Department of Gastroenterology and Hepatology, Department of Health, Medicine, and Caring Sciences, Linköping University, SE-581 83 Linköping, Sweden.
Metabolism. 2021 Feb;115:154439. doi: 10.1016/j.metabol.2020.154439. Epub 2020 Nov 25.
Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease worldwide. Whether moderate alcohol consumption plays a role for progression of NAFLD is disputed. Moreover, it is not known which tool is ideal for assessment of alcohol consumption in NAFLD. This study aimed to evaluate if moderate alcohol consumption assessed with different methods, including the biological marker phosphatidylethanol (PEth), is associated with advanced fibrosis in NAFLD.
We conducted a cross-sectional study of patients with biopsy-proven NAFLD. All participants were clinically evaluated with medical history, blood tests, and anthropometric measurements. Alcohol consumption was assessed using PEth in blood, the questionnaire AUDIT-C, and clinical interview.
86 patients were included of which 17% had advanced fibrosis. All participants reported alcohol consumption < 140 g/week. Average weekly alcohol consumption was higher in the group with advanced fibrosis. Moderate alcohol consumption, independently of the method of assessment, was associated with increased probability of advanced fibrosis (adjusted OR 5.5-9.7, 95% CI 1.05-69.6). Patients with type 2 diabetes mellitus (T2DM) consuming moderate amounts of alcohol had a significantly higher rate of advanced fibrosis compared with those consuming low amounts (50.0-60.0% vs. 3.3-21.6%, p < 0.05).
Moderate alcohol consumption, irrespective of assessment method (clinical interview, AUDIT-C, and PEth), was associated with advanced fibrosis. PEth in blood ≥ 50 ng/mL may be a biological marker indicating increased risk for advanced fibrosis in NAFLD. Patients with T2DM consuming moderate amounts of alcohol had the highest risk of advanced fibrosis, indicating a synergistic effect of insulin resistance and alcohol on the histopathological progression of NAFLD.
非酒精性脂肪性肝病（NAFLD）是全球最常见的慢性肝病。适量饮酒是否会导致 NAFLD 进展仍存在争议。此外，目前尚不清楚哪种工具最适合评估 NAFLD 患者的饮酒量。本研究旨在评估使用不同方法（包括生物标志物乙醇膦酸酯（PEth））评估的适量饮酒是否与 NAFLD 中的晚期纤维化有关。
我们对经活检证实为 NAFLD 的患者进行了横断面研究。所有参与者均接受了病史、血液检查和人体测量学评估。使用血液中的 PEth、AUDIT-C 问卷和临床访谈评估饮酒量。
共纳入 86 例患者，其中 17%的患者存在晚期纤维化。所有参与者均报告每周饮酒量<140g。晚期纤维化组的平均每周饮酒量较高。独立于评估方法，适量饮酒与晚期纤维化的发生概率增加相关（调整后的 OR 5.5-9.7，95%CI 1.05-69.6）。与低量饮酒者相比，患有 2 型糖尿病（T2DM）且适量饮酒的患者晚期纤维化发生率显著更高（50.0-60.0%比 3.3-21.6%，p<0.05）。
无论评估方法（临床访谈、AUDIT-C 和 PEth）如何，适量饮酒均与晚期纤维化相关。血液中 PEth≥50ng/ml 可能是预示 NAFLD 晚期纤维化风险增加的生物标志物。患有 T2DM 且适量饮酒的患者晚期纤维化风险最高，表明胰岛素抵抗和酒精对 NAFLD 组织病理学进展有协同作用。
