From the Guidelines
Yes, alpha-fetoprotein (AFP) can be elevated due to both liver disease and gluten sensitivity. AFP is primarily used as a tumor marker for hepatocellular carcinoma and certain germ cell tumors, but it can also increase in non-cancerous conditions. In liver disease, particularly chronic hepatitis, cirrhosis, and acute liver injury, AFP levels may rise due to liver cell regeneration and inflammation, as noted in a study published in the Annals of Oncology 1. The more severe the liver damage, the higher the AFP levels typically become. In celiac disease (gluten sensitivity), AFP elevation can occur due to intestinal damage and increased permeability that allows AFP to enter the bloodstream, as well as associated liver inflammation that sometimes accompanies untreated celiac disease, as discussed in a guideline on clinical nutrition in liver disease published in Clinical Nutrition 1. However, the elevation in these conditions is usually modest (typically below 500 ng/mL) compared to the very high levels often seen in liver cancer. Some key points to consider include:
- Liver disease can cause AFP elevation due to liver cell regeneration and inflammation
- Celiac disease can cause AFP elevation due to intestinal damage and associated liver inflammation
- The elevation in these conditions is usually modest compared to liver cancer
- Treatment of the underlying liver disease or strict adherence to a gluten-free diet in celiac disease often results in normalization of AFP levels over time, as reported in a study on the management of hepatocellular carcinoma published in Hepatology 1. If elevated AFP is detected, it's essential to investigate both malignant and benign causes through additional testing such as imaging studies and, when appropriate, biopsy.
From the Research
Alpha-Fetoprotein (AFP) Elevations
- AFP is a tumor marker that can be elevated in various conditions, including liver disease and malignancies 2, 3, 4.
- Studies have shown that AFP can be elevated in patients with chronic liver disease, such as chronic viral hepatitis and cirrhosis, even in the absence of hepatocellular carcinoma (HCC) 2, 3, 4.
- Hereditary persistence of AFP (HPAFP) is a rare disorder that can cause elevated AFP levels in the absence of liver disease or malignancy, and is characterized by an autosomal dominant pattern of inheritance 3.
- In children with metabolic dysfunction-associated steatotic liver disease (MASLD), elevated AFP levels have been observed, but are not associated with malignancies or advanced fibrosis 5.
Gluten Sensitivity and AFP Elevations
- There is no direct evidence to suggest that gluten sensitivity can cause elevated AFP levels.
- However, it is possible that underlying liver disease or inflammation caused by gluten sensitivity could lead to elevated AFP levels, although this has not been specifically studied.
Liver Disease and AFP Elevations
- Liver disease, including chronic viral hepatitis, cirrhosis, and hepatocellular carcinoma, can cause elevated AFP levels 2, 3, 4.
- The degree of AFP elevation can vary depending on the underlying liver disease, with higher levels often associated with HCC or acute viral hepatitis 2, 4.
- In some cases, elevated AFP levels can be seen in patients with liver disease without malignancy, highlighting the importance of thorough evaluation to rule out underlying conditions 2, 3, 6.