Wednesday, April 4, 2018

Mild drinking habit is a risk factor for hepatocarcinogenesis in non-alcoholic fatty liver disease with advanced fibrosis

This study focused on the impact of a mild drinking habit on liver carcinogenesis in 301 biopsy-proven non-alcoholic fatty liver disease (NAFLD) patients. Multivariate analysis revealed that mild drinking of < 20 g/d might increase the risk of hepatocellular carcinoma in NAFLD patients, particularly those with advanced fibrosis (F3-4). NAFLD patients with severe fibrosis should abstain from even small amounts of regular alcohol consumption.

World J Gastroenterol. Apr 7, 2018; 24(13): 1440-1450
Published online Apr 7, 2018. doi: 10.3748/wjg.v24.i13.1440

Mild drinking habit is a risk factor for hepatocarcinogenesis in non-alcoholic fatty liver disease with advanced fibrosis
Takefumi Kimura, Naoki Tanaka, Naoyuki Fujimori, Ayumi Sugiura, Tomoo Yamazaki, Satoru Joshita, Michiharu Komatsu, Takeji Umemura, Akihiro Matsumoto, Eiji Tanaka

The impact of mild drinking habit (less than 20 g/d of ethanol) on the clinical course of non-alcoholic fatty liver disease (NAFLD) has not been determined. We examined the influence of a mild drinking habit on liver carcinogenesis from NAFLD.

A total of 301 patients who had been diagnosed as having NAFLD by liver biopsy between 2003 and 2016 [median age: 56 years, 45% male, 56% with non-alcoholic steatohepatitis, 26% with advanced fibrosis (F3-4)] were divided into the mild drinking group with ethanol consumption of less than 20 g/d (mild drinking group, n = 93) and the non-drinking group (n = 208). Clinicopathological features at the time of liver biopsy and factors related to hepatocellular carcinoma (HCC) occurrence were compared between the groups.

We observed significant differences in male prevalence (P = 0.01), platelet count (P = 0.04), and gamma-glutamyl transpeptidase (P = 0.02) between the test groups. Over 6 years of observation, the HCC appearance rate was significantly higher in the mild drinking group (6.5% vs 1.4%, P = 0.02). Multivariate survival analysis using Cox’s regression model revealed that hepatic advanced fibrosis (F3-4) (P < 0.01, risk ratio: 11.60), diabetes mellitus (P < 0.01, risk ratio: 89.50), and serum triglyceride (P = 0.04, risk ratio: 0.98) were factors significantly related to HCC in all NAFLD patients, while the effect of a drinking habit was marginal (P = 0.07, risk ratio: 4.43). In patients with advanced fibrosis (F3-4), however, a drinking habit (P = 0.04, risk ratio: 4.83), alpha-fetoprotein (P = 0.01, risk ratio: 1.23), and diabetes mellitus (P = 0.03, risk ratio: 12.00) were identified as significant contributors to HCC occurrence.

A mild drinking habit appears to be a risk factor for hepatocarcinogenesis in NAFLD patients, especially those with advanced fibrosis.

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Summary & Commentary
The Effect of Modest Alcohol Use in Patients with Nonalcoholic Steatohepatitis
Atif Zaman, MD, MPH reviewing Ajmera V et al. Clin Gastroenterol Hepatol 2018 Mar 14
Longitudinal data suggest that having 1 or 2 drinks daily worsens liver histology.

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