Is There a Safe Alcohol Limit in Early Liver Disease?

6 months ago
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Daily consumption of up to half of a standard US drink (7.4 gram/day) does not appear to increase mortality risk in adults with steatotic liver disease (SLD) who have low risk for advanced fibrosis.
• Researchers used data from the National Health and Nutrition Examination Survey III (1988-1994) to elucidate the dose-dependent association of alcohol use with SLD progression.
• They identified 2834 adults with confirmed SLD (51.8% male, 34.2% nonHispanic White), including 591 (20.8%) with intermediate or high risk for advanced fibrosis, defined as a Fibrosis-4 index (FIB-4) score of 1.3 or higher.
• Multivariable Cox regression with restricted cubic spines was used to investigate nonlinear associations between alcohol use and mortality.
• During median follow-up of 26 years, the mortality rate per 100,000 persons was 4342 in the group with intermediate and high risk for advanced fibrosis versus 1099 in the low-risk group.
• After adjustment for demographics and metabolic variables, there was a nonlinear association between alcohol intake and mortality in the low-risk group (P = .001 for nonlinearity).
• In the low-risk group, the mortality risk threshold was < 7.4 gram/day, which equals half a 12-oz beer or half a glass of wine. Each additional gram above this level led to a higher death rate. • No safe alcohol limit was evident in the intermediate- and high-risk group; their mortality risk rose with any alcohol intake. "Individuals with SLD should be advised to maintain regular health monitoring and lifestyle management. Recent guidelines have recommended the FIB-4 score as a first-line assessment tool given its low cost, high accuracy, and noninvasiveness," the authors write. "In this cohort study, we proposed using the FIB-4 score to guide clinicians in advising patients with SLD who choose not to abstain completely from alcohol." The study, with the first author Yee Hui Yeo, MD, at Cedars-Sinai Medical Center, Los Angeles, California, was published online on December 14, 2023, in JAMA Network Open. The study relied on self-reported alcohol intake and lacked data on drinking patterns. All variables were only available at baseline, with no tracking of alcohol intake changes during follow-up. Individual risks may vary and require case-by-case discussion as the data are population based. The study did not list funding. The authors report no conflicts of interest.…Read more by Megan Brooks

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