Supra-additive effect of alcohol consumption, cigarette smoking and metabolic syndrome on the elevation of liver enzyme levels.

<p>NOTES: Model of alcohol consumption x metabolic syndrome was adjusted for age, gender, education level and smoking status. Model of alcohol consumption × cigarette smoking was adjusted for age, gender, level of education, alcohol consumption, and metabolic syndrome. (a) The combined risk of heavy drinking (≥24 g/day) and metabolic syndrome was *AST: OR 6.42 (3.64–11.35), SI 2.37 (1.20–4.67); **ALT: OR 3.88 (2.00–7.55), SI 2.65 (0.80–8.76); ††GGT: OR 13.43 (8.35–21.60), SI 1.91 (1.17–3.13). The combined risk of moderate drinking (<24 g/day) and metabolic syndrome was shown only for ^†GGT: OR 6.04 (3.68–9.94), SI 2.33 (1.24–4.41). (b) The combined risk of heavy drinking (≥24 g/day) and >20 pack years was *AST: OR 6.71 (3.85–11.69), SI 4.55 (3.12–6.61). For GGT, **moderate alcohol consumption (<24 g/day) and ≤20 pack years, OR 3.60 (2.38–5.43), SI 5.57 (1.63–19.06); ^†<24 g/day and >20 pack years, OR 4.50 (3.04–6.67), SI 5.12 (2.19–12.00); ^††≥24 g/day and ≤20 pack years, OR 9.04 (5.85–13.99), SI 1.80 (1.57–2.06); ^‡≥24 g/day and >20 pack years, OR 10.31 (7.13–14.89), SI 2.03 (1.75–2.35). AST, aspartate aminotransferase; ALT, alanine aminotransferase; GGT, gamma-glutamyl transferase; OR, odds ratio; SI, synergy index.