Page 1 of 11
Journal of Biomedical Engineering and Medical Imaging - Vol. 8, No. 5
Publication Date: October, 25, 2021
DOI:10.14738/jbemi.85.10781. Ezeugwunne, I. P., Idris, S. S., Ogbodo, E. C., Nnaemeka, W. S., David, I. O., Elosiuba, N. V., Myke-Mbata, B. K., Edward, U., Nnamdi,
J. C., & Nwanguma, E. D. (2021). Pattern of Alpha Fetoprotein and Activities of Liver Enzymes in Type 2 Diabetic Patients Attending
Nnamdi Azikiwe University Teaching Hospital Nnewi, Anambra State, Nigeria. Journal of Biomedical Engineering and Medical
Imaging, 8(5). 1-11.
Services for Science and Education – United Kingdom
Pattern of Alpha Fetoprotein and Activities of Liver Enzymes in
Type 2 Diabetic Patients Attending Nnamdi Azikiwe University
Teaching Hospital Nnewi, Anambra State, Nigeria
Ifeoma Priscilla Ezeugwunne
Department of Human Biochemistry; College of Health Sciences
Nnamdi Azikiwe University, Nnewi, Nigeria
Stephen Shehu Idris
Department of Medical laboratory Science, College of Health Sciences
Nnamdi Azikiwe University, Nnewi, Nigeria
Emmanuel Chukwuemeka Ogbodo
Department of Medical laboratory Science, College of Health Sciences
Nnamdi Azikiwe University, Nnewi, Nigeria
Wurola Serah Nnaemeka
Department of Human Biochemistry; College of Health Sciences
Nnamdi Azikiwe University, Nnewi, Nigeria
Ibemere Obinna David
Department of Pediatrics, Maternal and Children Hospital
Hafar Al Batin City, Saudi Arabia
Nwanneka Victoria Elosiuba
Department of Parasitology and Entomology, Bioscience Faculty
Nnamdi Azikiwe University, Awka, Nigeria
Blessing K Myke-Mbata
Department of Chemical pathology, College of Health Sciences
Nnamdi Azikiwe University, Nnewi, Nigeria
Ukamaka Edward
Department of Chemical Pathology, Imo State University, Owerri, Nigeria.
Johnjude Chinonso Nnamdi
Department of Chemical pathology, College of Health Sciences
Nnamdi Azikiwe University, Nnewi, Nigeria
Eberechi D Nwanguma
Department of Medical Laboratory Science
Imo State University, Owerri, Nigeria
Page 2 of 11
2
Journal of Biomedical Engineering and Medical Imaging (JBEMI) Vol 8, Issue 5, October - 2021
Services for Science and Education – United Kingdom
ABSTRACT
Diabetes mellitus (DM) is a metabolic disorder characterized by hyperglycemia,
which has become health problem of global interest, linked to renal disease. The
study is to assess the activities of some liver enzymes and alpha fetoprotein level in
type 2 diabetic patients. 81 participants comprised 38 diabetics and 43 controls
were randomly recruited. Informed, oral and written consent was obtained from
the participants. Ethical approval was obtained. 6mls of fasting blood samples were
collected. Plasma glucose, alpha feto-protein (AFP) levels; serum alanine
aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase
(ALP) and gamma glutamyltransferase (GGT) activities were analyzed using
standard laboratory methods. The results showed significantly increased plasma
glucose level in the diabetics than in controls (p=0.000), as well as in male diabetics
than in female diabetics (p=0.048). But, the mean age, AFP, ALT, AST, ALP and GGT
activities were the same in the diabetics and the controls; and in male and female
diabetics at p>0.05 in each case. Relatively strong positive significant correlation
was observed between ALT Vs AST (r=0.566; p=0.000) and a weaker negative
association exist between ALT Vs Age (r= -0.353; p=0.022) in diabetics but no
associations were observed with other parameters studied. In conclusion the
positive association between ALT and AST may reveal transaminase derangements
in liver status of type 2 diabetic subjects studied.
Keyword: Type 2, Diabetes, Mellitus, ALT, AST, AFP.
INTRODUCTION
Diabetes mellitus (DM) is a chronic metabolic disease resulting from diminished secretion of
insulin or due to reduced tissue sensitivity to insulin and has a global health burden especially
in developing countries like Nigerian (Ogbodo et al., 2019).
Diabetes is one of the top 10 causes of death globally, together with respiratory disease,
cardiovascular disease and cancer, account for over 80% of all the non-communicable diseases
(NCDs) deaths (Forouzanfar, 2016).
Individuals with diabetes have a 2–3 folds risk of all-cause mortality (Yang, 2019). Presence of
diabetes is associated with increased mortality from chronic kidney disease, infections,
cardiovascular disease, stroke, chronic liver disease, and cancer (Policardo, 2015; Bragg, 2017).
