Moderate alcohol consumption is not associated with subclinical cardiovascular damage but with hepatic fibrosis in non-alcoholic fatty liver disease
Abstract
Background Moderate alcohol consumption is believed to be associated with reduced mortality from cardiovascular disease (CVD) in the general population. This cross-sectional study aimed to comprehensively examine the association between alcohol consumption and subclinical cardiovascular damage or hepatic fibrosis in non-alcoholic fatty liver disease (NAFLD).Methods Subjects with NAFLD without a history of heart disease were extracted from 977 consecutive examinees who completed health checkups and optional cardiovascular examinations. Subclinical cardiovascular damage was assessed by coronary artery calcification (CAC), carotid artery ultrasound, and brachial-ankle pulse wave velocity (ba-PWV). CAC scores were classified into three grades (0, ≤100, and >100) by Agatston's method. Alcohol consumption was divided into three groups [Non-drinking (G0); Light (G1), 0.1-6.9 drinks/week; Moderate (G2), 7-20.9 drinks/week for men and 7-13.9 drinks/week for women]. Noninvasive markers (FIB-4, Fibrosis-4; NFS, NAFLD fibrosis score) were calculated for assessment of hepatic fibrosis and classified into low and intermediate-high grade.Results The overall mean age was 60.2 years and males were 200 (74.6%) among 268 subjects with NAFLD. Number (%) of G0, G1, and G2 were 102 (38.1%), 103 (38.4%), and 63 (23.5%). Binary logistic regression analysis showed no significant difference between G0 and G1, or G0 and G2 in any of the above subclinical cardiovascular damages (CAC score >0, or CAC score >100, carotid plaque +, intima-media thickness ≥1.1 mm, and ba-PWV >1400 cm/s). However, only G2 had a significant association with intermediate-high grade of FIB-4 or NFS [odds ratio (95% confidence intervals), p value: 1.871 (1.209-2.893), p = 0.005; 2.910 (1.715-4.939), p = 0.000], compared to G0.Conclusions Non-heavy drinking might not reduce the risk of CVD in NAFLD subjects. On the contrary, even moderate drinking could promote hepatic fibrosis. Thus, NAFLD drinkers should not be recommended for even a moderate amount of alcohol.
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The evidence for cardiovascular protection is conflicting in individuals with MASLD, with a documented lack of protection towards subclinical atherosclerotic markers or lesions.
“Finally, the evidence for cardiovascular protection is con fl icting in individuals with MASLD, 98 with a documented lack of protection towards subclinical atherosclerotic markers or lesions.”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [98]
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- Authors
- Kashiwagi, K., Yamaguchi, A., Shiba, S., Taniki, N., Inoue, N., Takaishi, H., Iwao, Y., & Kanai, T.
- Affiliations
- Keio University Hospital (JP)
- Keio University (JP)
- Corresponding author
- Kashiwagi, Kazuhiro
- Venue
- Alcohol
- Publisher
- Elsevier BV
- Published
- 2020-12
- Volume
- 89
- Pages
- 1-7
- ISSN
- 0741-8329 (ISSN-L)
- OpenAlex
- W3045600159
- Cited by
- 26
- References
- 31
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 5 · 2023: 6 · 2022: 6 · 2021: 2
- FWCI
- 2.30
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Alcohol (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
- Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Keywords
- moderate drinking, non-alcoholic fatty liver disease, liver fibrosis, coronary artery calcification, carotid intima-media thickness, carotid plaque, pulse wave velocity, FIB-4, NAFLD fibrosis score, cardiovascular risk, sex differences in alcohol consumption
- MeSH terms
- Alcohol Drinking, Cross-Sectional Studies, Female, Humans, Liver Cirrhosis, Male, Middle Aged, Risk Factors, Ankle Brachial Index, Carotid Intima-Media Thickness, Pulse Wave Analysis, Non-alcoholic Fatty Liver Disease
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