Metabolic syndrome and transaminases: systematic review and meta-analysis

Raya-Cano, Elena; Molina-Luque, Rafael; Vaquero-Abellán, Manuel; Molina-Recio, Guillermo; Jiménez-Mérida, Rocío; Romero-Saldaña, Manuel

doi:10.1186/s13098-023-01200-z

Diabetology & Metabolic Syndrome

Table 1 Characteristics of included studies (n = 17)

From: Metabolic syndrome and transaminases: systematic review and meta-analysis

Author, year, country	Study design	STROBE(21) Reporting Guidelines	Age of participants	No. Of subjects MetS+/MetS-	MetS criteria	Results
Cheng, et al., 2017, Italy [24].	Cross sectional study	18	Men MetS + 56.57 ± 16.25 MetS- 47.88 ± 18.45 Women MetS + 56.61 ± 17.58 MetS- 44.57 ± 18.36	Men 969/2595 Total 3564 Women 1130/2676 Total 3806	NCEP ATP III	ALT values were significantly higher in MetS + participants.
Cheng, et al., 2017, Italy [24].	Cross sectional study	18		Men 969/2595 Total 3564 Women 1130/2676 Total 3806	NCEP ATP III	Men MetS + 33.89 ± 23.55 (ALT) MetS- 29.3 ± 32.27 (ALT)				Women MetS + 24.92 ± 58.29 (ALT) MetS 20.45 ± 19.43 (ALT)
Cheng YL, et al., 2017. Taiwan [25]	Cohort study	18	MetS + 56.3 ± 12.5 MetS- 50.6 ± 13.2	8564/21,233 Total 29,797	IDF	Subjects with MetS + have higher ALT, AST and GGT levels compared to subjects without MetS-.
Cheng YL, et al., 2017. Taiwan [25]	Cohort study	18	MetS + 56.3 ± 12.5 MetS- 50.6 ± 13.2	8564/21,233 Total 29,797	IDF	MetS + 35.1 ± 29.1 (ALT) MetS- 23.8 ± 17.6 (ALT)		MetS + 26 ± 18.2 (AST) MetS- 21.9 ± 10.3(AST)				MetS + 34.2 ± 50.9 (GGT) MetS-21 ± 28.4 (GGT)
Choi, et al., 2017. Japan [26]	Cross sectional study	21	Men MetS + 49.5 ± 6.5 MetS- 48.8 ± 6.1	Men 251/474 Total 725	NCEP ATP III	ALT, AST, and GGT were significantly higher in middle-aged men with MetS + than in those without MetS-.
Choi, et al., 2017. Japan [26]	Cross sectional study	21	Men MetS + 49.5 ± 6.5 MetS- 48.8 ± 6.1	Men 251/474 Total 725	NCEP ATP III	MetS + 37.5 ± 22.5 (ALT) MetS- 27.6 ± 17.7 (ALT)		MetS + 30.6 ± 12.4 (AST) MetS- 27.4 ± 13 (AST)				MetS + 58.3 ± 48.1 (GGT) MetS- 40.8 ± 49.2 (GGT)
Huang, et al., 2018. China [27]	Cross sectional study	18	Men MetS + 45.2 ± 9.4 MetS-42.14 ± 11.0 Women MetS + 48.5 ± 13.3 MetS- 41.9 ± 10.9	Men 43/176 Total 219 Women 18/196 Total 214	NCEP ATP III	Subjects with elevated ALT levels are at increased risk of MetS. ALT may be significantly associated with the presence of MetS.
Huang, et al., 2018. China [27]	Cross sectional study	18		Men 43/176 Total 219 Women 18/196 Total 214	NCEP ATP III	Men MetS + 27.7 ± 7.5 (ALT) MetS- 24.4 ± 8.9 (ALT)				Women MetS + 22.3 ± 9.5 (ALT) MetS- 17.4 ± 7.6 (ALT)
Kim, et al., 2022, Korea [28].	Cross sectional study	19	Men MetS + 68.5 ± 6.1 MetS- 69.5 ± 6.3 Women MetS + 69.3 ± 6.1 MetS- 68.8 ± 6.4	Men 583/1106 Total 1689 Women 1299/1493 Total 2792	Harmonised criteria	Elevated ALT and AST levels in MetS + subjects.
Kim, et al., 2022, Korea [28].	Cross sectional study	19		Men 583/1106 Total 1689 Women 1299/1493 Total 2792	Harmonised criteria	Men MetS + 25.8 ± 15.3 (ALT) MetS- 20.1 ± 10.3 (ALT) MetS + 25.2 ± 12.4 (AST) MetS- 23.3 ± 7.7 (AST)				Women MetS + 21.2 ± 12.3 (ALT) MetS-17.9 ± 11.3 (ALT) MetS + 23.3 ± 9.2 (AST) MetS- 22.5 ± 8.3 (AST)