Type 2 diabetes mellitus (T2DM) accounts for well over 90% of diabetes mellitus in Sub- Saharan Africa, and population prevalence proportions ranged from 1% in rural areas to 12%
in urban (Hall et al., 2011) and accounts for a prevalence of 2.4% with total number of mortality
amounting to 3028 deaths in 2017 in Nigeria (IDF, 2017).
In 2017, the global incidence of diabetes was 22.9 million, the prevalence rate was 570.9 million
and the death rate will be 1.59 million. It has been projected that in 2025, the global incidence
of diabetes will be 26.6 million, the prevalence rate will be 476.0 million and the death rate was
1.37 million (Lin et al., 2020). According to the International Diabetes Federation (IDF),
approximately 463 million adults (20-79 years) were living with diabetes in 2019 and by 2045
this is expected to rise to 700 million people (IDF, 2019).
Page 3 of 11
3
Ezeugwunne, I. P., Idris, S. S., Ogbodo, E. C., Nnaemeka, W. S., David, I. O., Elosiuba, N. V., Myke-Mbata, B. K., Edward, U., Nnamdi, J. C., &
Nwanguma, E. D. (2021). Pattern of Alpha Fetoprotein and Activities of Liver Enzymes in Type 2 Diabetic Patients Attending Nnamdi Azikiwe
University Teaching Hospital Nnewi, Anambra State, Nigeria. Journal of Biomedical Engineering and Medical Imaging, 8(5). 1-11.
URL: http://dx.doi.org/10.14738/jbemi.85.10781
There are number of risk factors that accelerate the deleterious effects of diabetes such as high
blood pressure, elevated cholesterol level, glycemic control, smoking, obesity, and lack of
regular exercises (Peer et al., 2014).
Moreover, report has it that developing countries will suffer more negative impacts of type 2
diabetes mellitus because of sedentary lifestyles, obesity, aging, unhealthy diets, and high
population growth (World Health Organization (WHO), 2016).
The liver is an insulin- sensitive organ and plays an important role in maintenance of normal
glucose levels during fasting as well as in the postprandial period, and its role in the
pathogenesis of type 2 diabetes has attracted much interest (Traupe et al., 2010). The liver is a
metabolic food factory where all types of nutrients, especially, proteins, carbohydrates, and
lipids are metabolized. It plays an important role in maintaining blood sugar levels in both a
fasting state and a postprandial state.
Diabetes causes lipid disorders and, consequently, long-term complications and injury to many
organs of the body, including the liver (Garcia-Caballero et al., 2014). Glycogenesis,
glycogenolysis, glyconeogenesis, lipid metabolism, and insulin degradation take place in the
liver (Wannamethee et al., 2005). There are numerous complications associated with T2DM
which include diabetic nephropathy, diabetic neuropathy, diabetic retinopathy, diabetic
ketoacidosis, stroke, liver injury, fatty liver disease among others (Papatheodorou et al., 2016).
T2DM is considered one of the causes of liver diseases such as nonalcoholic steatohepatitis
(NASH), nonalcoholic fatty liver disease (NAFLD), cirrhosis, and eventually hepatocellular
carcinoma (Moscatiello et al., 2007; Mantovani and Targher, 2017).). Liver disease comprises
substantial comorbidity in T2DM (Gouri et al., 2013). The liver enzymes, aspartate amino
transferase (AST), alanine aminotransferase (ALT), and gamma glutamyltransferase (GGT) are
routinely used in evaluation of liver function. Measurement of serum ALT and AST serve as a
marker of hepatocytes injury although ALT is the most specific marker of liver pathology such
as acute hepatic dysfunction and is found primarily in the liver (Crook, 2012). AST is also found
in other tissues and are therefore less specific markers or sensitive indicators of liver damage.
ALP, and gamma-glutamyltranspeptidase (GGT) act as markers of biliary function and
cholestasis (Crook, 2012). Studies have suggested that alteration in liver enzymes may be a
predisposing and probable risk factor of Type 2 Diabetes Mellitus (T2DM) and complication of
long standing T2DM (Al-Dahhan, 2015). Elevated activities in liver enzymes such as alanine
aminotransferase, aspartate aminotransferase, alkaline phosphatase and gamma
glutamyltransferase have been recorded in T2DM patients (Ghimire et al., 2018; Alzahrani et
al., 2019; Islam et al., 2020).
Human Alpha-fetoprotein (AFP) is a plasma protein produced by the embryonic yolk sac and
the fetal liver. AFP content in fetal serum is high and gradually decreases to the level of adults
after birth. An elevated serum alpha fetoprotein level serves as a tumor marker in identification
of cancers especially those related to the liver (Ertle et al., 2017). AFP is commonly used as a
tumor marker for hepatocellular carcinoma (HCC) (Marzinke and Dufour, 2020). Type 2
diabetes mellitus (T2DM) is a major risk factor associated with hepatocellular carcinoma (HCC),
(Makol et al., 2018).Hence, this study is targeted at evaluating the liver enzyme activities and
alpha fetoprotein levelin type 2 diabetes mellitus patients attending diabetes clinic in
NnamdiAzikiwe University Teaching Hospital, Nnewi.