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Åberg F, Puukka P, Salomaa V, Männistö S, Lundqvist A, Valsta L, Perola M, Färkkilä M, Jula A. Risks of Light and Moderate Alcohol Use in Fatty Liver Disease: Follow-Up of Population Cohorts. Hepatology 2020; 71:835-848. [PMID: 31323122 DOI: 10.1002/hep.30864] [Citation(s) in RCA: 100] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 07/09/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS The effects of alcohol use in nonalcoholic fatty liver disease are unclear. We investigated the impact of alcohol use in fatty liver disease on incident liver, cardiovascular, and malignant disease, as well as death. APPROACH AND RESULTS Our study comprised 8,345 persons with hepatic steatosis (fatty liver index >60) who participated in health-examination surveys (FINRISK 1992-2012 or Health 2000), with available data on baseline alcohol intake. Main exclusions were baseline clinical liver disease, viral hepatitis, ethanol intake >50 g/day, and current abstainers. Data were linked with national registers for hospital admissions, malignancies, and death regarding liver, cardiovascular, and malignant disease, as well as all-cause death. Adjustment were for multiple confounders. Alcohol consumption showed a dose-dependent risk increase for incident advanced liver disease and malignancies. Consuming 10-19 g/day of alcohol in general or 0-9 g/day as nonwine beverages doubled the risk for advanced liver disease compared to lifetime abstainers. In contrast, alcohol intake up to 49 g/day was associated with a 22%-40% reduction of incident cardiovascular disease (CVD). We observed a J-shaped association between alcohol intake and all-cause death with a maximal risk reduction of 21% (95% confidence interval, 5%-34%) at alcohol intake of 0-9 g/day compared to lifetime abstainers. However, these benefits on CVD and mortality were only observed in never smokers. Alcohol intake >30 g/day yielded increased risk estimates for mortality compared to lifetime abstainers. In a subpopulation with longitudinal data, alcohol intake remained stable over time in >80% of subjects. CONCLUSIONS Even low alcohol intake in fatty liver disease is associated with increased risks for advanced liver disease and cancer. Low to moderate alcohol use is associated with reduced mortality and CVD risk but only among never smokers.
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Affiliation(s)
- Fredrik Åberg
- Transplantation and Liver Surgery Clinic, Helsinki University Hospital, Helsinki University, Helsinki, Finland.,The Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Pauli Puukka
- National Institute for Health and Welfare, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Veikko Salomaa
- National Institute for Health and Welfare, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Satu Männistö
- National Institute for Health and Welfare, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Annamari Lundqvist
- National Institute for Health and Welfare, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Liisa Valsta
- National Institute for Health and Welfare, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Markus Perola
- National Institute for Health and Welfare, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Martti Färkkilä
- Clinic of Gastroenterology, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Antti Jula
- National Institute for Health and Welfare, Helsinki University and Helsinki University Hospital, Helsinki, Finland
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Petroni ML, Brodosi L, Marchignoli F, Musio A, Marchesini G. Moderate Alcohol Intake in Non-Alcoholic Fatty Liver Disease: To Drink or Not to Drink? Nutrients 2019; 11:E3048. [PMID: 31847199 PMCID: PMC6950084 DOI: 10.3390/nu11123048] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 12/06/2019] [Accepted: 12/10/2019] [Indexed: 12/13/2022] Open
Abstract
Nonalcoholic fatty liver disease (NAFLD) is defined by hepatic steatosis in the presence of alcohol intake within safe limits, defined by guidelines of scientific associations (usually 20 g or 2 units/day in women, 30 g or 3 units in men). The diagnosis is usually followed by medical counseling of total abstinence, in order to prevent disease progression. This policy has been challenged by epidemiological studies, suggesting that the risk of liver disease and disease progression is lower in modest drinkers than in total abstainers. We revised the literature on the effects of modest alcohol intake on disease burden. Epidemiological data may suffer from several potential biases (recall bias for retrospective analyses, difficulties in the calculation of g/day), limiting their validity. Prospective data suggest that NAFLD patients with regular alcohol intake, although within the safe thresholds, are at higher risk of liver disease progression, including hepatocellular carcinoma; a detrimental effect of modest alcohol drinking is similarly observed in liver disease of viral etiology. Alcohol intake is also a risk factor for extrahepatic cancers, particularly breast, oral, and pharyngeal cancers, with gender difference and no floor effect, which outweigh the possible beneficial effects on cardiovascular system, also derived from retrospective studies. Finally, the negative effects of the calorie content of alcohol on dietary restriction and weight loss, the pivotal intervention to reduce NAFLD burden, should be considered. In summary, the policy of counseling NAFLD patients for alcohol abstinence should be maintained.
