January 27, 2020
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Individuals with alcohol use disorder have an increased fibrosis risk

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The risk of fibrosis is highest in young adults with harmful drinking patterns and steatosis, according to data from a population-based study.

“Approximately one in four adults in the United States and United Kingdom will have nonalcoholic fatty liver disease (NAFLD),” Kushala W. M. Abeysekera, MRCP, of population health sciences at Bristol Medical School at the University of Bristol in the U.K., told Healio Gastroenterology and Liver Disease. “Young adults remain a blind spot for clinicians to understand the burden of disease as generally they will be fit and well, so are not routinely assessed. This study is the first attempt to screen young asymptomatic adults in the general population using FibroScan, which utilizes transient elastography technology.”

The Avon Longitudinal Study of Parents and Children recruited 15,454 pregnant women in the Bristol area with expected delivery dates between April 1991 and December 1992. The offspring of these women were invited to the Focus@24+ clinic at the University of Bristol between June 2015 and October 2017.

Of the 10,018 active participants were invited to the clinic, 4,021 (40.1%) attended (mean age 24 years). All participants were asked to fast for at least 6 hours or overnight before blood tests and transient elastography with FibroScan.

Alcohol consumption was assessed with questionnaires based on the Alcohol Use Disorder Identification Test for Consumption (AUDIT-C), and participants were categorized into three groups: low-risk drinkers (AUDIT-C score of less than 5), hazardous drinkers (score of 5 or more) and harmful drinkers (evidence of alcohol use disorder).

In relation to steatosis, 3,768 participants had controlled attenuation parameter scores eligible for evaluation. Of those, 780 (20.7%, 95% CI) had suspected steatosis and 377 (10%) had severe steatosis. There were 3,600 participants with valid transient elastography results for fibrosis. Of those, 96 (2.7%, 95% CI) had suspected fibrosis and 10.6% had late-stage fibrosis.

“The concern is we will see more people present with NAFLD and alcohol-related cirrhosis earlier which has major implications for our health care service,” Abeysekera said.

Results showed that one in five young adults had steatosis and one in 40 had fibrosis around the age of 24 with a higher risk of fibrosis in those with harmful drinking patterns and steatosis.

“One of the processes that drive progression to cirrhosis involves fat accumulation in the liver related to alcohol or obesity — namely alcohol-related fatty liver disease and nonalcoholic fatty liver disease,” Elisabetta Bugianesi, MD, PhD, of the department of medical sciences at the University of Torino in Torino, Italy, wrote in an accompanying editorial.

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Bugainesi explained that the strengths of the study are “manifold,” saying that nonmodifiable risk factors may provide background for acceleration progression of NAFLD.

NAFLD in young adults has clinical implications of the upmost importance.

With the steady increase in childhood obesity, outcomes of morbidity, mortality and transplantation related to advanced liver disease will be reached at younger ages, which will increase the societal burden. By addressing and tracking each risk factor for liver disease early in life, it may help with preventing liver disease.

“The study has the unquestionable merit of highlighting the burden of NAFLD in young adults; furthermore, it confirms the amplificatory synergy of alcohol and obesity on liver fibrogenesis, while disproving the hypothesis of a beneficial effect of moderate alcohol consumption in NAFLD,” Bugianesi wrote. – by Erin T. Welsh

Disclosures: The authors report no relevant financial disclosures.