Association between Total and Indirect Bilirubin Levels and Metabolic Syndrome in the Population of Lahore, Pakistan

Abstract

Abstract

Introduction: Metabolic syndrome is the blend of metabolic abnormalities that rise the risk of cardiovascular diseases and diabetes. It has been evident that bilirubin, particularly its indirect form, has protective antioxidant properties that can influence the risk for metabolic syndrome. Besides, Lahore is region with diverse population from across the country, probably faced with dissimilar genetic and environmental background, bringing various exposure levels and disease incidence characteristics, thus putting forward a special population for such studies on association.

Objective: To determine the relationship between levels of total, indirect and direct bilirubin and prevalence of metabolic syndrome in Lahore.

Methods A cross-sectional study on 546 Lahore; the subjects were equally divided between male and female and stratified random sampling was used for selection. Exclusion criteria consisted of the past history of liver disease, cholecystectomy, or intake of medications affecting liver function. Baseline characteristics including age, smoking, alcohol, and other various metabolic health markers, and bilirubin and liver enzyme levels were collected from fasting blood samples. Descriptive statistics, t-tests, chi-squared tests, and logistic regression models were used for data analysis in SPSS version 25.

Results: The mean age of the participants was 40.33 ± 11.86 years. According to statistics, there was a significant predominance of smokers among the male population (52.7% of male and 13.2% of Female; p < 0.001) and those with alcohol habits (18.7% of male and 1.1% of Female; p < 0.001). Male also had higher average levels of TBIL (11.84 ± 4.71 μmol/L) and IBIL (8.76 ± 3.88 μmol/L) than Female (TBIL: 10.19 ± 4.59 μmol/L; IBIL: 7.65 ± 3.73 μmol/L; p < 0.001 for both). Increasing quartiles of TBIL and IBIL had a lowered risk of metabolic syndrome (HR for TBIL Q4 vs. Q1: 0.48, 95% CI: 0.32 to 0.72, p < 0.001; HR for IBIL Q4 vs. Q1).

Conclusion: The increased levels of the common and indirect bilirubin are inversely associated with the risk of the metabolic syndrome among Lahore population. These findings support the antioxidant properties of bilirubin that protect against the metabolic syndrome.

Keywords: Bilirubin, Metabolic Syndrome, Lahore, Antioxidant, Cardiovascular Risk.