Alcohol intake and insulin resistance. A cross-sectional study

Reduced Alcohol Consumption and Major Adverse Cardiovascular Events Among Individuals With Previously High Alcohol Consumption

Importance

Cardiovascular benefits of mild to moderate alcohol consumption need to be validated in the context of behavioral changes. The benefits of reduced alcohol consumption among people who drink heavily across different subtypes of cardiovascular disease (CVD) are unclear.

Objective

To investigate the association between reduced alcohol consumption and risk of major adverse cardiovascular events (MACEs) in individuals who drink heavily across different CVD subtypes.

Design, Setting, and Participants

This cohort study analyzed data from the Korean National Health Insurance Service-Health Screening database and self-reported questionnaires. The nationally representative cohort comprised Korean citizens aged 40 to 79 years who had national health insurance coverage on December 31, 2002, and were included in the 2002 to 2003 National Health Screening Program. People who drank heavily who underwent serial health examinations over 2 consecutive periods (first period: 2005-2008; second period: 2009-2012) were included and analyzed between February and May 2023. Heavy drinking was defined as more than 4 drinks (56 g) per day or more than 14 drinks (196 g) per week for males and more than 3 drinks (42 g) per day or more than 7 drinks (98 g) per week for females.

Exposures

Habitual change in heavy alcohol consumption during the second health examination period. People who drank heavily at baseline were categorized into 2 groups according to changes in alcohol consumption during the second health examination period as sustained heavy drinking or reduced drinking.

Main Outcomes and Measures

The primary outcome was the occurrence of MACEs, a composite of nonfatal myocardial infarction or angina undergoing revascularization, any stroke accompanied by hospitalization, and all-cause death.

Results

Of the 21 011 participants with heavy alcohol consumption at baseline (18 963 males [90.3%]; mean [SD] age, 56.08 [6.16] years) included in the study, 14 220 (67.7%) sustained heavy drinking, whereas 6791 (32.2%) shifted to mild to moderate drinking. During the follow-up of 162 378 person-years, the sustained heavy drinking group experienced a significantly higher incidence of MACEs than the reduced drinking group (817 vs 675 per 100 000 person-years; log-rank P = .003). Reduced alcohol consumption was associated with a 23% lower risk of MACEs compared with sustained heavy drinking (propensity score matching hazard ratio [PSM HR], 0.77; 95% CI, 0.67-0.88). These benefits were mostly accounted for by a significant reduction in the incidence of angina (PSM HR, 0.70; 95% CI, 0.51-0.97) and ischemic stroke (PSM HR, 0.66; 95% CI, 0.51-0.86). The preventive attributes of reduced alcohol intake were consistently observed across various subgroups of participants.

Conclusions and Relevance

Results of this cohort study suggest that reducing alcohol consumption is associated with a decreased risk of future CVD, with the most pronounced benefits expected for angina and ischemic stroke.

Targeting Peroxisome Proliferator-Activated Receptor-β/δ (PPARβ/δ) for the Treatment or Prevention of Alcoholic Liver Disease

Excessive, chronic alcohol consumption can lead to alcoholic liver disease. The etiology of alcoholic liver disease is multifactorial and is influenced by alterations in gene expression and changes in fatty acid metabolism, oxidative stress, and insulin resistance. These events can lead to steatosis, fibrosis, and eventually to cirrhosis and liver cancer. Many of these functions are regulated by peroxisome proliferator-activated receptors (PPARs). Thus, it is not surprising that PPARs can modulate the mechanisms that cause alcoholic liver disease. While the roles of PPARα and PPARγ are clearer, the role of PPARβ/δ in alcoholic liver disease requires further clarification. This review summarizes the current understanding based on recent studies that indicate that PPARβ/δ can likely be targeted for the treatment and/or the prevention of alcoholic liver disease.

Insulin Resistance as a Common Link Between Current Alzheimer's Disease Hypotheses

Almost 115 years ago, Alois Alzheimer described Alzheimer's disease (AD) for the first time. Since then, many hypotheses have been proposed. However, AD remains a severe health public problem. The current medical approaches for AD are limited to symptomatic interventions and the complexity of this disease has led to a failure rate of approximately 99.6%in AD clinical trials. In fact, no new drug has been approved for AD treatment since 2003. These failures indicate that we are failing in mimicking this disease in experimental models. Although most studies have focused on the amyloid cascade hypothesis of AD, the literature has made clear that AD is rather a multifactorial disorder. Therefore, the persistence in a single theory has resulted in lost opportunities. In this review, we aim to present the striking points of the long scientific path followed since the description of the first AD case and the main AD hypotheses discussed over the last decades. We also propose insulin resistance as a common link between many other hypotheses.

