Non-alcoholic and alcohol-related fatty liver disease tend to overlap. Metabolic syndrome and alcohol consumption are known to have a role in progressive liver disease in these conditions.

A study was conducted to determine the impact of alcohol consumption and metabolic syndrome on mortality in individuals with fatty liver.

Investigators explored the National Health and Nutrition and Examination Survey III for adults (20–74 years old) with hepatic steatosis, identified by ultrasonography, for whom mortality and follow-up data were available. Data were obtained from the alcohol use questionnaire  - self-reported number of days a participant drank alcohol; the number of drinks [10 g alcohol] per day on a drinking day; the number of days the participant had 5 or more drinks. Investigators calculated the average alcohol consumption in drinks/day for all the participants during the year preceding enrolment.

Excessive alcohol consumption for men was characterized as >3 drinks/day and for women as >1.5 drinks/day. Besides aggregating clinical data, mortality data were accessed from the National Death Index. Investigators compared the demographic and clinical parameters among the consumption groups.

The study cohort included 4264 individuals with hepatic steatosis, with mean age 45.9 years. The cohort included 51% male subjects. About 46% of the cohort had metabolic syndrome and 6.2% had excessive alcohol use. There appeared to be no significant difference in mean age between individuals with, compared to without, excessive alcohol consumption. Overall mortality was shown to be significantly higher among participants with excessive alcohol consumption (32.2%) compared to those with non-excessive alcohol use (22.2%) after follow-up of a mean 20 years, as well as after 5 years of follow-up. The multivariate analysis revealed that the presence of metabolic syndrome and excessive alcohol consumption had an independent association with an increased risk of death in individuals with hepatic steatosis. Any lower average amount of alcohol consumption was found not to be linked with mortality. A subgroup analysis revealed a significant association of excessive alcohol consumption with mortality among those with metabolic syndrome (aHR, 2.46; 95% CI, 1.40–4.32), but not among without it (P=.74).

Alcohol consumption was thus shown to be associated with increased mortality in individuals with fatty liver and metabolic syndrome. There is an overlap between non-alcoholic and alcohol-related fatty liver disease, suggest the results.

Source: Younossi ZM, Stepanova M, Ong J, et al. Effects of Alcohol Consumption and Metabolic Syndrome on Mortality in Patients With Nonalcoholic and Alcohol-Related Fatty Liver Disease. Clinical Gastroenterology and Hepatology 2019;17(8):1625-33.e1.