Haren et al. BMC Public Health 2010, 10:454 http://www.biomedcentral.com/1471-2458/10/454 Page 7 of 10 Figure 1 A standardized comparison of metabolic risk factors between distinct Indigenous population clusters. This radial/spider plot clearly shows the differences in metabolic risk factors between clusters. In the favorable compared to the adverse cluster, people have higher HDL levels and lower systolic and diastolic blood pressures, triglycerides, glucose and waist circumference. Data are shown in standardized units so that the magnitude of the difference between clusters can be compared between variables. Having an adverse metabolic profile was associated with a 2.6 to 4.3-fold increase, and metabolic syndrome with a 2.1 to 3.5-fold increase, in the odds of having elevated GGT (≥50 U/L). A similar result for metabolic syndrome has been shown within abstainers in this cohort [13]. In this Indigenous population, an adverse metabolic profile conferred 3 times the risk of elevated GGT in risky drinkers than in abstainers. Interestingly, Table 4 Alcohol drinking and metabolic risk versus elevated GGT (GGT ≥ 50 U/L) by ethnicity Aboriginal TSI Crude OR Adj. OR* Crude OR Adj. OR* Alcohol Drinking No 1.0 1.0 1.0 1.0 Yes 4.9 (3.6-6.7) 5.6 (3.9-8.0) 3.3 (2.1- 5.1) 2.2 (1.3-3.7) Alcohol risk No 1.0 1.0 1.0 1.0 Moderate 2.1 (1.4-3.2) 2.7 (1.7-4.1) 1.9 (1.1-3.2) 1.4 (0.8-2.5) Risky 6.3 (4.6-8.7) 7.6 (5.2-11.1) 4.5 (2.9-7.1) 3.4 (1.9-5.9) Metabolic syndrome † No 1.0 1.0 1.0 1.0 Yes 2.1 (1.7-2.6) 2.7 (2.0-3.6) 2.8 (2.0-4.0) 2.2 (1.4-3.4) MR cluster profile † Favorable 1.0 1.0 1.0 1.0 Adverse 3.3 (2.6-4.1) 3.4 (2.5-4.5) 3.9 (2.7-5.7) 3.2 (2.0-5.0) * Adjusted for age, sex, ethnicity, BMI, smoking, and PA level. † Risky drinking was defined as > 6 drinks on any occasion or >4 drinks per day in males and >4 drinks on any occasion or >2 drinks per day in female in the week prior to the survey. Metabolic syndrome defined by IDF criteria: waist circumference (≥94 cm in males and ≥80 for females), raised triglycerides (≥1.7 mmol/L), reduced HDL (<1.03 in males or <1.29 in females), raised blood pressure (systolic >130 mmHg or diastolic≥85 mmHg), and plasma glucose (≥5.6 mmol/L). Adverse MR (metabolic risk) cluster profile was obtained by EM cluster analysis. this finding did not hold when using the metabolic syn- drome classification in place of the MR cluster. Previous studies in moderate alcohol drinkers and abstainers have claimed additive effects of alcohol consumption and BMI on elevated serum GGT and ALT [14,15], but an interactive effect modeled using logistic regression was not evident in this Australian indigenous population. Table 5 Alcohol drinking and metabolic risk versus elevated GGT (GGT ≥ 50 U/L) by gender Female Male Crude OR Adj. OR* Crude OR Adj. OR* Alcohol drinking No 1.0 1.0 1.0 1.0 Yes 2.7 (1.9-3.8) 3.5 (2.3-5.2) 5.4 (3.6-8.0) 5.9 (4.0-9.9) Alcohol risk No 1.0 1.0 1.0 1.0 Moderate 1.0 (0.6-1.9) 1.5 (0.9-2.6) 2.8 (1.8-4.5) 3.5 (2.1-5.9) Risky 4.1 (2.9-5.8) 5.2 (3.4-8.0) 6.7 (4.4-10.0) 8.5 (5.3-13.5) Metabolic syndrome † No 1.0 1.0 1.0 1.0 Yes 2.7 (2.0-3.7) 3.1 (2.2-4.5) 2.1 (1.6-2.6) 1.8 (1.3-2.5) MR cluster profile † Favorable 1.0 1.0 1.0 1.0 Adverse 2.9 (2.1-3.9) 3.2 (2.2-4.7) 3.0 (2.3-3.8) 3.2 (2.3-4.4) * Adjusted for age, ethnicity, BMI, smoking, and PA level. † Risky drinking was defined as > 6 drinks on any occasion or >4 drinks per day in males and >4 drinks on any occasion or >2 drinks per day in female in the week prior to the survey. Metabolic syndrome defined by IDF criteria: waist circumference (≥94 cm in males and ≥80 for females), raised triglycerides (≥1.7 mmol/L), reduced HDL (<1.03 in males or <1.29 in females), raised blood pressure (systolic >130 mmHg or diastolic≥85 mmHg), and plasma glucose (≥5.6 mmol/L). Adverse MR (metabolic risk) cluster profile was obtained by EM cluster analysis.