Elevated gamma-glutamyl transferase to high-density lipoprotein cholesterol ratio has a non-linear association with incident diabetes mellitus: A second analysis of a cohort study.

Evidence regarding the association between the GGT/HDL-c ratio and incident diabetes is still limited. On that account, our research aims to survey the link of the GGT/HDL-c ratio with the risk of diabetes. In this retrospective cohort study, data of 15,171 participants who participated in the medical examination program were collected in Murakami Memorial Hospital in Japan from 2004 to 2015. The independent and dependent variables were the baseline GGT/HDL-c ratio and diabetes during the follow-up, respectively. The Cox proportional-hazards regression model was used to explore the association between the GGT/HDL-c ratio and diabetes risk. A Cox proportional hazards regression with the cubic spline smoothing was used to recognize non-linear relationships between the GGT/HDL-c ratio and incident diabetes. After adjusting covariates, the results showed that the GGT/HDL-c ratio was positively associated with incident diabetes (HR = 1.013, 95% CI: 1.002, 1.024). There was also a non-linear relationship between the GGT/HDL-c ratio and the risk of diabetes, and the inflection point of the GGT/HDL-c ratio was 6.477. The HR on the left and right sides of the inflection point was 2.568 (1.157, 5.699) and 1.012 (1.001, 1.023), respectively. The sensitivity analysis demonstrated the robustness of the results. Besides, the performance of the FPG + GGT/HDL-c ratio was better than FPG + GGT, FPG + HDL-c, and FPG in predicting diabetes. This study demonstrates a positive and non-linear relationship between the GGT/HDL-c ratio and incident diabetes in the Japanese population. The GGT/HDL-c ratio is strongly related to diabetes risk when it is <6.477.

Hu H ，Han Y ，Guan M ，Wei L ，Wan Q ，Hu Y ... -  《-》

Gamma-glutamyl transferase to high-density lipoprotein cholesterol ratio has a non-linear association with non-alcoholic fatty liver disease: A secondary prospective cohort study in non-obese Chinese adults.

The evidence for a relationship between the ratio of gamma-glutamyl transferase (GGT) to high-density lipoprotein cholesterol (HDL-c) and non-alcoholic fatty liver disease (NAFLD) is currently inadequate. This study aimed to investigate the relationship between the GGT/HDL-c ratio and NAFLD. This study is a prospective cohort study that recruited a total of 11,891 non-obese volunteers in a Chinese hospital from January 2010 to December 2014 in a non-selective manner. The Cox proportional-hazards regression model was then used to investigate the relationship between baseline GGT/HDL-c ratio and the probability of developing NAFLD. The non-linear link between the GGT/HDL-c ratio and NAFLD was identified using a Cox proportional hazards regression with cubic spline functions and smooth curve fitting (cubic spline smoothing). Furthermore, we conducted several sensitivity and subgroup analyses. Data had been uploaded to the DATADRYAD website. The mean age of study participants was 43.29 ± 14.95 years old, and 6,502 (54.68%) were male. The median (interquartile ranges) of GGT/HDL-c ratio was 15.56 (10.73-23.84). During a median follow-up of 29.35 months, 2028 (17.05%) participants were diagnosed with NAFLD. After adjusting for covariates, the results showed that GGT/HDL-c ratio was positively associated with incident NAFLD (HR = 1.014, 95% CI 1.011-1.017). There was also a non-linear relationship between GGT/HDL-c ratio and NAFLD, and the inflection point of the GGT/HDL-c ratio was 20.35. The effect sizes (HR) on the left and right sides of the inflection point were 1.113 (95% CI 1.096, 1.130) and 1.003 (95% CI 1.000-1.007), respectively. Moreover, the sensitivity analysis demonstrated the robustness of our results. Subgroup analysis showed that GGT/HDL-c ratio was more strongly associated with incident NAFLD in triglyceride (TG) < 1.7 mmol/L participants. In contrast, the weaker association was probed in those with TG ≥ 1.7 mmol/L. The present study reveals a positive and non-linear relationship between the GGT/HDL-c ratio and NAFLD risk in a non-obese Chinese population. GGT/HDL-c ratio is strongly associated with NAFLD when GGT/HDL-c ratio is less than 20.35. Therefore, maintaining the GGT/HDL-c ratio lower than the inflection point is recommended from a treatment perspective.

Li Q ，Han Y ，Hu H ，Zhuge Y ... -  《-》

Association of Triglyceride to high-density lipoprotein cholesterol ratio and incident of diabetes mellitus: a secondary retrospective analysis based on a Chinese cohort study.

