Alcohol consumption and metabolic syndrome: Clinical and epidemiological impact on liver disease

Alcohol use and metabolic syndrome are highly prevalent in the population and frequently co-exist. Both are implicated in a large range of health problems, including chronic liver disease, hepatocellular carcinoma, and liver-related outcomes (i.e. decompensation or liver transplantation). Studies have yielded mixed results regarding the effects of mild-moderate alcohol consumption on the risk of metabolic syndrome and fatty liver disease, possibly due to methodological differences. The few available prospective studies have indicated that mild-moderate alcohol use is associated with an increase in liver-related outcomes. This conclusion was substantiated by systems biology analyses suggesting that alcohol and metabolic syndrome may play a similar role in fatty liver disease, potentiating an already existing dysregulation of common vital homeostatic pathways. Alcohol and metabolic factors are independently and jointly associated with liver-related outcomes. Indeed, metabolic syndrome increases the risk of liver-related outcomes, regardless of alcohol intake. Moreover, the components of metabolic syndrome appear to have additive effects when it comes to the risk of liver-related outcomes. A number of population studies have implied that measures of central/abdominal obesity, such as the waist-to-hip ratio, can predict liver-related outcomes more accurately than BMI, including in individuals who consume harmful quantities of alcohol. Many studies even point to synergistic interactions between harmful alcohol use and many metabolic components. This accumulating evidence showing independent, combined, and modifying effects of alcohol and metabolic factors on the onset and progression of chronic liver disease highlights the multifactorial background of liver disease in the population. The available evidence suggests that more holistic approaches could be useful for risk prediction, diagnostics and treatment planning. (c) 2022 The Author(s). Published by Elsevier B.V. on behalf of European Association for the Study of the Liver. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

Automated summary

Alcohol use and metabolic syndrome frequently co-exist and are associated with various health problems including chronic liver disease and hepatocellular carcinoma. The effects of mild-moderate alcohol consumption on the risk of metabolic syndrome and fatty liver disease are unclear, with mixed results from studies. However, prospective studies indicate that mild-moderate alcohol use is associated with an increase in liver-related outcomes. Alcohol and metabolic factors independently and together contribute to liver-related outcomes, and components of metabolic syndrome have additive effects. Central/abdominal obesity measures may predict liver-related outcomes more accurately than BMI, even in individuals who consume harmful amounts of alcohol. The accumulating evidence highlights the multifactorial nature of liver disease and suggests the need for holistic approaches in risk prediction and treatment planning.