Effect of Alcohol Consumption on Survival in Nonalcoholic Fatty Liver Disease: A National Prospective Cohort Study

Hajifathalian, Kaveh; Sagvand, Babak Torabi; McCullough, Arthur J.

doi:10.1002/hep.30226

Cited by 108 publications

(84 citation statements)

References 52 publications

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“…A recent study based on the US population with 4,568 subjects with NAFLD (defined by the hepatic steatosis index) found reduced mortality among subjects consuming 0.5‐1.5 alcoholic drinks/day, whereas >1.5 drinks/day became harmful, thus reinforcing a J‐shaped association …”

Section: Discussionmentioning

confidence: 99%

Risks of Light and Moderate Alcohol Use in Fatty Liver Disease: Follow‐Up of Population Cohorts

et al. 2019

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Background and Aims The effects of alcohol use in nonalcoholic fatty liver disease are unclear. We investigated the impact of alcohol use in fatty liver disease on incident liver, cardiovascular, and malignant disease, as well as death. Approach and Results Our study comprised 8,345 persons with hepatic steatosis (fatty liver index >60) who participated in health‐examination surveys (FINRISK 1992‐2012 or Health 2000), with available data on baseline alcohol intake. Main exclusions were baseline clinical liver disease, viral hepatitis, ethanol intake >50 g/day, and current abstainers. Data were linked with national registers for hospital admissions, malignancies, and death regarding liver, cardiovascular, and malignant disease, as well as all‐cause death. Adjustment were for multiple confounders. Alcohol consumption showed a dose‐dependent risk increase for incident advanced liver disease and malignancies. Consuming 10‐19 g/day of alcohol in general or 0‐9 g/day as nonwine beverages doubled the risk for advanced liver disease compared to lifetime abstainers. In contrast, alcohol intake up to 49 g/day was associated with a 22%‐40% reduction of incident cardiovascular disease (CVD). We observed a J‐shaped association between alcohol intake and all‐cause death with a maximal risk reduction of 21% (95% confidence interval, 5%‐34%) at alcohol intake of 0‐9 g/day compared to lifetime abstainers. However, these benefits on CVD and mortality were only observed in never smokers. Alcohol intake >30 g/day yielded increased risk estimates for mortality compared to lifetime abstainers. In a subpopulation with longitudinal data, alcohol intake remained stable over time in >80% of subjects. Conclusions Even low alcohol intake in fatty liver disease is associated with increased risks for advanced liver disease and cancer. Low to moderate alcohol use is associated with reduced mortality and CVD risk but only among never smokers.

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Section: Discussionmentioning

confidence: 99%

Risks of Light and Moderate Alcohol Use in Fatty Liver Disease: Follow‐Up of Population Cohorts

et al. 2019

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“…12 After further adjustment for diabetes and general/abdominal obesity, the association was attenuated and remained significant suggesting that the link between depression and NAFLD is partly mediated by diabetes and obesity. [23][24][25][26][27][28][29]44,45 However, prospective studies using imaging or histology are needed to reproduce and reconfirm these observations in future. 43 When we further adjusted for insulin resistance, the association was attenuated and remained significant suggesting that the association between depression and NAFLD may be partly mediated by insulin resistance.…”

Section: Discussionmentioning

confidence: 99%

Depression is associated with non‐alcoholic fatty liver disease among adults in the United States

Kim

Yoo

et al. 2019

Aliment Pharmacol Ther

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Background: Currently, the relationship between depression and non-alcoholic fatty liver disease (NAFLD) is not clearly defined. Aim:To determine whether depression is associated with NAFLD and NAFLD-related advanced fibrosis in a large population sample. Methods: We performed a cross-sectional analysis using the 2007-2016 National Health and Nutrition Examination Survey database among adults (20 years or older) in the United States (US). Depression and functional impairment due to depression were assessed with the Patient Health Questionnaire (PHQ-9). NAFLD was defined by utilising the US fatty liver index (USFLI), hepatic steatosis index (HSI) and the fatty liver index (FLI) in the absence of other causes of chronic liver disease. The presence and absence of advanced fibrosis in NAFLD were defined by Fibrosis-4 score.Results: Of the 10 484 subjects (mean age 47.0 years; 48.8% men), the prevalence of depression and functional impairment due to depression was higher in subjects with NAFLD than in those without. Compared to subjects without depression, those with depression were 1.6-2.2-fold more likely to have NAFLD. In our multivariate analyses, depression_med was associated with increased risk of NAFLD using USFLI (odds ratio [OR] 1.48 95% confidence interval [CI] 1.17-1.87), HSI (OR 1.51 95% CI 1.04-2.19) and FLI (OR 2.01 95% CI 1.65-2.48), respectively. The addition of diabetes, obesity and lipid profile to the model reduced the ORs for depression, but the significance persisted. Depression was not associated with NAFLD-related advanced fibrosis. Conclusions:In a nationally representative sample of US adults, depression was independently associated with NAFLD. | 591KIM et al.

