Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.
BMJ Open. 2022 Jan 4;12(1):e049767. doi: 10.1136/bmjopen-2021-049767.
Liver disease is a leading cause of premature death, partly driven by the increasing incidence of non-alcohol-related fatty liver disease (NAFLD). Many people with a diagnosis of NAFLD drink moderate amounts of alcohol. There is limited guidance for clinicians looking to advise these patients on the effect this will have on their liver disease progression. This review synthesises the evidence on moderate alcohol consumption and its potential to predict liver disease progression in people with diagnosed NAFLD.
A systematic review of longitudinal observational cohort studies was conducted. Databases (Medline, Embase, The Cochrane Library and ClinicalTrials.gov) were searched up to September 2020. Studies were included that reported progression of liver disease in adults with NAFLD, looking at moderate levels of alcohol consumption as the exposure of interest. Risk of bias was assessed using the Quality in Prognostic factor Studies tool.
Of 4578 unique citations, 6 met the inclusion criteria. Pooling of data was not possible due to heterogeneity and studies were analysed using narrative synthesis. Evidence suggested that any level of alcohol consumption is associated with worsening of liver outcomes in NAFLD, even for drinking within recommended limits. Well conducted population based studies estimated up to a doubling of incident liver disease outcomes in patients with NAFLD drinking at moderate levels.
This review found that any level of alcohol intake in NAFLD may be harmful to liver health.Study heterogeneity in definitions of alcohol exposure as well as in outcomes limited quantitative pooling of results. Use of standardised definitions for exposure and outcomes would support future meta-analysis.Based on this synthesis of the most up to date longitudinal evidence, clinicians seeing patients with NAFLD should currently advise abstinence from alcohol.
The protocol was registered with PROSPERO (#CRD42020168022).
肝脏疾病是导致过早死亡的主要原因之一，部分原因是与非酒精性脂肪性肝病（NAFLD）相关的发病率不断上升。许多被诊断为 NAFLD 的人都适度饮酒。对于希望就这对他们的肝脏疾病进展的影响向这些患者提供建议的临床医生来说，目前的指导有限。本综述综合了关于适度饮酒及其对诊断为 NAFLD 的人群肝脏疾病进展预测的潜在影响的证据。
对纵向观察性队列研究进行了系统评价。检索了数据库（Medline、Embase、The Cochrane Library 和 ClinicalTrials.gov），检索时间截至 2020 年 9 月。研究报告了 NAFLD 成年人肝脏疾病进展的情况，将适度饮酒作为感兴趣的暴露因素。使用预后因素研究质量工具评估偏倚风险。
在 4578 篇独特的引用中，有 6 篇符合纳入标准。由于异质性，无法对数据进行汇总，因此使用叙述性综合分析对研究进行了分析。证据表明，即使在推荐范围内饮酒，任何水平的酒精摄入都与 NAFLD 患者肝脏结局的恶化有关。精心设计的基于人群的研究估计，在 NAFLD 患者中，即使适度饮酒，也会使肝脏疾病的发生率增加一倍。
本综述发现，NAFLD 患者摄入任何水平的酒精都可能对肝脏健康有害。酒精暴露的定义以及结局的异质性限制了结果的定量汇总。使用标准化的暴露和结局定义将支持未来的荟萃分析。基于对最新纵向证据的综合分析，目前临床医生在诊治 NAFLD 患者时应建议其戒酒。
PROSPERO 注册号：该方案在 PROSPERO 注册（#CRD42020168022）。
