Excess weight risk factor for alcoholic liver disease

Abstract

PATIENTS AND METHODSThough the hepatotoxicity of ethanol has been established, only 8% to 20% of chronic alcoholics develop cirBetween January of 1982 and May of 1995, a total of 2,848 patients rhosis. The aim of this study was to assess whether being were admitted to the Hepatogastroenterology Unit of the Antoine overweight is a risk factor for alcoholic liver disease. Béclère Hospital in Clamart, France, for alcoholism or alcoholic liver One thousand six hundred four alcoholic patients were disease. To be included in the study, patients must have drunk at studied. According to the liver biopsies, 194 patients had least 50 g of alcohol per day over the previous year. We used only a normal liver; 402 had steatosis without fibrosis; 281 the data that were recorded during the first admissions in our unit. presented with fibrosis, with or without steatosis; 119 From these 2,848 patients, 1,244 patients were excluded, including 596 on whom no liver biopsy was performed and for whom cirrhosis presented with acute alcoholic hepatitis (AAH) without was not clinically obvious, and 313 because of missing data. Fortycirrhosis; 232 indicated cirrhosis without AAH; and 179 one patients were excluded because of the presence of hepatitis B presented with cirrhosis with AAH. One hundred ninetysurface antigen; 289 were excluded because of the presence of antiseven patients had clinically obvious cirrhosis. In the bodies to hepatitis C virus; and 5 patients were excluded because of study, five variables were studied as risk factors: age, the presence of hepatitis B surface antigen and antibodies to hepatisex, daily consumption of alcohol during the previous 5 tis C virus. In fact, hepatitis B virus markers were prospectively and years, the total duration of alcohol abuse, and tendency systematically recorded in all patients. Serum antibodies against to be overweight (body mass index [BMI] ¢ 25 in women hepatitis C virus were also assessed in all patients when serum and ¢ 27 in men). The BMI was calculated according to markers for hepatitis C virus infection became available. 5 Hepatitis C virus antibodies were tested retrospectively with a first-generathe minimum weight over the 10 previous years. In the tion, enzyme-linked immunosorbent assay system (Ortho Diagnostic first stepwise logistic regression analysis, age, being System, Raritan, NJ) from January 1982 to May 1991, afterward, overweight for at least 10 years, being of the female sex, they were tested prospectively with second-and third-generation and the total duration of alcohol abuse were indepenenzyme-linked immunosorbent assay systems. dently correlated with the presence of cirrhosis. In the One thousand six hundred and four patients were included in the second analysis, female sex being overweight were the study of which 608 had cirrhosis. This was histologically proven in 411 two independent risk factors of AAH. In the third analy-patients and was clinically obvious in the other 197 patients, who had sis, being overweight for at least 10 years was the only a posi...

Obesity and liver disease

“…The observation that some obese individuals presented a liver disease histologically indistinguishable from alcoholic liver disease itself had long been recognized. [42][43][44][45][46][47][48][49] Interestingly, it has been recently demonstrated that obesity also increases the risk of liver disease induced by either alcohol 50 or chronic hepatitis C. [51][52][53] In a literature survey of 41 original articles comprising information on liver morphology in 1515 morbidly obese patients, liver biopsy was considered as normal in only 12% of the cases. 54 The most frequent abnormality reported was fatty changes present in 80% of the biopsies; portal inflammation was also common (33%) while portal or periportal fibrosis was observed in 29%.…”

Obesity and overweight in relation to liver disease mortality in men: 38 year follow-up of the original Whitehall study

“…[8][9][10][11][12] In the few general population-based surveys conducted, the prevalence of liver disease, particularly hepatic steatosis (fatty liver disease), also appears to be higher in heavier people. 13,14 However, as has been highlighted, 15 interpretation of these findings is complicated by the issue of reverse causality.…”

Nutritional deficiencies in German middle-class male alcohol consumers: relation to dietary intake and severity of liver disease

“…In this population alcohol is added to the diet rather than replacing nutrients derived from food sources. These results differ from those reported in most studies performed in the USA and in some other countries, in which malnutrition seems to be frequent and the leading cause of a deficient nutritional state (Hurt et al, 1981, Italian Multicentre, 1994Leevy et al, 1965, Leo & Lieber, 1999McClain & Su, 1983;Mezey, 1991;Naveau et al, 1997;Patek et al, 1975;Sarin et al, 1997). However, the plasma content of several vitamins (vitamin C, E, carotenoids) and trace elements (zinc, selenium) was significantly reduced in the alcohol consumers, the depression being independent of the stage of ALD.…”

“…These changes were more pronounced as the severity of the liver disease increased and were also observed in patients with advanced non-alcoholic cirrhosis (Naveau et al, 1997). The normal energy and protein intakes in the subgroup with alcoholic cirrhosis in the present study might be explained by the exclusion of patients with advanced stages of cirrhosis (Child C) and also by the fact that most alcohol consumers in Germany remain in the economic range of what is called 'middle-class' in many industrialized countries (Italian Multicentre, 1994;Leo & Lieber, 1999;Naveau et al, 1997;Sarin et al, 1997).…”

“…Other authors have reported about the reduced intake of energy, protein, and carbohydrates in patients with alcoholic cirrhosis (Naveau et al, 1997;Sarin et al, 1997). These changes were more pronounced as the severity of the liver disease increased and were also observed in patients with advanced non-alcoholic cirrhosis (Naveau et al, 1997).…”