Does moderate consumption of alcoholic beverages protect NAFLD patients from cardiovascular disease?

In this critical review, the effect of moderate intake of alcoholic beverages on cardiovascular and liver disease in patients with Non-Alcoholic-Fatty-Liver-Disease (NAFLD) was examined.

Non-Alcoholic-Fatty-Liver-DiseaseNon-alcoholic-fatty-liver-disease is defined as the presence of fat in the liver (with > 5 5% of ... (NAFLD) is defined as the presence of fat in the liver (hepatic steatosis) after the excluding secondary causes of fat accumulation in the liver (e.g. significant alcohol consumption, certain medications, and other medical conditions). NAFLD is now the most common chronic liver disease in high-income countries, and it is estimated to affect at least 25%–40% of the general population.

It can progress from simple steatosis (*) to non-alcoholic steatohepatitis (NASH) and hepatic fibrosis to liver cancer. NAFLD, also leads to or is accompanied by an altered metabolism, including abdominal obesity, insulin resistance, hypertension, abnormal blood glucose levels (dysglycaemia) and atherogenic abnormal lipid levels. Particularly, elevated triglycerides and lowered HDL cholesterol, an increased ratio of total cholesterol to HDL cholesterol and apolipoprotein (apo) B to apo A-I and an increase in small dense LDL-Cholesterol particles can be observed.

Since there is also a strong association with central obesity, NAFLD is considered to reflect the hepatic component of the metabolic syndrome.  Cumulatively, all these factors increase the risk for cardiovascular disease (CVD), and thus, CVD is the leading cause of mortality in patients with NAFLD.

However, moderate wine consumption with the observed lowering effect on insulin resistance, its anti-inflammatory and anti-thrombotic actions and the HDL raising properties, has been shown to exert beneficial effects on CVD morbidity and mortality.

In addition, there is growing evidence that light to moderate alcohol consumption might lower the risk of developing NAFD. With CVD as the most common cause of death among patients with NAFLD, all of these data raise the question whether patients with NAFLD-associated liver disease may benefit from moderate intake of alcoholic beverages.

US researchers investigated this question and carried out a critical review of the effect of a moderate intake of alcoholic beverages on cardiovascular and liver disease in patients with NAFLD. A total of seven observational studies met the criteria for inclusion (one for cardiovascular endpoints and 6 for liver endpoints).

While there were insufficient studies to this date to assess the association with cardiovascular outcomes, an association between moderate alcohol use and a decreased risk for non-alcoholic fatty liver (NASH) and fibrosis was found.

When exceeding moderate alcohol intake through heavy episodic drinking though, an increased risk for progression to fibrosis was found in one study. Furthermore, in patients with manifest NAFLD cirrhosis, even moderate consumption of alcoholic beverages was associated with an increased risk for liver cancer.

Because of the rising prevalence of NAFLD in the industrialized world, the authors urgently call for additional, high quality studies to be conducted in individuals with NAFLD. Ideally, such studies in patients with NAFLD should be longitudinal, evaluate the relationship between moderate alcohol intake, serum lipids and insulin resistance, and investigate how they are associated with cardiovascular endpoints, such as heart attack, etc.

Ajmera VH, Terrault NA, Harrison SA. Is moderate alcohol use in nonalcoholic fatty liver disease good or bad? A critical review. Hepatology 2017;65(6):2090-9.

For more information about this article, read the scientific abstract here.

(*) SteatosisSteatosis also known as fatty liver is the collection of excessive amounts of triglycerides and othe...: Fatty liver is the collection of excessive amounts of triglycerides and other fats inside liver cells.