Kohsari et al., 2021, Iran [29].	Cross sectional study	18	Age of participants 47.3 ± 4.1	Men 1329/3397 Total 4730 Women 1936/3141 Total 5092	Harmonised criteria	Significant association between elevated ALT, AST, GGT and ALP levels and increased risk of MetS.
Kohsari et al., 2021, Iran [29].	Cross sectional study	18	Age of participants 47.3 ± 4.1	Men 1329/3397 Total 4730 Women 1936/3141 Total 5092	Harmonised criteria	MetS + 27.6 ± 27.1 (ALT) MetS- 23.5 ± 13.9 (ALT)	MetS + 21.8 ± 8.5 (AST) MetS- 21.2 ± 8.9 (AST)					MetS + 28.9 ± 22.2 (GGT) MetS- 22.4 ± 18.2 (GGT)
Kuo et al., 2018, Taiwan [30].	Cross sectional study	19	MetS + 61.0 ± 11.0 MetS − 57.5 ± 11.6	54,361/125,998 Total 180,359	Harmonised criteria	Subjects with MetS + had higher ALT and AST levels.
Kuo et al., 2018, Taiwan [30].	Cross sectional study	19	MetS + 61.0 ± 11.0 MetS − 57.5 ± 11.6	54,361/125,998 Total 180,359	Harmonised criteria	MetS + 33.1 ± 25.0 (ALT) MetS- 24.6 ± 19.1 (ALT)			MetS + 28.6 ± 15.8 (AST) MetS- 25.1 ± 12.1(AST)
Liu, et al., 2018. China [31]	Cross sectional study	19	MetS + 69.58 ± 7.01 MetS- 70.04 ± 7.65	524/920 Total 1444	Harmonised criteria	Elevated ALT, GGT and ALP levels are positively associated with the prevalence of MetS in the elderly population.
Liu, et al., 2018. China [31]	Cross sectional study	19	MetS + 69.58 ± 7.01 MetS- 70.04 ± 7.65	524/920 Total 1444	Harmonised criteria	MetS + 26.98 ± 15.51 (ALT) MetS- 22.01 ± 12.58 (ALT)		MetS + 23.37 ± 8.85 (AST) MetS- 23.25 ± 8.66 (AST)				MetS + 29.80 ± 19.54 (GGT) MetS- 23.42 ± 18.93 (GGT)
Mitsuhashi et al., 2017, Japan [32].	Cohort study	18	MetS + 50.1 ± 9.3 MetS- 44.5 ± 9.4	698/13,266 Total 13,964	IDF	Higher AST, ALT and GGTP values in non-fatty liver MetS subjects.
Mitsuhashi et al., 2017, Japan [32].	Cohort study	18	MetS + 50.1 ± 9.3 MetS- 44.5 ± 9.4	698/13,266 Total 13,964	IDF	MetS + 23.2 ± 12.7 (ALT) MetS- 17.5 ± 11.4 (ALT)		MetS + 20.7 ± 11.0 (AST) MetS- 17.8 ± 8. (AST)				MetS + 34.6 ± 40.0 (GGTP) MetS- 19.3 ± 19.0 (GGTP)
Osadnik et al., 2020, Poland. [33]	Cross sectional study	19	MetS + 28.07 ± 4.48 MetS- 26.86 ± 4.49	70/390 Total 460	Buscemi et al. (46)	MetS + subjects had increased activity of liver enzymes ALT, AST and GGTP.
Osadnik et al., 2020, Poland. [33]	Cross sectional study	19	MetS + 28.07 ± 4.48 MetS- 26.86 ± 4.49	70/390 Total 460	Buscemi et al. (46)	MetS + 30.61 ± 26.97 (ALT) MetS- 18.74 ± 16.01 (ALT)	MetS + 31.06 ± 54.85 (AST) MetS- 20.58 ± 9.7 (AST)				MetS + 36.27 ± 38.78 (GGTP) MetS- 16.56 ± 9.65 (GGTP)
Sakane et al., 2020, Japan [34].	Cluster randomised controlled trial	20	MetS + 49.4 ± 6.7 MetS- 48.4 ± 7.9	490/844 Total 1334	NCEP ATP III	MetS + group has elevated AST and ALT levels compared to the MetS- group.
Sakane et al., 2020, Japan [34].	Cluster randomised controlled trial	20	MetS + 49.4 ± 6.7 MetS- 48.4 ± 7.9	490/844 Total 1334	NCEP ATP III	MetS + 27.9 ± 11.4 (AST) MetS- 23.4 ± 13.8 (AST)			MetS + 37.2 ± 22.0 (ALT) MetS- 25 ± 15.8 (ALT)
