Effects of Alcohol Consumption and Metabolic Syndrome on Mortality in Patients With Nonalcoholic and Alcohol-Related Fatty Liver Disease

Younossi, Zobair M.; Stepanova, Maria; Ong, Janus P.; Yılmaz, Yusuf; Duseja, Ajay; Eguchi, Yuichiro; Kassas, Mohamed El; Fernández, Marlen Ivón Castellanos; George, Jacob; Jacobson, Ira M.; Bugianesi, Elisabetta; Wong, Vincent Wai‐Sun; Arrese, Marco; Lédinghen, Victor de; Romero–Gómez, Manuel; Méndez-Sánchez, Nahúm; Ahmed, Aijaz; Wong, Robert J.; Papatheodoridis, George V.; Serfaty, Lawrence; Younossi, Issah; Nader, Fatema; Ziayee, Mariam; Afendy, Arian

doi:10.1016/j.cgh.2018.11.033

Cited by 139 publications

(126 citation statements)

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“…In addition to these studies, Younossi and colleagues () reported supraadditive interaction between hazardous alcohol use and the MetS for all‐cause death in subjects with baseline liver steatosis, based on the NHANES III survey. However, they found that the interaction term between binge drinking and MetS was nonsignificant for all‐cause death in these subjects.…”

Section: Interaction Between Hazardous Alcohol Use and Other Metabolimentioning

confidence: 99%

“…Six studies stated explicitly how they treated former drinkers (current abstainers with previous drinking; Åberg et al, ; Ajmera et al, ; Ascha et al, ; Dixon et al, ; Dunn et al, ; Kwon et al, ), 6 stated how they treated binge drinkers (Åberg et al, ; Ajmera et al, ; Dunn et al, ; Ekstedt et al, ; Mitchell et al, ; Younossi et al, ), and 5 evaluated lifetime drinking in their analyses (Ajmera et al, ; Dunn et al, ; Hagström et al, ; Kwon et al, ; Mitchell et al, ). Two studies had repeated measurements of alcohol use over time (Ajmera et al, ; Ekstedt et al, ), although these findings were not explicitly reported.…”

Section: Low Alcohol Intake In the Presence Of Nafld And/or Metabolicmentioning

confidence: 99%

“…There are conflicting data regarding a J‐shaped relationship between low alcohol use and all‐cause death in NAFLD cohorts in recent population‐based studies (Åberg et al, ; Hajifathalian et al, ; Younossi et al, ). In our longitudinal population study, such a J‐shaped association between low alcohol use and all‐cause death was only seen among never smokers, not among current or former smokers (Åberg et al, ).…”

Section: Extrahepatic Outcomes In Nafldmentioning

confidence: 99%

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Interaction Between Alcohol Use and Metabolic Risk Factors for Liver Disease: A Critical Review of Epidemiological Studies

Åberg

Färkkilä

Männistö

2020

Alcoholism Clin & Exp Res

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Coexistence of alcohol use and metabolic risk-the 2 commonest population risk factors for nonviral chronic liver disease-is a growing concern. Clinical evidence and mechanistic evidence point to considerable supraadditive interaction effects for the development and progression of chronic liver disease between hazardous alcohol use and metabolic abnormalities including obesity, diabetes, and the metabolic syndrome (MetS). Intermittent binge drinking once monthly or more often seems to be associated with progression of liver disease even when average alcohol intake is within the currently allowed limits for a diagnosis of nonalcoholic fatty liver disease (NAFLD), and supraadditive interaction between binge drinking and the MetS has been reported. There are contradictory findings regarding the association between low alcohol use and liver steatosis, but, clearly, the mechanisms of alcoholic hepatotoxicity extend beyond simple fat accumulation. The presence of liver steatosis seems to amplify alcoholic hepatotoxicity. Recent longitudinal studies of NAFLD subjects report low alcohol use associated with both increased fibrosis progression and an elevated risk for liver cancer and severe liver disease. There is no clear safe limit of alcohol intake in the presence of NAFLD or metabolic risk. The interaction effects between alcohol and metabolic dysfunction merit increased attention in public health policy, individual counseling, and risk stratification. Based on current evidence, a strict dichotomization of liver disease into either pure alcoholic or nonalcoholic may be inappropriate.

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Section: Interaction Between Hazardous Alcohol Use and Other Metabolimentioning

confidence: 99%

Section: Low Alcohol Intake In the Presence Of Nafld And/or Metabolicmentioning

confidence: 99%

Section: Extrahepatic Outcomes In Nafldmentioning

confidence: 99%

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Interaction Between Alcohol Use and Metabolic Risk Factors for Liver Disease: A Critical Review of Epidemiological Studies

Åberg

Färkkilä

Männistö

2020

Alcoholism Clin & Exp Res

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“…Nonalcoholic fatty liver disease (NAFLD) is now the leading cause of liver disease (Rowe, ) and the prevalence is expected to continue to rise through 2030 (Estes et al., ), in part due to the increasing prevalence of obesity (Younossi, ). Despite differential diagnosis of alcohol‐related fatty liver disease (AFLD) and NAFLD relying solely on alcohol consumption (Dietrich and Hellerbrand, ), research suggests that there is an overlap between AFLD and NAFLD (Hajifathalian et al., ; Younossi et al., ). For example, among individuals with NAFLD, higher alcohol consumption is associated with higher mortality (Younossi et al., ).…”

