Association between obesity and liver enzyme levels: a cross-sectional observational study among individuals visiting a diagnostic laboratory in Burdwan, West Bengal
DOI:
https://doi.org/10.18203/2394-6040.ijcmph20252919Keywords:
Alanine aminotransferase, Aspartate aminotransferase, Alkaline phosphatase, Metabolic risk markers, Non-alcoholic fatty liver diseaseAbstract
Background: Obesity is a global health crisis, acting as a risk factor for various chronic diseases. Elevated levels of liver enzymes are important biomarkers of liver disease and may signal metabolic changes resulting from obesity. The aim of this study was to explore the association between obesity and liver enzyme levels, while also assessing the role of sociodemographic, behavioural, and dietary factors in obesity prevalence.
Methods: This was a cross-sectional observational study carried out among 390 individuals aged 18 to 59 years without any diagnosis of liver disease. Information regarding sociodemographic, behavioural, and dietary habits were collected using structured questionnaires. Anthropometric measures, blood pressure, fasting blood glucose, lipid profile, and liver enzyme levels were assessed using standard methods. Chi-square tests, t-tests, Pearson correlation, and univariate logistic regression were performed to evaluate the relationships between variables.
Results: Obesity prevalence among the study participants was 67.2% and a statistically significant relationship was found between obesity and elevated liver enzyme levels (p<0.05). No significant associations were found between obesity and sociodemographic or behavioural variables, but excess oil and sugar consumption were linked to obesity. Furthermore, logistic regression analysis revealed that sugar consumption, high systolic blood pressure, fasting plasma glucose, and liver enzyme levels were significantly associated with obesity.
Conclusion: A significant association was identified between obesity and elevated levels of liver enzymes, indicating that they could be used as non-invasive biomarkers for detecting liver disease in early stages among overweight and obese individuals.
Metrics
References
World Health Organization. Noncommunicable diseases country profiles 2018. 2018. Available at: https://www.who.int/publications/i/item/ncd-country-profiles-2018. Accessed on 28 July 2025.
World Health Organization. Global strategy on diet, physical activity and health. 2003. Available at: https://www.who.int/publications/i/item/9241592222. Accessed on 28 July 2025.
Mundi MS, Velapati S, Patel J, Kellogg TA, Abu Dayyeh BK, Hurt RT. Evolution of NAFLD and its management. Nutr Clin Pract. 2020;35(1):72-84. DOI: https://doi.org/10.1002/ncp.10449
Younossi ZM, Golabi P, Price JK, Owrangi S, Gundu-Rao N, Satchi R, et al. The global epidemiology of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis among patients with type 2 diabetes. Clin Gastroenterol Hepatol. 2024;22(10):1999-2010. DOI: https://doi.org/10.1016/j.cgh.2024.03.006
Charan J, Biswas T. How to calculate sample size for different study designs in medical research? Indian J Psychol Med. 2013;35(2):121-6. DOI: https://doi.org/10.4103/0253-7176.116232
Majumder S. Socioeconomic status scales: Revised Kuppuswamy, BG Prasad, and Udai Pareekh’s scale updated for 2021. J Fam Med Prim Care. 2021;10(11):3964-7. DOI: https://doi.org/10.4103/jfmpc.jfmpc_600_21
Ghodke M. Updated BG Prasad’s socioeconomic status classification for the year 2023. Indian J Community Med. 2023;48(6):934-6. DOI: https://doi.org/10.4103/ijcm.ijcm_401_23
Van Beek JHDA, De Moor MHM, De Geus EJC, Lubke GH, Vink JM, Willemsen G, et al. The genetic architecture of liver enzyme levels: GGT, ALT and AST. Behav Genet. 2013;43(4):329-39. DOI: https://doi.org/10.1007/s10519-013-9593-y
Giannini EG. Liver enzyme alteration: a guide for clinicians. Can Med Assoc J. 2005;172(3):367-79. DOI: https://doi.org/10.1503/cmaj.1040752
Marchesini G, Avagnina S, Barantani EG, Ciccarone AM, Corica F, Dall’Aglio E, et al. Aminotransferase and gamma-glutamyl transpeptidase levels in obesity are associated with insulin resistance and the metabolic syndrome. J Endocrinol Invest. 2005;28(6):333-9. DOI: https://doi.org/10.1007/BF03347199
Oh SY, Cho YK, Kang MS, Yoo TW, Park JH, Kim HJ, et al. The association between increased alanine aminotransferase activity and metabolic factors in nonalcoholic fatty liver disease. Metabolism. 2006;55(12):1604-9. DOI: https://doi.org/10.1016/j.metabol.2006.07.021
Xu L, Jiang CQ, Schooling CM, Zhang WS, Cheng KK, Lam TH. Liver enzymes as mediators of association between obesity and diabetes: the Guangzhou Biobank Cohort Study. Ann Epidemiol. 2017;27(3):204-7. DOI: https://doi.org/10.1016/j.annepidem.2016.11.002
