Does moderate alcohol consumption accelerate the progression of liver disease in NAFLD? A systematic review and narrative synthesis

ObjectivesLiver disease is a leading cause of premature death, partly driven by the increasing incidence of non-alcohol-related fatty liver disease (NAFLD). Many people with a diagnosis of NAFLD drink moderate amounts of alcohol. There is limited guidance for clinicians looking to advise these patients on the effect this will have on their liver disease progression. This review synthesises the evidence on moderate alcohol consumption and its potential to predict liver disease progression in people with diagnosed NAFLD.MethodsA systematic review of longitudinal observational cohort studies was conducted. Databases (Medline, Embase, The Cochrane Library and ClinicalTrials.gov) were searched up to September 2020. Studies were included that reported progression of liver disease in adults with NAFLD, looking at moderate levels of alcohol consumption as the exposure of interest. Risk of bias was assessed using the Quality in Prognostic factor Studies tool.ResultsOf 4578 unique citations, 6 met the inclusion criteria. Pooling of data was not possible due to heterogeneity and studies were analysed using narrative synthesis. Evidence suggested that any level of alcohol consumption is associated with worsening of liver outcomes in NAFLD, even for drinking within recommended limits. Well conducted population based studies estimated up to a doubling of incident liver disease outcomes in patients with NAFLD drinking at moderate levels.ConclusionsThis review found that any level of alcohol intake in NAFLD may be harmful to liver health.Study heterogeneity in definitions of alcohol exposure as well as in outcomes limited quantitative pooling of results. Use of standardised definitions for exposure and outcomes would support future meta-analysis.Based on this synthesis of the most up to date longitudinal evidence, clinicians seeing patients with NAFLD should currently advise abstinence from alcohol.PROSPERO registration numberThe protocol was registered with PROSPERO (#CRD42020168022).

Moderate alcohol consumption and depressive symptoms: A marginal structural model approach promoting causal inference

Importance: Prevention of depressive symptoms and disorders is a key public health priority but requires an improved understanding of modifiable risk and protective factors. A salient unanswered question in this context is whether the apparent protective effect of alcohol against depression may be causal.Objective: To compare the effects of consistent abstinence, occasional, moderate, and heavy alcohol consumption throughout early-to-middle adulthood on depressive symptoms at age 50.Design: This secondary analysis of the National Longitudinal Survey of Youth (NLSY79) cohort employed a marginal structural model approach in assessing the relationship between alcohol consumption in early-to-middle adulthood (29-37 through 41-49) and depressive symptoms at age 50. Alcohol consumption was based on measurements at 1994, 2002, and 2006, covariates at 1992, 1994, and age 40 (1998-2006), and outcome at age 50 (2008-2016). Setting: The NLSY79 is a nationally representative, population-based cohort study.Participants: 5,667 eligible participants at baseline provided valid data on alcohol consumption, depressive symptoms, and covariates of interest. Exposure: Alcohol consumption was categorised as either abstinence, occasional, moderate, or heavy drinking in 1994, 2002, and 2006.Main Outcome and Measure: Depressive symptoms at age 50 as measured by the Centre for Epidemiological Studies-Depression Scale short form (CES-D-SF).Results: Of the 5,667 eligible participants at baseline, 2,862 [50.50%] were female and the mean age was 30.81 [2.24], with 3,593 participants providing valid outcome data for analysis. Results of linear contrasts from marginal structural models were consistent with a J-shaped relationship, where both consistent occasional (b=-0.84, CI= -1.47, -.11) and consistent moderate (b=-1.08, CI=-1.88, -.20) drinkers had significantly reduced predicted CES-D-SF scores at age 50 compared to consistent abstainers. Consistent heavy drinkers were predicted to have increased depressive symptoms, but this was not statistically significant (b=0.34, CI=-0.62, 1.25). In sex-stratified analyses, results were similar for females and males.Conclusions and Relevance: In this secondary analysis of longitudinal data accounting for time-varying exposure and confounding, consistent low-to-moderate alcohol consumption in early-to-middle adulthood predicted lower depressive symptoms at age 50, compared with those abstaining from alcohol. This work offers preliminary evidence that such protective effects may be causal.

Epidemiology of risk factors of various morphological types of age-related cataract in eastern region of Nepal

Introduction: Age related cataract is the leading cause of preventable blindness globally, with multifactorial risk factors. Multiple mechanism contributes to the progressive loss of lens transparency. Objective: The purpose of this study is to determine the risk factors for different morphological types of senile cataract in eastern region of Nepal. Methodology: A hospital based cross sectional study was conducted in a tertiary care hospital. Four hundred patients aged ≥ 50 years with senile cataract attending eye out patient department for one year were enrolled and divided into two groups based on Lens Opacities Classification System (LOCS) III grading. Group A consisted of ‘no-moderate’ cataract and group B consisted of ‘severe’ cataract. The parameters studied were age, gender, education, occupation, smoking, alcohol consumption, diabetes and hypertension, body mass index and use of topical or oral medication. Statistical analysis was conducted to find an association of various parameters to different morphological type of cataract. Results: The mean age of presentation was 61±9.07 years. Male to female ratio was 1:02. Group A had 154 and group B 246 patients respectively. Statistically significant association was seen between older age group and severe cataract (p <0.002). Household activities and moderate alcohol consumption alcohol was seen associated with moderate nuclear sclerosis (p <0.001) and posterior sub-capsular cataract (p <0.003) respectively. High blood pressure was associated with severe Nuclear Sclerosis and Posterior Subcapsular Cataract (p <0.014). Conclusion: Older age groups, household activities, moderate alcohol consumption and high blood pressure were found to have significant association with age-related cataract.