Section: Discussionmentioning

confidence: 99%

“…Despite differential diagnosis of alcohol‐related fatty liver disease (AFLD) and NAFLD relying solely on alcohol consumption (Dietrich and Hellerbrand, ), research suggests that there is an overlap between AFLD and NAFLD (Hajifathalian et al., ; Younossi et al., ). For example, among individuals with NAFLD, higher alcohol consumption is associated with higher mortality (Younossi et al., ). Future research should further examine the impact of the overlap between weight status and alcohol use on the diagnosis and treatment of chronic liver disease.…”

Section: Discussionmentioning

confidence: 99%

Do Associations Between Alcohol Use and Alcohol Use Disorder Vary by Weight Status? Results From the National Epidemiologic Survey on Alcohol and Related Conditions‐III

White

Richardson

Mair

et al. 2019

Alcoholism Clin & Exp Res

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Background: Understanding whether the associations between alcohol use and alcohol use disorder (AUD) differ by weight status may be useful in screening for AUD in populations where obesity is common. We aimed to determine whether the associations between alcohol use and AUD differ by weight status.Methods: A total of 24,869 adult participants of the National Epidemiologic Survey on Alcohol and Related Conditions-III with a body mass index ≥18.5 kg/m 2 who reported past-year alcohol use were included. The AUD and Associated Disabilities Interview Schedule-5 were administered to identify past-year AUD. Logistic regression was used to test the associations between weight status and levels and patterns of alcohol use with AUD; interactions between weight status and alcohol use variables in relation to AUD were examined. Analyses were stratified by gender.Results: For males and females, the odds of AUD were higher with greater frequency of any alcohol use and heavy drinking, higher average quantity of drinks per drinking day, and past-year high-risk drinking. Among males, at the same average quantity of drinks per drinking day, frequency of heavy drinking, or presence of high-risk drinking, those with class 3 obesity had higher odds of AUD versus lower classes or no obesity (p for all interactions <0.01). Among females, at the same frequency of any alcohol use, those with healthy weight had the highest odds of AUD, while females with class 3 obesity had the lowest odds of AUD (p for interaction <0.001); interactions between weight status and other alcohol use variables were not significant (p ≥ 0.05).Conclusions: The associations between some measures of alcohol use and AUD differed by weight status, with inconsistent results between males and females. Alcohol use thresholds typically used in AUD screening may be too high in males with class 3 obesity.

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Characterizing the risk interplay between alcohol intake and body mass index on cirrhosis morbidity

et al. 2021

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Background and Aims It is thought that alcohol intake and body mass index (BMI) interact supra‐additively to modulate the risk of cirrhosis, but evidence for this phenomenon is limited. We investigated the interrelationship between alcohol and BMI on the incidence of cirrhosis morbidity for participants of the United Kingdom Biobank (UKB) study. Approach and Results The primary outcome was the cumulative incidence of cirrhosis morbidity, defined as a first‐time hospital admission for cirrhosis (with noncirrhosis mortality incorporated as a competing risk). All UKB participants without a previous hospital admission for cirrhosis were included in the analysis. We determined the ratio of the 10‐year cumulative incidence in harmful drinkers versus safe drinkers according to BMI. We also calculated the excess cumulative incidence at 10 years for individuals with obesity and/or harmful alcohol compared to safe drinkers with a healthy BMI of 20–25.0 kg/m2. A total of 489,285 UK Biobank participants were included, with mean of 10.7 person‐years’ follow‐up. A total of 2070 participants developed the primary outcome, equating to a crude cumulative incidence of 0.36% at 10 years (95% CI:0.34–0.38). The 10‐year cumulative incidence was 8.6 times higher for harmful (1.38%) versus safe drinkers (0.16%) if BMI was healthy. Conversely, it was only 3.6 times higher for obese participants (1.99% vs. 0.56%). Excess cumulative incidence was 1.22% (95% CI:0.89–1.55) for harmful drinkers with a healthy BMI, 0.40% (95% CI:0.34–0.46) for obese individuals drinking at safe levels, and 1.83% (95% CI:1.46–2.20) for obese harmful drinkers (all compared to safe drinkers with a healthy BMI). Conclusions Alcohol intake and obesity are independent risk factors for cirrhosis morbidity, but they do not interact supra‐additively to modulate the cumulative incidence of this outcome.

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Effects of Alcohol Consumption and Metabolic Syndrome on Mortality in Patients With Nonalcoholic and Alcohol-Related Fatty Liver Disease

Cited by 139 publications

References 23 publications

Interaction Between Alcohol Use and Metabolic Risk Factors for Liver Disease: A Critical Review of Epidemiological Studies

Interaction Between Alcohol Use and Metabolic Risk Factors for Liver Disease: A Critical Review of Epidemiological Studies

Do Associations Between Alcohol Use and Alcohol Use Disorder Vary by Weight Status? Results From the National Epidemiologic Survey on Alcohol and Related Conditions‐III

Characterizing the risk interplay between alcohol intake and body mass index on cirrhosis morbidity

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