THE PHYSIOLOGIC AND BIOCHEMICAL ROLE OF ALANINE AMINOTRANSFERASE IN NON-ALCOHOLIC FATTY LIVER DISEASE AND ITS ASSOCIATION WITH DIABETES MELLITUS
Main Article Content
Keywords
Alanine Aminotransferase, Non-Alcoholic Fatty Liver Disease, Diabetes Mellitus, Liver Enzymes, Insulin Resistance, Metabolic Syndrome
Abstract
Background: Non-alcoholic fatty liver disease (NAFLD) has emerged as one of the most prevalent liver disorders worldwide and is closely linked with obesity, insulin resistance, and diabetes mellitus. Among biochemical markers, Alanine Aminotransferase (ALT) plays a pivotal role in reflecting hepatocellular injury and may also indicate underlying metabolic dysfunction. Understanding the association between ALT levels and diabetes in patients with NAFLD can help in early identification of individuals at metabolic risk.
Methodology: A cross-sectional analytical study was conducted at Mercy Teaching Hospital from January 2023 to January 2024, in collaboration between the Departments of Medicine and Community Medicine. A total of 82 patients with ultrasonographically confirmed NAFLD were included and categorized into two groups ‘NAFLD with diabetes mellitus (n=36) and NAFLD without diabetes mellitus (n=46)’. Detailed demographic, clinical, and biochemical data were collected using a structured proforma. Laboratory investigations included liver function tests, fasting blood glucose, HbA1c, and lipid profile. Data were analyzed using SPSS version 25.0, applying independent t-tests, Chi-square tests, and Pearson correlation where appropriate.
Results: The mean ALT level was significantly higher among diabetic NAFLD participants (71.9 ± 18.4 IU/L) compared to non-diabetic individuals (58.2 ± 15.6 IU/L; p=0.001). ALT showed a strong positive correlation with fasting blood glucose (r = 0.512, p < 0.001), HbA1c (r = 0.484, p < 0.001), BMI (r = 0.426, p = 0.001), and triglyceride levels (r = 0.372, p = 0.002). Sedentary lifestyle and high-fat dietary intake were significantly associated with NAFLD among diabetic participants.
Conclusion: Elevated ALT levels in NAFLD patients reflect both hepatic and metabolic derangements. The enzyme serves as a useful biochemical marker linking fatty liver with glycemic imbalance and insulin resistance. Routine monitoring of ALT, along with lifestyle modification and early metabolic screening, can aid in the prevention and control of diabetes-related liver disease in the community.
References
2. Cuomo, P., et al., Role of branched-chain amino acid metabolism in type 2 diabetes, obesity, cardiovascular disease and non-alcoholic fatty liver disease. 2022. 23(8): p. 4325.
3. Ndrepepa, G.J.J.o.L. and P. Medicine, Aspartate aminotransferase and cardiovascular disease—a narrative review. 2021. 6.
4. Kelardeh, B.M., et al., Effects of non-linear resistance training and curcumin supplementation on the liver biochemical markers levels and structure in older women with non-alcoholic fatty liver disease. 2020. 24(3): p. 154-160.
5. Zhu, W., et al., Higher serum uric acid to HDL-cholesterol ratio is associated with onset of non-alcoholic fatty liver disease in a non-obese Chinese population with normal blood lipid levels. 2022. 22(1): p. 196.
6. Zhang, Y. and H.J.B.o. Liu, Cross-sectional association between prolactin levels and non-alcoholic fatty liver disease in patients with type 2 diabetes mellitus: a retrospective analysis of patients from a single hospital in China. 2022. 12(10): p. e062252.
7. Bahrami, M., et al., The effect of melatonin on treatment of patients with non-alcoholic fatty liver disease: a randomized double blind clinical trial. 2020. 52: p. 102452.
8. Pouwels, S., et al., Non-alcoholic fatty liver disease (NAFLD): a review of pathophysiology, clinical management and effects of weight loss. 2022. 22(1): p. 63.
9. Savic, D., et al., The importance of the fatty acid transporter L-carnitine in non-alcoholic fatty liver disease (NAFLD). 2020. 12(8): p. 2178.
10. Seth, A., et al., Severe obesity is associated with liver disease severity in pediatric non‐alcoholic fatty liver disease. 2020. 15(2): p. e12581.
11. Mirhafez, S.R., et al., The effect of curcumin phytosome on the treatment of patients with non-alcoholic fatty liver disease: a double-blind, randomized, placebo-controlled trial, in Pharmacological properties of plant-derived natural products and implications for human health. 2021, Springer. p. 25-35.
12. Yasmin, T., et al., Metformin treatment reverses high fat diet-induced non-alcoholic fatty liver diseases and dyslipidemia by stimulating multiple antioxidant and anti-inflammatory pathways. 2021. 28: p. 101168.
13. Dong, Y., et al., Assessment of left ventricular function in type 2 diabetes mellitus patients with non-alcoholic fatty liver disease using three-dimensional speckle-tracking echocardiography. 2020. 23(1).
14. Wang, W., X. Zhong, and J.J.I.J.o.M.M. Guo, Role of 2-series prostaglandins in the pathogenesis of type 2 diabetes mellitus and non-alcoholic fatty liver disease. 2021. 47(6): p. 114.
15. Lin, H., et al., Pharmacokinetic and metabolomic analyses of Mangiferin calcium salt in rat models of type 2 diabetes and non-alcoholic fatty liver disease. 2020. 21(1): p. 59.
16. Chen, L., et al., Critical overview of hepatic factors that link non-alcoholic fatty liver disease and acute kidney injury: physiology and therapeutic implications. 2022. 23(20): p. 12464.
17. Yang, T., et al., Amelioration of non-alcoholic fatty liver disease by sodium butyrate is linked to the modulation of intestinal tight junctions in db/db mice. 2020. 11(12): p. 10675-10689.
18. Elkattawy, H.A., et al., Rho-kinase inhibition ameliorates non-alcoholic fatty liver disease in type 2 diabetic rats. 2022. 71(5): p. 615.
19. Monserrat-Mesquida, M., et al., Oxidative stress and pro-inflammatory status in patients with non-alcoholic fatty liver disease. 2020. 9(8): p. 759.
20. Musazadeh, V., et al., Effect of probiotics on liver enzymes in patients with non-alcoholic fatty liver disease: an umbrella of systematic review and meta-analysis. 2022. 9: p. 844242.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Faheem Ullah
Assistant Professor, Department of Endocrinology, Mercy Teaching Hospital, Peshawar, Pakistan
Intikhab Alam Khan
Medical Officer, Department of Medicine, THQ Hospital Takht Bhai, Mardan, Pakistan
Shabir Ahmad
Assistant Professor, Department of Community Medicine, Poonch Medical Collage,
Rawalakot AJK, Pakistan
Aneela Shabbir
Assistant Professor, Department of Biochemistry, Foundation University Islamabad, Pakistan
Anwar Shahzad
Associate Professor, Department of Community Medicine, Abbottabad International Medical Institute, Abbottabad, Pakistan
Saif Ur Rehman
Associate Professor, Department of Physiology, Frontier Medical and Dental College,
Abbottabad, Pakistan