1 Transplantation and Liver Surgery Clinic, Helsinki University Hospital, Helsinki University, Helsinki, Finland.
2 The Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden.
3 National Institute for Health and Welfare, Finland.
4 Clinic of Gastroenterology, Helsinki University and Helsinki University Hospital, Helsinki, Finland.
The effects of alcohol use in non-alcoholic fatty-liver disease are unclear. We investigated the impact of alcohol use in fatty liverdisease on incident liver, cardiovascular, and malignant disease, and death. Study comprised 8345 persons with hepatic steatosis (fatty-liver index >60) who participated in the health-examination surveys (FINRISK 1992-2012 or Health 2000), with available data on baseline alcohol intake. Main exclusions were baseline clinical liver disease, viral hepatitis, ethanol intake >50g/day, and current abstainers. Data were linked with national registers for hospital admissions, malignancies and death regarding liver, cardiovascular, and malignant disease, and all-cause death. Adjustment were for multiple confounders. Alcohol consumption showed a dose-dependent risk increase for incident advanced liver disease and malignancies. Consuming 10-19g/day of alcohol in general, or 0-9g/day as non-wine beverages, doubled the risk for advanced liver disease compared to lifetime abstainers. In contrast, alcohol intake up to 49g/day was associated with a 22-40% reduction of incident CVD. We observed a J-shaped association between alcohol intake and all-cause death with a maximal risk reduction of 21% (95%CI 5-34%) at alcohol intake of 0-9g/day compared to lifetime abstainers. However, these benefits on CVD and mortality were only observed in never smokers. Alcohol intake above 30g/day yielded increased risk estimates for mortality compared to lifetime abstainers. In a subpopulation with longitudinal data, alcohol intake remained stable over time in >80% of subjects. CONCLUSION: Even low alcohol intake in fatty liver disease is associated with increased risks for advanced liver disease and cancer. Low to moderate alcohol use is associated with reduced mortality and CVD risk, but only among never smokers.