title: Low to moderate lifetime alcohol consumption is associated with less advanced stages of fibrosis in non-alcoholic fatty liver disease.
abstract: OBJECTIVE
  Moderate alcohol consumption has been associated with a lower risk of disease severity in non-alcoholic fatty liver disease (NAFLD). It is unclear if this reflects current or lifetime drinking, or can be attributed to confounders such as diet and exercise. We evaluated the impact of lifetime alcohol consumption on fibrosis severity in NAFLD.
  
  
  METHODS
  We prospectively enrolled 120 subjects with biopsy-proven NAFLD and through detailed questionnaires examined lifetime alcohol consumption, diet and physical activity. Main outcome measures were odds ratios (OR) for fibrosis stage, calculated through ordinal regression after adjustment for body mass index, diabetes mellitus type 2, smoking and age at biopsy. A biomarker for recent alcohol consumption, phosphatidyl ethanol (PEth) was sampled.
  
  
  RESULTS
  An increase in median weekly alcohol consumption to a maximum of 13 drinks per week was associated with lower fibrosis stage (adjusted OR for each incremental unit, 0.86; 95% CI, 0.76-0.97; p = .017). The lowest risk for fibrosis was found with the lowes`t odds seen in the top quartile of alcohol consumption (aOR 0.23; 95% CI 0.08-0.66; p = .006). Adding soft drink and coffee consumptions, and physical activity to the model did not change the estimates. Subjects with PEth ≥0.3 μmol/L had higher ORs for a higher fibrosis stage (aOR 2.77; 95% CI 1.01-7.59; p = .047).
  
  
  CONCLUSIONS
  Lifetime alcohol consumption with up to 13 units per week is associated with lower fibrosis stage in NAFLD. Elevated PEth is associated with higher stages of fibrosis.
authors.affiliation: a Centre for Digestive Diseases, Division of Hepatology , Karolinska University Hospital , Stockholm , Sweden.|b Department of Medicine , Karolinska Institutet , Stockholm , Sweden.
authors.forename: Hannes
authors.initials: H
authors.lastname: Hagström
authors.affiliation: c Department of Gastroenterology and Hepatology , Linköping University , Linköping , Sweden.|d Department of Medical and Health Sciences , Linköping University , Linköping , Sweden.
authors.forename: Patrik
authors.initials: P
authors.lastname: Nasr
authors.affiliation: c Department of Gastroenterology and Hepatology , Linköping University , Linköping , Sweden.|d Department of Medical and Health Sciences , Linköping University , Linköping , Sweden.
authors.forename: Mattias
authors.initials: M
authors.lastname: Ekstedt
authors.affiliation: c Department of Gastroenterology and Hepatology , Linköping University , Linköping , Sweden.|d Department of Medical and Health Sciences , Linköping University , Linköping , Sweden.
authors.forename: Stergios
authors.initials: S
authors.lastname: Kechagias
authors.affiliation: e Department of Gastroenterology and Hepatology , Skåne University Hospital, Malmö/Lund , Sweden.
authors.forename: Kristina
authors.initials: K
authors.lastname: Önnerhag
authors.affiliation: e Department of Gastroenterology and Hepatology , Skåne University Hospital, Malmö/Lund , Sweden.
authors.forename: Emma
authors.initials: E
authors.lastname: Nilsson
authors.affiliation: f Department of Gastroenterology and Hepatology , Uppsala University Hospital , Uppsala , Sweden.
authors.forename: Fredrik
authors.initials: F
authors.lastname: Rorsman
authors.affiliation: f Department of Gastroenterology and Hepatology , Uppsala University Hospital , Uppsala , Sweden.
authors.forename: Reza
authors.initials: R
authors.lastname: Sheikhi
authors.affiliation: g Department of Molecular and Clinical Medicine, Sahlgrenska Academy , Institute of Medicine, University of Gothenburg , Gothenburg , Sweden.
authors.forename: Hanns-Ulrich
authors.initials: HU
authors.lastname: Marschall
authors.affiliation: a Centre for Digestive Diseases, Division of Hepatology , Karolinska University Hospital , Stockholm , Sweden.|b Department of Medicine , Karolinska Institutet , Stockholm , Sweden.
authors.forename: Rolf
authors.initials: R
authors.lastname: Hultcrantz
authors.affiliation: a Centre for Digestive Diseases, Division of Hepatology , Karolinska University Hospital , Stockholm , Sweden.|b Department of Medicine , Karolinska Institutet , Stockholm , Sweden.
authors.forename: Per
authors.initials: P
authors.lastname: Stål
mesh_terms: D000328:Adult; D000368:Aged; D000428:Alcohol Drinking; D015415:Biomarkers / Q000097:blood; D005227:Fatty Acids / Q000097:blood; D005260:Female; D005355:Fibrosis; D020404:Glycerophospholipids / Q000097:blood; D006801:Humans; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000209:etiology / Q000473:pathology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D065626:Non-alcoholic Fatty Liver Disease / Q000150:complications* / Q000473:pathology*; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013548:Sweden; D055815:Young Adult
chemical_list: D015415:Biomarkers; D005227:Fatty Acids; D020404:Glycerophospholipids
keywords: NAFLD; NASH; alcohol; fibrosis stage; lifetime alcohol consumption