“Moderate” Drinking Associated With Progression of Non-alcoholic Fatty Liver Disease

Non-alcoholic fatty liver disease (NAFLD) is common, but it is unknown how drinking low amounts of alcohol affects it. Investigators studied a prospective cohort of 58,927 Korean adults with NAFLD (identified from among ~350,000 people, a prevalence of 17%), followed for about 8 years. Participants had fatty liver by ultrasound but drank <20g of alcohol a day (30g/day for men), did not have hepatitis B or C or other known liver disease, were not taking medications known to cause fatty liver, and did not have an intermediate or higher probability of fibrosis based on non-invasive markers of liver fibrosis.* Light and “moderate” drinking, respectively, were defined as 1 to <10g/day and 10 to <20g/day for women, and 1 to <10g/day and 10 to <30g/day for men.

  • “Moderate” drinking was associated with progression of the FIB-4* (hazard ratio [HR], 1.3) and worsening of the APRI* (HR, 1.1). Both light and “moderate” drinking were associated with worsening of the NFS (HR, 1.1 and 1.3, respectively).*

*FIB-4 (fibrosis-4 score, calculated based on age, asparate and alanine aminotransferase levels, and platelet count), APRI (aspartate aminotransferase to platelet ratio index), NFS (NAFLD fibrosis score).

Comments: The label “moderate” is a misnomer given that alcohol is a carcinogen at low doses; there are numerous studies identifying health risks at low doses and calling into question the existence of any health benefits. Low amounts of alcohol appear to be associated with liver disease progression in NAFLD. These findings raise questions about whether to identify people with NAFLD, a very common condition, to more appropriately advise them regarding alcohol risks.

Richard Saitz, MD, MPH

Reference: Chang Y, Cho YK, Kim Y, et al. Non-heavy drinking and worsening of non-invasive fibrosis markers in non-alcoholic fatty liver disease: a cohort study. Hepatology. 2018 [Epub ahead of print]. doi: 10.1002/hep.30170.

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