Alcohol Consumption and Risk of Mortality in People With Nonalcoholic Fatty Liver Disease

The majority of chronic liver disease in the US is nonalcoholic fatty liver disease (NAFLD), which is strongly related to obesity and glucose intolerance. People with alcohol-related chronic liver disease should avoid alcohol consumption, but it is unclear how “moderate” alcohol intake affects the health of those with NAFLD. The authors analyzed results from the National Health and Nutrition Examination Survey from 1988 to 2010, relating reported alcohol intake with risk of mortality, as derived from the National Death Index. The investigators excluded participants with “significant alcohol use” (undefined), viral hepatitis, or increased transferrin saturation. A total of 4568 participants with NAFLD were included in the analysis.

  • Compared with those who reported abstinence, and with adjustments for age, race, sex, smoking, physical activity, education level, diabetes, and fiber and polyunsaturated fatty acid intake, participants reporting an average alcohol consumption of 0.5–1.5 drinks in a day had lower mortality (hazard ratio [HR], 0.64).
  • Participants reporting ≥1.5 drinks in a day had higher mortality (HR, 1.45).

Comments: People with NAFLD who reported low average alcohol consumption experienced a decrease in all-cause mortality (probably due mainly to a decrease in cardiovascular disease mortality), while those with heavier consumption experienced increased mortality. However, participants who reported “significant alcohol use” were excluded from the analysis, which would be expected to lead to an underestimation of an increase in mortality risk associated with heavy alcohol intake.

R. Curtis Ellison, MD

Reference: Hajifathalian K, Torabi Sagvand B, McCullough AJ. Effect of alcohol consumption on survival in nonalcoholic fatty liver disease: a national prospective cohort study. Hepatology. 2018 [Epub ahead of print]. doi: 10.1002/hep.30226.

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