The Effects of Moderate Alcohol Consumption on Circulating Metabolites and Gut Microbiota in Patients With Coronary Artery Disease

Background: Epidemiological studies confirmed that moderate alcohol consumption was associated with a reduced risk of adverse cardiovascular events. It is increasingly recognized that the composition of gut microbiota and metabolites is involved in modulating the cardiovascular health of the host. However, the association of moderate alcohol consumption with serum metabolites and gut microbiome and its impact on coronary artery disease (CAD) is not fully investigated.Method: Serum untargeted metabolomics analysis and fecal 16S rRNA sequencing were performed on 72 male patients with CAD having various alcohol consumption (36 non-drinkers, 18 moderate drinkers, and 18 heavy drinkers) and 17 matched healthy controls. MetaboAnalyst and PICRUSt2 were utilized to analyze the possible involved metabolic pathways. Multi-omics analysis was achieved by Spearman correlation to reveal the interactions of alcohol consumption with gut microbiome and serum metabolites in patients with CAD.Results: We noted distinct differences between patients with CAD, with varying levels of alcohol consumption and healthy controls in aspects of serum metabolome and the gut microbiome. Moderate alcohol consumption significantly changed the lipidomic profiles, including reductions of sphingolipids and glycerophospholipids in moderate drinkers with CAD when compared with non and heavy drinkers with CAD. Moreover, we also found the reduction of microbial-derived metabolites in moderate drinkers with CAD, such as 2-phenylacetamide and mevalonic acid. To be noted, the gut microbiota of moderate drinkers with CAD tended to resemble that of healthy controls. Compared with non-drinkers, the relative abundance of genus Paraprevotella, Lysinibacillus was significantly elevated in moderate drinkers with CAD, while the genus Bifidobacterium, Megasphaera, and Streptococcus were significantly reduced in moderate drinkers with CAD. Multi-omics analysis revealed that specific metabolites and microbes associated with moderate alcohol consumption were correlated with the severity of CAD.Conclusions: Our study revealed that the impact of moderate alcohol consumption on serum metabolites and gut microbiota in patients with CAD seemed to be separated from that of heavy and non-alcohol consumption. Moderate drinking tended to have more positive effects on metabolic profiles and commensal flora, which may explain its beneficial effects on cardiovascular health. Overall, our study provides a novel insight into the effects of moderate alcohol consumption in patients with CAD.

Analysis of the accuracy and completeness of cardiovascular health information on alcohol industry-funded websites

Background The Alcohol Industry (AI), and the Social Aspects/Public Relations Organisations (SAPRO) it funds, has been shown to mis-represent the risk of alcohol with respect to cancer and pregnancy. It is theorized that the AI would position alcohol as ‘heart healthy’ to further undermine public perceptions of risks from drinking. Methods A comparative analysis (including content, thematic and context analyses) of cardiovascular health information published on the websites of AI-funded (n = 18, such as ‘Drinkaware’ and the ‘Distilled Spirits Council of the US’) and non-AI-funded (n = 18, such as ‘NHS.uk’) organizations based in multiple high-income jurisdictions. Results Websites of non-industry-funded health organizations were more likely than AI/SAPRO websites to label alcohol as a risk factor for a range of important cardiovascular diseases (such as myocardial infarction, congestive cardiac failure, hypertension and stroke). Conversely, AI/SAPRO websites were more likely to suggest alcohol was protective in the development of some heart conditions. AI/SAPRO websites frequently referenced the J-shaped curve as proof of benefit from moderate alcohol consumption; suggested a balance between the benefits and harms from drinking; positioned alcohol as consistent with a ‘healthy lifestyle’; and framed drinking as a social norm. Conclusions AI-funded health organizations mis-represent the evidence on cardiovascular effects of moderate alcohol consumption. Healthcare professionals should appreciate the role of funding source in biasing content, and exercise caution when directing patients to content funded by the AI. Tighter regulation of messaging that AI/SAPRO’s provide to the public is required, to avoid the dissemination of harmful misinformation.

Unbiased, comprehensive analysis of Japanese health checkup data reveals a protective effect of light to moderate alcohol consumption on lung function

The overall effect of lifestyle habits, such as alcohol consumption, on general health remains controversial and it is important to clarify how such habits affect aging-related health impairments. To discover novel impacts of lifestyle on general health, we employed a mathematical approach to perform a comprehensive, unbiased, cross-sectional analysis of data from 6036 subjects who participated in a Japanese health checkup. Notably, we found that moderate alcohol consumption was positively correlated with lung function, muscle mass, and strength. Health checkup data were collected periodically from the same subjects. These people were light to moderate drinkers who had high health awareness and were basically free of major underlying diseases. We next analyzed 5 years of data from 1765 of these subjects. We found that higher baseline alcohol consumption, as well as increased alcohol intake over 5 years attenuated time-related deterioration of forced vital capacity without affecting total lung volume. This effect was independent of smoking. Our study suggests a possible protective effect of moderate amounts of alcohol on lung function, due to increased muscle mass/strength and forced vital capacity.