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6 top stories on alcohol-related risks in liver disease

As research continues regarding health-related behavioral risks and their association with liver disease and mortality, recent reports have focused on alcohol consumption and abuse, including the importance of addiction therapy and abstinence for alcoholic hepatitis.

Healio.com/Hepatology presents six recent reports on alcohol consumption and its effect on liver health, digestive cancer risks, liver lipids and relation to cardiovascular disease.

Alcohol intake highest in Europe, increasing digestive cancer risks

The United European Gastroenterology organization released a report stating that the average daily alcohol intake was between one and four drinks per person in all 28 European Union states, representing a 21% increased risk for developing digestive cancers.

“Despite attempts in Europe to tackle the impact of alcohol on health, the amount of alcohol consumed by EU countries is higher than the rest of the world and the incidence of many alcohol related digestive cancers is on the increase,” Michael Manns, MD, president of United European Gastroenterology for 2015 to 2017, said in the report. “We urgently require a focused multi-dimensional approach from policy and decision makers at both European and national levels to dramatically increase public and healthcare professional awareness of the dangers of alcohol, as well as to implement further strategies across the region to reduce alcohol intake and the resulting incidence of digestive cancers.” Read more

Addiction therapy for those with alcoholic hepatitis improves survival

Complete abstinence of alcohol consumption after an episode of alcoholic hepatitis improved long-term survival, according to recently published data. The researchers advise that early initiation of addiction counseling may therefore also improve survival by avoiding recidivism.

“The risks of resuming alcohol use should not be understated,” the researchers wrote. “In one study, a significant portion of patients with recidivism developed a subsequent episode of [alcoholic hepatitis] that was more severe than the index episode with [approximately] 60% mortality. Identification of patients with high risk of recidivism is relevant because it can be used to select patients for salvage transplantation and to identify those patients needing more intense alcohol therapy.” Read more

Universal electronic screening detects alcohol abuse in emergency patients

An electronic universal screening procedure implemented by admitting nurses in the emergency room identified alcohol misuse, associating it with higher liver disease risk and providing a “teachable moment” for possible interventions for the patients.

“The medical consequences of alcohol misuse are a significant burden on the workload of acute hospitals and yet patients with severe alcohol problems are often not recognized or referred to appropriate services, with the potential for life threatening complications to develop. This is particularly relevant for the early detection and management of [alcohol-related liver disease], given that patients may have few symptoms or signs until an advanced stage,” Greta Westwood PhD, MSc, from the Queen Alexandra Hospital, Portsmouth, U.K., and colleagues wrote. “Unselected screening for alcohol misuse is feasible and identifies distinct cohorts of patients with high levels of dependency, frequent ED attendance, multiple hospital admissions and an elevated risk of ARLD. These patients can be targeted with evidence-based treatments aimed at reducing the growing morbidity and mortality from alcohol related illness.” Read more

Moderate alcohol use in fatty liver may protect against cardiovascular death

Significant risk factors for cardiovascular disease or markers of subclinical cardiovascular disease in adults with nonalcoholic fatty liver disease remained constant or saw a reduction with moderate alcohol use, according to a recently published prospective study.

“Results from large epidemiological studies consistently show that moderate alcohol use (compared to abstinence) is associated with lower mortality, especially among middle-aged and older men and women — an association which may reflect salutary effects of moderate alcohol consumption on coronary heart disease, diabetes, and ischemic stroke,” Lisa B. VanWagner, MD, MS, clinical fellow in the division of gastroenterology and hepatology, Northwestern University Feinberg School of Medicine, and colleagues wrote. “Identification of CVD as the leading cause of death in NAFLD raises the question of whether persons with NAFLD may benefit from moderate alcohol use.” Read more

Genetics outweigh abstinence in alcoholic hepatitis survival

Patients with severe alcoholic hepatitis who were homozygous for the rs738409:G variant in the PNPLA3 gene have an increased risk for mortality even when they stop drinking alcohol, according to recently published data.

“The variant rs738409:G in PNPLA3 has been consistently associated with the risk of developing alcohol-related cirrhosis and has also been implicated in more rapid disease progression and the risk of developing hepatocellular carcinoma,” Stephen R. Atkinson, MBBS, MA, MRCP, clinical research fellow in the department of internal medicine at Imperial College London, U.K., and colleagues wrote. “Genotyping rs738409 in PNPLA3 will identify these individuals and the results could be taken into account in clinical decision-making, potentially allowing these particularly vulnerable individuals to be considered for early liver transplantation or novel therapies. The need to employ measures to assist patients with severe alcoholic hepatitis to attain and maintain abstinence is highlighted again in this study as of critical importance.” Read more

Alcohol abstinence may be necessary to induce changes in liver lipids

After 12 weeks of exercise without weight change or reduction of alcohol, patients with obesity who consume alcohol increased lean body mass, reduced fat mass and reduced cytokeratin-18, but no effect on liver lipid was seen, according to results of a recently published study.

“Despite the multiplicative effects of alcohol and obesity, lifestyle studies in [nonalcoholic fatty liver disease] have focused on people who, by definition, do not consume alcohol,” the researchers wrote. “[This study examined] the effects of exercise on liver lipid, metabolism and liver function in overweight/obese sedentary adults consuming alcohol.” Read more