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Metabolic factors combined with alcohol increase risk of severe liver disease

Alcoholic and non-alcoholic liver disease should not be considered separate entities, study suggests

Ingrid Torjesen

Wednesday, 22 November 2017

Multiple components of the metabolic syndrome affect the risk of severe liver disease in conjunction with alcohol consumption at levels that are typically not considered so great as to cause liver damage, a study* published in Hepatology shows.

Researchers at Helsinki University Hospital in Finland analysed follow-up data on 6,732 individuals without liver disease who participated in the Finnish population-based Health 2000 Study (2000-2001). They looked at liver-related hospital admissions, mortality, and liver cancer from national registers until 2013.

The results showed that 84 people experienced a severe liver event during follow-up. Factors predictive of liver events were older age, female gender, alcohol use, diabetes, LDL cholesterol, and insulin resistance. Among individuals who consumed higher amounts of alcohol (average alcohol use ≥210 g/week for men, ≥140 g/week for women), diabetes was the only significant predictor. Among those who consumed less or no alcohol, older age, alcohol use, smoking, abdominal obesity, LDL cholesterol, and insulin resistance were significant predictors.

Dr Fredrik Åberg, one of the researchers, noted that alcoholic liver disease (ALD) and non-alcoholic liver disease (NAFLD) are currently considered separate entities, distinguished from each other by an arbitrary threshold of average alcohol intake. This diagnostic approach assumes that alcohol intake does not affect the course of NAFLD and that the metabolic syndrome - the hallmark of NAFLD - is not a factor in ALD. However, Dr Åberg said that this study reveals that alcohol is a relevant risk factor even when alcohol consumption is within the limits currently used to separate NAFLD from ALD.

"We suggest that liver disease should perhaps not be considered in terms of mutually exclusive entities of ALD and NAFLD, because in a large number of patients with liver disease, the effect of alcohol is difficult, and sometimes impossible, to separate from the effect of metabolic factors," said Dr Åberg. "Our study brings support to this suggestion and calls for a more holistic approach, where alcohol use and metabolic factors are taken into account at the same time in order to identify individuals with a high risk for severe liver complications."

Dr Åberg also stressed that liver disease is often discovered at late stages and that the findings of the study could be used to "help improve risk assessment in the general population to detect at early stages individuals who are at high risk of progressive liver disease".

* Åberg F, Helenius-Hietala J, Puukka P, et al. Interaction between alcohol consumption and metabolic syndrome in predicting severe liver disease in the general population. Hepatology, 22 November 2017. DOI: 10.1002/hep.29631

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