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Affiliation(s)
- Maria L. Petroni
- Department of Medical and Surgical Sciences, “Alma Mater” University, Sant’Orsola-Malpighi Hospital, Via Massarenti 9, 1-40135 Bologna, Italy; (L.B.); (F.M.); (A.M.)
| | | | | | | | - Giulio Marchesini
- Department of Medical and Surgical Sciences, “Alma Mater” University, Sant’Orsola-Malpighi Hospital, Via Massarenti 9, 1-40135 Bologna, Italy; (L.B.); (F.M.); (A.M.)
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3
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Alcohol Consumption in Patients with Non-alcoholic Fatty Liver Disease: Convenient vs. Inconvenient Truths. Am J Gastroenterol 2018; 113:1437-1439. [PMID: 30166633 DOI: 10.1038/s41395-018-0237-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 07/18/2018] [Indexed: 12/11/2022]
Abstract
Understanding the role of modest alcohol consumption in patients with non-alcohol induced fatty liver disease (NAFLD) remains a significant challenge, with no clear guidance on counselling regarding alcohol use. Conventionally, the strong association of alcohol excess and development of complications related to chronic liver disease, including hepatocellular carcinoma, has led practitioners to advocate complete abstinence to those with NAFLD. New evidence published in this issue of the Red Journal challenges the historic paradigm by showing that modest, non-binge wine consumption (<70 g/week) associates with significantly lower risk of advanced hepatic fibrosis on biopsy compared with complete abstinence across a well-characterised single centre cohort of nearly 200 patients with NAFLD.
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Boyle M, Masson S, Anstee QM. The bidirectional impacts of alcohol consumption and the metabolic syndrome: Cofactors for progressive fatty liver disease. J Hepatol 2018; 68:251-267. [PMID: 29113910 DOI: 10.1016/j.jhep.2017.11.006] [Citation(s) in RCA: 105] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 10/30/2017] [Accepted: 11/01/2017] [Indexed: 12/12/2022]
Abstract
Current medical practice artificially dichotomises a diagnosis of fatty liver disease into one of two common forms: alcoholic liver disease (ALD) and non-alcoholic fatty liver disease (NAFLD). Together, these account for the majority of chronic liver diseases worldwide. In recent years, there has been a dramatic increase in the prevalence of obesity and metabolic syndrome within the general population. These factors now coexist with alcohol consumption in a substantial proportion of the population. Each exposure sensitises the liver to the injurious effects of the other; an interaction that drives and potentially accelerates the genesis of liver disease. We review the epidemiological evidence and scientific literature that considers how alcohol consumption interacts with components of the metabolic syndrome to exert synergistic or supra-additive effects on the development and progression of liver disease, before discussing how these interactions may be addressed in clinical practice.
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Affiliation(s)
- Marie Boyle
- Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom; Liver Unit, Newcastle Upon Tyne Hospitals NHS Trust, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Steven Masson
- Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom; Liver Unit, Newcastle Upon Tyne Hospitals NHS Trust, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Quentin M Anstee
- Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom; Liver Unit, Newcastle Upon Tyne Hospitals NHS Trust, Freeman Hospital, Newcastle upon Tyne, United Kingdom.
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Scotti L, Tavani A, Bosetti C, Maso LD, Talamini R, Montella M, Franceschi S, La Vecchia C. Diabetes and Risk of Non-Hodgkin Lymphoma: A Case-Control Study. TUMORI JOURNAL 2018; 93:1-3. [PMID: 17455863 DOI: 10.1177/030089160709300101] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Aims and background We investigated the relation between diabetes and the risk of non-Hodgkin lymphoma, as epidemiological results are controversial and diabetes has been related to the risk of several neoplasms. Patients and methods We analyzed the combined dataset of two Italian case-control studies conducted in 1985-1997 and 1999-2002. Cases were 671 patients, aged <85 years, with incident, histologically confirmed non-Hodgkin lymphoma, and controls were 1799 patients admitted to hospitals for acute non-neoplastic conditions. Odds ratios were estimated using unconditional multiple logistic regression models including terms for age, center, sex, residence and educational level. Results No material association between diabetes and non-Hodgkin lymphoma risk was observed, with an odds ratio of 1.12 (95% confidence intervals, 0.70-1.77). No association was found in relation to age at first diagnosis of diabetes, years since diagnosis, or in younger and older subjects at diagnosis of non-Hodgkin lymphoma. Conclusions The results of the study allow to exclude a strong association between diabetes and non-Hodgkin lymphoma, although the small number of cases with diabetes leaves open the possibility of a moderate direct relation.
