Exp Clin Endocrinol Diabetes 2012; 120(08): 445-450
DOI: 10.1055/s-0032-1311642
Article
© J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York

Effects of Supervised Exercise on Gamma-Glutamyl Transferase Levels in Patients with Isolated Impaired Fasting Glucose and Those with Impaired Fasting Glucose Plus Impaired Glucose Tolerance

M. Burtscher
1   Department of Sport Science, Medical Section, University of Innsbruck, Austria
,
H. Gatterer
1   Department of Sport Science, Medical Section, University of Innsbruck, Austria
,
T. Dünnwald
1   Department of Sport Science, Medical Section, University of Innsbruck, Austria
,
D. Pesta
1   Department of Sport Science, Medical Section, University of Innsbruck, Austria
,
M. Faulhaber
1   Department of Sport Science, Medical Section, University of Innsbruck, Austria
,
N. Netzer
2   Hermann Buhl Institute for Hypoxia and Sleep Medicine Research, Paracelsus Medical University, Salzburg, Austria
,
R. Koch
3   Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University Innsbruck, Austria
,
K. König
4   General practitioner, Vorarlberg, Austria
,
H. Ulmer
5   Department of Medical Statistics, Informatics and Health Economics, Medical University Innsbruck, Austria
› Author Affiliations
Further Information

Publication History

received 13 March 2012
first decision 13 March 2012

accepted 02 April 2012

Publication Date:
25 May 2012 (online)

Abstract

Aim:

To study the effects of a supervised exercise program on serum gamma-glutamyl transferase (GGT), glycemic control and cardiovascular risk factors in pre-diabetic patients with isolated impaired fasting glucose (IFG) and those with IFG plus impaired glucose tolerance (IGT).

Methods:

Out of 60 pre-diabetic patients (30 with isolated IFG and 30 with IFG + IGT) 24 were randomly assigned to the supervised exercise program (1 h twice a week) and 36 only obtained counselling on the risk of diabetes and its prevention. Patients have been followed over a 12-month period.

Results:

The main findings were that patients with IFG + IGT had increased GGT levels at baseline (49.2±27.4 U/L) compared to subjects with isolated IFG (28.1±21.9 U/L) (p<0.01), and that GGT levels improved only after the supervised exercise intervention within the IFG + IGT subjects ( − 17.7±19.6 U/L). Similarly, baseline triglyceride levels were also higher in IFG + IGT patients (p<0.001) and there was a decrease through exercise intervention in these patients only (p<0.05).

Conclusion:

GGT is an unspecific marker of oxidative stress and both high plasma glucose and triglycerides levels may produce oxidative stress. Thus, patients with IFG + IGT seem to have higher levels of oxidative stress than those with isolated IFG. Based on the known association between GGT levels and cardiovascular risk factors, IFG + IGT patients may be at higher risk for the development of cardiovascular diseases. The specific effect of regular exercise on GGT in pre-diabetic patients may contribute to the understanding of the preventive effects related to exercise.

