Modest alcohol consumption is associated with decreased prevalence of steatohepatitis in patients with non-alcoholic fatty liver disease (NAFLD)

• Published in: Journal of hepatology Vol. 57; no. 2; pp. 384 - 391
• Main Authors: Dunn, Winston, Sanyal, Arun J., Brunt, Elizabeth M., Unalp-Arida, Aynur, Donohue, Michael, McCullough, Arthur J., Schwimmer, Jeffrey B.
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier B.V 01.08.2012; Elsevier
• Subjects: Adult; Aged; Alcohol; Alcohol Drinking; Biological and medical sciences; Cross-Sectional Studies; Digestive system; Fatty Liver - complications; Fatty Liver - epidemiology; Fatty Liver - prevention & control; Female; Gastroenterology and Hepatology; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Investigative techniques, diagnostic techniques (general aspects); Liver biopsy; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Middle Aged; Non-alcoholic Fatty Liver Disease; Non-alcoholic steatohepatitis; Other diseases. Semiology; Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques; Prevalence; AUDIT; Liver biopsy; NAFLD; OR; CI; Alcohol; NASH; Non-alcoholic fatty liver disease; Non-alcoholic steatohepatitis; CHD; NASH CRN; non-alcoholic fatty liver disease; Non-alcoholic Steatohepatitis Clinical Research Network; odds ratio; coronary heart disease; confidence interval; Alcohol Use Disorders Identification Test; non-alcoholic steatohepatitis; Consumption; Human; Prevalence; Non alcoholic steatohepatitis; Gastroenterology; Digestive diseases; Hepatic disease; Epidemiology
• ISSN: 0168-8278; 1600-0641; 1600-0641
• DOI: 10.1016/j.jhep.2012.03.024

Non-alcoholic fatty liver disease (NAFLD) is a cardiovascular risk factor. Although modest alcohol consumption may reduce the risk for cardiovascular mortality, whether patients with NAFLD should be allowed modest alcohol consumption remains an important unaddressed issue. We aimed to evaluate the association between modest alcohol drinking and non-alcoholic steatohepatitis (NASH), among subjects with NAFLD. In a cross-sectional analysis of adult participants in the NIH NASH Clinical Research Network, only modest or non-drinkers were included: participants identified as (1) drinking >20g/day, (2) binge drinkers, or (3) non-drinkers with previous alcohol consumption were excluded. The odds of having a histological diagnosis of NASH and other histological features of NAFLD were analyzed using multiple ordinal logistic regression. The analysis included 251 lifetime non-drinkers and 331 modest drinkers. Modest drinkers compared to non-drinkers had lower odds of having a diagnosis of NASH (summary odds ratio 0.56, 95% CI 0.39–0.84, p=0.002). The odds of NASH decreased as the frequency of alcohol consumption increased within the range of modest consumption. Modest drinkers also had significantly lower odds for fibrosis (OR 0.56 95% CI 0.41–0.77) and ballooning hepatocellular injury (OR 0.66 95% CI 0.48–0.92) than lifetime non-drinkers. In a large, well-characterized population with biopsy-proven NAFLD, modest alcohol consumption was associated with lesser degree of severity as determined by lower odds of the key features that comprise a diagnosis of steatohepatitis, as well as fibrosis. These findings demonstrate the need for prospective studies and a coordinated consensus on alcohol consumption recommendations in NAFLD.