Impact of High Fat Diet and Ethanol Consumption on Neurocircuitry Regulating Emotional Processing and Metabolic Function

The prevalence of psychiatry disorders such as anxiety and depression has steadily increased in recent years in the United States. This increased risk for anxiety and depression is associated with excess weight gain, which is often due to over-consumption of western diets that are typically high in fat, as well as with binge eating disorders, which often overlap with overweight and obesity outcomes. This finding suggests that diet, particularly diets high in fat, may have important consequences on the neurocircuitry regulating emotional processing as well as metabolic functions. Depression and anxiety disorders are also often comorbid with alcohol and substance use disorders. It is well-characterized that many of the neurocircuits that become dysregulated by overconsumption of high fat foods are also involved in drug and alcohol use disorders, suggesting overlapping central dysfunction may be involved. Emerging preclinical data suggest that high fat diets may be an important contributor to increased susceptibility of binge drug and ethanol intake in animal models, suggesting diet could be an important aspect in the etiology of substance use disorders. Neuroinflammation in pivotal brain regions modulating metabolic function, food intake, and binge-like behaviors, such as the hypothalamus, mesolimbic dopamine circuits, and amygdala, may be a critical link between diet, ethanol, metabolic dysfunction, and neuropsychiatric conditions. This brief review will provide an overview of behavioral and physiological changes elicited by both diets high in fat and ethanol consumption, as well as some of their potential effects on neurocircuitry regulating emotional processing and metabolic function.

Access schedules mediate the impact of high fat diet on ethanol intake and insulin and glucose function in mice

Alcoholism and high fat diet (HFD)-induced obesity individually promote insulin resistance and glucose intolerance in clinical populations, increasing risk for metabolic diseases. HFD can also stimulate alcohol intake in short-term clinical studies. Unfortunately, there is currently a disconnect between animal models and the clinical findings, as animal studies typically show that HFD decreases ethanol intake while ethanol intake mitigates HFD-induced effects on insulin and glucose dysfunction. However, most previous animal studies utilized forced or continuous HFD and/or ethanol. In three experiments we sought to determine whether HFD (HFD = 60% calories from fat) vs. control diet (chow = 16% fat) alters voluntary two-bottle choice ethanol intake in male C57Bl/6J mice given differing access schedules for 6-7 weeks, and we assessed the resultant impact on metabolic function via insulin and glucose tolerance tests. Experiment 1: Unlimited Access Ethanol + HFD (UAE + HFD; n = 15; 10% ethanol v/v, ad libitum diet and ethanol) or UAE + Chow (n = 15). Experiment 2: Limited Access Ethanol + HFD (LAE + HFD; n = 15; ethanol = 4 h/day; 3 days/week, ad libitum diet) or LAE + Chow (n = 15) with increasing ethanol concentrations (10%, 15%, 20%). Experiment 3: Intermittent HFD with limited access to ethanol (iHFD-E; HFD = single 24-h session/week; ethanol = 4 h/day; 4 days/week) (n = 10). UAE + HFD mice consumed significantly less ethanol and were insulin-resistant and hyperglycemic compared with UAE + Chow mice. LAE + HFD mice consumed ethanol similarly to LAE + Chow mice, but exhibited hyperglycemia, insulin resistance, and glucose intolerance. iHFD-E mice displayed binge eating-like behaviors and consumed significantly more ethanol than mice given ad libitum chow or HFD. iHFD-E mice did not have significantly altered body composition, but developed insulin insensitivity and glucose intolerance. These findings suggest that access schedules influence HFD effects on ethanol consumption and resultant metabolic dysfunction, ethanol intake does not improve HFD-induced metabolic dysfunction, and binge eating-like behaviors can transfer to binge drinking behaviors.

Lifetime marijuana use in relation to insulin resistance in lean, overweight, and obese US adults

BACKGROUND

Obese individuals are more likely to show insulin resistance (IR). However, limited population studies on marijuana use with markers of IR have yielded mixed results. The aim of this study was to examine the association of marijuana use with IR in US adults with different body mass index (BMI) status.

METHODS

Data from the 2009 to 2016 National Health and Nutrition Examination Survey (NHANES) were abstracted. Minimal lifetime marijuana use was estimated using the duration of regular exposure and frequency of use. The association of marijuana use with both fasting insulin (FINS) and homeostasis model assessment of insulin resistance (HOMA-IR) was determined in lean, overweight, and obese individuals separately using generalized linear models. Interview weight years of data were used to account for the unequal probability of sampling and non-response.