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“…44 Recently, Hajifathalian et al presented data from the National Health and Nutrition Examination (NHANES) survey, that modest alcohol consumption of less than 1.5 drinks of alcohol per day is associated with decreased risk of overall mortality in persons with biochemically-assessed NAFLD (HR 0.64, CI 0.42–0.97, p=0.035). 45 However, the authors also found that drinking more than 1.5 drinks of alcohol per day was actually linked to an increased hazard of death (HR 1.45, CI 1.01–2.19, p=0.047). 45 Thus, the potential “therapeutic window” for the beneficial effect of alcohol use in NAFLD appears very narrow limiting the safely profile for a clinical recommendation of moderate alcohol use as a preventive measure to reduce morbidity and mortality in NAFLD.…”

Section: Discussionmentioning

confidence: 95%

“…45 However, the authors also found that drinking more than 1.5 drinks of alcohol per day was actually linked to an increased hazard of death (HR 1.45, CI 1.01–2.19, p=0.047). 45 Thus, the potential “therapeutic window” for the beneficial effect of alcohol use in NAFLD appears very narrow limiting the safely profile for a clinical recommendation of moderate alcohol use as a preventive measure to reduce morbidity and mortality in NAFLD. Importantly, cause of death was not reported in this study and the authors did not account for interactions between race and sex by alcohol consumption.…”

Section: Discussionmentioning

confidence: 95%

Alcohol Use and Cardiovascular Disease Risk in Patients With Nonalcoholic Fatty Liver Disease

et al. 2017

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Background & Aims Cardiovascular disease (CVD) is the leading cause of death among patients with non-alcoholic fatty liver disease (NAFLD). Moderate drinking (vs abstinence) is associated with lower risk of CVD in the general population. We assessed whether alcohol use is associated with CVD risk in patients with NAFLD. Methods We analyzed data from participants in the Coronary Artery Risk Development in Young Adults longitudinal cohort study of 5115 black and white young adults, 18–30 years old, recruited from 4 cities in the United States from 1985 through 1986. Participants self-reported alcohol use at study entry and then again after 15, 20, and 25 years. At year 25 (2010–2011), participants underwent computed tomography examination of the thorax and abdomen and tissue Doppler echocardiography with myocardial strain measured by speckle tracking. Coronary artery calcification was defined as an Agatston score above 0. NAFLD was defined as liver attenuation less than 51 Hounsfield Units after exclusions. Drinkers reported 1–21 (men) or 1–14 (women) standard drinks/week at years 15, 20, or 25. Nondrinkers reported no alcohol use at years 15, 20, and 25. Results Of the 570 participants with NAFLD (mean age 50 years; 54% black; 46% female), 332 (58%) were drinkers; significantly higher proportions of drinkers were white, male, and with higher levels of education compared with nondrinkers (P<.05 for all). Higher proportions of drinkers had obesity, diabetes, and the metabolic syndrome compared with nondrinkers (P<.01). There was no difference in liver attenuation between groups (P=.12). After multivariable adjustment, there was no association between alcohol use and CVD risk factors (diabetes, hypertension, hyperlipidemia) or subclinical CVD measures (coronary artery calcification, E/A ratio, global longitudinal strain). Conclusions In a population-based sample of individuals with NAFLD in midlife, prospectively assessed alcohol use is not associated with significant differences in risk factors for CVD or markers of subclinical CVD. In contrast to general population findings, alcohol use may not reduce risk of CVD in patients with NAFLD.

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Effect of Alcohol Consumption on Survival in Nonalcoholic Fatty Liver Disease: A National Prospective Cohort Study

Cited by 108 publications

References 52 publications

Risks of Light and Moderate Alcohol Use in Fatty Liver Disease: Follow‐Up of Population Cohorts

Risks of Light and Moderate Alcohol Use in Fatty Liver Disease: Follow‐Up of Population Cohorts

Depression is associated with non‐alcoholic fatty liver disease among adults in the United States

Alcohol Use and Cardiovascular Disease Risk in Patients With Nonalcoholic Fatty Liver Disease

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