Rise in liver disease deaths not fully explained by metabolic syndrome or alcohol use

An analysis of the prevalence of metabolic syndrome and alcohol use in the U.S. between 1999 and 2018 found that while the proportion of patients with metabolic syndrome and nonheavy alcohol use grew the most, liver disease increased the most among those who drank heavily.

A recent increase in deaths from alcohol-related liver disease (ALD) may be partially due to co-occurrence of metabolic syndrome and alcohol use, a recent study found.

The analysis used data from 42,224 participants in the National Health and Nutrition Examination Survey (NHANES) to produce weighted study samples that were representative of the adult population in the U.S. without viral hepatitis between 1999 and 2018. Researchers defined heavy alcohol use as average alcohol use in the past 12 months higher than 28 g/d for women or 42 g/d for men. They defined metabolic syndrome using the National Cholesterol Education Program's Adult Treatment Panel III classification. Results were published as a research letter in Annals of Internal Medicine on May 9.

NHANES participants were categorized by whether they had metabolic syndrome or not and whether they used alcohol not at all, not heavily, or heavily. The study found that the survey-weighted prevalence of metabolic syndrome with nonheavy alcohol use increased significantly between 1999 to 2002 and 2015 to 2018, from 18.7% (95% CI, 17.1% to 20.3%) to 27.5% (95% CI, 25.9% to 29.2%), whereas all the other subgroups remained stable or decreased. In the same time periods, adjusted probability of advanced liver disease increased among all subgroups but most significantly among the heavy alcohol users, both with and without metabolic syndrome (by 7.8 percentage points and 2.8 percentage points, respectively).

“We did not find increasing prevalence of heavy alcohol use with or without MetS [metabolic syndrome] to explain increases in ALD,” the study authors concluded. However, the study did show increasing rates of liver disease among heavy alcohol users, including those with metabolic syndrome, they noted. “These findings suggest an increasing interaction effect with MetS and heavy alcohol use that may be contributing to the recent surge in ALD-related mortality, but the reasons for this are not fully elucidated; thus, this is an area for future research,” the authors said.

Limitations of the study include that alcohol use was captured through self-report and advanced fibrosis through surrogate biomarkers.