title: Ethnicity matters: A Systematic Review and Meta-Analysis of the Non-Linear Relationship Between Alcohol Consumption and Prevalence and Incidence of Hepatic Steatosis.
abstract: BACKGROUND
  Fatty liver (hepatic steatosis) is one of the most common diseases globally, with increasing prevalence. The role of alcohol consumption in the development of hepatic steatosis has not been systematically examined.
  
  
  METHODS
  We searched Medline, Embase, and ProQuest Dissertations & Theses Global for original data on the relationship between alcohol consumption and hepatic steatosis measured by non-invasive imagery, excluding studies conducted in participants <18years, or subgroups related to viral and drug-induced liver disease. We identified 18 articles reporting adjusted data (Japan=11, other high-income countries=7). Random-effect categorical meta-analyses (<20g/day pure alcohol consumption vs non-drinkers) and dose-response meta-analyses for the whole range of alcohol consumption were conducted.
  
  
  RESULTS
  In total, 99,370 participants and 25,662 cases of hepatic steatosis were included. In Japan, low alcohol consumption was consistently associated with substantially reduced incidence and prevalence of hepatic steatosis compared to non-drinkers (RR for <20g pure alcohol/day=0.75, 95% CI: 0.71-0.79, I(2)=0%). No overall association was found in other countries (RR=1.05, 95% CI: 0.86-1.30, I(2)=84%). Dose-response analyses in Japan (up to 80g/day) showed an inverse relationship in men and a J-shape in women.
  
  
  CONCLUSIONS
  Alcohol consumption showed a complex association with hepatic steatosis with substantial differences by ethnicity and sex. Low alcohol consumption was beneficial in Japan with good epidemiological evidence, whereas there was no association in other countries. However, heterogeneity was large in countries other than Japan. More and higher quality research in diverse ethnic populations is needed to further clarify this relationship.
authors.affiliation: Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Canada; Dalla Lana School of Public Health (DLSPH), University of Toronto, Toronto, Canada; PAHO/WHO Collaborating Centre for Addiction and Mental Health, Toronto, Canada. Electronic address: m.roerecke@web.de.
authors.forename: Michael
authors.initials: M
authors.lastname: Roerecke
authors.affiliation: In Vitro Drug Safety and Biotechnology, Toronto, Canada.
authors.forename: Radu
authors.initials: R
authors.lastname: Nanau
authors.affiliation: Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Canada; Dalla Lana School of Public Health (DLSPH), University of Toronto, Toronto, Canada; PAHO/WHO Collaborating Centre for Addiction and Mental Health, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada; Institute for Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Germany; Department of Psychiatry, University of Toronto, Toronto, Canada; Campbell Family Mental Health Research Institute, CAMH, Toronto, Canada.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Rehm
authors.affiliation: In Vitro Drug Safety and Biotechnology, Toronto, Canada; Department of Pharmacology and Toxicology, Faculty of Medicine, University of Toronto, Toronto, Canada; Division of Nephrology and Internal Medicine, Fundeni Clinical Institute, Bucharest, Romania; University of Medicine and Pharmacy, "Carol Davila", Bucharest, Romania.
authors.forename: Manuela
authors.initials: M
authors.lastname: Neuman
mesh_terms: D000428:Alcohol Drinking / Q000009:adverse effects; D005006:Ethnicity; D005234:Fatty Liver / Q000453:epidemiology* / Q000209:etiology*; D005260:Female; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology / Q000208:ethnology; D008297:Male; D016017:Odds Ratio; D011159:Population Surveillance; D015995:Prevalence; D012307:Risk Factors
keywords: Alcohol drinking; Alcoholic fatty liver; Binge drinking; Incidence; Meta-analysis; Non-alcoholic fatty liver; Prevalence; Systematic review