Roerecke Michael, Nanau Radu, Rehm Jürgen, Neuman Manuela
Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Canada; Dalla Lana School of Public Health (DLSPH), University of Toronto, Toronto, Canada; PAHO/WHO Collaborating Centre for Addiction and Mental Health, Toronto, Canada.
In Vitro Drug Safety and Biotechnology, Toronto, Canada.
EBioMedicine. 2016 Jun;8:317-330. doi: 10.1016/j.ebiom.2016.04.023. Epub 2016 Apr 20.
Fatty liver (hepatic steatosis) is one of the most common diseases globally, with increasing prevalence. The role of alcohol consumption in the development of hepatic steatosis has not been systematically examined.
We searched Medline, Embase, and ProQuest Dissertations & Theses Global for original data on the relationship between alcohol consumption and hepatic steatosis measured by non-invasive imagery, excluding studies conducted in participants <18years, or subgroups related to viral and drug-induced liver disease. We identified 18 articles reporting adjusted data (Japan=11, other high-income countries=7). Random-effect categorical meta-analyses (<20g/day pure alcohol consumption vs non-drinkers) and dose-response meta-analyses for the whole range of alcohol consumption were conducted.
In total, 99,370 participants and 25,662 cases of hepatic steatosis were included. In Japan, low alcohol consumption was consistently associated with substantially reduced incidence and prevalence of hepatic steatosis compared to non-drinkers (RR for <20g pure alcohol/day=0.75, 95% CI: 0.71-0.79, I(2)=0%). No overall association was found in other countries (RR=1.05, 95% CI: 0.86-1.30, I(2)=84%). Dose-response analyses in Japan (up to 80g/day) showed an inverse relationship in men and a J-shape in women.
Alcohol consumption showed a complex association with hepatic steatosis with substantial differences by ethnicity and sex. Low alcohol consumption was beneficial in Japan with good epidemiological evidence, whereas there was no association in other countries. However, heterogeneity was large in countries other than Japan. More and higher quality research in diverse ethnic populations is needed to further clarify this relationship.
脂肪肝（肝脂肪变性）是全球最常见的疾病之一，其患病率呈上升趋势。饮酒在肝脂肪变性发展过程中的作用尚未得到系统研究。
我们检索了Medline、Embase和ProQuest Dissertations & Theses Global，以获取关于饮酒与通过非侵入性成像测量的肝脂肪变性之间关系的原始数据，排除在18岁以下参与者中进行的研究，或与病毒和药物性肝病相关的亚组研究。我们确定了18篇报告调整后数据的文章（日本=11篇，其他高收入国家=7篇）。进行了随机效应分类荟萃分析（每天纯酒精摄入量<20克与不饮酒者相比）以及对整个饮酒范围的剂量反应荟萃分析。
总共纳入了99370名参与者和25662例肝脂肪变性病例。在日本，与不饮酒者相比，低酒精摄入量始终与肝脂肪变性的发病率和患病率大幅降低相关（每天纯酒精摄入量<20克的相对风险=0.75，95%置信区间：0.71 - 0.79，I²=0%）。在其他国家未发现总体关联（相对风险=1.05，95%置信区间：0.86 - 1.30，I²=84%）。日本的剂量反应分析（最高80克/天）显示男性呈负相关，女性呈J形。
饮酒与肝脂肪变性呈现复杂的关联，因种族和性别存在显著差异。低酒精摄入量在日本有益，有充分的流行病学证据，而在其他国家则无关联。然而，日本以外的国家异质性很大。需要在不同种族人群中进行更多更高质量的研究，以进一步阐明这种关系。
