Division of Gastroenterology and Hepatology, Department of Medicine, University of California, San Francisco, San Francisco, California, USA.
Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA.
Alcohol Clin Exp Res. 2022 Jan;46(1):87-99. doi: 10.1111/acer.14743. Epub 2021 Nov 23.
Alcohol, insulin resistance (IR), and hepatitis C (HCV) are all significant contributors to adverse outcomes of chronic liver disease. Latinos are disproportionately affected by these risk factors. We investigated the relationship between alcohol use and insulin action in a prospective cohort of Latino individuals with and without HCV.
One hundred fifty-three nondiabetic Latino individuals (60 HCV+, 93 HCV-) underwent clinical evaluation and metabolic testing; 56 had repeat testing over a median follow-up of 1.5 years. Peripheral IR and hepatic IR were measured via steady-state plasma glucose (SSPG) and endogenous glucose production during a two-step, 240-min insulin suppression test. Insulin secretion (IS) was measured using the graded glucose infusion test. Alcohol use was categorized as none, moderate (≤1 drink/day for women and ≤2 drinks/day for men), and heavy (>moderate). Multivariable models including HCV status assessed associations of alcohol use with baseline SSPG, hepatic IR and IS, and changes in these parameters over time.
Overall, the median age was 44 years, 63.4% were male, 66.7% overweight/ obese, and 31.9% had heavy lifetime alcohol use while 60.4% had moderate lifetime alcohol use. SSPG and IS were similar by levels of alcohol use at baseline and alcohol use was not statistically significantly associated with change in these measures over time. However, lifetime daily heavy alcohol use (vs. not heavy, coef 2.4 μU-mg/kg-min-ml, p = 0.04) and HCV status (coef 4.4 μU-mg/kg-min-ml, p = 0.0003) were independently associated with higher baseline hepatic IR, and current heavy alcohol use was associated with greater change in hepatic IR in follow-up (coef 5.8 μU-mg/kg-min-ml, p = 0.03).
In this cohort of Latino individuals, lifetime and current heavy alcohol use influenced hepatic IR and its change over time. Strategies to decrease rates of heavy alcohol use or increase abstinence along with lifestyle modification and anti-HCV therapy to reduce metabolic risk are critical to prevent adverse liver and metabolic outcomes in Latino individuals.
酒精、胰岛素抵抗（IR）和丙型肝炎（HCV）都是导致慢性肝病不良后果的重要因素。拉丁裔人群受这些风险因素的影响不成比例。我们在一个有和没有 HCV 的拉丁裔个体的前瞻性队列中研究了酒精使用与胰岛素作用之间的关系。
153 名非糖尿病拉丁裔个体（60 名 HCV+，93 名 HCV-）接受了临床评估和代谢测试；56 名个体在中位数为 1.5 年的随访中进行了重复测试。通过稳态血糖（SSPG）和两步 240 分钟胰岛素抑制试验期间的内源性葡萄糖产生来测量外周胰岛素抵抗和肝胰岛素抵抗。使用分级葡萄糖输注试验测量胰岛素分泌（IS）。酒精使用分为无、中度（女性≤1 份/天，男性≤2 份/天）和重度（>中度）。包括 HCV 状态的多变量模型评估了酒精使用与基线 SSPG、肝胰岛素抵抗和 IS 以及这些参数随时间的变化之间的关联。
总体而言，中位年龄为 44 岁，63.4%为男性，66.7%超重/肥胖，31.9%有终生重度饮酒史，60.4%有中度饮酒史。在基线时，酒精使用水平与 SSPG 和 IS 相似，酒精使用与这些措施随时间的变化没有统计学上的显著相关性。然而，终生每日重度饮酒（vs. 不重度，系数 2.4 μU-mg/kg-min-ml，p=0.04）和 HCV 状态（系数 4.4 μU-mg/kg-min-ml，p=0.0003）与较高的基线肝胰岛素抵抗独立相关，目前的重度饮酒与随访中肝胰岛素抵抗的变化更大（系数 5.8 μU-mg/kg-min-ml，p=0.03）。
在这个拉丁裔个体队列中，终生和当前的重度饮酒影响肝胰岛素抵抗及其随时间的变化。减少重度饮酒率或增加戒酒率、改变生活方式以及抗 HCV 治疗以降低代谢风险的策略对于预防拉丁裔个体的不良肝脏和代谢后果至关重要。
