Impact of Khat Chewing on Liver Enzyme Levels among University Students in Yemen: A Cross-sectional Study

Aims and background: Khat (Catha edulis) chewing is a widespread sociocultural practice in Yemen and East Africa, yet its hepatotoxic effects remain poorly defined, with existing evidence on its impact on serum liver enzymes being inconsistent.This study aimed to assess the impact of khat chewing on serum liver enzyme levels among university students in Yemen. Materials and methods:A comparative cross-sectional study was conducted between July and December 2021 at 21 September University, Sana'a, Yemen.Ninety-eight male students (49 khat chewers and 49 non-chewers) were enrolled.Data on sociodemographics and khat use were collected via a structured questionnaire.Serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT), and alkaline phosphatase (ALP) were measured using a Cobas Integra 400 Plus analyzer.Data were analyzed with SPSS version 21.0, with a p-value < 0.05 considered statistically significant.Results: No significant differences were found between khat chewers and non-chewers for ALT, AST, or GGT (all p > 0.05).However, ALP elevation was significantly more frequent among khat chewers (16.3%) compared to non-chewers (2.0%) (p = 0.014).No associations were found between the duration or daily frequency of khat chewing and enzyme abnormalities.Conclusion: Khat chewing was associated with a significant increase in ALP levels, suggesting a cholestatic pattern of liver injury distinct from the hepatocellular or autoimmune phenotypes described in prior studies.Clinical significance: These findings alert clinicians in khat-prevalent regions to consider khat use as a potential etiology for isolated ALP elevation.They also provide a specific evidence base for public health education on the hepatotoxic risks of khat, particularly its cholestatic effects, which may not be detected by standard liver transaminase tests.