Modest alcohol consumption is associated with decreased prevalence of steatohepatitis in patients with non-alcoholic fatty liver disease (NAFLD)

Winston Dunn, Arun J. Sanyal, Elizabeth M. Brunt, Aynur Unalp-Arida, Michael Donohue, Arthur J. McCullough, Jeffrey B. Schwimmer

Research output: Contribution to journalArticle

Abstract

Background & Aims: Non-alcoholic fatty liver disease (NAFLD) is a cardiovascular risk factor. Although modest alcohol consumption may reduce the risk for cardiovascular mortality, whether patients with NAFLD should be allowed modest alcohol consumption remains an important unaddressed issue. We aimed to evaluate the association between modest alcohol drinking and non-alcoholic steatohepatitis (NASH), among subjects with NAFLD. Methods: In a cross-sectional analysis of adult participants in the NIH NASH Clinical Research Network, only modest or non-drinkers were included: participants identified as (1) drinking >20 g/day, (2) binge drinkers, or (3) non-drinkers with previous alcohol consumption were excluded. The odds of having a histological diagnosis of NASH and other histological features of NAFLD were analyzed using multiple ordinal logistic regression. Results: The analysis included 251 lifetime non-drinkers and 331 modest drinkers. Modest drinkers compared to non-drinkers had lower odds of having a diagnosis of NASH (summary odds ratio 0.56, 95% CI 0.39-0.84, p = 0.002). The odds of NASH decreased as the frequency of alcohol consumption increased within the range of modest consumption. Modest drinkers also had significantly lower odds for fibrosis (OR 0.56 95% CI 0.41-0.77) and ballooning hepatocellular injury (OR 0.66 95% CI 0.48-0.92) than lifetime non-drinkers. Conclusions: In a large, well-characterized population with biopsy-proven NAFLD, modest alcohol consumption was associated with lesser degree of severity as determined by lower odds of the key features that comprise a diagnosis of steatohepatitis, as well as fibrosis. These findings demonstrate the need for prospective studies and a coordinated consensus on alcohol consumption recommendations in NAFLD.

Original languageEnglish (US)
Pages (from-to)384-391
Number of pages8
JournalJournal of Hepatology
Volume57
Issue number2
DOIs
StatePublished - Aug 2012

Fingerprint

Fatty Liver
Alcohol Drinking
Fibrosis
Non-alcoholic Fatty Liver Disease
Drinking
Consensus
Cross-Sectional Studies
Logistic Models
Odds Ratio
Prospective Studies
Biopsy
Mortality
Wounds and Injuries
Research
Population

Keywords

  • Alcohol
  • Liver biopsy
  • Non-alcoholic fatty liver disease
  • Non-alcoholic steatohepatitis

ASJC Scopus subject areas

  • Hepatology

Cite this

Modest alcohol consumption is associated with decreased prevalence of steatohepatitis in patients with non-alcoholic fatty liver disease (NAFLD). / Dunn, Winston; Sanyal, Arun J.; Brunt, Elizabeth M.; Unalp-Arida, Aynur; Donohue, Michael; McCullough, Arthur J.; Schwimmer, Jeffrey B.

In: Journal of Hepatology, Vol. 57, No. 2, 08.2012, p. 384-391.

Research output: Contribution to journalArticle

Dunn, Winston ; Sanyal, Arun J. ; Brunt, Elizabeth M. ; Unalp-Arida, Aynur ; Donohue, Michael ; McCullough, Arthur J. ; Schwimmer, Jeffrey B. / Modest alcohol consumption is associated with decreased prevalence of steatohepatitis in patients with non-alcoholic fatty liver disease (NAFLD). In: Journal of Hepatology. 2012 ; Vol. 57, No. 2. pp. 384-391.
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abstract = "Background & Aims: Non-alcoholic fatty liver disease (NAFLD) is a cardiovascular risk factor. Although modest alcohol consumption may reduce the risk for cardiovascular mortality, whether patients with NAFLD should be allowed modest alcohol consumption remains an important unaddressed issue. We aimed to evaluate the association between modest alcohol drinking and non-alcoholic steatohepatitis (NASH), among subjects with NAFLD. Methods: In a cross-sectional analysis of adult participants in the NIH NASH Clinical Research Network, only modest or non-drinkers were included: participants identified as (1) drinking >20 g/day, (2) binge drinkers, or (3) non-drinkers with previous alcohol consumption were excluded. The odds of having a histological diagnosis of NASH and other histological features of NAFLD were analyzed using multiple ordinal logistic regression. Results: The analysis included 251 lifetime non-drinkers and 331 modest drinkers. Modest drinkers compared to non-drinkers had lower odds of having a diagnosis of NASH (summary odds ratio 0.56, 95{\%} CI 0.39-0.84, p = 0.002). The odds of NASH decreased as the frequency of alcohol consumption increased within the range of modest consumption. Modest drinkers also had significantly lower odds for fibrosis (OR 0.56 95{\%} CI 0.41-0.77) and ballooning hepatocellular injury (OR 0.66 95{\%} CI 0.48-0.92) than lifetime non-drinkers. Conclusions: In a large, well-characterized population with biopsy-proven NAFLD, modest alcohol consumption was associated with lesser degree of severity as determined by lower odds of the key features that comprise a diagnosis of steatohepatitis, as well as fibrosis. These findings demonstrate the need for prospective studies and a coordinated consensus on alcohol consumption recommendations in NAFLD.",
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T1 - Modest alcohol consumption is associated with decreased prevalence of steatohepatitis in patients with non-alcoholic fatty liver disease (NAFLD)

AU - Dunn, Winston

AU - Sanyal, Arun J.

AU - Brunt, Elizabeth M.

AU - Unalp-Arida, Aynur

AU - Donohue, Michael

AU - McCullough, Arthur J.

AU - Schwimmer, Jeffrey B.

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AB - Background & Aims: Non-alcoholic fatty liver disease (NAFLD) is a cardiovascular risk factor. Although modest alcohol consumption may reduce the risk for cardiovascular mortality, whether patients with NAFLD should be allowed modest alcohol consumption remains an important unaddressed issue. We aimed to evaluate the association between modest alcohol drinking and non-alcoholic steatohepatitis (NASH), among subjects with NAFLD. Methods: In a cross-sectional analysis of adult participants in the NIH NASH Clinical Research Network, only modest or non-drinkers were included: participants identified as (1) drinking >20 g/day, (2) binge drinkers, or (3) non-drinkers with previous alcohol consumption were excluded. The odds of having a histological diagnosis of NASH and other histological features of NAFLD were analyzed using multiple ordinal logistic regression. Results: The analysis included 251 lifetime non-drinkers and 331 modest drinkers. Modest drinkers compared to non-drinkers had lower odds of having a diagnosis of NASH (summary odds ratio 0.56, 95% CI 0.39-0.84, p = 0.002). The odds of NASH decreased as the frequency of alcohol consumption increased within the range of modest consumption. Modest drinkers also had significantly lower odds for fibrosis (OR 0.56 95% CI 0.41-0.77) and ballooning hepatocellular injury (OR 0.66 95% CI 0.48-0.92) than lifetime non-drinkers. Conclusions: In a large, well-characterized population with biopsy-proven NAFLD, modest alcohol consumption was associated with lesser degree of severity as determined by lower odds of the key features that comprise a diagnosis of steatohepatitis, as well as fibrosis. These findings demonstrate the need for prospective studies and a coordinated consensus on alcohol consumption recommendations in NAFLD.

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KW - Non-alcoholic steatohepatitis

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