 
  • References

  • 1 Lee DH, Ha MH, Kim JH et al. Gamma-glutamyltransferase and diabetes – a 4 year follow-up study. Diabetologia 2003; 46: 359-364
  • 2 Meisinger C, Löwel H, Heier M et al. KORA Study Group . Serum gamma-glutamyltransferase and risk of type 2 diabetes mellitus in men and women from the general population. J Intern Med 2005; 258: 527-535
  • 3 Andre P, Balkau B, Born C et al. D.E.S.I.R. study group . Three-year increase of gamma-glutamyltransferase level and development of type 2 diabetes in middle-aged men and women: the D.E.S.I.R. cohort. Diabetologia 2006; 49: 2599-2603
  • 4 Montonen J, Drogan D, Joost HG et al. Estimation of the contribution of biomarkers of different metabolic pathways to risk of type 2 diabetes. Eur J Epidemiol 2011; 26: 29-38
  • 5 Ruttmann E, Brant LJ, Concin H et al. Vorarlberg Health Monitoring and Promotion Program Study Group . Gamma-glutamyltransferase as a risk factor for cardiovascular disease mortality: an epidemiological investigation in a cohort of 163 944 Austrian adults. Circulation 2005; 112: 2130-2137
  • 6 Lee DS, Evans JC, Robins SJ et al. Gamma glutamyl transferase and metabolic syndrome, cardiovascular disease, and mortality risk: the Framingham Heart Study. Arterioscler Thromb Vasc Biol 2007; 27: 127-133
  • 7 Targher G. Elevated serum gamma-glutamyltransferase activity is associated with increased risk of mortality, incident type 2 diabetes, cardiovascular events, chronic kidney disease and cancer – a narrative review. Clin Chem Lab Med 2010; 48: 147-157
  • 8 Lattuada G, Ragogna F, Perseghin G. Why Does NAFLD Predict Type 2 Diabetes?. Curr Diab Rep 2011; 11: 167-172
  • 9 Unwin N, Shaw J, Zimmet P et al. Impaired glucose tolerance and impaired fasting glycaemia: the current status on definition and intervention. Diabet Med 2002; 19: 708-723
  • 10 Peteresen JL, McGuire DK. Impaired glucose tolerance and impaired fasting glucose – a review of diagnosis, clinical implications and management. Diabetes Vasc Dis Res 2005; 2: 9-15
  • 11 James C, Bullard KM, Rolka DB et al. Implications of alternative definitions of prediabetes for prevalence in U.S. adults. Diabetes Care 2011; 34: 387-391
  • 12 Li CL, Tsai ST, Chou P. Comparison of metabolic risk profiles between subjects with fasting and 2-hour plasma glucose impairment: The Kinmen Study. J Clin Epidemiol 2002; 55: 19-24
  • 13 DECODE study group . Glucose tolerance and cardiovascular mortality: comparison of fasting and 2-hour diagnostic criteria. Arch Intern Med 2001; 161: 397-405
  • 14 Rosen P, Nawroth PP, King G et al. The role of oxidative stress in the onset and progression of diabetes and its complications: a summary of a Congress Series sponsored by UNESCO-MCBN, the American Diabetes Association and the German Diabetes Society. Diabetes Metab Res Rev 2001; 17: 189-212
  • 15 West IC. Radicals and oxidative stress in diabetes. Diabet Med 2000; 17: 171-180
  • 16 Hu FB, Li TY, Colditz GA et al. Television watching and other sedentary behaviors in relation to risk of obesity and type 2 diabetes mellitus in women. JAMA 2003; 289: 1785-1791
  • 17 Mlinar B, Marc J. Review: New insights into adipose tissue dysfunction in insulin resistance. Clin Chem Lab Med 2011; Sep 6. [Epub ahead of print]
  • 18 Cusi K. Nonalcoholic fatty liver disease in type 2 diabetes mellitus. Curr Opin Endocrinol Diabetes Obes 2009; 16: 141-149
  • 19 Henriksen EJ. Exercise training and the antioxidant alpha-lipoic acid in the treatment of insulin resistance and type 2 diabetes. Free Radic Biol Med 2006; 40: 3-12
  • 20 Teixeira-Lemos E, Nunes S, Teixeira F et al. Regular physical exercise training assists in preventing type 2 diabetes development: focus on its antioxidant and anti-inflammatory properties. Cardiovasc Diabetol 2011; 10: 12
  • 21 Bo S, Gambino R, Durazzo M et al. Associations between gamma-glutamyl transferase, metabolic abnormalities and inflammation in healthy subjects from a population-based cohort: a possible implication for oxidative stress. World J Gastroenterol 2005; 11: 7109-7117
  • 22 Lim JS, Yang JH, Chun BY et al. Is serum gamma-glutamyltransferase inversely associated with serum antioxidants as a marker of oxidative stress?. Free Radic Biol Med 2004; 37: 1018-1023
  • 23 Burtscher M, Gatterer H, Kunczicky H et al. Supervised exercise in patients with impaired fasting glucose: impact on exercise capacity. Clin J Sport Med 2009; 19: 394-398
  • 24 Gatterer H, Ulmer H, Dzien A et al. High cardiorespiratory fitness is more beneficial in pre-diabetic men than women. Clinics 2011; 66: 747-751
