Interaction between alcohol consumption and metabolic syndrome in predicting severe liver disease in the general population

Åberg, Fredrik; Helenius‐Hietala, Jaana; Puukka, Pauli; Färkkilä, Martti; Jula, Antti

doi:10.1002/hep.29631

Cited by 200 publications

(207 citation statements)

References 34 publications

(78 reference statements)

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“…However, Aberg et al . reported that mild‐to‐moderate alcohol consumption is associated with an increase in liver‐related events, including decompensated liver cirrhosis . This result differs from the present result, and this might be explained by the difference in the prevalence of individuals with metabolic syndrome.…”

Section: Discussioncontrasting

confidence: 99%

Profiles of advanced hepatic fibrosis evaluated by FIB‐4 index and shear wave elastography in health checkup examinees

Yamamura

Kawaguchi

Nakano

et al. 2019

Hepatology Research

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Aim Advanced hepatic fibrosis is seen in individuals with potential hepatocellular carcinoma and cardiovascular disease. Hepatic fibrosis can be assessed using a combination of the FIB‐4 index and imaging modalities, including shear wave elastography. We aimed to investigate the prevalence of advanced fibrosis in the general population and the profiles associated with advanced fibrosis using a data‐mining analysis. Methods We enrolled 1155 health checkup examinees (median age 53 years, 685 women, 470 male). Advanced fibrosis was defined by FIB‐4 index ≥1.3 and liver stiffness ≥8.07 kPa using shear wave elastography. Participants were classified as normal‐mild fibrosis (n = 1035) or advanced fibrosis (n = 120). Factors associated with advanced fibrosis were analyzed by logistic regression and decision‐tree analyses. Results Advanced fibrosis was observed in 10.4% of participants (120/1155). In the logistic regression analysis, independent factors for advanced fibrosis were age (≥75 years; OR 2.12, 95% CI 1.021–4.415; P = 0.0419) and the presence of metabolic syndrome (OR 2.51, 95% CI 1.416–4.462; P = 0.0017). The decision‐tree analysis showed two profiles associated with advanced fibrosis: profile 1 – individuals aged ≥65 years with metabolic syndrome and mild‐to‐moderate alcohol consumption (prevalence of advanced fibrosis 73.3%); and profile 2 – individuals without metabolic syndrome, aged ≥75 years, with no exercise habit (prevalence of advanced fibrosis 56.3%). Conclusions Advanced fibrosis was observed in 10.4% of health checkup examinees. Furthermore, we showed that aging, metabolic syndrome with mild‐to‐moderate alcohol consumption, and physical inactivity were associated with advanced fibrosis. Thus, prevention of metabolic syndrome and alcohol withdrawal, as well as exercise habits, might inhibit the progression of hepatic fibrosis.

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Section: Discussioncontrasting

confidence: 99%

Profiles of advanced hepatic fibrosis evaluated by FIB‐4 index and shear wave elastography in health checkup examinees

Yamamura

Kawaguchi

Nakano

et al. 2019

Hepatology Research

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“…Unfortunately, patients with liver cirrhosis are often referred after cirrhosis is well established [11], especially in case of alcohol use disorders. Despite this, there are steps that can be taken to prevent progression of cirrhosis such as more attention to life style, since being overweight, having diabetes and excess alcohol intake share pathways for the pathogenesis of chronic liver disease, cirrhosis and portal hypertension [12].…”

