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Liver enzymes and incident diabetes in China: a prospective analysis of 10 764 participants in the Guangzhou Biobank Cohort Study
  1. S Goya Wannamethee
  1. Correspondence to Professor S Goya Wannamethee, Department of Primary Care and Population Health, University College London Medical School, Royal Free Campus, London NW3 2PF, UK; g.wannamethee{at}

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In recent years, there has been increased interest in the potential role of liver enzymes in diabetes risk prediction. γ Glutamyl-transferase (GGT), alanine aminotransferase (ALT) and aspartate aminotransferase (AST) are common liver enzymes. ALT and AST have been regarded as markers of liver injury; GGT is considered to be a sensitive marker of liver damage but is also found in other tissues and therefore is less specific. GGT may also represent a non-specific marker of oxidative stress,1 which plays a role in the pathogenesis of diabetes.2 Over the past two decades, there has been a growing body of evidence from both Western and Asian populations including Korea and Japan linking elevated levels of liver enzymes even within the normal range to type 2 diabetes mellitus (T2DM) risk.3–7 Consequently, of the three markers, GGT is emerging as be the most consistent and strongest liver enzyme predictor of diabetes risk.3 ,4 Non-alcoholic fatty liver disease (NAFLD) is the most common cause of elevated ALT levels. While it is well established that NAFLD is associated with diabetes, higher ALT levels within the normal range have also been shown to predict T2DM.3–7 However, in contrast with GGT and …

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  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.

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