麻豆传媒

Non-alcoholic fatty liver disease (NAFLD) and the more-recently coined term metabolic dysfunction-associated fatty liver disease (MAFLD) are used interchangeably.¹ The investigators of a newly published study on increased mortality with MAFLD and heavy alcohol consumption define MAFLD by the presence of steatohepatitis with at least one of either obesity/overweight, type 2 diabetes, or metabolic dysfunction.² They report that the incidence of MAFLD is on the rise globally due to increased rates of all of these comorbidities.

MAFLD management is generally limited to behavioral modifications (adopting a healthy diet and regular exercise, mainly), though pharmacologic management of patients with comorbid diabetes and/or obesity鈥攚ith medications that may lower liver enzymes, reduce steatosis, or improve liver histology鈥攕hould be considered.³

Criteria for MAFLD, unlike the definition of NAFLD, may be used to characterize patients with additional risk factors for chronic liver disorders that include heavy alcohol use or persistent viral hepatitis, say the authors of the new study. They suggest that the combination of MAFLD and excessive alcohol use is a clinical issue that requires further study.²

Participants are divided into 6 groups

Using the Korean National Health Insurance Service database for the current retrospective study, Cho and colleagues examined the relationship between the amount of alcohol consumed and all-cause and cause-specific mortality.² The study included nearly 1 million (n=996,508) Asian adults ages 40 to 79 years who underwent health checkups between 2009 and 2012 and were characterized as either having or not having MAFLD.

Study participants were categorized into a total of 6 groups. First, they were characterized by whether they were considered non-alcohol drinkers, moderate alcohol drinkers, or heavy alcohol drinkers, on the basis of their answers to questionnaires. Less than 30 g/day for men and <20 g/day for women of pure alcohol was considered moderate (a standard glass was calculated as 8 g of pure alcohol). Heavy alcohol consumption was considered to be 鈮�30 g/day for men or 鈮�20 g/day for women.

Within each drinking group, participants were then further classified by whether they also had MAFLD. The investigators defined hepatic steatosis as 鈮�30 on the fatty liver index (FLI). The association between alcohol consumption and MAFLD, as well as all-cause and cause-specific mortality, was assessed using Cox analyses.

The highest risk? No surprises鈥�

The largest segment of patients was the non-MAFLD/non-alcohol group, which made up 38.8% of the entire cohort population, followed by 22.1% in the MAFLD/non-alcohol group, 16.3% in the MAFLD/moderate alcohol group,14.6% in the non-MAFLD/moderate alcohol group, 5.8% in the MAFLD/heavy alcohol group, and 2.4% in the non-MAFLD/heavy alcohol group.

The investigators found that all-cause, liver-, and cancer-related mortality were all significantly increased in patients with MAFLD than in those without it. The highest risk of liver-related mortality, compared to those without MAFLD in the non-alcohol group, occurred in patients with MAFLD in the heavy alcohol consumption group (adjusted hazard ratio 9.8, 95% confidence interval 8.20 to 12.29; P<.001). Heavy alcohol consumption increased the risk of liver- and cancer-related mortality irrespective of MAFLD status.

Importantly, the authors added that the combination of MAFLD and heavy alcohol consumption 鈥渟ynergistically increase liver-related mortality.鈥�²

Study limitations included a lack of use of biopsy in the analysis. 鈥淲e compared mortality using the FLI when defining hepatic steatosis rather than using imaging methods or histology,鈥� the authors wrote. 鈥淎lthough liver biopsy is regarded as the gold standard for diagnosing hepatic steatosis, it is an invasive and expensive procedure for nationwide study populations.鈥�²

Published: October 10, 2024