Alcohol consumption, metabolic risk factors tied to cirrhosis, hepatocellular carcinoma
Heavy alcohol consumption and obesity increase the risk for liver-related morbidity and death, while metabolic risk factors also elevate the risk for hepatocellular carcinoma, according to data presented at the International Liver Congress in Amsterdam.
In a study of 107,742 women (median age 60 years) stratified according to BMI (less than 25 kg/m2 vs. 25 kg/m2 or more) and alcohol intake (15 units or fewer consumed weekly vs. more than 15), researchers observed 90 incidents of morbidity or mortality related to liver disease. Patients with high BMI and alcohol intake were at significantly increased risk (HR=7.2; 95% CI, 3.4-15.5) compared with those with low BMI and low alcohol consumption, while the association also neared statistical significance among those with low BMI and high alcohol intake (HR=2.9; 95% CI 1.0-8.4).
“These findings will have a significant impact on how we can help millions of people across the world at risk of developing liver disease,” Daniele Prati, MD, EASL Scientific Committee Member, said in a press release. “More research is required to determine the exact thresholds for each risk factor that independently and in combination increase the risk of chronic liver disease, but this is an important first step in the right direction.”
In another study presented at the congress, investigators evaluated 100 liver transplant recipients with alcoholic cirrhosis, including 24 with steatosis, 24 with metabolic risk factors such as obesity and/or diabetes (MRF), 20 with both and 32 with neither steatosis nor MRF.
Hepatocellular carcinoma (HCC) was present in 28 patients, who were significantly more likely to be overweight (54% of cases vs. 14%; P<.001) and have diabetes (43% vs. 22%; P<.04) than those without HCC. Half of participants with both steatosis and MRF had HCC, compared with 6% of those with neither. Significantly more patients in either the MRF/steatosis combined or MRF alone groups had HCC than those with neither or steatosis alone (48% vs. 13%; P=.0001). Adjustment for factors including age, sex and alcohol consumption did not eliminate the associations between HCC and obesity (P<.01) or diabetes (P<.04).
“Fatty liver and alcohol have long been known as risk factors for HCC, but this study tested their combined effect in patients with alcoholic cirrhosis,” Prati said in the release. “The results will be useful to improve the management of patients with cirrhosis, and to identify cancer at early stages.”
For more information:
Trembling PM. #115: Influence of BMI and Alcohol on Liver-Related Morbidity and Mortality in a Cohort of 108,000 Women From the General Population From UKCTOCS. Presented at: The International Liver Congress 2013; April 24-28, Amsterdam.
Pais R. #118: Metabolic Fatty-Liver Disease Increases the Risk of Hepatocellular Carcinoma in Patients With Alcoholic Cirrhosis Listed for Liver Transplantation. Presented at: The International Liver Congress 2013; April 24-28, Amsterdam.