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Int J Mol Epidemiol Genet 2012;3(4):276-285

Original Article
Gamma-glutamyl transferase and C-reactive protein as alternative markers of
metabolic abnormalities and their associated comorbidites: a prospective
cohort study

Jennifer C Melvin, Crystal Rodrigues, Lars Holmberg, Hans Garmo, Niklas Hammar, Ingmar Jungner, Göran Walldius, Mats
Lambe, Wayel Jassem, Mieke Van-Hemelrijck

King’s College London, School of Medicine, Division of Cancer Studies, Cancer Epidemiology Group, London, UK;
Regional Oncologic Centre, Uppsala University, Uppsala, Sweden; Department of Surgical Sciences, Uppsala
University, Uppsala, Sweden; Department of Epidemiology, Insitute of Environmental Medicine, Karolinska Institutet,
Stockholm, Sweden; AstraZeneca Sverige, Södertalje, Sweden; Department of Medicine, Clinical Epidemiological
Unit, Karolinska Institutet and CALAB Research, Stockholm, Sweden; Department of Medicine, Karolinska
Institutet, Stockholm, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet,
Stockholm, Sweden; King’s College London, School of Medicine, Institute of Liver Studies, London, UK

Received August, 2012; Accepted September 21, 2012; Epub November 15, 2012; Published November 30, 2012

Abstract: Background: Recent studies suggested that gamma-glutamyl transferase (GGT) and C-reactive protein
(CRP) are good markers of metabolic abnormalities. We assessed the link between GGT, CRP and common metabolic
abnormalities, as well their link to related diseases, such as cancer and cardiovascular disease (CVD). Methods:
We selected 333,313 subjects with baseline measurements of triglycerides (TG), total cholesterol (TC), glucose,
GGT and CRP in the Swedish AMORIS study. Baseline measurement of BMI was available for 63,900 persons and
77,944 had baseline measurements of HDL. Pearson correlation coefficients between CRP, GGT, and metabolic
components (TG, HDL, BMI and TC) were calculated. To investigate the combined effect of GGT and CRP we created
a score ranging from 0 to 6 and used Cox proportional hazard models to evaluate its association with CVD and
cancer. Results: 21,216 individuals developed cancer and 47,939 CVD. GGT and TG had the strongest correlation
(r=0.22). An increased risk of cancer was identified with elevated levels of GGT or CRP or both markers (GGT-CRP
score ≥3); the greatest risk of cancer was found when GGT-CRP score = 6 (HR: 1.40 (95%CI: 1.31-1.48) and 1.60
(1.47-1.76) compared to GGT-CRP score = 0, respectively). Conclusion: While GGT and CRP have been shown to be
associated with metabolic abnormalities previously, their association to the components investigated in this study
was limited. Results did demonstrate that these markers were predictive of associated diseases, such as cancer.

Keywords: GGT, CRP, metabolic abnormalities, cardiovascular disease, cancer

Address all correspondence to:
Dr. Jennifer Melvin
King’s College London, School of Medicine
Division of Cancer Studies, Cancer Epidemiology Group
Research Oncology, 3rd Floor, Bermondsey Wing
Guy’s Hospital, London SE1 9RT, UK.
Phone: 020 7188 7904
E-mail: jennifer.melvin@kcl.ac.uk