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Affiliation(s)
- Lorenza Scotti
- Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
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Ajmera VH, Terrault NA, Harrison SA. Is moderate alcohol use in nonalcoholic fatty liver disease good or bad? A critical review. Hepatology 2017; 65:2090-2099. [PMID: 28100008 PMCID: PMC5444963 DOI: 10.1002/hep.29055] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 12/29/2016] [Accepted: 01/12/2017] [Indexed: 12/27/2022]
Abstract
Moderate alcohol consumption in patients with nonalcoholic fatty liver disease (NAFLD) is common, yet the effects on cardiovascular and liver health are unclear. Moderate alcohol use is associated with improved insulin sensitivity and decreased cardiovascular mortality in the general population, but whether similar benefits would be observed in persons with NAFLD remains largely unstudied. There is significant overlap in the pathogenesis of alcoholic liver disease (ALD) and NAFLD, although studies of ALD have focused on pathological alcohol intake and few mechanistic studies of moderate alcohol use in NAFLD exist. We undertook a critical review of the effect of moderate alcohol use on cardiovascular and liver disease in patients with NAFLD. A total of seven observational studies met the criteria for inclusion (one for cardiovascular endpoints and six for liver endpoints). Insufficient studies have assessed the association of moderate alcohol use with cardiovascular outcomes. There was a positive association between moderate alcohol use and decreased NASH and fibrosis; however, heavy episodic drinking may accelerate fibrosis progression and moderate alcohol use may increase the risk of hepatocellular carcinoma in patients with advanced fibrosis. Significant methodological limitations were present, including incomplete adjustment for confounding factors and failure to measure lifetime use or the pattern of alcohol intake. Thus, a strong recommendation of benefit of moderate alcohol use in NAFLD cannot be made. There remains a need for additional high-quality longitudinal studies that evaluate both cardiovascular and liver outcomes among NAFLD patients with moderate or lesser degrees of alcohol use. (Hepatology 2017;65:2090-2099).
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Affiliation(s)
- Veeral H. Ajmera
- Division of Gastroenterology, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Norah A. Terrault
- Division of Gastroenterology, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Stephen A. Harrison
- Division of Gastroenterology, Department of Medicine, San Antonio Military Medical Center, Fort Sam Houston, TX, United States
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Liu CC, Huang SP, Wu WJ, Chou YH, Juo S, Tsai LY, Huang CH, Wu MT. The Impact of Cigarette Smoking, Alcohol Drinking and Betel Quid Chewing on the Risk of Calcium Urolithiasis. Ann Epidemiol 2009; 19:539-45. [DOI: 10.1016/j.annepidem.2009.02.006] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2008] [Revised: 02/05/2009] [Accepted: 02/23/2009] [Indexed: 10/20/2022]
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8
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Lucenteforte E, Bosetti C, Talamini R, Montella M, Zucchetto A, Pelucchi C, Franceschi S, Negri E, Levi F, La Vecchia C. Diabetes and endometrial cancer: effect modification by body weight, physical activity and hypertension. Br J Cancer 2007; 97:995-8. [PMID: 17912243 PMCID: PMC2360421 DOI: 10.1038/sj.bjc.6603933] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Among 777 endometrial cancer cases and 1550 controls from Italy and Switzerland, odds ratio was 1.7 (95% confidence interval: 1.2–2.5) for diabetes, and 5.1 for obese diabetic women as compared with non-obese non-diabetic ones. Diabetes shows a supramultiplicative effect with body mass index, but not with physical activity or hypertension.
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Affiliation(s)
- E Lucenteforte
- Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy.
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Crispo A, Talamini R, Gallus S, Negri E, Gallo A, Bosetti C, La Vecchia C, Dal Maso L, Montella M. Alcohol and the risk of prostate cancer and benign prostatic hyperplasia. Urology 2005; 64:717-22. [PMID: 15491708 DOI: 10.1016/j.urology.2004.05.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2004] [Accepted: 05/04/2004] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To examine the association between alcohol and the risk of prostate cancer/benign prostatic hyperplasia (BPH) in a population with a wide range of alcohol consumption, using a hospital-based, case-control study. Data from several epidemiologic studies have allowed us to exclude a strong association between alcohol drinking and prostate cancer risk. However, limited information is available for BPH. Also, it is unclear whether various types of alcoholic beverages may have a different impact on risk. METHODS We conducted this hospital-based case-control study in Italy between 1991 and 2002. A total of 2663 men younger than 75 years had incident, histologically confirmed prostate carcinoma (1294 cases) or symptomatic obstructive BPH (1369 cases) (maximal flow rate less than 15 mL/s) refractory to medical treatment. A total of 1451 patients younger than 75 years were used as controls. Odds ratios and corresponding 95% confidence intervals were estimated using unconditional multiple logistic regression models including terms for age, center, education, body mass index, physical activity, and family history of prostate cancer. RESULTS Alcohol consumption showed no consistent association with prostate cancer risk, but a statistically significant inverse trend in risk for BPH. Compared with abstainers, the odds ratio was 0.88 for fewer than three drinks, 0.71 for three to four drinks, 0.79 for five to six drinks, and 0.65 for seven or more drinks per day. The patterns of risk were similar with reference to different alcoholic beverages. The inverse relation between elevated alcohol consumption and BPH was apparently stronger in subjects with a lower body mass index. CONCLUSIONS Alcohol drinking is unrelated to prostate cancer risk. The inverse relationship with BPH may be related to the hormonal correlates (ie, lower androgen levels) of heavy alcohol drinkers.
