Risk factors of fibrosis in alcohol-induced liver disease

Abstract

In patients with nonalcoholic steatohepatitis (NASH), age, obesity, and diabetes mellitus are independent predictors of the degree of fibrosis. The relative risk for fibrosis adjusted for sex was also associated with increasing grade of Perls stain. The aim of this study was to determine whether the risk factors for fibrosis described in NASH are also risk factors in alcohol-induced liver disease. A total of 268 alcoholic patients with negative hepatitis B virus and hepatitis C virus serology underwent liver biopsy. Fibrosis was assessed semiquantitatively by a score fluctuating between 0 to 8. Liver iron overload was assessed by Perls staining and graded in 4 classes. We have used multivariate regression with partial correlation analysis to assess the variability of fibrosis score according to the value of 7 variables: sex, age, body mass index (BMI) in the past year before the hospitalization when the patient was asymptomatic, daily alcohol intake over the past 5 years, total duration of alcohol abuse, Perls grade, and blood glucose level. In the multivariate regression, fibrosis score was positively correlated with age (P ‫؍‬ .001), BMI (P ‫؍‬ .002), female sex (P < .05), Perls grade (P < .05), and blood glucose level (P < .05). Twenty percent of the variability of fibrosis score was explained by the 7 variables. In conclusion, after adjustment for daily alcohol intake and total duration of alcohol abuse, BMI, Perls grade, and blood glucose are also independent risk factors for fibrosis in alcohol-induced liver disease, raising therapeutic implications for the management of these patients. (HEPATOLOGY 2002;35:635-638.)

The role of fatty acids in the development and progression of nonalcoholic fatty liver disease

“…The natural history of both diseases is characterized by an initial over accumulation of fat in the liver, which progresses in some individuals to steatohepatitis and cirrhosis. Obesity and insulin resistance, the two principal risk factors for NAFLD, appear to also increase the incidence of all stages of AFLD in heavy drinkers [84,85]. Histologically, the two diseases are indistinguishable, and pathologically, the two diseases appear to share at least two mechanistic pathways, oxidative stress and pro-inflammatory cytokines [86,87].…”

Steatosis: Co-factor in Other Liver Diseases *

“…In subjects with heavy alcohol consumption, excess body weight markedly increases the presence of steatosis 62 and is a risk factor for the development of acute alcoholic hepatitis and cirrhosis. 63,64 Multiple factors are involved in alcohol-induced liver injury, and the mechanisms by which obesity contributes to this process are now being examined. 65 The up-regulation of microsomal cytochrome P4502E1 (CYP2E1) by ethanol has a key role in the pathogenesis of alcoholic liver injury.…”

Obesity and overweight in relation to liver disease mortality in men: 38 year follow-up of the original Whitehall study

“…[8][9][10][11][12] In the few general population-based surveys conducted, the prevalence of liver disease, particularly hepatic steatosis (fatty liver disease), also appears to be higher in heavier people. 13,14 However, as has been highlighted, 15 interpretation of these findings is complicated by the issue of reverse causality.…”