RESULTS

Of all 129 509 adults aged 18 to 59 years, 50.3% were women. In current obese marijuana consumers, mean FINS in those with less than four uses per month was 52% (95% confidence interval [CI] 19%-71%) lower than in never users. In former obese consumers with eight or more uses per month and who stopped marijuana use <12 months ago, mean FINS was 47% (95% CI 18%-66%) lower than in never users. Mean FINS in those who quit marijuana 12 to 119 and 120 months and more prior the survey was 36% (95% CI 7%-57%) and 36% (95% CI 10%-54%) lower, respectively.

CONCLUSIONS

Marijuana use is associated with lower FINS and HOMA-IR in obese but not non-obese adults, even at low frequency of less than four uses per month. Former marijuana consumers with high lifetime use had significantly lower FINS levels that persisted, independent of the duration of time since last use.

Impact of Alcohol on Glycemic Control and Insulin Action

Alcohol has profound effects on tissue and whole-body fuel metabolism which contribute to the increased morbidity and mortality in individuals with alcohol use disorder. This review focuses on the glucose metabolic effects of alcohol, primarily in the muscle, liver and adipose tissue, under basal postabsorptive conditions and in response to insulin stimulation. While there is a relatively extensive literature in this area, results are often discordant and extrapolating between models and tissues is fraught with uncertainty. Comparisons between data generated in experimental cell and animals systems will be contrasted with that obtained from human subjects as often times results differ. Further, the nutritional status is also an important component of the sometimes divergent findings pertaining to the effects of alcohol on the regulation of insulin and glucose metabolism. This work is relevant as the contribution of alcohol intake to the development or exacerbation of type 2 diabetes remains ill-defined and a multi-systems approach is likely needed as both alcohol and diabetes affect multiple targets within the body.

Association between alcohol consumption and risk of cardiovascular disease and all-cause mortality in patients with hypertension: a meta-analysis of prospective cohort studies

OBJECTIVE

To conduct a meta-analysis summarizing the risk of cardiovascular disease (CVD) and all-cause mortality (ACM) in relation to alcohol consumption in patients with hypertension, focusing on clarifying dose-response associations.

PATIENTS AND METHODS

PubMed and EMBASE were searched for eligible prospective cohort studies from December 3, 1949, through January 18, 2014. The semi-parameter method and dose-response analysis were used.

RESULTS

Nine studies (11 cohorts) were included in the meta-analysis. Compared with the lowest alcohol level (abstainers/occasional drinkers), the pooled relative risk (RR) was 0.72 (95% CI, 0.68-0.77) for the third highest category (median, 10 g/d), 0.81 (95% CI, 0.71-0.93) for the second highest category (median, 20 g/d), and 0.60 (95% CI, 0.54-0.67) for the highest category (median, 30 g/d). A J-shaped relationship between alcohol use and ACM was observed, and the nadir (RR, 0.82; 95% CI, 0.76-0.88) was found to be at a dose of 8 to 10 g of alcohol consumption per day.

CONCLUSION

Findings of this meta-analysis suggest that low-to-moderate alcohol consumption was inversely significantly associated with the risk of CVD and ACM in patients with hypertension.

Flushing response modifies the association of alcohol consumption with markers of glucose metabolism in Japanese men and women

BACKGROUND

Influences of alcohol use on glucose metabolism may depend on alcohol flushing response. We investigated the effect of alcohol flushing response on the associations between alcohol consumption and markers of glucose metabolism in Japanese men and women.

METHODS

The subjects were 979 employees (885 men and 94 women), aged 18 to 69 years, of a manufacturing company in Japan. Flushing response and alcohol consumption were determined using a self-administered questionnaire. Homeostasis model assessment-insulin resistance (HOMA-IR) and homeostasis model assessment for β-cell function (HOMA-β) were computed using fasting plasma glucose and insulin. For each group of flushers and nonflushers, multiple regression analysis was used to estimate means of fasting plasma glucose, hemoglobin A1c (HbA1c), and HOMAs for each category of alcohol consumption, with adjustments for potential confounders.