  • 25 American Diabetes Association . Standards of medical care in diabetes. Diabetes Care 2005; 28: 4-36
  • 26 Buchfuhrer MJ, Hansen JE, Robinson TE et al. Optimizing the exercise protocol for cardiopulmonary assessment. J Appl Physiol 1983; 55: 1558-1564
  • 27 Wallace TM, Utzschneider KM, Tong J et al. Relationship of liver enzymes to insulin sensitivity and intra-abdominal fat. Diabetes Care 2007; 30: 2673-2678
  • 28 Bianchi C, Penno G, Crisci I et al. Serum gamma-glutamyltransferase levels are related to insulin sensitivity and secretion in subjects with abnormal glucose regulation. Diabetes Metab Res Rev 2010; 26: 181-186
  • 29 Song F, Jia W, Yao Y et al. Oxidative stress, antioxidant status and DNA damage in patients with impaired glucose regulation and newly diagnosed Type 2 diabetes. Clin Sci (Lond) 2007; 112: 599-606
  • 30 Faerch K, Borch-Johnsen K, Holst JJ et al. Pathophysiology and aetiology of impaired fasting glycaemia and impaired glucose tolerance: does it matter for prevention and treatment of type 2 diabetes?. Diabetologia 2009; 52: 1714-1723
  • 31 Henriksen EJ, Diamond-Stanic MK, Marchionne EM. Oxidative stress and the etiology of insulin resistance and type 2 diabetes. Free Radic Biol Med 2011; 51: 993-999
  • 32 Abdul-Ghani MA, Matsuda M, Balas B et al. Muscle and liver insulin resistance indexes derived from the oral glucose tolerance test. Diabetes Care 2007; 30: 89-94
  • 33 Nathan DM, Davidson MB, DeFronzo RA et al. Impaired fasting glucose and impaired glucose tolerance: implications for care. Diabetes Care 2007; 30: 753-759
  • 34 Katsuki A, Sumida Y, Urakawa H et al. Increased oxidative stress is associated with serum levels of triglyceride, insulin resistance, and hyperinsulinemia in Japanese metabolically obese, normal-weight men. Diabetes Care 2004; 27: 631-632
  • 35 Ascaso JF, Pardo S, Real JT et al. Diagnosing insulin resistance by simple quantitative methods in subjects with normal glucose metabolism. Diabetes Care 2003; 26: 3320-3325
  • 36 Festa A, D’Agostino Jr R, Hanley AJ et al. Differences in insulin resistance in nondiabetic subjects with isolated impaired glucose tolerance or isolated impaired fasting glucose. Diabetes 2004; 53: 1549-1555
  • 37 Bae JH, Bassenge E, Kim KB et al. Postprandial hypertriglyceridemia impairs endothelial function by enhanced oxidant stress. Atherosclerosis 2001; 155: 517-523
  • 38 Morino K, Petersen KF, Dufour S et al. Reduced mitochondrial density and increased IRS-1 serine phosphorylation in muscle of insulin-resistant offspring of type 2 diabetic parents. J Clin Invest 2005; 115: 3587-3593
  • 39 Samuel VT, Petersen KF, Shulman GI. Lipid-induced insulin resistance: unravelling the mechanism. Lancet 2010; 375: 2267-2277
  • 40 Pesta D, Hoppel F, Macek C et al. Similar qualitative and quantitative changes of mitochondrial respiration following strength and endurance training in normoxia and hypoxia in sedentary humans. Am J Physiol Regul Integr Comp Physiol 2011; 301: R1078-R1087
  • 41 Ohno H, Yahata T, Yamashita K et al. Effect of physical training on immunoreactive gamma-glutamyltransferase in human plasma. Enzyme 1988; 39: 110-114
  • 42 Borodulin K, Laatikainen T, Lahti-Koski M et al. Associations between estimated aerobic fitness and cardiovascular risk factors in adults with different levels of abdominal obesity. Eur J Cardiovasc Prev Rehabil 2005; 12: 126-131
  • 43 Lawlor DA, Sattar N, Smith GD et al. The associations of physical activity and adiposity with alanine aminotransferase and gamma-glutamyltransferase. Am J Epidemiol 2005; 161: 1081-1088
  • 44 Zhang J, Thomas TR, Ball SD. Effect of exercise timing on postprandial lipemia and HDL cholesterol subfractions. J Appl Physiol 1998; 85: 1516-1522
  • 45 Plaisance EP, Mestek ML, Mahurin AJ et al. Postprandial triglyceride responses to aerobic exercise and extended-release niacin. Am J Clin Nutr 2008; 88: 30-37
  • 46 Bloomer RJ, Goldfarb AH. Anaerobic exercise and oxidative stress: a review. Can J Appl Physiol 2004; 29: 245-263
  • 47 Cooper CE, Vollaard NB, Choueiri T et al. Exercise, free radicals and oxidative stress. Biochem Soc Trans 2002; 30: 280-285
  • 48 Mason JE, Starke RD, Van Kirk JE. Gamma-glutamyl transferase: a novel cardiovascular risk biomarker. Prev Cardiol 2010; 13: 36-41
  • 49 Emdin M, Pompella A, Paolicchi A. Gamma-glutamyltransferase, atherosclerosis, and cardiovascular disease: triggering oxidative stress within the plaque. Circulation 2005; 112: 2078-2080
  • 50 Smith BW, Adams LA. Non-alcoholic fatty liver disease. Crit Rev Clin Lab Sci 2011; 48: 97-113