Researchers advise limit of 7.4 grams of alcohol per day in early steatotic liver disease
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Key takeaways:
- Mortality rates for those at intermediate/high risk vs. low risk for advanced cirrhosis were 4,342 vs. 1,099 per 100,000.
- Recommended intake for low-risk patients is half a 12 oz. beer or half a glass of wine.
Researchers recommended that patients with steatotic liver disease who are at a lower risk for advanced cirrhosis should consume no more than 7.4 grams of alcohol per day, the equivalent of a half a 12 oz. beer or half a glass of wine.
“A recent update in nomenclature, steatotic liver disease (SLD), encompasses all fatty liver diseases confirmed by histological or radiological evidence, irrespective of etiology,” Yee Hui Yeo, MD, of Cedars-Sinai Medical Center in Los Angeles, and colleagues wrote in JAMA Network Open. “While individuals with severe SLD should abstain from alcohol, little evidence exists for acceptable alcohol intake for patients with early stages of SLD who are disinclined toward complete abstinence.”
To determine the dose-dependent association between alcohol use and disease progression, Yeo and colleagues analyzed 2,834 patients with SLD (median age, 42 years; 51.8% men) using the U.S. National Health and Nutrition Examination Survey III database. Researchers reported an intermediate or high risk for advanced fibrosis, defined as a Fibrosis-4 index score of 1.3 or higher, among 20.8% of patients.
During 66,299 person-years of follow-up, the mortality rate for those at intermediate or high risk was 4,342 per 100,000 vs. 1,099 per 100,000 for those at low-risk.
After adjusting for demographic and metabolic variables, researchers identified a nonlinear association between alcohol consumption and mortality in the low-risk group, noting that mortality risk “exceeded an adjusted hazard ratio of 1” with intake of 7.4 grams per day (HR = 0.99).
Researchers further observed a linear association between daily alcohol consumption and the increased risk for mortality in the intermediate- or high-risk group.
“In this cohort study, the recommended level of alcohol consumption was less than 7.4 g per day for individuals with SLD at lower risk for advanced fibrosis, which equals half a 12-oz (336 g) beer or half a glass of wine,” Yeo and colleagues wrote. “Notably, 7.4 g per day corresponds to half a standard U.S. drinking unit and three-fourths of a traditional European drink, emphasizing modest ranges of acceptable alcohol consumption per individual.”
They added, “Individuals with SLD should be advised to maintain regular health monitoring and lifestyle management.”
Perspective
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William Carey, MD
Alcohol use is nearly ubiquitous in many countries. Steatotic liver disease, or fatty liver disease, is present in up to 40% of the U.S. population.
Alcohol excess is clearly detrimental to overall health. Is there an amount below which alcohol is not associated with adverse health outcomes? A “standard drink” in the U.S. — 12 oz. of beer, 5 oz. of wine or 1.5 oz. spirits — contains 14 grams of alcohol. Guidelines recommend women consume no more than one drink, or 14 grams, per day and men no more than two drinks, or 28 grams.
This study study suggests that, in those with steatotic liver disease, these amounts are not without excess mortality risk and recommends “safe” limits be re-evaluated. A reduction by 50% for women and 75% for men may be appropriate, as more than 7.4 grams per day appeared to increase mortality even in those with little if any hepatic fibrosis at the outset. Even this may not be truly safe, as a 15-year study in Finland could not identify a lower limit below which harm was not apparent.
Substantial methodologic issues pervade this study and every study on alcohol use. That said, individuals with steatotic liver disease would be well-advised to severely curtail or eliminate alcohol use, and those with concurrent fibrosis should abstain.
Reference:
- Aberg F, et al. Hepatology. 2018; doi:10.1002/hep.29631.
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