Modest alcohol consumption may improve survival in NAFLD patients

CHICAGO — According to a presentation at Digestive Disease Week, modest alcohol consumption of about half to one drink of alcohol per day showed an increase in survival rates in patients with non-alcoholic fatty liver disease, while more than one and a half drinks per day was linked to an increased trend in harm.

“We don’t really know the effect of alcohol consumption in NAFLD patients,” Kaveh Hajifathalian, MD, MPH, said in his presentation. “It’s easy to assume that these are patients with chronic liver disease and that they should abstain from drinking even a drop of alcohol, but ... cardiovascular disease remains the most common cause of mortality and morbidity in these patients. There is really good evidence that modest alcohol consumption has protective effects for cardiovascular outcomes. Beyond the association with cardiovascular outcomes in NAFLD, there is also evidence for beneficial effects of alcohol in metabolic syndrome.”

To assess the effects of alcohol consumption, particularly modest alcohol intake, on the overall mortality and survival rates of patients with NAFLD, the researchers gathered data of 5,222 patients from the National Health and Nutrition Examination Survey from 1988 to 2010.

Comorbidities and characteristics examined included hepatitis C and hepatitis B, iron status, drinking habits, liver enzymes, obesity, diabetes, smoking habits, sex, race, physical activity, education and diet. Patients with significant alcohol abuse were excluded from the study.

Mean patient age was 49 years, 54% were men and mean BMI was 32 kg/m². Over a median of 69 months (range, 37-111 months), 319 deaths occurred. Overall, 1,591 patients had a history of alcohol use, defined by the researchers as a daily average of at least half a standard drink.

Patients who consumed an average of one drink per day had a decreased risk for overall mortality (HR = 0.53; 95% CI, 0.37-0.76) compared with patients who did not drink. However, average consumption of two drinks (HR = 1.27; 95% CI, 0.87-1.87) or three or more drinks (HR = 1.1; 95% CI, 0.66-1.56) per day did not affect survival.

After the researchers adjusted for race, physical activity, educational level, diabetes and fiber and polyunsaturated fatty acid intake, an average of one drink per day showed a protective effect on survival (HR = 0.58; 95% CI 0.38-0.87), while two drinks per day (HR = 1.44; 95% CI, 0.94-2.19) and three or more drinks (HR = 1.19; 95% CI 0.73-1.93) showed a trend toward harm.

“We found that modest alcohol consumption, which we define here as half a drink to one and a half drinks ... per day in a cohort of NAFLD patients was associated with a robust and significant decrease in all-cause mortality,” Hajifathalian said. “We also showed that drinking more than an average of one and a half drinks ... was associated with an increase in all-cause mortality. We also failed to find any harmful affect from modest alcohol consumption in NAFLD patients who had elevated ALT levels.” – by Talitha Bennett

References:

Hajifathalian K, McCullough A. Abstract 353. Presented at: Digestive Disease Week; May 6-9, 2017; Chicago.

Disclosure: Hajifathalian reports no relevant financial disclosures.