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There is an increasing burden of liver disease and liver cancer. The metabolic syndrome and heavy alcohol consumption are associated with increased risks of liver disease, although only a minority of patients with early-stage liver disease (e.g. fatty liver) develop liver failure or liver cancer. Few general population studies have analyzed metabolic predictors of such severe liver complications.
Researchers studied which metabolic factors best predict severe liver complications. Their analysis included people without liver disease who participated in the Finnish population-based Health 2000 Study (2000-2001). The researchers analyzed follow-up data on liver-related hospital admissions, mortality, and liver cancer from national registers.
Some of the participants experienced a severe liver event during follow-up. Factors predictive of liver events were older age, female gender, alcohol use, diabetes, LDL cholesterol, and insulin resistance. Among individuals who consumed higher amounts of alcohol (average alcohol use ?210 g/week for men, ?140 g/week for women), diabetes was the only significant predictor.
Among those who consumed less or no alcohol, older age, alcohol use, smoking, abdominal obesity, LDL cholesterol, and insulin resistance were significant predictors. Alcoholic liver disease ALD and non-alcoholic liver disease NAFLD are considered separate entities, distinguished from each other by an arbitrary threshold of average alcohol intake.
This diagnostic approach assumes that alcohol intake does not affect the course of NAFLD and that the metabolic syndrome is the hallmark of NAFLD is not a factor in ALD. This study reveals that alcohol is a relevant risk factor even when alcohol consumption is within the limits currently used to separate NAFLD from ALD.
Liver disease should perhaps not be considered in terms of mutually exclusive entities of ALD and NAFLD, because in a large number of patients with liver disease, the effect of alcohol is difficult, and sometimes impossible, to separate from the effect of metabolic factors.
Alcohol use and metabolic factors are taken into account at the same time in order to identify individuals with a high risk for severe liver complications. For a comprehensive liver-risk assessment, lipid abnormalities, abdominal obesity, insulin resistance, diabetes, and alcohol use should all be considered at the same time.
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