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

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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, George, Jacob, Jacobson, Ira M., Bugianesi, Elisabetta, Wong, Vincent Wai-Sun, Arrese, Marco, de Ledinghen, Victor, Romero-Gomez, Manuel, Mendez-Sanchez, Nahum, Ahmed, Aijaz, Wong, Robert, Papatheodoridis, Georgios, Serfaty, Lawrence, Younossi, Issah, Nader, Fatema, Ziayee, Mariam, Afendy, Arian·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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Result
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“The cohort study analysis by Younossi et al. 27 and Mengqi Li 73 con ﬁ rmed that alcohol consumption increase mortality in participants with SLD and MetS and that patients with MetALD have a poorer prognosis.”
Influential
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What are the common downstream molecular events between alcoholic and nonalcoholic fatty liver?
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“YOU-NOSSI et al. [21] further found that metabolic syndrome and excessive alcohol consumption had a supercumula-tive effect on all-cause mortality, but excessive alcohol consumption was linked to outcome only when metabolic syndrome was present.”

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: Younossi, Zobair M.
Stepanova, Maria
Ong, Janus
Yilmaz, Yusuf
Duseja, Ajay
Eguchi, Yuichiro
George, Jacob
Jacobson, Ira M.
Bugianesi, Elisabetta
Wong, Vincent Wai-Sun
Arrese, Marco
Romero-Gomez, Manuel
Ahmed, Aijaz
Wong, Robert
Serfaty, Lawrence
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: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
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 › Hepatology › 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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Effects of Alcohol Consumption and Metabolic Syndrome on Mortality in Patients With Nonalcoholic and Alcohol-Related Fatty Liver Disease

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