Chen Z ，Hu H ，Chen M ，Luo X ，Yao W ，Liang Q ，Yang F ，Wang X ... -  《Lipids in Health and Disease》

Gamma-glutamyl transferase to high-density lipoprotein cholesterol ratio: A valuable predictor of type 2 diabetes mellitus incidence.

Gamma-glutamyl transferase (GGT) and high-density lipoprotein cholesterol (HDL-C) have been proven to be valuable predictors of type 2 diabetes mellitus (T2DM). The aim of this study was to investigate the association between GGT/HDL-C ratio and incident T2DM. The study retrospectively analyzed 15453 participants from 2004 to 2015. Cox proportional hazards regression models and Kaplan-Meier curves were used to elucidate the effect of GGT/HDL-C ratio on T2DM. Restricted cubic spline (RCS) analysis was performed to explore any non-linear correlation between GGT/HDL-C ratio and the risk of T2DM. The predictive performance of GGT, HDL-C and GGT/HDL-C ratio for T2DM was evaluated utilizing receiver-operating-characteristic (ROC) curves. During a median follow-up of 5.39 years, 373 cases of incident T2DM were observed. Kaplan-Meier curves showed that the cumulative probabilities of T2DM increased in the participants with higher GGT/HDL-C ratio significantly (P < 0.001). Cox models further clarified that high GGT/HDL-C ratio was an independent risk factor for T2DM (HR = 1.01, 95% CI = 1.00-1.01, P = 0.011). Linear positive correlation between GGT/HDL-C ratio and the risk of T2DM was demonstrated through RCS analysis. In the ROC analysis, GGT/HDL-C ratio (AUC = 0.75, 95% CI = 0.73-0.77) showed competitive role in the prediction of T2DM compared with single GGT and HDL-C. The GGT/HDL-C ratio could serve as a valuable predictor of T2DM, and the risk of T2DM increases in the condition of higher GGT/HDL-C ratio.

Xie W ，Liu B ，Tang Y ，Yang T ，Song Z ... -  《Frontiers in Endocrinology》

The nonlinear correlation between alanine aminotransferase to high-density lipoprotein cholesterol ratio and the risk of diabetes: a historical Japanese cohort study.

Low levels of high-density lipoprotein cholesterol (HDL-C) and high levels of alanine aminotransferase (ALT) are related to insulin resistance, metabolic syndrome, and diabetes mellitus (DM). However, evidence on the connection between the alanine aminotransferase to high-density lipoprotein cholesterol (ALT/HDL-C) ratio and diabetes mellitus (DM) risk was limited. The study aimed to investigate the relationship between baseline ALT/HDL-C ratio and DM among Japanese individuals. This second analysis was based on a cohort study using open-source data. Data from 15,342 individuals who participated in the medical examination program were recorded at Murakami Memorial Hospital in Japan between 2004 and 2015. Smooth curve fitting, subgroup analysis, Cox proportional-hazards regression, and a series of sensitivity analyses were conducted to examine the relationship between ALT/HDL-C ratio and incident diabetes. The ability of the ALT/HDL-C ratio to predict diabetes was evaluated using a receiver operating characteristic curve analysis. After controlling for confounding covariates, the ALT/HDL-C ratio was found to be positively correlated to the DM risk in Japanese adults (HR: 1.01, 95%CI: 1.00-1.02, P = 0.049). This study also found a stable relationship between ALT/HDL-C ratio and diabetes after employing a series of sensitivity analyses. Additionally, there was a non-linear association between the ALT/HDL-C ratio and incident diabetes, and the ALT/HDL-C ratio inflection point was 30.12. When the ALT/HDL-C ratio was below 30.12, the present study discovered a significant positive association between the ALT/HDL-C ratio and incident diabetes (HR: 1.04, 95%CI: 1.02-1.06, P = 0.001). Furthermore, among liver enzymes, blood lipids, and anthropometric indicators, the ALT/HDL-C ratio best predicts DM (AUC = 0.75, 95%CI: 0.73-0.78). Increased ALT/HDL-C ratio levels at baseline correlated to incident DM. The relationship between ALT/HDL-C ratio and incident DM was also non-linear. When the ALT/HDL-C ratio is below 30.12, there is a statistically significant positive correlation between the ALT/HDL-C ratio and incident DM.

Cao C ，Hu H ，Han Y ，Yuan S ，Zheng X ，Zhang X ，Zan Y ，Wang Y ，He Y ... -  《-》