Department of Internal Medicine III, Division of Gastroenterology & Hepatology, Medical University of Vienna, Vienna, Austria; Department of General Surgery, Division of Transplantation, Medical University of Vienna, Vienna, Austria.
Department of Internal Medicine, Krankenhaus Oberndorf, Teaching Hospital of the Paracelsus Private Medical University of Salzburg, Oberndorf, Austria.
J Hepatol. 2022 Oct;77(4):918-930. doi: 10.1016/j.jhep.2022.04.040. Epub 2022 May 20.
BACKGROUND & AIMS: Non-alcoholic fatty liver disease (NAFLD) and alcohol-related liver disease (ALD) cannot reliably be distinguished by routine diagnostics, and the role of alcohol consumption in metabolic dysfunction-associated fatty liver disease (MAFLD) remains unclear. We investigated alcohol consumption in patients with presumed NAFLD and ALD using novel objective alcohol markers.
In total, 184 consecutive patients were included in this prospective observational study. Alcohol intake was assessed by ethylglucuronide in hair (hEtG) and urine (uEtG); the utility of these measures for alcohol detection was compared to Alcohol Use Disorders Identification Test-Consumption (AUDIT-C), carbohydrate deficient transferrin (CDT), mean corpuscular volume (MCV), gamma-glutamyltransferase (GGT), and ALD/NAFLD index (ANI). Clinical characteristics of patients with NAFLD and ALD were re-assessed after reclassification based on repeated moderate (≥10 g <60 g EtOH/day) and excessive (≥60 g EtOH/day) alcohol consumption, and patients were retrospectively reclassified based on MAFLD criteria.
Repeated moderate to excessive alcohol consumption was detected in 28.6%, 28.5%, and 25.0% of patients with presumed NAFLD, ALD or MAFLD, respectively. ANI score, AUDIT-C, uEtG, and hEtG showed AUCs of 0.628, 0.733, 0.754, and 0.927 for the detection of repeated moderate to excessive alcohol consumption, respectively. The indirect markers CDT, MCV and GGT were not reliable. Patients with repeated moderate or excessive alcohol consumption were significantly more often male, had a significantly lower BMI, and suffered significantly less often from type 2 diabetes or impaired glucose tolerance.
In total, 28.6% of patients with presumed NAFLD, and 25.0% with MAFLD are at risk of alcohol-related liver damage. AUDIT-C, uEtG and hEtG should be used to screen for alcohol consumption in patients with fatty liver disease.
Fatty liver disease can be caused by metabolic factors and/or alcohol consumption. The diagnosis of non-alcoholic fatty liver disease (NAFLD) is based on the exclusion of harmful alcohol consumption, while metabolic dysfunction-associated fatty liver disease (MAFLD), which has been proposed as a new name for NAFLD, is based on the presence of metabolic comorbidities and allows for alcohol consumption. Herein, we show that up to 29% of patients diagnosed with NAFLD and 25% with MAFLD are at risk of alcohol-related liver damage. We show that ethyl glucuronide (a metabolite of alcohol) in the hair and urine can accurately detect potentially harmful alcohol consumption in these patients - as such, these tests should be integrated into routine diagnostic work-up for patients with fatty liver disease.
非酒精性脂肪性肝病（NAFLD）和酒精性肝病（ALD）不能通过常规诊断可靠地区分，酒精摄入在代谢功能障碍相关脂肪性肝病（MAFLD）中的作用仍不清楚。我们使用新型客观酒精标志物研究了疑似 NAFLD 和 ALD 患者的酒精摄入情况。
共纳入 184 例连续患者进行前瞻性观察性研究。通过毛发（hEtG）和尿液（uEtG）中的乙基葡萄糖醛酸苷（EtG）评估酒精摄入量；将这些措施用于酒精检测的效用与酒精使用障碍识别测试-摄入量（AUDIT-C）、转铁蛋白缺乏（CDT）、平均红细胞体积（MCV）、γ-谷氨酰转移酶（GGT）和酒精性肝病/非酒精性肝病指数（ANI）进行了比较。根据重复的中等（≥10 g <60 g EtOH/天）和过量（≥60 g EtOH/天）酒精摄入对 NAFLD 和 ALD 患者重新分类后，重新评估其临床特征，并根据 MAFLD 标准对患者进行回顾性重新分类。
分别有 28.6%、28.5%和 25.0%的疑似 NAFLD、ALD 或 MAFLD 患者检测到重复的中等至过量酒精摄入。ANI 评分、AUDIT-C、uEtG 和 hEtG 检测重复中等至过量酒精摄入的 AUC 分别为 0.628、0.733、0.754 和 0.927。间接标志物 CDT、MCV 和 GGT 不可靠。重复中等或过量饮酒的患者中，男性明显更多，BMI 明显更低，2 型糖尿病或糖耐量受损的发生率明显更低。
在疑似 NAFLD 患者中，有 28.6%，在 MAFLD 患者中，有 25.0%存在酒精性肝损伤的风险。AUDIT-C、uEtG 和 hEtG 应用于筛查脂肪性肝病患者的饮酒情况。
非酒精性脂肪性肝病（NAFLD）可由代谢因素和/或酒精摄入引起。NAFLD 的诊断基于排除有害的酒精摄入，而代谢功能障碍相关脂肪性肝病（MAFLD）是 NAFLD 的新名称，基于代谢合并症的存在并允许酒精摄入。在此，我们发现高达 29%的 NAFLD 患者和 25%的 MAFLD 患者有发生酒精性肝损伤的风险。我们发现，毛发和尿液中的乙基葡萄糖醛酸（酒精的代谢产物）可以准确检测到这些患者中潜在的有害酒精摄入-因此，这些检测应纳入脂肪性肝病患者的常规诊断。
