Serum alpha-fetoprotein in patients with nonalcoholic fatty liver disease.

We read with interest the Kara et al1, article showing similar serum alpha-fetoprotein (AFP) levels among men with nonalcoholic simple steatosis (SS), steatohepatitis and controls of lower body mass index (BMI), and no discriminating value for NASH1. Following this publication, we performed a post-hoc analysis in a Greek cohort (30 [22 women] patients with biopsy-proven nonalcoholic fatty liver disease [NAFLD] and 24 [20 women] age-, waist circumferenceand BMI-matched controls), whose characteristics were described previously2. We also found similar serum AFP levels (immunochemiluminescence; ADVIA Centaur XP; Siemens Helthcare Diagnostics; Deerfield, IL, USA) in patients with NASH (n = 15; 4.0 ± 0.8 ng/ml), SS (n = 15; 4.0 ± 0.5 ng/ml) and controls (3.3 ± 0.3 ng/ml; p = 0.567). AFP was also similar in different histological lesions (Table I). AFP was not correlated with any anthropometric, clinical or biochemical parameter, including liver function tests, serum lipids, insulin resistance and adipocytokines (adiponectin, leptin, visfatin, resistin, tumor necrosis factor-α, interleukin-6). Remarkably, during a follow up of 3.8 ± 0.1 years (routinely every 6 months), none of NAFLD patients developed hepatocellular carcinoma (HCC). Other data regarding serum AFP in NAFLD patients are limited. Wójtowicz-Chomicz et al. showed similar AFP levels between NAFLD patients and controls, whereas lower in NAFLD than other liver diseases3. On the contrary, Babali et al. showed higher AFP levels in NAFLD patients than controls (of lower BMI)4; AFP also increased by increasing steatosis grade; however, in this study, NAFLD was ultrasoundand not biopsyproven and AFP had high variability in NAFLD patients4.