RESULTS

In flushers, alcohol consumption was associated with HbA1c levels in a U-shaped manner, with the lowest HbA1c levels being observed at an alcohol consumption level of 23.0 to <34.5 g ethanol/d (p for quadratic trend = 0.002). In nonflushers, alcohol consumption was linearly and inversely associated with HbA1c levels (p for linear trend = 0.001). Decreases in HbA1c were more evident among flushers compared with nonflushers at moderate alcohol consumption levels (p for interaction = 0.049). An increase of fasting glucose associated with highest alcohol consumption was observed in both flushers and nonflushers. A statistically significant decrease in HOMA-IR with increasing alcohol consumption was observed in flushers (p for trend = 0.007), whereas HOMA-IR levels slightly decreased at higher alcohol consumption in nonflushers. HOMA-β similarly decreased with increasing alcohol consumption in both flushers and nonflushers (both p for trend < 0.001).

CONCLUSIONS

The results suggest that the alcohol flushing response may improve glucose metabolism and insulin resistance at moderate alcohol use levels in apparently healthy Japanese adults.

Alcohol consumption and atherosclerotic burden in the proximal thoracic aorta

BACKGROUND

The relationship between alcohol consumption and ischemic stroke or aortic atherosclerosis is unclear, but a protective effect of moderate consumption on stroke risk has been suggested. We conducted a cross-sectional analysis in a population-based sample to evaluate the possible association between alcohol consumption and aortic atherosclerotic plaque (AAP), which is associated with increased stroke risk.

METHODS

As part of the NINDS-funded Aortic Plaques and Risk of Ischemic Stroke (APRIS) study, 464 subjects over the age of 55 were studied (mean age 69.1 ± 9.0 with 251 males and 213 females), including 255 patients with first ischemic stroke and 209 stroke-free controls. Transesophageal echocardiogram was performed for the detection of AAP. Alcohol consumption was measured in number of drinks per week during the previous year using a standardized questionnaire, and categorized as: (1) none or minimal (<1 drink per month); (2) light to moderate (between 1 drink per month and 2 drinks daily); and (3) heavy (>2 daily). Multivariate conditional logistic regression analysis was used to calculate the odds ratios (ORs) and 95% confidence interval (CI) for alcohol consumption and AAP after adjustment for the potential confounding risk factors (age, sex, hypertension, diabetes, dyslipidemia, and cigarette smoking).

RESULTS

Overall, AAP was detected in 326 subjects (70.4%), and 174 subjects (37.6%) had AAP ≥ 4 mm, which carry higher stroke risk. No or minimal alcohol consumption was present in 241 subjects (53.2%), and 177 subjects (39.0%) had light to moderate consumption. Prevalence of light to moderate alcohol consumption was significantly lower in stroke patients than in controls (35.5% vs. 60.3%, p < 0.001) and in subjects who had AAP compared with those without it (41.6% vs. 58.8%, p = 0.008). After adjusting for significant predictors of atherosclerosis, alcohol consumption of any degree was inversely associated with AAP (OR 0.61; 95% CI 0.37-0.98, p = 0.042). The significance of the association was borderline for AAP ≥ 4 mm (OR 0.64, 95% CI 0.41-1.00, p = 0.054). In the dose-response analysis, only light to moderate alcohol consumption was significantly associated with a lower risk of having any AAP (adjusted OR 0.45; 95% CI 0.29-0.68, p < 0.001) or AAP ≥ 4 mm (adjusted OR 0.51; 95% CI 0.34-0.77, p = 0.001).

CONCLUSIONS

Our data indicate that light to moderate alcohol consumption is associated with lower atherosclerotic burden in the proximal aortic arch. This observation may explain at least in part the lower risk of ischemic stroke observed in moderate alcohol consumers.

Prevalence and determinants of metabolic syndrome according to three definitions in middle-aged Chinese men

BACKGROUND

The prevalence of metabolic syndrome has varied markedly between different studies because of the lack of internationally agreed-upon criteria to define the condition. We estimated the prevalence and lifestyle risk factors of metabolic syndrome according to three definitions of metabolic syndrome in urban Chinese men participating in the Shanghai Men's Health Study (SMHS).

METHODS

In this cross-sectional study, 3988 middle-aged, urban Chinese men 40-74 years of age who were free of type 2 diabetes at baseline provided fasting blood samples, anthropometric measurements, and information on lifestyle factors and disease history.

