Abstract
Non-alcoholic fatty live disease is a condition defined by excessive fat accumulation in the form of triglycerides in the liver (> 5% of hepatocytes). There is a need for noninvasive biomarkers to detect progression of liver damage in NAFLD. . As of today, limited studies exist on usage of liver enzymes as non-invasive biomarkers in NAFLD.
Material & Method: This original research study included total of forty-one (41) cases and forty (40) controls were selected for the study. Patients with Ultrasound diagnosed fatty liver disease with no history of alcohol consumption referred to phlebotomy for liver function test.AST, ALT and GGT estimated by Modified IFCC with P5P method. Data analysis was done by applying R software
Result: The mean value of serum AST, ALT and GGT were elevated in non-alcoholic fatty liver disease compared to controls. Serum AST/ALT ratio decreased and GGT values were increased in cases compared to controls. Independent student T test was used to analyze the data set for serum AST/ALT ratio and GGT amongst cases and the p value obtained was statistically significant.
Conclusion: As increased level of liver enzymes could indicate severity of steatohepatitis and fibrosis. There is poor correlation between AST/ALT ration and GGT in NAFLD. So along with liver enzymes other noninvasive biomarkers (TNF α, IL 6, IL 8) are useful to know the extent of liver injury in NAFLD patients.
Keywords: NAFLD, AST, ALT, GGT, steatosis, NASH (Non alcoholic steatohepatitis).
References
- Marchesini G, Moscatiello S, Di Domizio S, Forlani G. Obesity-associated liver disease. J Clin Endocrinol Metab. 2008 Nov;93(11 Suppl 1):S74-80.
- Sattar N, Forrest E, Preiss D. Non-alcoholic fatty liver disease. The BMJ [Internet]. 2014 Jul 29 [cited 2018 Sep 11];349. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4168663/
- Ludwig J, Viggiano TR, McGill DB, Oh BJ. Nonalcoholic steatohepatitis: Mayo Clinic experiences with a hitherto unnamed disease. Mayo Clin Proc. 1980 Jul;55(7):434–8.
- Ryysy L, Häkkinen AM, Goto T, Vehkavaara S, Westerbacka J, Halavaara J, et al. Hepatic fat content and insulin action on free fatty acids and glucose metabolism rather than insulin absorption are associated with insulin requirements during insulin therapy in type 2 diabetic patients. Diabetes. 2000 May;49(5):749–58.
- Poynard T, Ratziu V, Charlotte F, Messous D, Munteanu M, Imbert-Bismut F, et al. Diagnostic value of biochemical markers (NashTest) for the prediction of non alcoholosteato hepatitis in patients with non-alcoholic fatty liver disease. BMC Gastroenterol. 2006 Nov 10;6:34.
- Review Team, LaBrecque DR, Abbas Z, Anania F, Ferenci P, Khan AG, et al. World Gastroenterology Organisation global guidelines: Nonalcoholic fatty liver disease and nonalcoholic steatohepatitis. J Clin Gastroenterol. 2014 Jul;48(6):467–73.
- Sanyal D, Mukherjee P, Raychaudhuri M, Ghosh S, Mukherjee S, Chowdhury S. Profile of liver enzymes in non-alcoholic fatty liver disease in patients with impaired glucose tolerance and newly detected untreated type 2 diabetes. Indian J Endocrinol Metab. 2015;19(5):597–601.
- Liver-Enzymes-in-Patients-Diagnosed-with-Nonalcoholic-Fatty-Liver-Disease-nafld-In-Veracruz-a-Comparative-Analysis-with-.pdf [Internet]. [cited 2018 Oct 10]. Available from: https://www.openaccessjournals.com/articles/Liver-Enzymes-in-Patients-Diagnosed-with-Nonalcoholic-Fatty-Liver-Disease-nafld-In-Veracruz-a-Comparative-Analysis-with-.pdf
- Vernon G, Baranova A, Younossi ZM. Systematic review: the epidemiology and natural history of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in adults. Aliment PharmacolTher. 2011 Aug;34(3):274–85.
- Arinc H, Sarli B, Baktir AO, Saglam H, Demirci E, Dogan Y, et al. Serum gamma glutamyl transferase and alanine transaminase concentrations predict endothelial dysfunction in patients with non-alcoholic steatohepatitis. Ups J Med Sci. 2013 Nov;118(4):228–34.
- Dixon JB, Bhathal PS, O’Brien PE. Nonalcoholic Fatty Liver Disease: Predictors of Nonalcoholic Steatohepatitis and Liver Fibrosis in the Severely Obese. Gastroenterology. 2001 Jul 1;121(1):91–100.
- Turgut O, Yilmaz A, Yalta K, Karadas F, Birhan Yilmaz M. gamma-Glutamyltransferase is a promising biomarker for cardiovascular risk. Med Hypotheses. 2006;67(5):1060–4.
- Kerner A, Avizohar O, Sella R, Bartha P, Zinder O, Markiewicz W, et al. Association between elevated liver enzymes and C-reactive protein: possible hepatic contribution to systemic inflammation in the metabolic syndrome. Arterioscler Thromb Vasc Biol. 2005 Jan;25(1):193–7.
- Sorbi D, Boynton J, Lindor KD. The ratio of aspartate aminotransferase to alanine aminotransferase: potential value in differentiating nonalcoholic steatohepatitis from alcoholic liver disease. Am J Gastroenterol. 1999 Apr;94(4):1018–22.
- Kunde SS, Lazenby AJ, Clements RH, Abrams GA. Spectrum of NAFLD and diagnostic implications of the proposed new normal range for serum ALT in obese women. Hepatol Baltim Md. 2005 Sep;42(3):650–6.
- Fracanzani AL, Valenti L, Bugianesi E, Andreoletti M, Colli A, Vanni E, et al. Risk of severe liver disease in nonalcoholic fatty liver disease with normal aminotransferase levels: a role for insulin resistance and diabetes. Hepatol Baltim Md. 2008 Sep;48(3):792–8.
- Adams LA, Angulo P, Lindor KD. Nonalcoholic fatty liver disease. CMAJ Can Med Assoc J. 2005 Mar 29;172(7):899–905.
Corresponding Author
Dr Swetha B
John Nagar, Bangalore, India
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.
DOI: https://dx.doi.org/10.18535/jmscr/v7i4.02
