Aims: Alpha-fetoprotein (AFP) is a well-known biomarker of liver cancer and liver injury. However, apparently healthy individuals having AFP elevation on heath check-ups were encountered in clinics. Their clinical features and cause of AFP elevation were not clear. Thus, we aim to investigate the clinical characteristics of the patients with an “elevated AFP level” (>7 ng/ mL cutoff), and its relation with body fat deposition in terms of hepatic steatosis and visceral adiposity.
Methods: Patients having a diagnostic code of “elevated AFP level” (R772) were searched from 2009 to 2018 in a tertiary hospital. After excluding patients with any malignancies, liver cirrhosis, or viral hepatitis, 146 patients were included in the case group. As a control group, age and sex-matched 146 hepatic hemangioma (<3cm) patients were selected. Among the subgroup of case (n=49) and controls (n=49) who underwent liver CT, hepatic fat and visceral fat were measured using the pre-contrast CT image.
Results: The case group showed a mean age of 48.7 years, male proportion of 64.4%, and a higher mean serum AFP level (12.76 ng/mL) than the control (2.85 ng/mL). The case group showed a higher prevalence of dyslipidemia (21.2 vs 3.4%, P<0.001) and hypertension (11.6 vs 4.8%, P=0.033), but a lower body mass index (BMI) (22.68 vs 23.85 kg/m2, P=0.003) than the control. Total-bilirubin level was higher in the case group (0.8 vs 0.5 mg/dL, P<0.001), but other laboratory results were similar to the control group. Hepatic fat measured by Hounsfield units of 8 regions of liver segments and visceral adiposity index in the subgroups of case and control were not different (59.40 vs 61.76, P=0.158 and 28.53 vs 27.32 ㎠/㎡, P=0.788, respectively).
Conclusions: Asymptomatic patients with an elevated AFP level showed a higher prevalence of hypertension and dyslipidemia despite lower BMI than controls. Its relationship with abnormal fat metabolism warrants further study.