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Cited by 172Liver Disease Diagnosis and TreatmentAlcohol Consumption and Health EffectsSubstance Abuse Treatment and Outcomes

Effects of alcohol consumption and metabolic syndrome on mortality in patients with nonalcoholic and alcohol-related fatty liver disease

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Younossi, Zobair M., Stepanova, Maria, Ong, Janus, Yilmaz, Yusuf, Duseja, Ajay, Eguchi, Yuichiro, El Kassas, Mohamed, Castellanos-Fernandez, Marlen +16 more·2019·Clinical Gastroenterology and Hepatology
DOI 10.1016/j.cgh.2018.11.033
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Abstract

Background & aims Non-alcoholic and alcohol-related fatty liver disease are overlapping diseases in which metabolic syndrome and alcohol consumption each contribute to progressive liver disease. We aimed to assess the effects of alcohol consumption and metabolic syndrome on mortality in individuals with fatty liver.Methods We searched the National Health and Nutrition and Examination Survey III for adults (20-74 years old) with hepatic steatosis, detected by ultrasound, for whom mortality and follow-up data were available. We collected data from the alcohol use questionnaire (self-reported number of days a participant drank alcohol; the number of drinks [10 g alcohol] per day on a drinking day; the number of days the participant had 5 or more drinks) and calculated the average amount of alcohol consumption in drinks/day for each participant during the year preceding enrollment. Excessive alcohol consumption for men was >3 drinks/day and for women was >1.5 drinks/day. We also collected clinical data, and mortality data were obtained from the National Death Index. Demographic and clinical parameters were compared among consumption groups using the χ 2 test for independence or survey regression models. We used Cox proportional hazard models to identify independent predictors of all-cause and cause-specific mortality.Results The study cohort included 4264 individuals with hepatic steatosis (mean age, 45.9 years; 51% male; 76% white; 46% with metabolic syndrome; 6.2% with excessive alcohol use). There was no significant difference in mean age between individuals with vs without excessive alcohol consumption (P=.65). However, overall mortality was significantly higher among participants with excessive alcohol consumption (32.2%) vs participants with non-excessive alcohol use (22.2%) after mean 20 years of follow up (P=.003), as well as after 5 years of follow up. In multivariate analysis, the presence of metabolic syndrome (adjusted hazard ratio [aHR], 1.43; 95% CI, 1.12-1.83) and excessive alcohol consumption (aHR, 1.79; 95% CI, 1.21-2.66) were independently associated with an increased risk of death in individuals with hepatic steatosis; any lower average amount of alcohol consumption was not associated with mortality (all P>.60). In a subgroup analysis, the association of excessive alcohol use with mortality was significant in individuals with metabolic syndrome (aHR, 2.46; 95% CI, 1.40-4.32) but not without it (P=.74).Conclusion In review of data from the National Health and Nutrition and Examination Survey III, we associated alcohol consumption with increased mortality in participants with fatty liver and metabolic syndrome. These findings indicate an overlap between non-alcoholic and alcohol-related fatty liver disease.

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  • Earlier cohort and cross-sectional studies on individuals with non-cirrhotic MASLD showed no effect or even protective effects of low-moderate alcohol consumption on overall mortality, MASLD and steatohepatitis.

    “Earlier cohort and cross-sectional studies on individuals with non-cirrhotic MASLD showed no effect or even protective effects of lowmoderate alcohol consumption on overall mortality, MASLD and steatohepatitis.”

    From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [87]

    The introduction (labeled Abstract in our copy; page unavailable) says earlier studies suggested protective effects of moderate alcohol use, and the References list studies concerning fatty liver, steatohepatitis prevalence, and survival. This paper’s Mortality Follow-Up section also finds no significant mortality association at lower alcohol thresholds. Our copy does not establish that the earlier studies all concerned non-cirrhotic MASLD or had the cohort and cross-sectional designs specified in the claim. (LLM, conf=0.82)

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  • In people with non-cirrhotic MASLD the evidence for low or moderate alcohol consumption is conflicting.

    “In people with non-cirrhotic MASLD the evidence for low or moderate alcohol consumption is con fl icting.”

    From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [87]

    The paper’s introduction (labelled Abstract in our copy; page unavailable) says studies of moderate alcohol use in fatty liver disease have reported both protective effects and increased risks. The Discussion says an association between mild or moderate use and mortality could not be confirmed. These passages support the conflicting-evidence point, but do not establish it specifically for people with non-cirrhotic MASLD. (LLM, conf=0.81)

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Authors
Younossi, Z. M., Stepanova, M., Ong, J., Yilmaz, Y., Duseja, A., Eguchi, Y., El Kassas, M., Castellanos-Fernandez, M., George, J., Jacobson, I. M., Bugianesi, E., Wong, V. W.-S., Arrese, M., de Ledinghen, V., Romero-Gomez, M., Mendez-Sanchez, N., Ahmed, A., Wong, R., Papatheodoridis, G., Serfaty, L., Younossi, I., Nader, F., Ziayee, M., & Afendy, A.
Affiliations
  • Inova Health System (US)
  • Center for Outcomes Research in Liver Diseases (US)
  • University of the Philippines Manila (PH)
  • Marmara University (TR)
  • Post Graduate Institute of Medical Education and Research (IN)
  • Saga University (JP)
  • The University of Sydney (AU)
  • NYU Langone Health (US)
  • University of Turin (IT)
  • Chinese University of Hong Kong (HK)
  • Pontificia Universidad Católica de Chile (CL)
  • Stanford Medicine (US)
  • Alameda Health System (US)
  • Hôpital d'Hautepierre (FR)
Corresponding author
Younossi, Zobair M.
ORCID
Venue
Clinical Gastroenterology and Hepatology
Publisher
Elsevier BV
Published
2019-07
Volume
17
Issue
8
Pages
1625-1633.e1
ISSN
1542-3565 (ISSN-L)
DOI
10.1016/j.cgh.2018.11.033
OpenAlex
W2901363517
Cited by
172
References
23
Citations by year
2026: 13 · 2025: 18 · 2024: 37 · 2023: 23 · 2022: 19 · 2021: 22 · 2020: 24 · 2019: 16
FWCI
12.10
Type
journal article
Language
en
Open access
Licence
Locations
  • Clinical Gastroenterology and Hepatology (publishedVersion)
  • PubMed (publishedVersion)
  • Institutional Research Information System University of Turin (University of Turin) (submittedVersion, other-oa)
  • RISalud Institutional Health Repository of Andalucía (submittedVersion, other-oa)
  • Dspace Repository (Marmara Üniversitesi) (submittedVersion, other-oa)
  • Dspace Repository (Marmara Üniversitesi) (submittedVersion)
Funders
Center for Outcomes Research in Liver Disease
Topics
  • Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
  • Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
Keywords
non-alcoholic fatty liver disease, hepatic steatosis, alcohol consumption, metabolic syndrome, mortality, excessive drinking, all-cause mortality, cause-specific mortality, liver disease progression, NHANES III, mortality risk factors, alcohol screening and brief intervention
MeSH terms
Adult, Aged, Alcohol Drinking, Female, Follow-Up Studies, Humans, Liver Cirrhosis, Alcoholic, Male, Middle Aged, Prognosis, Retrospective Studies, Risk Factors, United States, Incidence, Survival Rate, Disease Progression, Metabolic Syndrome, Young Adult, Non-alcoholic Fatty Liver Disease

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