title: Modest alcohol consumption is associated with decreased prevalence of steatohepatitis in patients with non-alcoholic fatty liver disease (NAFLD).
abstract: OBJECTIVE
  Non-alcoholic fatty liver disease (NAFLD) is a cardiovascular risk factor. Although modest alcohol consumption may reduce the risk for cardiovascular mortality, whether patients with NAFLD should be allowed modest alcohol consumption remains an important unaddressed issue. We aimed to evaluate the association between modest alcohol drinking and non-alcoholic steatohepatitis (NASH), among subjects with NAFLD.
  
  
  METHODS
  In a cross-sectional analysis of adult participants in the NIH NASH Clinical Research Network, only modest or non-drinkers were included: participants identified as (1) drinking >20 g/day, (2) binge drinkers, or (3) non-drinkers with previous alcohol consumption were excluded. The odds of having a histological diagnosis of NASH and other histological features of NAFLD were analyzed using multiple ordinal logistic regression.
  
  
  RESULTS
  The analysis included 251 lifetime non-drinkers and 331 modest drinkers. Modest drinkers compared to non-drinkers had lower odds of having a diagnosis of NASH (summary odds ratio 0.56, 95% CI 0.39-0.84, p=0.002). The odds of NASH decreased as the frequency of alcohol consumption increased within the range of modest consumption. Modest drinkers also had significantly lower odds for fibrosis (OR 0.56 95% CI 0.41-0.77) and ballooning hepatocellular injury (OR 0.66 95% CI 0.48-0.92) than lifetime non-drinkers.
  
  
  CONCLUSIONS
  In a large, well-characterized population with biopsy-proven NAFLD, modest alcohol consumption was associated with lesser degree of severity as determined by lower odds of the key features that comprise a diagnosis of steatohepatitis, as well as fibrosis. These findings demonstrate the need for prospective studies and a coordinated consensus on alcohol consumption recommendations in NAFLD.
authors.affiliation: Departments of Pediatrics and Medicine, University of California, San Diego, La Jolla, CA 92103-8450, United States.
authors.forename: Winston
authors.initials: W
authors.lastname: Dunn
authors.forename: Arun J
authors.initials: AJ
authors.lastname: Sanyal
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Brunt
authors.forename: Aynur
authors.initials: A
authors.lastname: Unalp-Arida
authors.forename: Michael
authors.initials: M
authors.lastname: Donohue
authors.forename: Arthur J
authors.initials: AJ
authors.lastname: McCullough
authors.forename: Jeffrey B
authors.initials: JB
authors.lastname: Schwimmer
mesh_terms: D000328:Adult; D000368:Aged; D000428:Alcohol Drinking; D003430:Cross-Sectional Studies; D005234:Fatty Liver / Q000150:complications / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease; D015995:Prevalence