Elsevier

Metabolism

Volume 115, February 2021, 154439
Metabolism

Clinical Science
Moderate alcohol consumption is associated with advanced fibrosis in non-alcoholic fatty liver disease and shows a synergistic effect with type 2 diabetes mellitus

https://doi.org/10.1016/j.metabol.2020.154439Get rights and content
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Highlights

  • If moderate alcohol consumption plays a role for progression of NAFLD is disputed.

  • Herein, we present data from 86 patients with biopsy-proven NAFLD.

  • Moderate alcohol consumption, assessed with three methods, was associated with advanced fibrosis.

  • Phosphatidylethanol in blood ≥ 50 ng/mL indicates an increased risk for advanced fibrosis.

  • Patients with T2DM consuming moderate amounts of alcohol had the highest risk of advanced fibrosis.

Abstract

Background

Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease worldwide. Whether moderate alcohol consumption plays a role for progression of NAFLD is disputed. Moreover, it is not known which tool is ideal for assessment of alcohol consumption in NAFLD. This study aimed to evaluate if moderate alcohol consumption assessed with different methods, including the biological marker phosphatidylethanol (PEth), is associated with advanced fibrosis in NAFLD.

Methods

We conducted a cross-sectional study of patients with biopsy-proven NAFLD. All participants were clinically evaluated with medical history, blood tests, and anthropometric measurements. Alcohol consumption was assessed using PEth in blood, the questionnaire AUDIT-C, and clinical interview.

Findings

86 patients were included of which 17% had advanced fibrosis. All participants reported alcohol consumption < 140 g/week. Average weekly alcohol consumption was higher in the group with advanced fibrosis. Moderate alcohol consumption, independently of the method of assessment, was associated with increased probability of advanced fibrosis (adjusted OR 5.5–9.7, 95% CI 1.05–69.6). Patients with type 2 diabetes mellitus (T2DM) consuming moderate amounts of alcohol had a significantly higher rate of advanced fibrosis compared with those consuming low amounts (50.0–60.0% vs. 3.3–21.6%, p < 0.05).

Conclusions

Moderate alcohol consumption, irrespective of assessment method (clinical interview, AUDIT-C, and PEth), was associated with advanced fibrosis. PEth in blood ≥ 50 ng/mL may be a biological marker indicating increased risk for advanced fibrosis in NAFLD. Patients with T2DM consuming moderate amounts of alcohol had the highest risk of advanced fibrosis, indicating a synergistic effect of insulin resistance and alcohol on the histopathological progression of NAFLD.

Abbreviations

NAFLD
non-alcoholic fatty liver disease
NASH
non-alcoholic steatohepatitis
AUDIT
Alcohol Use Disorders Identification Test
AUDIT-C
Alcohol Use Disorders Identification Test – Consumption
PEth
phosphatidylethanol
LC-MS/MS
liquid chromatography tandem mass spectrometry
LOQ
level of quantification
T2DM
type 2 diabetes mellitus
BMI
body mass index
HOMA-IR
homeostatic model assessment for insulin resistance
ALT
alanine transaminase
AST
aspartate transaminase
INR
international normalised ratio

Keywords

Non-alcoholic fatty liver disease
Alcohol drinking
Type 2 diabetes mellitus
Phosphatidylethanol

Cited by (0)

1

Senior authors contributed equally.