Alcohol Consumption in Non-Alcoholic Fatty Liver Disease: Safety and Disease Overlap
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FATTY LIVER DISEASE (V AJMERA, SECTION EDITOR)
Alcohol Consumption in Non-Alcoholic Fatty Liver Disease: Safety and Disease Overlap Sheela S. Reddy 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review As the non-alcoholic fatty liver disease (NAFLD) epidemic continues to grow, more patients will be seeking advice on the safety of low to moderate alcohol use in the setting of underlying liver disease. Data suggests a beneficial effect in the general population, but whether this can be extended to the NAFLD population remains unclear. The purpose of this review is to summarize pertinent data in order to help guide medical decision-making and patient counseling. Recent Findings Newer data suggests light to moderate alcohol use in patients with NAFLD can improve all-cause mortality, as well as cardiovascular risk. However, dose-dependent detrimental liver-related effects have also been noted. Summary The data is both limited and mixed in terms of the safety and potential benefit of low to moderate alcohol use in underlying NAFLD. More research is needed in specific NAFLD sub-groups in order to better counsel individual patients. Keywords Non-alcoholic fatty liver disease . Low to moderate alcohol use . Liver-related outcomes . All-cause mortality
Introduction With the ever-growing obesity epidemic, the burden of nonalcoholic fatty liver disease (NAFLD) continues to grow, affecting one in four people worldwide [1]. The global death rate due to NAFLD-related cirrhosis increased 9% in 2017 and is the fastest growing reason for liver-related complications [2•]. Models predicting the annual NAFLD burden in the USA project a prevalence of 64 million cases, with upwards of 12 million incident cases [3]. The ballooning prevalence of NAFLD parallels the increasing rates of obesity and type 2 diabetes (DM2), highlighting the interplay between fatty liver and metabolic risk factors [4]. Globally, more than half of patients with DM2 have NAFLD [5]. Retrospective data has shown that DM2 is most strongly associated with the development of hepatocellular carcinoma (HCC) in patients with underlying NAFLD [6]. Moreover, there is a stepwise
This article is part of the Topical Collection on Fatty Liver Disease * Sheela S. Reddy [email protected] 1
Division of Gastroenterology and Hepatology, University of Vermont, 111 Colchester Avenue, Smith 251, Burlington, VT 05401, USA
increase in risk of cirrhosis and HCC with every additional metabolic risk factor [7]. This association between NAFLD and features of the metabolic syndrome, as well as the disease heterogeneity, has led to a recent push from experts to revise nomenclature from NAFLD to metabolic (dysfunction) associated fatty liver disease (MAFLD) [8]. Assessing alcohol history is at the crux of diagnosing NAFLD, as both the American Association of the Study of Liver (AASLD) and the European Association for the Study of the Liver (EASL) limit alcohol intake to less than 30 g daily in men, and less than 20 g daily in women in
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