Gastroenterology, University of California San Francisco, San Francisco, California; Gastroenterology, University of California San Diego, San Diego, California.
Epidemiology, Johns Hopkins, Baltimore, Maryland.
Clin Gastroenterol Hepatol. 2018 Sep;16(9):1511-1520.e5. doi: 10.1016/j.cgh.2018.01.026. Epub 2018 Mar 14.
BACKGROUND & AIMS: Cross-sectional studies of patients with nonalcoholic fatty liver disease (NAFLD) have reported a lower prevalence of severe disease among modest drinkers compared with nondrinkers. We collected data from adult participants in the Nonalcoholic Steatohepatitis (NASH) Clinical Research Network to evaluate the longitudinal association between modest use of alcohol and histology findings in patients with NAFLD, using paired liver biopsies collected more than 1 year apart.
We studied NASH Clinical Research Network participants 21 years or older, not receiving pharmacologic therapy, from whom 2 or more liver biopsies and data on alcohol use within 2 years of the initial biopsy were available. Alcohol consumption was evaluated at study entry using the Alcohol Use Disorders Identification Test and Skinner Lifetime Drinking History questionnaires. At each follow-up visit participants were asked about alcohol use frequency, number of drinks on a typical day, and frequency of heavy drinking. The association between baseline drinking status and changes in fibrosis stage, NASH histology, and the NAFLD Activity Score and its individual components were evaluated by analysis of covariance. The association between change in drinking status and change in histology was evaluated using adjusted logistic regression.
Of 285 participants (82% white, 70% female, mean age, 47 y) meeting entry criteria, 168 (59%) were modest alcohol users (≤2 drinks/d) and the remaining 117 were abstinent. At baseline, a higher proportion of modest alcohol users were white (86% vs 76% nonwhite) (P = .04) and a lower proportion of modest alcohol users were diagnosed with definite NASH (57% vs 74% without NASH; P = .01). During a mean follow-up period of 47 months between biopsies, nondrinkers had a greater mean reduction in steatosis grade (reduction, 0.49) than modest drinkers (reduction, 0.30; P = .04) and a greater reduction in mean level of aspartate transaminase (reduction, 7 U/L vs an increase of 2 U/L in modest drinkers; P = .04). Modest drinkers had significantly lower odds of NASH resolution compared with nondrinkers (adjusted odds ratio, 0.32; 95% CI, 0.11-0.92; P = .04) on adjusted analysis.
In a longitudinal analysis of liver biopsies from patients with NAFLD not receiving pharmacologic therapy, modest alcohol use was associated with less improvement in steatosis and level of aspartate transaminase, as well as lower odds of NASH resolution, compared with no use of alcohol.
非酒精性脂肪性肝病（NAFLD）患者的横断面研究报告称，与不饮酒者相比，适度饮酒者的严重疾病患病率较低。我们从非酒精性脂肪性肝炎（NASH）临床研究网络的成年参与者那里收集数据，使用相隔 1 年以上采集的配对肝活检来评估 NAFLD 患者中适度饮酒与组织学发现之间的纵向关联。
我们研究了 NASH 临床研究网络中年龄在 21 岁或以上、未接受药物治疗的参与者，这些参与者有 2 次或更多次肝活检，并且在初次活检的 2 年内有酒精使用数据。在研究入组时使用酒精使用障碍识别测试和斯金纳终生饮酒史问卷评估饮酒情况。在每次随访时，参与者被问及饮酒频率、典型日饮酒量和重度饮酒频率。使用协方差分析评估基线饮酒状况与纤维化分期、NASH 组织学以及 NAFLD 活动评分及其各组成部分变化之间的关联。使用调整后的逻辑回归评估饮酒状况变化与组织学变化之间的关联。
符合入组标准的 285 名参与者（82%为白人，70%为女性，平均年龄 47 岁）中，168 名（59%）为适度饮酒者（≤2 份/天），其余 117 名参与者为不饮酒者。在基线时，较高比例的适度饮酒者为白人（86%比非白人 76%）（P =.04），较低比例的适度饮酒者被诊断为明确的 NASH（57%比无 NASH 者 74%；P =.01）。在两次活检之间平均 47 个月的随访期间，不饮酒者的脂肪变性程度平均降低更多（降低 0.49），而适度饮酒者的脂肪变性程度平均降低较少（降低 0.30；P =.04），天冬氨酸转氨酶水平平均降低更多（降低 7 U/L，而适度饮酒者增加 2 U/L；P =.04）。与不饮酒者相比，适度饮酒者的 NASH 缓解几率显著降低（调整后的比值比，0.32；95%CI，0.11-0.92；P =.04）。
在未接受药物治疗的 NAFLD 患者的肝活检进行的纵向分析中，与不饮酒相比，适度饮酒与脂肪变性和天冬氨酸转氨酶水平改善较少以及 NASH 缓解几率较低相关。
