Association of Oxidative Stress and Inflammatory Biomarkers with Liver Enzyme Alterations in Patients with Non-Alcoholic Fatty Liver Disease
Author(s):
1Sama Amer Abbas El-Tekreti, 2Yousif khalid hameed, 3Samar Abdulwahab Abdulla
Date: 09/10/2026
doi: https://doi.org/10.5281/zenodo.8425890
Abstract
Background: Oxidative stress and chronic inflammation contribute to hepatocellular injury in NAFLD,
potentially explaining altered liver enzymes and progressive disease severity. Aims of the study: This
study aimed to evaluate oxidative-stress and inflammatory biomarkers in patients with non-alcoholic fatty
liver disease and determine their relationships with liver-enzyme alterations. It also assessed whether
MDA, SOD, GSH, hs-CRP, IL-6, and TNF-α were independently associated with ALT levels after
adjustment for relevant metabolic factors. Methodology: This analytical case-control study enrolled 150
adults at Al-Nasiriyah General Hospital and affiliated clinics between October 2025 and May 2026: 100
ultrasonographically confirmed NAFLD patients and 50 controls. After 8–12-hour fasting, venous blood
was collected, processed, and stored at −80°C. Metabolic and liver parameters were measured using
automated enzymatic methods. MDA, SOD, GSH, and hs-CRP were assessed colorimetrically or
immunoturbidimetrically, while IL-6 and TNF-α were quantified by duplicate sandwich ELISA.
Appropriate exclusion criteria and internal quality controls were applied throughout. Result: NAFLD
patients had higher BMI, fasting glucose, triglycerides, ALT, AST, GGT, MDA, hs-CRP, IL-6, and TNF
α, but lower HDL-C, SOD, and GSH than controls. Oxidative and inflammatory biomarkers correlated
significantly with liver enzymes; MDA and IL-6 showed the strongest positive relationships with ALT.
Multivariable analysis identified MDA, IL-6, BMI, and hs-CRP as independent positive correlates of
ALT, whereas SOD was inversely associated. Triglycerides and TNF-α were nonsignificant after
adjustment, supporting a combined oxidative, inflammatory, and metabolic contribution to hepatic injury.
Conclusions; NAFLD was associated with adverse metabolic features, elevated liver enzymes, increased
lipid peroxidation, weakened antioxidant defenses, and systemic inflammation. MDA, IL-6, hs-CRP,
BMI, and SOD independently correlated with ALT, supporting their potential complementary value in
assessing hepatocellular injury and activity.
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