Profile of liver enzymes in non-alcoholic fatty liver disease in patients with impaired glucose tolerance and newly detected untreated type

ncbi.nlm.nih.gov/pmc/articl...

Context:

The perception of non-alcoholic fatty liver disease (NAFLD) as an uncommon and benign condition is rapidly changing. Approximately, 70% type 2 diabetes mellitus (T2DM) patients have a fatty liver, which may follow an aggressive course with necroinflammation and fibrosis.

Aims:

To assess the profile of liver enzymes in subjects with impaired glucose tolerance (IGT), new onset treatment naive T2DM and normal glucose tolerance (NGT) with and without NAFLD.

Results:

NAFLD was significantly associated with higher alanine aminotransferase (ALT) and gamma-glutamyl transferase (GGT) but not ALP levels in IGT and T2DM patients. ALT, GGT significant correlated with waist circumference, body mass index, fasting insulin, homeostatic model assessment- insulin resistance, fasting blood glucose, high density lipoprotein cholesterol, triglyceride. 57% of NAFLD patients had normal ALT between 25 and 40 U/L, 53% of NAFLD subjects had normal GGT between 15 and 30 U/L. ALT <25 U/L and GGT <15 U/L had highest negative predictivity whereas ALT >40 U/L and GGT > 30 U/L had highest positive predictivity for presence of NAFLD in our study sample.

Conclusions:

Mild elevations of liver enzymes in the upper normal range are associated with features of metabolic syndrome and NAFLD even in IGT and recently detected T2DM patients. Novel cut-offs for liver enzymes are warranted in order to prevent unnecessary diagnostic work-ups and early detection of NAFLD to reduce the risk of cirrhosis, hepatocellular carcinoma and classical cardiovascular disease in T2DM and IGT patients.

Introduction

The prevalence of non-alcoholic fatty liver disease (NAFLD) has doubled during last 20 years and is the number one cause of liver disease in the western countries, but recent data confirm that NAFLD play an equally important role worldwide.[1] NAFLD is diagnosed in clinical settings using ultrasound imaging as a liver biopsy is not practically feasible. In developing countries like India, affordability of ultrasound imaging modalities may be a crucial factor. Thus World Gastroenterology Organisation guidelines prescribe a hierarchical resource-sensitive approach.[1] Aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transferase (GGT) and other markers of liver injury may be useful surrogate measures of NAFLD. NAFLD is closely related to insulin resistance, obesity, metabolic syndrome, and diabetes: Triggers for testing of liver enzymes and considering a diagnosis of NAFLD.[1] We need novel cut-offs for liver enzymes as a qualifying criteria for patients to undergo ultrasonography for detection of NAFLD, but there is a paucity of data from Indian literature in this regard. We studied the profile of liver enzymes in NAFLD in patients with impaired glucose tolerance (IGT) and newly detected untreated type 2 diabetes mellitus (T2DM).

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  • Activity2004

    Mild elevations of liver enzymes in the upper normal range are associated with features of metabolic syndrome and NAFLD even in IGT and recently detected T2DM patients, which should prompt clinicians to initiate further diagnostic work-up. Novel cut-offs for liver enzymes are warranted in order to prevent unnecessary diagnostic work-ups as well as early detection of NAFLD to reduce the risk of cirrhosis, hepatocellular carcinoma and CVD in T2DM and IGT patients.

  • Thanks, suramo for the information.

  • People don't accumulate fat because they eat more and exercise less. People accumulate fat because of influence of INSULIN (which no "balanced diet" proponent ever talks). What kicks up INSULIN? Simple answer CARBS the most and so called balanced diet is 60% CARBS. So, INSULIN holds the answers.

    And, to make matters worse, FRUCTOSE (read fruits) is considered healthy. Some even suggested eating 2 mangoes a day. Double whammy.

  • FollowMessage

    suramo-You have obviously presented very valuable data.As a service others,please interpret the data for the benefit of all.

  • ramana42

    Recently i had an interaction with a renown diabetologist affiliated to Apollo hospital. He didn't know that ggt levels in nafld is an important diagnotic as well as prognostic tool. Since then i was looking for an article that can explicitly convey the role of various liver enzymes. It's become clear from the article that

    1) nafld is not a benign condition

    2) alt and ggt levels are raised in nafld associated with t2d and igt.

    3) so far usg and liver biopsy were considered the main diagnostic procedures but now enzyme study can replace an invasive liver biopsy.

    If you have anything more to know we may discuss that out.

  • jan-ran is a live example of what a LC diet can do to ggt.

    Even her expert doctors were surprised as she dropped from 254 U/L. to double digits per her last feedback :)

  • anup

    Yes i know about jan ran. Docs are same everywhere. Don't want to update though have to deal with one subject only 😳😳

  • But, you are a different doctor altogether. A Doctor who reads what a non doctor like me and others had to say, updated knowledge based on literature available and then took the plunge. :)

  • @Anup

    Thanks for saying that. 😜

  • Well, ask anyone here who knows you and (s)he would say you deserve all the praise. :)

  • πŸ‘πŸ‘

    HU jo dimaag ki batti jala de πŸ˜ƒπŸ˜ƒπŸ˜†πŸ˜†πŸ˜πŸ˜πŸ˜

  • Dimag ki dahee bhi hotee hai yahin par :D :D :D

  • suramo-a simple question from a lay man.Please correct me if I am wrong.In our digestive system.proteins get digested in the stomach,fats by the liver,carbohydrates in small intestine and fiber in the in large intestine.Can I presume that a balanced diet will help in optimal utilization of all these organs,thereby ensuring that conditions like NFALD are avoided.Is overloading a particular segment cause any complication?

  • ramana42

    Carb digestion starts in mouth. That why loaf tastes sweet on long mastication.

    Stomach is for storage, sterilisation and partial digestion by acid.

    Protein and fat digestion starts from doudenum with the liver and pancreatic enzymes - different than hormones produced by the pancreas. Digestion and absorption continues all throughout the length of small intestine.

    Large bowels mainly for storage of solid waste from food and fibre digestion and production of vit k etc.

    After digestion the carbs, proteins and fats are converted to basic units like glucose, amino acids and fatty acids. It's these basic units that then are converted to various carbs proteins and fats inside our body. Balanced diet is fine but for those who have balanced health and can utilize the food efficiently. For us balanced food is lchf. Apart from vitamins, minerals etc.

  • Great Information bhai suramo

    I always thought my diabetes is due to my fatty liver condition... in my progress report I always mentions my SGPT and SGOT level...

    When our friend Shashikantiyengar achieved remarkable 4.8 Hba1c I looked at his SGPT and SGOT levels... and they were down below 18.(I think around 15).

    I think for PPBS we have low carb diet... but for FBS...we need to focus on liver.

  • cure

    Ya big bro. But i'd love to hear your story. You say you had nash when diagnosed D. Also you reduced your waist circumference by 8". That's a wonderful thing you achieved. How ? Also nash is an advanced diseses with lots of liver fibrosis. Please tell us your story.

    Thanks.

  • This is an oversimplification, ramana42, but it will do. You're right, you can look at it as overloading a segment. The body always looks for balance - homeostasis - in everything. For example, calcium-magnesium, sodium-potassium, rest-work, carbs-fat-protein, etc. By consuming 'food-like' substances, aka processed foods, we upset this balance and that leads to illness.