Sobage et al., 2020, Japan [35].	Cross sectional study	20	MetS + 51.2 ± 9.7 MetS- 55.4 ± 7.2	418/2246 Total 2664	NCEP ATP III	ALT, AST, GGT and the prevalence of NAFLD were significantly higher in the MetS + group.
Sobage et al., 2020, Japan [35].	Cross sectional study	20	MetS + 51.2 ± 9.7 MetS- 55.4 ± 7.2	418/2246 Total 2664	NCEP ATP III	MetS + 37.0 ± 25.3 (ALT) MetS- 19.3 ± 11.4 (ALT)		MetS + 29.6 ± 15.1 (AST) MetS- 22.3 ± 6.6 (AST)				MetS + 48.0 ± 37.5 (GGTP) MetS- 26.2 ± 27.0 (GGTP)
Sumiyoshi et al., 2018, Japan [36].	Retrospect. observational study	19	MetS + 50.8 ± 9.5 MetS- 48.8 ± 9.6	1031/13,762 Total 14,793	Japan Diagnostic criteria	Higher ALT and AST levels are observed in the MetS + group.
Sumiyoshi et al., 2018, Japan [36].	Retrospect. observational study	19	MetS + 50.8 ± 9.5 MetS- 48.8 ± 9.6	1031/13,762 Total 14,793	Japan Diagnostic criteria	MetS + 32 ± 22 (ALT) MetS- 21 ± 15 (ALT)			MetS + 25 ± 12 (AST) MetS- 21 ± 9 (AST)
Wang, et al., 2018, China [37].	Cross sectional study	19	MetS + 69.34 ± 7.11 MetS- 70.6 ± 6.76	161/307 Total 468	Harmonized criteria	Significantly higher ALT levels in the MetS + group.
Wang, et al., 2018, China [37].	Cross sectional study	19	MetS + 69.34 ± 7.11 MetS- 70.6 ± 6.76	161/307 Total 468	Harmonized criteria	MetS + 24.77 ± 14.58 (ALT) MetS- 21.64 ± 14.17 (ALT)			MetS + 24.62 ± 14.58 (AST) MetS- 24.19 ± 8.80 (AST)
Wang, et al., 2020, China [38].	Cross sectional study	19	MetS 68.79 ± 6.53 MetS- 68.34 ± 6.58	2207/1791 Total 3998	NCEP ATP III	The combined increase in serum uric acid (SUA) and alanine aminotransferase (ALT) were significantly correlated with MetS and its components.
Wang, et al., 2020, China [38].	Cross sectional study	19	MetS 68.79 ± 6.53 MetS- 68.34 ± 6.58	2207/1791 Total 3998	NCEP ATP III	MetS + 22.32 ± 18.39 (ALT) MetS- 18.27 ± 13.52 (ALT)			MetS + 23.18 ± 14.31 (AST) MetS- 22.08 ± 10.98 (AST)
Wu et al., 2021, Taiwan [39].	Prospective Cohort study	20	MetS + 42.88 ± 8.96 MetS- 37.97 ± 9.0	66/680 Total 746	NCEP ATP III	Higher ALT and AST levels are associated with an elevated risk of MetS+.
Wu et al., 2021, Taiwan [39].	Prospective Cohort study	20	MetS + 42.88 ± 8.96 MetS- 37.97 ± 9.0	66/680 Total 746	NCEP ATP III	MetS + 31.77 ± 23.77 (ALT) MetS- 20.58 ± 24.07 (ALT)			MetS + 22.92 ± 12.09 (AST) MetS- 19.49 ± 12.52 (AST)
Yang, et al., 2021. China [40]	Case-control study	18	MetS + 54.89 ± 12.53 MetS- 45.67 ± 12.73	538/5164 Total 5702	Chinese society of Diabetes	Higher ALT, AST levels in MetS + subjects.
Yang, et al., 2021. China [40]	Case-control study	18	MetS + 54.89 ± 12.53 MetS- 45.67 ± 12.73	538/5164 Total 5702	Chinese society of Diabetes	MetS- 30.19 ± 19.87 (ALT) MetS- 25.38 ± 20.74 (ALT)			MetS + 25.65 ± 10.82 (AST) MetS- 23.37 ± 11.42 (AST)

Abbreviations: ALP, alkaline phosphatase; ALT, alanine aminotransferase; AST, aspartate aminotransferase; GGT, gamma-glutamyltransferase; IDF, International Diabetes Federation; MetS, metabolic syndrome; NAFLD, Non-alcoholic fatty liver disease; NCEP ATP III, National Cholesterol Education Program Adult Treatment Panel III; STROBE, Strengthening the Reporting of Observational Studies in Epidemiology; SUA, serum uric acid

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