The effect of chronic khat chewing on liver enzyme levels - in Radfan Districts- Yemen / Cross sectional study

Khat (Catha edulis) is a widely consumed natural stimulant in Yemen and other regions of East Africa and the Arabian Peninsula, known for its psychoactive effects attributed to cathinone and cathine alkaloids. Despite its cultural significance, chronic khat use has been associated with adverse health effects, including potential hepatotoxicity. The primary objective was to assess and compare liver enzyme levels, specifically glutamic pyruvic transaminase (GPT/ALT) and glutamic oxaloacetic transaminase (GOT/AST), between chronic khat chewers and non-chewers in the Radfan Districts of Yemen. A cross-sectional study was conducted in Radfan Districts, Yemen, comprising 264 participants stratified into two groups: 216 chronic khat chewers (study group) and 48 non-khat-chewing individuals (control group). Blood samples were collected and analyzed for GPT (ALT) and GOT (AST) levels. Statistical analyses were performed using SPSS version 27.0, with independent t-tests, Mann-Whitney U tests, ANOVA, and correlation analyses employed as appropriate. Statistical significance was set at p < 0.05. The analysis revealed a statistically significant increase in GPT (ALT) levels among khat chewers compared to controls (30.30 ± 25.46 U/L vs. 21.52 ± 7.31 U/L; t = 2.365, p = 0.0187). GOT (AST) levels were elevated in chewers (29.01 ± 13.11 U/L vs. 25.96 ± 7.65 U/L) but did not reach statistical significance (p = 0.1258). Also, results show participants chewing >9 hours daily exhibited significantly higher GPT (ALT) levels compared to controls (35.00 ± 41.94 U/L, p = 0.0298). Long-term chewers (>20 years) demonstrated significantly elevated GOT (AST) levels (30.15 ± 14.61 U/L, p = 0.0063). Concurrent use of cigarettes or shamma further exacerbated liver enzyme elevation, with the khat + cigarette group showing the highest mean GPT (ALT) (34.58 ± 42.89 U/L, p = 0.048). Chronic khat chewing is significantly associated with elevated liver enzyme levels, particularly GPT (ALT), indicating potential hepatotoxicity in the Radfan population. The observed dose-dependent relationship with chewing duration and the compounding effects of concurrent tobacco use underscore the need for targeted public health interventions and regular liver function monitoring among khat users.