Abstract
Objective
To study the interaction of alcohol consumption with body mass index (BMI) in the
development of hepatic steatosis and mortality.
Participants and Methods
We conducted a retrospective cohort study of 18,506 participants without fatty liver
disease or cirrhosis at enrollment in the Mayo Clinic Biobank from April 9, 2009,
through March 31, 2016. Participants were classified by self-reported alcohol consumption
status (nondrinkers, moderate drinkers [0 to 2 drinks per day], and heavy drinkers
[>2 drinks per day]). The primary outcome of interest was the incidence of hepatic
steatosis, identified by International Classification of Diseases, Ninth Revision code and confirmed with imaging. The secondary outcome of interest was all-cause
mortality. Multivariate Cox regression analysis determined the impact of alcohol consumption
stratified by BMI on outcomes compared with nondrinkers.
Results
The cohort (mean ± SD age, 55.8±16.9 years; 63.8% female; mean ± SD BMI, 28.8±6.1
kg/m2) of 18,506 participants included 3657 (19.8%) nondrinkers, 14,236 (76.9%) moderate
drinkers, and 613 (3.3%) heavy drinkers at enrollment. After a median follow-up of
5.8 years (interquartile range, 3.8 to 7.2 years), 684 participants had development
of hepatic steatosis and 968 died. In moderate drinkers, the risk of hepatic steatosis
development was high in the obese group (adjusted hazard ratio [AHR], 1.31; 95% CI,
1.03 to 1.67), insignificant in the overweight group (AHR, 0.86; 95% CI, 0.58 to 1.26),
and decreased in the normal-BMI group (AHR, 0.48; 95% CI, 0.26 to 0.90). Heavy drinkers
had an increased risk of hepatic steatosis irrespective of BMI. Moderate alcohol use
was associated with decreased mortality in the normal-weight (AHR, 0.44; 95% CI, 0.34
to 0.58) and overweight (AHR, 0.70; 95% CI, 0.56 to 0.88) groups but not in the obese
group (AHR, 0.80; 95% CI, 0.64 to 1.00).
Conclusion
In obese individuals, even moderate alcohol use is associated with the development
of hepatic steatosis. Moderate alcohol consumption is associated with lower mortality
in normal-BMI and overweight individuals but not in those who are obese.
Abbreviations and Acronyms:
AHR (adjusted hazard ratio), BMI (body mass index), FLD (fatty liver disease), ICD-9 (International Classification of Diseases, Ninth Revision), IQR (interquartile range)To read this article in full you will need to make a payment
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Article Info
Footnotes
For editorial comment, see page 2580
Grant Support: This work was supported in part by Mayo Clinic’s Carol M . Gatton Professorship in Digestive Diseases Research Honoring Peter Carryer, M.D. (V.H.S.) and grant AA026974 from the National Institutes of Health (P.S.K., V.H.S.) .
Potential Competing Interests: Dr Shah is a consultant for Afimmune Limited, Ambys Medicines, Durect Corporation, Enterome SAB, Merck Research Laboratories, and Novartis Pharmaceuticals; serves on the advisory boards of Akaza Bioscience, Generon Corporation (Shanghai), GRI Bio, Inc, Surrozen, and Vital Therapies, Inc; and has patents/patents pending related to the diagnosis and treatment of alcoholic hepatitis. The other authors report no competing interests.
Data Previously Presented: These data were presented in part at the 2018 American Association for the Study of Liver Diseases Liver Meeting in San Francisco, CA.
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