Plethora of studies demonstrate that alcohol and obesity in combination can increase the risk of liver-related mortality. Moreover, obesity is observed to be a common finding in alcoholic hepatitis (AH) and is related to a greater than two-fold rise in short-term mortality. The authors of the current study investigated the effect of adiposity on clinical outcomes in AH and the underlying inflammatory association between adipose tissue (AT) and the liver.

The study included a cohort of 233 patients with AH to determine the effects of obesity in AH. Body mass index was modified for the severity of ascites, also known as cBMI. Inflammatory and metabolic profiling was assessed by proteome analysis of human serum samples. Moreover, the study also reviewed the effect of alcohol on adipose tissue and CXCL11 expression in 3 T3-derived adipocytes and in experimental animals using the high-fat diet-plus-binge ethanol model.

The outcome revealed that obesity was prevalent as was seen in 19% of individuals amongst patients. Obesity (HR 2.22, 95%CI 1.1–4.3) and underweight (HR 2.38, 1.00–5.6) were found to be independently correlated with mortality at 3 months. When evaluated with proteome analysis, several metabolic and inflammatory factors were found to be differentially expressed in obese AH in contrast to lean AH, with CXCL11 being the most increased factor in obese AH. Furthermore, in vitro examination of cultured adipocytes and in vivo investigation of experimental models revealed that alcohol did not have the potential to stimulate CXCL11 expression in liver, however it got triggered in AT.

The findings of the study showed that AH in obese is related with a numerous inflammatory phenotype, with the greater elevation seen in CXCL11. Therefore, it can be concluded that clinically, obesity is crucial in acute alcohol-related liver disease and clarifies the adipose-liver inflammatory axis in AH.

Source: Parker R, Kim SJ, Im GY, et al. Obesity in acute alcoholic hepatitis increases morbidity and mortality. EBioMedicine. 2019;45:511-518.