Issue: February 2023
Fact checked byHeather Biele

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January 09, 2023
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Non-heavy alcohol use, total weekly consumption linked to fibrosis, NASH

Issue: February 2023
Fact checked byHeather Biele
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Non-heavy alcohol consumption was associated with fibrosis and at-risk nonalcoholic steatohepatitis, prompting researchers to suggest that current fatty liver disease categorization as alcoholic or nonalcoholic may be “misleading.”

Perspective from Shreya Sengupta, MD

“Although the link between heavy drinking and chronic liver disease is well-accepted, there is no current consensus on how non-heavy alcohol use affects liver health,” Brooke A. Rice, MD, internal medicine specialist at Boston Medical Center and Boston University School of Medicine, told Healio. “We demonstrated that even non-heavy alcohol consumption is associated with liver fibrosis and at-risk NASH, which both predict long-term liver-related morbidity and mortality.”

“Current terminology classifies fatty liver disease as ‘alcoholic’ or ‘non-alcoholic’; our results suggest that this categorization is misleading, and that non-heavy alcohol use should be considered as a factor contributing to more advanced-NAFLD phenotypes.” Brooke A. Rice, MD

In a cross-sectional study published in Clinical Gastroenterology and Hepatology, Rice and colleagues analyzed 2,629 active drinkers (53.3% women; mean age, 54.4 years) in the Framingham Heart Study, who completed consumption frequency and quantity questionnaires, as well as transient elastography.

Researchers defined fibrosis as liver stiffness measurement (LSM) of at least 8.2 kPa and at-risk NASH as FibroScan-aspartate aminotransferase (FAST) score greater than 0.35 with a 90% sensitivity or a FAST score of at least 0.67 with a 90% specificity. Logistic regression determined the association between alcohol use measures, fibrosis and NASH.

Among participants, the mean LSM was 5.6 kPa, 8.2% had fibrosis, 12.4% had NASH with a FAST score greater than 0.35 and 1.9% had NASH with a FAST score of at least 0.67. Participants reported a mean consumption of 6.2 drinks per week and 17.4% were “risky” weekly drinkers, defined as consuming 8 or more drinks per week for women and 15 or more drinks per week for men.

According to analysis, total drinks per week (adjusted OR = 1.18; 95% CI, 1.04-1.33), consumption frequency (aOR = 1.08; 95% CI, 1.01-1.16) and risky weekly drinking (aOR = 1.49; 95% CI, 1.03-2.14) correlated with an increased risk for fibrosis.

“Current terminology classifies fatty liver disease as ‘alcoholic’ or ‘nonalcoholic,’” Rice told Healio. “Our results suggest that this categorization is misleading, and that non-heavy alcohol use should be considered as a factor contributing to more advanced-NAFLD phenotypes.”

When researchers excluded heavy drinkers from analysis (n = 158), increased total number of drinks per week remained associated with fibrosis (aOR = 1.16; 95% CI, 1-1.35), while associations for frequency (aOR = 1.06; 95% CI, 0.99-1.15) and risky weekly drinking (aOR = 1.48; 95% CI, 0.95-2.31) were reduced.

After multivariable adjustment, most evaluated alcohol-use measures associated with a FAST score greater than 0.35, researchers reported.

“Our research has important implications both for NAFLD clinical trials and for patient care, underlying the importance of counseling all patients to reduce alcohol intake as much as possible and to at least adhere to current U.S. dietary guidelines recommended limits,” Rice said.

“Since our study design was cross-sectional, further longitudinal research is needed to understand the temporal relationship of non-heavy alcohol use and liver disease and to determine the benefits of reducing alcohol consumption among persons with NAFLD or NASH.”