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Coffee Protects Against, Genetics Increase Risk for Alcoholic Hepatitis in Drinkers
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LAS VEGAS — Heavy alcohol drinkers presenting with the PNPLA3 G/G genotype who do not drink coffee on a regular basis have the greatest risk for alcoholic hepatitis, according to data presented during a plenary session at ACG 2016.
“Alcoholic hepatitis is rare, but when it happens, it is catastrophic,” Naga P. Chalasani, MD, FACG, professor of gastroenterology and hepatology at Indiana University School of Medicine, said during his presentation. “We sought to describe clinical characteristics and outcomes of the subjects with alcoholic hepatitis and to investigate the risk factors for alcoholic hepatitis.”
Between May 2013 and May 2016, 190 patients presenting with 186 cases of alcoholic hepatitis and 150 controls who drank heavily were prospectively enrolled by Chalasani and colleagues. Controls were age-, gender-, and race-matched heavy drinkers with normal bilirubin, aspartate aminotransferase and alanine aminotransferase serum at baseline. The details of alcohol and coffee tea consumption were systematically assessed. The PNPLA3 genotype for rs738409 was also measured among patients of European ancestry.
The researchers found that regular coffee consumption was significantly lower in patients with alcoholic hepatitis (20%) compared with controls (43%; P < .0001).
“This relationship persisted even after controlling for relevant covariates including the PNPLA3 genotype,” Chalasani said.
The frequency of PNPLA3 allele was 0.34 in the patients with alcoholic hepatitis compared with 0.22 in the controls (OR = 1.89; 95% CI, 1.1-3.06). This persisted after controlling for relevant covariates, such as coffee consumption, according to Chalasani.
Analysis measuring gene-environment interaction showed patients with the PNPLA3 CC gene who also drank coffee had a 27% risk for alcoholic hepatitis compared with 86% of patients with PNPLA3 G/G gene who did not drink coffee (P = .003).
“Coffee drinking was protective, whereas PNPLA3 genotype was hazardous,” Chalasani said.
Patients with the PNPLA3 CC gene who did not drink coffee had a 48% risk for alcoholic hepatitis; patients with the PNPLA3 GC gene who drank coffee had a 37% risk; patients with PNPLA3 GC gene who did not drink coffee had a 64% risk; and PNPLA3 GG gene who drank coffee had a 57% risk, according to Chalasani’s presentation.
The mortality rates for patients with alcoholic hepatitis were 9.6% at 30 days; 16% at 60 days; 22.5% at 180 days; and 27.5% at 1 year.
Chalasani concluded: “Alcoholic hepatitis remains a highly fatal condition. … Regular coffee drinking protects against whereas PNPLA3 G allele increases risk of alcoholic hepatitis among heavy drinkers. Heavy drinkers with PNPLA3 G/G genotype who are not regular coffee drinkers are at the highest risk for alcoholic hepatitis.” – by Melinda Stevens
Reference:
Chalasani NP, et al. Abstract #18. Presented at: American College of Gastroenterology Annual Scientific Meeting; Oct. 14-19, 2016; Las Vegas, NV.
Disclosure: Chalasani reports no relevant financial disclosures. One researcher reports financial relationships with AbbVie, Bristol-Myers Squibb, Galectin, Genentech, Gilead Sciences, Hemoshear, Ikaria, Immuron, Intercept, Merck, Nimbus, Nitto Denko, Novartis, Salix and Takeda.
Perspective
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Tram T. Tran, MD, FACG
I think the presentation on acute alcoholic hepatitis in the U.S. is looking at some potentially interesting relationships between how coffee drinking may actually help patients who have acute alcoholic hepatitis but there are also some interesting genetic tests that may predict which patients will have worse outcomes with alcohol on board. So I think the combination of whether coffee is good and genetics is bad and how it interplays is interesting.
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