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Modest drinking decreases steatosis improvement in fatty liver

Patients with nonalcoholic fatty liver disease who consumed modest amounts of alcohol showed less improvement in histologic steatosis and nonalcoholic steatohepatitis compared with patients who abstained entirely, according to recently published data.

“Our longitudinal study found that modest alcohol use was associated with less improvement in NAFLD histology over an average of nearly 4 years of follow-up,” Veeral H. Ajmera, MD, from the University of California San Francisco, and colleagues wrote. “Importantly, our results suggest cessation of alcohol use may mitigate these changes. The spectrum of NAFLD, particularly the diagnosis of NASH, should be considered in individualized recommendations to patients regarding modest alcohol use.”

The study comprised 285 adult patients with biopsy-proven NAFLD, recruited from studies conducted by the NASH Clinical Research Network (mean patient age, 47 years; 70% women; 82% white; mean BMI, 34.7 kg/m²).

Ajmera and colleagues classified patients as having definite NASH (64%), NAFLD but not NASH (54%) or borderline NASH (17%). At baseline, 117 patients reported abstinence from alcohol and 168 reported modest alcohol consumption. Most of the modest drinkers (78%) reported drinking alcohol monthly or less frequently.

Modest drinkers had lower mean alkaline phosphatase (77 vs. 86 U/L; P < .001) and were more likely to have definite NASH (74% vs. 57%; P = .01) compared with non-drinkers at baseline. In contrast, non-drinkers had better improved steatosis grade (–0.49 vs. –0.3; P = .04) and better improved aspartate aminotransferase levels (–7 vs. 2 U/L; P = .04) at follow-up compared with modest drinkers.

Fourteen patients who were non-drinkers at baseline reported modest drinking at follow-up, and 55 modest drinkers reported they ceased alcohol consumption. Patients who were modest drinkers at baseline were more likely to change drinking status than non-drinkers (33% vs. 12%; P < .001).

After adjusting for age, sex, ethnicity and smoking history, consistent modest drinkers were less likely to have NASH resolution (OR = 0.32; 95% CI, 0.11-0.92). Meanwhile, adjusted mean change in steatosis grade was better in consistent non-drinkers compared with consistent modest drinkers (0.26 grades; 95% CI, 0.05-0.48).

Non-drinkers who became modest drinkers by follow-up had significant improvement in portal inflammation (–0.35 grades; 95% CI, –0.68 to –0.02). The researchers noted, however, that sample size was small (n = 14).

“Fourteen non-drinkers who became modest drinkers at follow up had greater improvement in portal inflammation than consistent non-drinkers,” the researchers wrote. “Conversely, consistent modest drinkers had significantly less NASH resolution and less improvement in steatosis compared to consistent non-drinkers on adjusted analysis. These data challenge the previously published literature that suggested a potential benefit from modest alcohol use in patients with NAFLD and warrant further study on the impact of modest alcohol use in NAFLD.” – by Talitha Bennett

Disclosure: The authors report no relevant financial disclosures.