Section: Treatment Of Cirrhosis Aetiologymentioning

confidence: 99%

Treatment of Oesophageal Varices in Liver Cirrhosis

Sauerbruch

2018

Digestion

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Background: The development of cirrhosis with resultant portal hypertension can lead to oesophageal varices at a rate of 7% per annum. Bleeding from varices happens when the portal pressure is ≥12 mm Hg and can threaten life. Summary: Eliminating the aetiology of cirrhosis is a pivotal step to prevent the formation of varices. In patients with established varices, primary prophylaxis with non-selective beta blockers (NSBB) may slow down the progression of varices and prevent the first variceal bleed. NSBB, similar to other agents such as renin/angiotensin blockers, statins, and rifaximin, may have the additional advantage of blunting inflammatory stimuli, which can contribute to the progression of varices. Variceal band ligation is an alternative for primary bleeding prophylaxis with excellent results. Any acute variceal bleed should be managed with band ligation after careful resuscitation. Early pre-emptive transjugular intrahepatic portosystemic shunt (TIPS) in decompensated cirrhotic patients is very effective in controlling the bleeding and improves survival. Secondary prophylaxis against further variceal bleeding using NSBB and band ligation is recommended in most other patients. TIPS may be considered in appropriate patients as a secondary prophylaxis against recurrent variceal bleed. Future research should be directed towards the prevention of varices and targeting inflammation to reduce cirrhotic complications. Key Messages: Treatment strategies depend on the stage the patient is at along the natural history of varices: NSBB or band ligation for primary prophylaxis; band ligation or early TIPS for acute bleed; and a combination of NSBB + band ligation or TIPS for secondary prophylaxis (Fig. 1).

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“…High BMI is a risk factor for ALD 20 and has even a supra-additive effect on the risk of ALD. 24 Our model recognized WHR as an independent risk factor. 22 Overweight increases the risk of hepatocellular carcinoma, as well.…”

Section: Risk Factors For Advanced Liver Diseasementioning

confidence: 88%

Genetic and lifestyle risk factors for advanced liver disease among men and women

Sahlman

Nissinen

Puukka

et al. 2019

J of Gastro and Hepatol

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Background and Aim Liver disease is traditionally categorized as alcoholic and non‐alcoholic. We studied various risk factors predictive of advanced non‐viral liver disease in general population and analyzed the interaction between these factors and alcohol consumption. Methods Persons without underlying liver disease who participated in the Health2000 or FINRISK studies 1992–2012 comprised a cohort of 41 260 individuals. Pattern of alcohol consumption and metabolic, lifestyle‐related, and anthropometric parameters were analyzed with Cox regression analysis using severe liver disease hospitalization, cancer, or death as end‐point. Viral liver diseases were excluded. Results A total of 355 liver events occurred during the mean 12.4‐year follow‐up (511 789 person‐years). In the multivariate model, age (hazard ratio [HR] 1.03, P = 0.0083 for men; HR 1.04, P = 0.0198 for women), waist‐to‐hip ratio (WHR) (HR 1.52, P = 0.0006 for men; HR 1.58, P = 0.0167 for women), patatin‐like phospholipase‐containing domain 3 mutations (HR 1.9, P = 0.024 for men; HR 2.7, P = 0.0109 for women), and weekly binge drinking (HR 2.4, P = 0.0024 for men; HR 7.4, P < 0.0001 for women) predicted development of severe liver disease. Among men, diabetes (HR 2.7, P = 0.0002), average alcohol consumption (HR for 10 g/day 1.1, P = 0.0022), non‐married status (HR 1.9, P = 0.0397 for single; HR 2.4, P = 0.0002 for widowed/separated), and serum high‐density lipoprotein (HR 2.2, P = 0.0022) and non‐high‐density lipoprotein cholesterol (HR 1.2, P = 0.0237) were additional risk factors. Alcohol intake increased the risk especially among persons with high WHR (P for interaction 0.009). Conclusions Age, patatin‐like phospholipase‐containing domain 3 haplotype, and WHR increase the risk for development of severe liver disease. We found strong synergism between alcohol and central obesity. Binge drinking is an additional risk factor.

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Interaction between alcohol consumption and metabolic syndrome in predicting severe liver disease in the general population

Abstract: Multiple components of the metabolic syndrome independently affected the risk for severe liver disease. Alcohol was significant even when average alcohol consumption was within the limits currently defining nonalcoholic fatty liver disease. (Hepatology 2018;67:2141-2149).

Cited by 200 publications

References 34 publications

Profiles of advanced hepatic fibrosis evaluated by FIB‐4 index and shear wave elastography in health checkup examinees

Profiles of advanced hepatic fibrosis evaluated by FIB‐4 index and shear wave elastography in health checkup examinees

Treatment of Oesophageal Varices in Liver Cirrhosis

Genetic and lifestyle risk factors for advanced liver disease among men and women

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