Julia Blomdahl1, Patrik Nasr2, Mattias Ekstedt3, Stergios Kechagias4. 1. Department of Gastroenterology and Hepatology, Department of Health, Medicine, and Caring Sciences, Linköping University, SE-581 83 Linköping, Sweden. Electronic address: julia.blomdahl@liu.se. 2. Department of Gastroenterology and Hepatology, Department of Health, Medicine, and Caring Sciences, Linköping University, SE-581 83 Linköping, Sweden. Electronic address: patrik.nasr@liu.se. 3. Department of Gastroenterology and Hepatology, Department of Health, Medicine, and Caring Sciences, Linköping University, SE-581 83 Linköping, Sweden. Electronic address: mattias.ekstedt@liu.se. 4. Department of Gastroenterology and Hepatology, Department of Health, Medicine, and Caring Sciences, Linköping University, SE-581 83 Linköping, Sweden. Electronic address: stergios.kechagias@liu.se.
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.
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.
Authors: Judith A Hahn; Pamela M Murnane; Eric Vittinghoff; Winnie R Muyindike; Nneka I Emenyonu; Robin Fatch; Gabriel Chamie; Jessica E Haberer; Joel M Francis; Saidi Kapiga; Karen Jacobson; Bronwyn Myers; Marie Claude Couture; Ralph J DiClemente; Jennifer L Brown; Kaku So-Armah; Mark Sulkowski; Gregory M Marcus; Sarah Woolf-King; Robert L Cook; Veronica L Richards; Patricia Molina; Tekeda Ferguson; David Welsh; Mariann R Piano; Shane A Phillips; Scott Stewart; Majid Afshar; Kimberly Page; Kathleen McGinnis; David A Fiellin; Amy C Justice; Kendall Bryant; Richard Saitz Journal: Alcohol Clin Exp Res Date: 2021-05-07 Impact factor: 3.928
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