Abstract
BackgroundAlanine aminotransferase (ALT) levels are widely used to screen liver disease, and many asymptomatic individuals show elevated ALT levels. As elevated ALT level indicates liver injury, even a small amount of alcohol intake may be harmful in subjects with elevated ALT levels, but there is limited evidence of the effect of light to moderate amount of alcohol intake in this subgroup.MethodsA cohort of 367,612 men and women without established liver diseases (including chronic viral hepatitis, alcohol-associated liver disease, cirrhosis, liver transplantation, or rare forms of liver disease) who underwent at least 1 health screening exam between 2009 and 2015 were assessed for liver-related and all-cause mortality. Elevated ALT levels were defined as ≥ 34 U/L for men and 25 U/L for women.ResultsIn participants with normal ALT levels, the fully-adjusted hazard ratios (95% CI) for liver-related mortality comparing light and moderate drinkers to non-drinkers were 0.73 (0.51–1.05), and 1.06 (0.73–1.52), respectively. In participants with elevated ALT levels, the corresponding hazard ratios were 1.57 (1.08–2.28), and 2.09 (CI 1.46–2.99), respectively (p value for alcohol intake by ALT interaction < 0.01). For all-cause mortality, the fully-adjusted hazard ratios comparing light and moderate drinkers to non-drinkers in participants with normal ALT levels were 0.72 (0.66–0.77), and 0.89 (0.82–0.97), respectively. In participants with elevated ALT levels, the corresponding hazard ratios were 0.93 (0.81–1.08), and 1.31 (1.14–1.50), respectively (p value for alcohol intake by ALT interaction < 0.01).ConclusionsSmall amounts of alcohol intake were associated with increased liver-related and all-cause mortality among individuals with elevated ALT levels. Subjects with elevated ALT levels should be advised complete abstinence from alcohol.
Highlights
Alanine aminotransferase (ALT) levels are widely used to screen liver disease, and many asymptomatic individuals show elevated ALT levels
The fully-adjusted liver-related mortality rates in participants with normal and elevated ALT levels were 7 and 28 per 100,000 person-years, respectively (HR 4.07, 95% confidence intervals (CIs) 3.32–5.01)
Alcohol intake showed a positive association with liver-related mortality in participants with elevated ALT levels, but not in those with normal ALT levels (p value for alcohol intake by ALT interaction < 0.01; Table 2)
Summary
Alanine aminotransferase (ALT) levels are widely used to screen liver disease, and many asymptomatic individuals show elevated ALT levels. As elevated ALT level indicates liver injury, even a small amount of alcohol intake may be harmful in subjects with elevated ALT levels, but there is limited evidence of the effect of light to moderate amount of alcohol intake in this subgroup. The liver is the main organ that metabolizes alcohol [9], and the effects of light to moderate alcohol intake may differ in individuals with and without liver disease. Complete abstinence is recommended for patients with alcoholassociated liver disease, as any amount of alcohol intake can be harmful [10]. Light to moderate alcohol intake was associated with increased all-cause mortality in patients with chronic viral hepatitis [11], and abstinence is recommended for them as well [12, 13]. The health effects of light to moderate alcohol intake in people with nonalcoholic fatty liver disease (NAFLD) or with less prevalent forms of liver disease (e.g., Wilson’s disease, autoimmune, or cryptogenic liver disease) are controversial and information is scarce [14]
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