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Affiliation(s)
- Anna Crispo
- Servizio di Epidemiologia, Istituto Tumori Fondazione Pascale, Naples, Italy
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Pelucchi C, La Vecchia C, Negri E, Talamini R, Franceschi S. Alcohol drinking and renal cell carcinoma in women and men. Eur J Cancer Prev 2002; 11:543-5. [PMID: 12457106 DOI: 10.1097/00008469-200212000-00006] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The role of alcohol consumption on the risk of renal cell cancer was investigated separately for women and men, in a case-control study of 348 people with incident histologically confirmed cancer and 1048 hospital controls from northern Italy. No significant relationship emerged, nor any differences between the sexes. The odds ratios were 1.2 (95% confidence interval, 0.6-2.4) for the highest tertile of intake in women (>or=3 drinks per day) and 0.8 (0.4-1.3) for the highest quartile of intake in men (>or=6 drinks per day).
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Affiliation(s)
- C Pelucchi
- Istituto di Ricerche Farmacologiche 'Mario Negri' Milan, Italy.
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Abstract
The relation between alcoholic beverage consumption and bladder cancer risk was investigated using data from a case-control study conducted between 1985 and 1992 in two areas of northern Italy. Cases were 727 patients with incident, histologically confirmed bladder cancer, and controls 1,067 patients admitted to the same network of hospitals for acute, non-neoplastic, nonurologic, or genital tract diseases. Compared to nondrinkers, the odds ratio (OR) was 0.79 (95% confidence interval, CI, 0.58-1.08) for drinkers, and 0.84 (95%CI, 0.58-1.22) for > or =6 drinks/day. The OR was 0.86 (95%CI, 0.60-1.23) for > or =5 wine drinks/day, 0.69 for beer, and 0.85 for spirits. No trend was observed with duration (OR =1.00 for > or =40 years). ORs were consistent across various strata of covariates including age, sex, and smoking habits. Our study, based on a population with high alcohol (mainly wine) intake, found no association between bladder cancer risk and alcohol intake, even at high levels of consumption.
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Affiliation(s)
- Claudio Pelucchi
- Istituto di Ricerche Farmacologiche Mario Negri. 20157 Milan, Italy.
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Tavani A, Gallus S, La Vecchia C, Franceschi S. Alcohol drinking and risk of non-Hodgkin's lymphoma. Eur J Clin Nutr 2001; 55:824-6. [PMID: 11593342 DOI: 10.1038/sj.ejcn.1601245] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2000] [Revised: 03/26/2001] [Accepted: 03/30/2001] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To analyse the relation between alcohol intake and the risk of non-Hodgkin's lymphoma (NHL). DESIGN Hospital-based case-control study. SETTINGS The greater Milan area and the province of Pordenone, Northern Italy. SUBJECTS Cases were 446 (256 men and 190 women) with histologically confirmed incident NHL, and controls were 1295 (791 men and 504 women) with acute non-neoplastic conditions. RESULTS Compared to non-drinkers, the odds ratio (OR) was 0.92 for <3 drinks per day, 0.98 for 3-6 drinks, and 1.02 for > or =7 drinks per day. Wine drinking was also not associated with risk, and the OR was 0.85 for drinkers of > or =7 drinks/day compared to non-drinkers. Beer and spirit intake was also not associated with NHL risk. CONCLUSIONS Our study, based on a population with relatively high alcohol intakes, indicates that there is no appreciable association between intake of various alcoholic beverages and the risk of NHL. SPONSORSHIP Italian Association for Research on Cancer, Milan, Italy.
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Affiliation(s)
- A Tavani
- Istituto di Ricerche Farmacologiche Mario Negri, Milano, Italy.
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