Complete alcohol abstinence increases the risk of NAFLD but not severity. A population analysis with transient elastography

Abstract

Background & Aims

As the global prevalence of non-alcoholic fatty liver disease (NAFLD) continues to rise, ubiquity of alcohol use has also prompted discussion regarding the potential interactions between the two. This study aims to examine the effects of modest alcohol consumption on the prevalence and complications of NAFLD in a multi-ethnic population.

Methods

This study analyses the 2017–2018 cycles of NHANES that examined liver fibrosis and steatosis with vibration controlled transient elastography. A coarsened exact matching was conducted to reduce confounding. Logistic regression was done with a multivariate model to assess the relationship between alcohol consumption (modest drinkers and non-drinkers) and risk of NAFLD and its complications.

Results

2,067 individuals were found to have NAFLD and 284 NAFLD patients had a total history of alcohol abstinence. After coarsened exact matching, the prevalence of NAFLD was 49% (CI: 0.41 − 0.58) in non-drinkers and 33% (CI: 0.26 − 0.41) in modest drinkers. Non-drinkers had twice the odds of NAFLD compared to modest drinkers (OR: 1.99, CI: 1.22 − 3.22, p<.01) after adjustment for confounders. There were no significant differences in the odds of significant fibrosis, advance fibrosis, cirrhosis, cardiovascular disease and stroke between non-drinkers and modest drinkers. The odds of malignancy in non-drinkers were almost significantly less than modest drinkers (OR: 0.28, CI:0.08 − 1.02, p=.053).

Conclusion

Interestingly, modest alcohol consumption is associated with decreased odds of NAFLD. Further investigations are required to examine the relationship between alcohol consumption and NAFLD and subsequently the potential impact on NAFLD management.

Keywords:

• Non-alcoholic fatty liver disease
• modest alcohol consumption
• alcohol abstinence
• fibrosis

Acknowledgements

All authors have made substantial contributions to all of the following: (1) the conception and design of the study, or acquisition of data, or analysis and interpretation of data, (2) drafting the article or revising it critically for important intellectual content, (3) final approval of the version to be submitted. No writing assistance was obtained in the preparation of the manuscript. The manuscript, including related data, figures and tables has not been previously published and that the manuscript is not under consideration elsewhere.

Ethical approval

The study was conducted in accordance with the Declaration of Helsinki. The study was exempt from IRB review was no confidential patient information was involved.

Author contributions

All authors approve the final version of the manuscript, including the authorship list and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Guarantor of the article: Mark Muthiah.

Conceptualisation and Design: Khin Maung Win, Aung Hlaing Bwa, Nicholas WS Chew, Daniel Q Huang, Nobuharu Tamaki, Mazen Noureddin, Mohammad Shadab Siddiqui, Arun Sanyal, Mark Muthiah.

Acquisition of Data: Khin Maung Win, Aung Hlaing Bwa, Nicholas WS Chew, Daniel Q Huang, Nobuharu Tamaki, Mazen Noureddin, Mohammad Shadab Siddiqui, Arun Sanyal, Mark Muthiah.

Analysis and Interpretation of Data: Jieling Xiao, Cheng Han Ng, Ansel Tang, Kai En Chan, Readon Teh, Wen Hui Lim, Darren Jun Hao Tan.

Writing – original draft: Jieling Xiao, Cheng Han Ng, Ansel Tang, Kai En Chan, Readon Teh, Wen Hui Lim, Darren Jun Hao Tan.

Writing – review & editing: Jieling Xiao, Cheng Han Ng, Ansel Tang, Kai En Chan, Readon Teh, Wen Hui Lim, Darren Jun Hao Tan, Khin Maung Win, Aung Hlaing Bwa, Nicholas WS Chew, Daniel Q Huang, Nobuharu Tamaki, Mazen Noureddin, Mohammad Shadab Siddiqui, Arun Sanyal, Mark Muthiah.

Disclosure statement

AJS is President of Sanyal Biotechnology and has stock options in Genfit, Akarna, Tiziana, Indalo, Durect and Galmed. He has served as a consultant to Astra Zeneca, Nitto Denko, Enyo, Ardelyx, Conatus, Nimbus, Amarin, Salix, Tobira, Takeda, Jannsen, Gilead, Terns, Birdrock, Merck, Valeant, Boehringer-Ingelheim, Lilly, Hemoshear, Zafgen, Novartis, Novo Nordisk, Pfizer, Exhalenz and Genfit. He has been an unpaid consultant to Intercept, Echosens, Immuron, Galectin, Fractyl, Syntlogic, Affimune, Chemomab, Zydus, Nordic Bioscience, Albireo, Prosciento, Surrozen and Bristol Myers Squibb. His institution has received grant support from Gilead, Salix, Tobira, Bristol Myers, Shire, Intercept, Merck, Astra Zeneca, Malinckrodt, Cumberland and Norvatis. He receives royalties from Elsevier and UptoDate. MN has been on the advisory board for 89BIO, Gilead, Intercept, Pfizer, Novo Nordisk, Blade, EchoSens, Fractyl, Terns, Siemens and Roche diagnostic; MN has received research support from Allergan, BMS, Gilead, Galmed, Galectin, Genfit, Conatus, Enanta, Madrigal, Novartis, Pfizer, Shire, Viking and Zydus; MN is a minor shareholder or has stocks in Anaetos, Rivus Pharma and Viking.

Data availability statement

Data were retrieved from the National Health and Nutrition Examination Survey Registry.