Characterization of patients with both alcoholic and nonalcoholic fatty liver disease in a large United States cohort

Abstract

BACKGROUNDNonalcoholic fatty liver disease (NAFLD) is the hepatic manifestation of the metabolic syndrome (MetS) and is characterized by steatosis in the absence of significant alcohol consumption. However, MetS and significant alcohol intake coexist in certain individuals which may lead to the development of BAFLD.AIMTo assess the clinical characteristics of patients with both alcoholic and NAFLD (BAFLD) in a large cohort in the United States.METHODSAdults from the National Health and Nutrition Examination Survey between 2003-2014 were included. NAFLD was diagnosed based on elevated alanine aminotransferase (ALT) and being overweight or obese in the absence of other liver diseases. BAFLD patients met the criteria for NAFLD but also had either MetS or type 2 diabetes and consumed excessive amounts of alcohol. Univariable and multivariable analysis were performed to assess differences between NAFLD and BAFLD and to compare severity based on a validated fibrosis score (FIB4 index).RESULTSThe prevalence of NAFLD was at 25.9% (95%CI; 25.1-26.8) and that of BAFLD was 0.84% (0.67, 1.02) which corresponds to an estimated 1.24 million Americans affected by BAFLD. Compared to NAFLD, patients with BAFLD were more likely to be male, smokers, have higher ALT, aspartate aminotransferase, triglycerides, and lower platelets; P < 0.01 for all. More importantly, after adjusting for MetS components, BAFLD patients were significantly more likely to have advanced fibrosis [adjusted OR (95%CI) based on FIB4 index > 2.67 was 3.2 (1.4, 7.0), P = 0.004].CONCLUSIONA significant percentage of the American general population is afflicted by BAFLD and these patients tend to have more advanced liver fibrosis.

Evidence-based clinical advice for nutrition and dietary weight loss strategies for the management of NAFLD and NASH

“…136 There is, however, strong evi-dence that patients drinking excessively (≥2 drinks/day for women and ≥3 drinks/day for men) with NAFLD are at significantly increased risk of developing advanced liver fibrosis and this should therefore be discouraged. 137 Even mild to moderate drinking (<210 g/week) has been found to increase the risk of steatohepatitis, fibrosis, decompensated liver disease, mortality and liver cancer among individuals with obesity and diabetes, [138][139][140][141][142][143][144] although there is some disagreement among studies. 135,145,146 Abstinence has been advocated for patients with NASH cirrhosis in order to reduce the risk for decompensation and hepatocellular carcinoma (HCC).…”

Both Alcoholic and Nonalcoholic Steatohepatitis Is an Emerging Indication for Liver Transplantation in the United States

“…Patients in the United States with both alcoholic and nonalcoholic liver disease (BAFLD), for example, are more likely to have advanced fibrosis than those patients with NAFLD alone. 4 In another large prospective study, the risk of liver disease mortality in overweight and obese British men increased markedly with increased alcohol consumption. Those obese men consuming any alcohol had a 5-fold increased risk of liver-related mortality, with a greater than 18-fold relative risk in those drinking heavily.…”

“…This condition, termed both alcoholic and nonalcoholic steatohepatitis or BASH, is not yet well understood. 3,4 To date, there are very little data characterizing patients with this combination of disease processes who undergo LT, with no reported transplant outcomes specifically for patients with BASH.…”

The Roles and Mechanisms of lncRNAs in Liver Fibrosis

“…Moreover, the lncRNA expression patterns of fibrotic and normal liver samples in NASH patients have been investigated [27]. In NASH patients, there are strong links between fibrosis and both liver-related mortality and a heightened risk of cirrhosis [39,40]. A total of 4057 lncRNAs were identified in fibrotic NASH samples and normal hepatic samples [27].…”