Estudios científicos
Type and Pattern of Alcohol Consumption is Associated With Liver Fibrosis in Patients With Non-alcoholic Fatty Liver Disease
Abstract:
INTRODUCTION:
It is unclear whether low levels of alcohol are harmful in patients with non-alcoholic fatty liver disease (NAFLD). We aimed to determine whether quantity, binge pattern consumption, or type of alcohol was associated with liver fibrosis in patients with NAFLD.
METHODS:
Previous and current alcohol consumption was assessed in NAFLD patients undergoing liver biopsy. All subjects currently consumed <210 g per week (male) or <140 g per week (female). Binge consumption was defined as ≥4 standard drinks (female) or ≥5 standard drinks (male) in one sitting. Liver biopsies were scored according to the NASH CRN system with F3/4 fibrosis defined as advanced.
RESULTS:
Among 187 patients (24% with advanced fibrosis), the median weekly alcohol consumption was 20 (2.3-60) g over an average of 18 years. Modest consumption (1-70 g per week) was associated with lower mean fibrosis stage compared to lifetime abstainers (p < 0.05) and a decreased risk of advanced fibrosis (OR 0.33, 95% CI 0.14-0.78, p = 0.01). The association with reduced fibrosis was not seen in subjects drinking in a binge-type fashion. Exclusive wine drinkers but not exclusive beer drinkers, had lower mean fibrosis stage and lower odds of advanced fibrosis (OR 0.20, 95% CI 0.06-0.69, p = 0.01), compared to lifetime abstinent subjects. No interaction between gender and alcohol quantity, type, or binge consumption on fibrosis was observed.
DISCUSSION:
Modest (1-70 g per week) alcohol consumption, particularly wine in a non-binge pattern, is associated with lower fibrosis in patients with NAFLD. Prospective longitudinal studies into fibrosis progression, cardiovascular outcomes, and mortality are required before clinical recommendations can be made.
Comentarios divulgativos:
Existe controversia en relación a la recomendación de consumo de alcohol entre los pacientes con hígado graso no alcohólico.
El objetivo de este estudio es determinar si la cantidad, el patrón de consumo o el tipo de alcohol están asociado con la fibrosis hepática en estos pacientes.
Para ello se seleccionó 187 pacientes con biopsia hepática y se determinó el patrón de consumo de alcohol previo y habitual. El 24% de los pacientes tenían fibrosis avanzada, la ingesta media de alcohol en los últimos 18 años era de 20 mg por semana. Y se observó que un consumo moderado de alcohol (1-70 g a la semana) se asociaba con un menor grado de fibrosis y menor riesgo de fibrosis avanzada, cuando se comparaba con los abstemios. Sin embargo, esta asociación no se observaba en el caso de los bebedores "de borrachera". Y específicamente los bebedores de vino mostraban un grado menor de fibrosis y menor riesgo de fibrosis avanzada (Odds Ratio 0,20. 95% IC 0.06-0.69, P = 0,01) en comparación con los participantes que nunca habían bebido. No se identificaron interacciones entre el género, cantidad de alcohol ingerida, tipo o patrón de consumo y la fibrosis. Estos resultados relacionan un consumo bajo- moderado de alcohol con una menor fibrosis entre los pacientes con hígado graso no alcohólico. Sin embargo, sería interesante realizar más estudios prospectivos, longitudinales que evalúen esta asociación, para poder establecer recomendaciones clínicas.
