Brian P Lee, Justene Molina, Steve Kim, Jennifer L Dodge, Norah A Terrault
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引用次数: 0
Abstract
Background & aims: New nomenclature allows a single cardiometabolic risk factor (CMRF) with alcohol to classify metabolic dysfunction-associated steatotic liver disease (MASLD) and with "increased alcohol intake" (MetALD), which is controversial because alcohol causes CMRFs. Studies regarding incremental CMRFs and liver-related outcomes among alcohol users would be informative.
Methods: Using NHANES (1/2001-3/2020), we included participants aged≥20 with complete alcohol and CMRF status. CMRFs were defined by the National Cholesterol Education Program's Adult Treatment Panel III. Increased alcohol use corresponded to ≥140g/week[women] / ≥210g/week[men]. The primary outcome was FIB-4 >2.67.
Results: Among 40,898 participants, 2,282 had increased vs. 38,616 without increased alcohol use. Prevalence of high FIB-4 among increased vs. without increased alcohol use was higher at each quantity of CMRFs, and with each incremental CMRF: zero (2.3%[95%CI 1.0-5.0%] vs. 0.7%[0.5-0.9%]), one (3.0%[1.6-5.6%] vs. 1.7%[1.4-2.1%]), two (3.3%[2.1-5.1%] vs. 2.1%[1.8-2.4%]), three (5.9%[3.5-9.6%] vs. 2.5%[2.1-2.9%]), and four or five (6.1%[3.3-9.7%] vs. 4.0%[3.5-4.5%]) CMRFs. Among increased alcohol users, in multivariable logistic regression, three (aOR 2.57[0.93-7.08]), four or five (aOR 2.64[1.05-6.67]) CMRFs was associated with 2-fold higher odds of high FIB-4 (vs. 0 CMRFs), but not one (aOR 1.24[0.41-3.69]) or two (aOR 1.39[0.56-3.50]) CMRFs. Among individuals with increased alcohol use, sensitivity/specificity-based Euclidean distance suggested an optimal cut-off of ≥3 CMRFs to differentiate higher probability of high FIB-4.
Conclusions: Stratifying MetALD as ≥3 CMRFs, rather than 1 CMRF may provide more optimal fibrosis stratification. Diabetes, high waist circumference, and hypertension, are associated with significant liver fibrosis among individuals with increased alcohol use, but not dyslipidemia.
期刊介绍：
Clinical Gastroenterology and Hepatology (CGH) is dedicated to offering readers a comprehensive exploration of themes in clinical gastroenterology and hepatology. Encompassing diagnostic, endoscopic, interventional, and therapeutic advances, the journal covers areas such as cancer, inflammatory diseases, functional gastrointestinal disorders, nutrition, absorption, and secretion.
As a peer-reviewed publication, CGH features original articles and scholarly reviews, ensuring immediate relevance to the practice of gastroenterology and hepatology. Beyond peer-reviewed content, the journal includes invited key reviews and articles on endoscopy/practice-based technology, health-care policy, and practice management. Multimedia elements, including images, video abstracts, and podcasts, enhance the reader's experience. CGH remains actively engaged with its audience through updates and commentary shared via platforms such as Facebook and Twitter.
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