RESULTS

The three definitions of metabolic syndrome used in this report are from the International Diabetes Federation (IDF), the U.S. Third Report of the National Cholesterol Education Program, Adult Treatment Panel (ATP III), and a modified version of the ATP III criteria for Asian populations (ATP III-modified criteria). The prevalence of metabolic syndrome was 18.63%, 18.36%, and 29.34% according to IDF, ATP III, and ATP III-modified criteria, respectively. Agreement between the IDF and ATP III criteria was moderate (kappa = 0.43), whereas agreement between ATP III-modified and the IDF and ATP III criteria was good (kappa = 0.71 and 0.70, respectively). Physical activity was associated with a lower prevalence of metabolic syndrome, whereas drinking more than three drinks per day was associated with a higher risk of metabolic syndrome, regardless of the criteria employed. The association between smoking and the prevalence of metabolic syndrome in this population failed to reach significance.

CONCLUSIONS

Results from this representative sample of middle-aged, urban Chinese men show that metabolic syndrome is highly prevalent in this population. Our data support the hypothesis that physical activity decreases the risk of developing metabolic syndrome and that high alcohol consumption increases risk.

Alcohol consumption and mortality in patients with cardiovascular disease: a meta-analysis

OBJECTIVES

The purpose of this study was to quantify the relation between alcohol consumption and cardiovascular and total mortality in patients with a history of cardiovascular events.

BACKGROUND

Regular, moderate alcohol consumption by healthy people is associated with lower cardiovascular and all-cause mortality. No extensive meta-analysis is presently available on the possible association of alcohol consumption with secondary events in patients with cardiovascular disease.

METHODS

Articles were retrieved through October 2009 by search in PubMed and EMBASE. Fifty-four publications were identified, but only 8 were selected for our analyses, including 16,351 patients with a history of cardiovascular disease. Secondary events were cardiovascular or all-cause mortality. All selected studies were prospective. Data were pooled with a weighted, least-squares regression analysis of second-order fractional polynomial models.

RESULTS

The meta-analysis on cardiovascular mortality showed a J-shaped pooled curve with a significant maximal protection (average 22%) by alcohol at approximately 26 g/day. In the meta-analysis on mortality for any cause, J-shaped pooled curves were observed in the overall analysis (average maximal protection of 18% in the range of 5 to 10 g/day) and in all subgroups according to either the type of patients or the characteristics of the studies.

CONCLUSIONS

In patients with cardiovascular disease, light to moderate alcohol consumption (5 to 25 g/day) was significantly associated with a lower incidence of cardiovascular and all-cause mortality.

Alcohol consumption is associated with decreased insulin resistance independent of body mass index in Japanese community-dwelling men

Alcohol consumption is associated with a decreased risk of type II diabetes and cardiovascular diseases. However, there is a great deal of controversy concerning the relationship between alcohol consumption and insulin resistance. This association may be further confounded by an increase in body weight levels. The aim of this study was to determine whether alcohol consumption promotes insulin resistance according to body weight levels in community-dwelling men. Study participants without a clinical history of stroke, transient ischemic attack, myocardial infarction, angina or diabetes were randomly recruited from a single community at the time of their annual health examination (678 men aged 59 +/- 14 years). They were classified into never drinkers, light drinkers [< 1 unit (22.9 g ethanol)/day], moderate drinkers (1-1.9 unit/day), and heavy drinkers (> or = 2 unit/day), and further divided into underweight [body mass index (BMI) < 23 kg/m(2)] or overweight (BMI > or = 23.0 kg/m(2)). Insulin resistance was estimated on the basis of the homeostasis model assessment of insulin resistance (HOMA-IR), and HOMA-IR and potential confounders were compared between the groups. The confounders included age, BMI, smoking status, serum gamma glutamyltransferase, and high molecular-weight adiponectin. In the overall, HOMA-IR is significantly correlated with age, BMI, serum gamma glutamyltransferase, and high molecular-weight adiponectin. After adjustment for potential confounders, mean log HOMA-IR is significantly lower in the heavy drinkers irrespective of BMI categories. In conclusion, alcohol consumption is associated with decreased insulin resistance independent of BMI in Japanese community-dwelling men.

Lifestyle-induced metabolic inflexibility and accelerated ageing syndrome: insulin resistance, friend or foe?