Hirani S, Kuril B, Lone D, Ankushe R, Doibale M. Obesity prevalence and its relation with some sociodemographic factors in bank employee of Aurangabad city, Maharashtra, India. Int J Community Med Public Health. 2016;1628-35. DOI: https://doi.org/10.18203/2394-6040.ijcmph20161641
Kadarkar K, Tiwari S, Velhal G, Giri P. Physical activity levels during work, leisure time and transport and its association with obesity in urban slum of Mumbai, India. Int J Community Med Public Health. 2016;715-20. DOI: https://doi.org/10.18203/2394-6040.ijcmph20160639
Patel M, Kaufman A, Hunt Y, Nebeling L. Understanding the relationship of cigarette smoking trajectories through adolescence and weight status in young adulthood in the United States. J Adolesc Health. 2017;61(2):163-70. DOI: https://doi.org/10.1016/j.jadohealth.2017.02.005
Plurphanswat N, Rodu B. The association of smoking and demographic characteristics on body mass index and obesity among adults in the U.S., 1999–2012. BMC Obes. 2014;1(1):18. DOI: https://doi.org/10.1186/s40608-014-0018-0
Veldheer S, Yingst J, Zhu J, Foulds J. Ten-year weight gain in smokers who quit, smokers who continued smoking and never smokers in the United States, NHANES 2003–2012. Int J Obes. 2015;39(12):1727-32. DOI: https://doi.org/10.1038/ijo.2015.127
Stedman RL. Chemical composition of tobacco and tobacco smoke. Chem Rev. 1968;68(2):153-207. DOI: https://doi.org/10.1021/cr60252a002
Schmidt HD, Rupprecht LE, Addy NA. Neurobiological and neurophysiological mechanisms underlying nicotine seeking and smoking relapse. Complex Psychiatry. 2018;4(4):169-89. DOI: https://doi.org/10.1159/000494799
Moffatt RJ, Owens SG. Cessation from cigarette smoking: Changes in body weight, body composition, resting metabolism, and energy consumption. Metabolism.1991;40(5):465-70. DOI: https://doi.org/10.1016/0026-0495(91)90225-L
Sinha R, Jastreboff AM. Stress as a common risk factor for obesity and addiction. Biol Psychiatry. 2013;73(9):827-35. DOI: https://doi.org/10.1016/j.biopsych.2013.01.032
AlKalbani SR, Murrin C. The association between alcohol intake and obesity in a sample of the Irish adult population, a cross-sectional study. BMC Public Health. 2023;23(1):2075. DOI: https://doi.org/10.1186/s12889-023-16946-4
Arif AA, Rohrer JE. Patterns of alcohol drinking and its association with obesity: data from the third national health and nutrition examination survey, 1988–1994. BMC Public Health. 2005;5(1):126. DOI: https://doi.org/10.1186/1471-2458-5-126
Narasimhan S, Nagarajan L, Vaidya R, Gunasekaran G, Rajagopal G, Parthasarathy V, et al. Dietary fat intake and its association with risk of selected components of the metabolic syndrome among rural South Indians. Indian J Endocrinol Metab. 2016;20(1):47. DOI: https://doi.org/10.4103/2230-8210.172248
Sharma H, Zhang X, Dwivedi C. The effect of ghee (clarified butter) on serum lipid levels and microsomal lipid peroxidation. AYU Int Q J Res Ayurveda. 2010;31(2):134. DOI: https://doi.org/10.4103/0974-8520.72361
Mohammadi Hosseinabadi S, Nasrollahzadeh J. Effects of diets rich in ghee or olive oil on cardiometabolic risk factors in healthy adults: a two-period, crossover, randomised trial. Br J Nutr. 2022;128(9):1720-9. DOI: https://doi.org/10.1017/S0007114521004645
Jensen T, Abdelmalek MF, Sullivan S, Nadeau KJ, Green M, Roncal C, et al. Fructose and sugar: A major mediator of non-alcoholic fatty liver disease. J Hepatol. 2018;68(5):1063-75. DOI: https://doi.org/10.1016/j.jhep.2018.01.019
Chen J, Sun M, Adeyemo A, Pirie F, Carstensen T, Pomilla C, et al. Genome-wide association study of type 2 diabetes in Africa. Diabetologia. 2019;62(7):1204-11. DOI: https://doi.org/10.1007/s00125-019-4880-7
Ma Y, He FJ, MacGregor GA. High salt intake: Independent risk factor for obesity? Hypertension. 2015;66(4):843-9. DOI: https://doi.org/10.1161/HYPERTENSIONAHA.115.05948
MacGregor G. ME 03-2 High salt intake as a cause of obesity. J Hypertens. 2016;34(1):e379. DOI: https://doi.org/10.1097/01.hjh.0000500973.69035.c2
Allison SJ. High salt intake as a driver of obesity. Nat Rev Nephrol. 2018;14(5):285-285. DOI: https://doi.org/10.1038/nrneph.2018.23
Musaiger A. Strategy to combat obesity and to promote physical activity in Arab countries. Diabetes Metab Syndr Obes Targets Ther. 2011;89. DOI: https://doi.org/10.2147/DMSO.S17322
Al-Mahroos F, Al-Roomi K. Overweight and obesity in the Arabian Peninsula: an overview. J R Soc Promot Health. 1999;119(4):251-3. DOI: https://doi.org/10.1177/146642409911900410