1 Section of Gastroenterology, Boston Medical Center, Boston University School of Medicine, Boston, MA. Electronic address: firstname.lastname@example.org.
2 Department of Mathematics and Statistics, Boston University, Boston, MA, United States.
3 Department of Radiology, Massachusetts General Hospital, Boston, MA.
4 National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA; Division of Cardiology, Boston Medical Center, Boston University School of Medicine, Boston, MA.
5 Section of General Internal Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA.
BACKGROUND & AIMS:
Many individuals presumed to have non-alcoholic fatty liver disease (NAFLD) consume moderate amounts of alcohol. Little known about patterns of alcohol use in patients with NAFLD or how drinking behaviors affect liver fat.
We conducted a cross-sectional study of 2475 participants of the Framingham Heart Study with hepatic steatosis, determined by computed tomography. We performed multivariable-adjusted logistic regression models to evaluate the association between alcohol drinking patterns and hepatic steatosis. Models were adjusted for sociodemographic factors, diet, and the components of the metabolic syndrome. We excluded heavy alcohol users, defined as women who consume more than 14 alcohol drinks/week and men who consume more than 21 alcohol drinks/week.
In our sample (mean age, 49.8±10.2; 50.3% women), the prevalence of hepatic steatosis was 17.5%. The total number of alcohol drinks/week and the maximum drinks consumed per drinking day were each associated with hepatic steatosis (adjusted-odds ratio [aOR] 1.15; 95% CI, 1.02-1.29 and aOR 1.15; 95% CI 1.02-1.30). Binge drinking occurred in 25.4% of individuals with presumed NAFLD and was associated with an increased odds of hepatic steatosis (aOR, 1.45; 95% CI, 1.06-1.98) among alcohol users. In a beverage-specific analysis, alcohol use patterns were associated with hepatic steatosis among beer drinkers, but not among wine drinkers.
In a cross-sectional study of participants of the Framingham Heart Study with hepatic steatosis, we observed an association between alcohol use and liver fat, even after excluding heavy alcohol users from our analysis. Alcohol use therefore appears to be a risk factor for NAFLD. Prospective studies are needed to validate these findings and determine if alcohol use should be a focus for research, prevention, and treatment of presumed NAFLD.