Nonalcoholic and alcohol-related fatty liver disease (NAFLD and AFLD) are overlapping diseases in which metabolic syndrome and alcohol consumption each contribute to progressive liver disease.

NYU Langone researchers aimed to assess the effects of alcohol consumption and metabolic syndrome on mortality in individuals with fatty liver. The study, headed by Dr. Zobair M. Younossi with a number of co-authors from other institutions including Ira M. Jacobson, MD, professor of medicine and director of hepatology at NYU Langone Health within the Division of Gastroenterology and Hepatology, indicates that the risk of mortality increases significantly in patients with both excessive alcohol use and metabolic syndrome—the main drivers of progressive liver disease.

Investigators reviewed data from the National Health and Nutrition Examination Survey III on 4,264 patients with hepatic steatosis, including 46 percent with metabolic syndrome and 6.2 percent with excessive alcohol use. Over a period of up to 20 years, overall mortality was highest among patients with excessive alcohol consumption, particularly among those who also had metabolic syndrome. The findings were published in the July 2019 issue of Clinical Gastroenterology and Hepatology.

The results indicate that the harmful effects of substantial alcohol consumption are accentuated in patients with metabolic syndrome, and conversely, metabolic syndrome is associated with higher risk in patients who drink excessively. In patients without metabolic syndrome, the harmful effects of drinking were not observed until consumption reached six drinks per day for men or three drinks per day for women.

The authors caution that data used in the study may not be reflective of the current fatty liver population, as the subjects were enrolled nearly 30 years ago. However, the findings have the potential to inform clinical practice as both metabolic syndrome and excessive alcohol use are modifiable risk factors.

“One immediate implication for clinicians is the importance of taking a careful alcohol consumption history from patients with fatty liver disease, many of whom have metabolic syndrome, with a view toward limiting such consumption in patients who drink heavily. The present study provides quantifiable information that can be imparted to patients,” says Dr. Jacobson. “Importantly, the paper also acknowledges that milder effects of lower amounts of alcohol may not have been captured in this study population.”

Disclosures: Ira M. Jacobson, MD, is a consultant to or received research funds from Gilead Sciences, Inc.; Intercept Pharmaceuticals, Inc.; GENFIT; and Novo Nordisk.