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Nonheavy Drinking and Worsening of Noninvasive Fibrosis Markers in Nonalcoholic Fatty Liver Disease: A Cohort Study

Hepatology. 2019 Jan;69(1):64-75. doi: 10.1002/hep.30170. Epub 2018 Dec 26.

Alcohol drinking, even in non-heavy amounts, was associated with the progression of non-alcoholic fatty liver disease (NAFLD) based on the worsening of non-invasive fibrosis markers.

According to the paper, even moderate alcohol consumption appears to adversely affect liver health.

Non-alcoholic fatty liver disease (NAFLD) is one of the most common chronic liver diseases with an estimated prevalence of 25% worldwide, and it is an important public health problem with its negative impact on the liver, metabolism, and cardiovascular health. In clinical practice, individuals with NAFLD often ask their health care providers about routinely consuming non-heavy amounts of alcohol for pleasure and for participating in a social occasion. Currently, there is insufficient data to make a recommendation regarding non-heavy alcohol drinking in patients with NAFLD although the hazard of drinking alcohol heavily is well established.

A team led by researchers, Seungho Ryu, Yong Kyun Cho, and Yoosoo Chang, at the Kangbuk Samsung Hospital Sunkyungkwan University School of Medicine performed a retrospective cohort study of 58,927 Korean adults with NAFLD and low fibrosis scores who were followed for the worsening of fibrosis scores. This cohort study was performed using a subsample of the Kangbuk Samsung Health Study (KSHS), a large cohort study conducted at the Health Screening Clinics of the Total Healthcare Center of the Kangbuk Samsung Hospital. In Korea, employees are required to participate in annual or biennial health examinations by the Industrial Safety and Health Law. Over 80% of participants of the KSHS are employees and are expected to have repeated health examinations every 1 – 2 years, depending on their age and job title, resulting in relatively high follow-up rates and providing a good opportunity to perform a longitudinal cohort study. During the median follow-up of 8.3 years, 5,630 subjects with a low fibrosis score progressed to an intermediate or high fibrosis score. After the adjustment for confounders, the multivariable-adjusted HRs (95% CI) for worsening of the fibrosis-4 index, one of the non-invasive fibrosis scores, comparing light-drinkers and moderate-drinkers with non-drinkers were 1.06 (0.98-1.16) and 1.29 (1.18-1.40), respectively. Similarly, using the NAFLD fibrosis score, the corresponding HRs (95% CI) comparing light-drinkers and moderate-drinkers with non-drinkers were 1.09 (1.02-1.16) and 1.31 (1.23-1.40), respectively. When taking changes in alcohol drinking into account and certain confounders over time, the association of moderate drinking with the worsening of liver fibrosis score remained significant. Our findings indicate that even low amounts of alcohol are associated with liver disease progression in NAFLD. Given that alcohol is a known carcinogen at low doses and, additionally, can be harmful to liver health, patients with NAFLD should be advised against the regular consumption of alcohol, even in non-heavy amounts. This paper has been published in the January 2019 issue of Hepatology, the official journal of the American Association for the Study of Liver Diseases (AASLD).