Abstract
Nonalcoholic fatty liver disease (NAFLD) is defined by hepatic steatosis in the presence of alcohol intake within safe limits, defined by guidelines of scientific associations (usually 20 g or 2 units/day in women, 30 g or 3 units in men). The diagnosis is usually followed by medical counseling of total abstinence, in order to prevent disease progression. This policy has been challenged by epidemiological studies, suggesting that the risk of liver disease and disease progression is lower in modest drinkers than in total abstainers. We revised the literature on the effects of modest alcohol intake on disease burden. Epidemiological data may suffer from several potential biases (recall bias for retrospective analyses, difficulties in the calculation of g/day), limiting their validity. Prospective data suggest that NAFLD patients with regular alcohol intake, although within the safe thresholds, are at higher risk of liver disease progression, including hepatocellular carcinoma; a detrimental effect of modest alcohol drinking is similarly observed in liver disease of viral etiology. Alcohol intake is also a risk factor for extrahepatic cancers, particularly breast, oral, and pharyngeal cancers, with gender difference and no floor effect, which outweigh the possible beneficial effects on cardiovascular system, also derived from retrospective studies. Finally, the negative effects of the calorie content of alcohol on dietary restriction and weight loss, the pivotal intervention to reduce NAFLD burden, should be considered. In summary, the policy of counseling NAFLD patients for alcohol abstinence should be maintained.
Highlights
Nonalcoholic fatty liver disease (NAFLD) is a chronic condition characterized by the accumulation of fat within hepatocytes, potentially progressive to nonalcoholic steatohepatitis (NASH), where hepatic necroinflammation and fibrosis add to steatosis, favoring progression to cirrhosis and terminal liver failure
Are expected to consume alcohol in amounts considered not at risk of hepatic involvement [1]. This definition raises the important question of the “safe” amount of alcohol consumption, considering that a moderate alcohol intake is very common in the population, during familial or social events, expectedly at rates not associated with any untoward effects and possibly with positive effects on cardiovascular disease [2]
What should we recommend to our patient with NAFLD regarding drinking habits? A few observational studies have reported beneficial effects on cardiovascular outcomes of low-to-moderate alcohol consumption in the general population as well as in patients with NAFLD [7,52]
Summary
Nonalcoholic fatty liver disease (NAFLD) is a chronic condition characterized by the accumulation of fat within hepatocytes (steatosis), potentially progressive to nonalcoholic steatohepatitis (NASH), where hepatic necroinflammation and fibrosis add to steatosis, favoring progression to cirrhosis and terminal liver failure. More than a decade ago a few epidemiological studies reported an inverse association between moderate alcohol consumption (within presumably safe limits) and the prevalence of NAFLD in the population [5,6], pointing to a favorable effect of moderate alcohol use extending from the cardiovascular system to the setting of metabolic liver disease. This raised a lot of debate on the correct dietary and lifestyle treatment of NAFLD, which has not settled yet. The conclusions are based on the experience of authors and the general effects of alcohol on the liver and outside the liver, in the hope to generate a common health policy among healthcare professionals
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
