Two forms of nonalcoholic fatty liver disease (NAFLD) are depicted in these images of liver biopsies from adults, taken from this study.  The first shows nonalcoholic fatty liver only. The second shows nonalcoholic steatohepatitis (NASH), a more serious condition with potential to progress to cirrhosis. Images courtesy of Elizabeth Brunt, MD, of Washington University in Saint Louis.

Modest Alcohol Consumption Lowers Risk and Severity of Liver Disease

People with nonalcoholic fatty liver disease (NALFD) who consume alcohol in modest amounts – no more than one or two servings per day – are half as likely to develop hepatitis as non-drinkers with the same condition, reports a national team of scientists led by researchers at the University of California, San Diego School of Medicine.

The findings are published in the April 19, 2012 online issue of The Journal of Hepatology.

NALFD is the most common liver disease in the United States, affecting up to one third of American adults. It’s characterized by abnormal fat accumulation in the liver. The specific cause or causes is not known, though obesity and diabetes are risk factors. Most patients with NAFLD have few or no symptoms, but in its most progressive form, known as nonalcoholic steatohepatitis or NASH, there is a significantly heightened risk of cirrhosis, liver cancer and liver-related death.

NALFD is also a known risk factor for cardiovascular disease (CVD). Patients with NAFLD are approximately two times more likely to die from coronary heart disease than from liver disease. The study’s authors wanted to know if the well-documented heart-healthy benefits of modest alcohol consumption outweighed alcohol’s negative effects.

“We know a 50-year-old patient with NAFLD has a higher risk of CVD,” said Jeffrey Schwimmer, MD, associate professor of clinical pediatrics at UC San Diego, director of the Fatty Liver Clinic at Rady Children’s Hospital-San Diego and senior author. “Data would suggest modest alcohol consumption would be beneficial (in reducing the patient’s CVD risk) if you don’t take liver disease into account. When you do take liver disease into account, however, the usual medical recommendation is no alcohol whatsoever.”

Schwimmer and colleagues discovered that the benefits of modest alcohol consumption were compelling, at least in terms of reducing the odds of patients with NAFLD from developing more severe forms of the disease. Patients with NASH are 10 times more likely to progress to cirrhosis, the final phase of chronic liver disease. Cirrhosis is the 12th leading cause of death in the U.S., killing an estimated 27,000 Americans annually.

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Thinking about drinking A new study out of Harvard Medical School, published this week in the Journal of the American Medical Association, raises new questions about how much alcohol consumption increases the risk of breast cancer. As in previous studies, the Harvard researchers found that women who consumed two or more drinks per day were 51 percent more likely to develop breast cancer in their lifetime than women who didn’t consume alcohol at all. What’s grabbing headlines is the authors’ analysis that even light drinking – three to six glasses of wine per week – could boost a woman’s lifetime risk of breast cancer by 15 percent. Clearly, if the findings hold up, any level of alcohol consumption appears to be a risk factor for breast cancer. Does this mean women should abstain from drinking entirely? There is no simple answer. Clarity remains harder to find than a good claret. On average, one in 8 American women will develop breast cancer over their lifetimes. That’s the baseline risk. Numerous other elements impact that number. Aging is major risk factor. Two out of every three invasive breast cancers are found in women 55 years and older. Genetic predisposition is another. Women who have inherited certain mutations in the BRCA1 and BRCA2 genes have a fivefold increased risk, and changes in other genes have been implicated. Ethnicity, tissue density, menstrual history and other particulars also play a role. You can read a fuller list here. What’s so confounding about effects of alcohol consumption, though, is that it also seems to provide some measurable health benefits. Moderate alcohol drinking has been shown to raise levels of HDL, the good cholesterol, and other substances that promote cardiovascular health. It’s also been linked to a decrease in middle-aged and older adults. And in 2008, researchers at UC San Diego challenged conventional thinking that alcohol consumption was bad for the liver with a study that found modest consumption (one glass of wine a day) might actually decrease the prevalence of Non-Alcoholic Fatty Liver Disease. So what’s the answer? Right now, it seems the best course is to individually weigh the trade-offs. Cardiovascular disease is far more prevalent than breast cancer, so maybe the heart health benefits of modest alcohol consumption outweigh the small increased risk of breast cancer. On the other hand, a woman with known, elevated cancer risk probably should shun drinking altogether. It remains a personal decision, one best made after serious, sober consideration.
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Thinking about drinking

A new study out of Harvard Medical School, published this week in the Journal of the American Medical Association, raises new questions about how much alcohol consumption increases the risk of breast cancer.

As in previous studies, the Harvard researchers found that women who consumed two or more drinks per day were 51 percent more likely to develop breast cancer in their lifetime than women who didn’t consume alcohol at all. What’s grabbing headlines is the authors’ analysis that even light drinking – three to six glasses of wine per week – could boost a woman’s lifetime risk of breast cancer by 15 percent.

Clearly, if the findings hold up, any level of alcohol consumption appears to be a risk factor for breast cancer. Does this mean women should abstain from drinking entirely? There is no simple answer. Clarity remains harder to find than a good claret.

On average, one in 8 American women will develop breast cancer over their lifetimes. That’s the baseline risk. Numerous other elements impact that number. Aging is major risk factor. Two out of every three invasive breast cancers are found in women 55 years and older. Genetic predisposition is another. Women who have inherited certain mutations in the BRCA1 and BRCA2 genes have a fivefold increased risk, and changes in other genes have been implicated. Ethnicity, tissue density, menstrual history and other particulars also play a role. You can read a fuller list here.

What’s so confounding about effects of alcohol consumption, though, is that it also seems to provide some measurable health benefits. Moderate alcohol drinking has been shown to raise levels of HDL, the good cholesterol, and other substances that promote cardiovascular health. It’s also been linked to a decrease in middle-aged and older adults. And in 2008, researchers at UC San Diego challenged conventional thinking that alcohol consumption was bad for the liver with a study that found modest consumption (one glass of wine a day) might actually decrease the prevalence of Non-Alcoholic Fatty Liver Disease.

So what’s the answer? Right now, it seems the best course is to individually weigh the trade-offs. Cardiovascular disease is far more prevalent than breast cancer, so maybe the heart health benefits of modest alcohol consumption outweigh the small increased risk of breast cancer. On the other hand, a woman with known, elevated cancer risk probably should shun drinking altogether.

It remains a personal decision, one best made after serious, sober consideration.