What advice should be given to patients with NAFLD about the consumption of alcohol?Nature Clinical Practice Gastroenterology & Hepatology (2009) 6, 18-19
Nonalcoholic fatty liver disease (NAFLD) is one of the most common liver diseases in the Western world. NAFLD is associated with chronic metabolic disorders such as obesity, type 2 diabetes, and dyslipidemia. Several studies have shown that individuals with NAFLD are more likely to have atherosclerosis and a heightened risk of cardiovascular disease than individuals without NAFLD. In fact, cardiovascular disease is the single most common cause of death in patients with NAFLD.1
Although heavy alcohol use has many detrimental effects, the cardiovascular benefits of moderate alcohol consumption are beyond doubt. In a prospective study of 490,000 people, Thun et al. demonstrated that individuals who consumed one alcoholic drink daily had a decrease in mortality from all causes of 20% and cardiovascular-associated mortality of 30–40% compared with nondrinkers.2 In the Copenhagen City Heart Study, individuals who consumed between three and five drinks of wine daily had a decreased relative risk of death from all causes, including cardiovascular and cerebrovascular events, of 50% compared with non-wine drinkers. No risk reduction was seen, however, with consumption of beer or liquor, suggesting that the nonalcohol constituents of wine were accountable for the protective effects observed in this study.3 A systematic review that evaluated the effects of alcohol on the incidence and progression of diabetes found that moderate alcohol consumption was associated with a decreased incidence of diabetes and with a decreased incidence of cardiovascular events in those already diagnosed with diabetes.4 These data raise the dilemma of whether patients with NAFLD who have a heightened risk of cardiovascular disease should, or should not, consume alcohol.
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