The metabolic syndrome may have its origins in thriftiness, insulin resistance and one of the most ancient of all signalling systems, redox. Thriftiness results from an evolutionarily-driven propensity to minimise energy expenditure. This has to be balanced with the need to resist the oxidative stress from cellular signalling and pathogen resistance, giving rise to something we call 'redox-thriftiness'. This is based on the notion that mitochondria may be able to both amplify membrane-derived redox growth signals as well as negatively regulate them, resulting in an increased ATP/ROS ratio. We suggest that 'redox-thriftiness' leads to insulin resistance, which has the effect of both protecting the individual cell from excessive growth/inflammatory stress, while ensuring energy is channelled to the brain, the immune system, and for storage. We also suggest that fine tuning of redox-thriftiness is achieved by hormetic (mild stress) signals that stimulate mitochondrial biogenesis and resistance to oxidative stress, which improves metabolic flexibility. However, in a non-hormetic environment with excessive calories, the protective nature of this system may lead to escalating insulin resistance and rising oxidative stress due to metabolic inflexibility and mitochondrial overload. Thus, the mitochondrially-associated resistance to oxidative stress (and metabolic flexibility) may determine insulin resistance. Genetically and environmentally determined mitochondrial function may define a 'tipping point' where protective insulin resistance tips over to inflammatory insulin resistance. Many hormetic factors may induce mild mitochondrial stress and biogenesis, including exercise, fasting, temperature extremes, unsaturated fats, polyphenols, alcohol, and even metformin and statins. Without hormesis, a proposed redox-thriftiness tipping point might lead to a feed forward insulin resistance cycle in the presence of excess calories. We therefore suggest that as oxidative stress determines functional longevity, a rather more descriptive term for the metabolic syndrome is the 'lifestyle-induced metabolic inflexibility and accelerated ageing syndrome'. Ultimately, thriftiness is good for us as long as we have hormetic stimuli; unfortunately, mankind is attempting to remove all hormetic (stressful) stimuli from his environment.

The cumulative effect of core lifestyle behaviours on the prevalence of hypertension and dyslipidemia

BACKGROUND

Most cardiovascular disease (CVD) occurs in the presence of traditional risk factors, including hypertension and dyslipidemia, and these in turn are influenced by behavioural factors such as diet and lifestyle. Previous research has identified a group at low risk of CVD based on a cluster of inter-related factors: body mass index (BMI) < 25 Kg/m2, moderate exercise, alcohol intake, non-smoking and a favourable dietary pattern. The objective of this study was to determine whether these factors are associated with a reduced prevalence of hypertension and dyslipidemia in an Irish adult population.

METHODS

The study was a cross-sectional survey of 1018 men and women sampled from 17 general practices. Participants completed health, lifestyle and food frequency questionnaires and provided fasting blood samples for analysis of glucose and insulin. We defined a low risk group based on the following protective factors: BMI <25 kg/m2; waist-hip ratio (WHR) <0.85 for women and <0.90 for men; never smoking status; participants with medium to high levels of physical activity; light alcohol consumption (3.5-7 units of alcohol/week) and a "prudent" diet. Dietary patterns were assessed by cluster analysis.

RESULTS

We found strong significant inverse associations between the number of protective factors and systolic blood pressure, diastolic blood pressure and dyslipidemia. The prevalence odds ratio of hypertension in persons with 1, 2, 3, > or = 4 protective factors relative to those with none, were 1.0, 0.76, 0.68 and 0.34 (trend p < 0.01). The prevalence odds ratio of dyslipidemia in persons with 1, 2, 3, > or = 4 protective factors relative to those with none were 0.83, 0.98, 0.49 and 0.24 (trend p = 0.001).

CONCLUSION

Our findings of a strong inverse association between low risk behaviours and two of the traditional risk factors for CVD highlight the importance of 'the causes of the causes' and the potential for behaviour modification in CVD prevention at a population level.

Assessment of liver fibrosis progression in patients with chronic hepatitis C and normal alanine aminotransferase values: the role of AST to the platelet ratio index

OBJECTIVES

To verify the value of indirect serum markers in the non-invasive assessment of liver fibrosis in patients with persistently normal or near normal alanine aminotransferases levels (NALT).

DESIGN AND METHODS

Forty HCV RNA positive, untreated patients with NALT (30 non-drinkers) underwent two liver biopsies, with a median interval of 78.5 months. The AST/ALT ratio, age-platelet index, AST to platelet ratio index (APRI), Forns fibrosis index and Bonacini's discriminant score were simultaneously determined.

RESULTS

In 19 patients, worsening of fibrosis was observed at the second biopsy in comparison to the index biopsy. Among non-drinkers, an APRI >0.4 had a 100% sensitivity in identifying subjects with significant liver fibrosis (Ishak staging score >2) and an APRI < or =0.4 had a 100% negative predictive value in excluding significant liver fibrosis.

CONCLUSIONS

APRI performs better, in comparison to all other markers, in correctly classifying patients with NALT with no progression to significant liver fibrosis.