2004, 23 patients with ultrasound-proved fatty liver and either normal (10 patients) or abnormal (13 patients) serum aminotransferase levels were enrolled. Blood tests included a routine biochemistry, a 75-g glucose oral glucose tolerance test (OGTT) with blood sampled at 30-minute intervals during a 120-minute period. Fasting and 120-minute serum leptin, insulin, and C-peptide concentrations were also measured. RESULTS: Using the Mann-Whitney U test, significant differences were found in gamma glutamyl transpeptidase (28.6+/-7.9 vs. 65.1+/-65.9 U/L, P=0.008), fasting insulin (FI) (13.11+/-7.53 vs. 31.76+/-42.95 muU/mL, P=0.02), fasting C-peptide (3.82+/-3.00 vs. 2.17+/-0.43 ng/mL, P=0.01), fasting leptin (10.34+/-4.05 vs. 24.27+/-24.97 ng/mL, P=0.01), HOMA-IR (3.34+/-1.06 vs. 8.81+/-13.18, P=0.02), and HOMA beta-cell function (120.32+/-52.50 vs. 242.20+/-247.29, P=0.02) between normal and abnormal ALT/AST function groups. From the 75-g OGTT, no significant difference of plasma glucose was noted at 0, 30, 60, and 90 minutes but significant change was noted in 120-minute plasma glucose (99.3+/-21.5 vs. 131.4+/-27.3 mg/dL, P=0.004) of 2 groups. CONCLUSIONS: In conclusion, patients with fatty liver proved by ultrasound sonography might be at high risk of developing type 2 diabetes, especially when they had elevated liver enzymes. OGTT is warranted for the early diagnosis of these high risk patients.