PDF(Pubmed)
Abstract：
UNASSIGNED: Non-alcoholic fatty liver disease (NAFLD) and alcohol-associated fatty liver disease (ALD) are the most common chronic liver diseases. Hepatic steatosis is an early histological subtype of both NAFLD and ALD. Excessive alcohol consumption is widely known to lead to hepatic steatosis and subsequent liver damage. However, reported findings concerning the association between moderate alcohol consumption and hepatic steatosis remain inconsistent. Notably, alcohol consumption as a modifiable lifestyle behavior is likely to change over time, but most previous studies covered alcohol intake only once at baseline. These inconsistent findings from existing studies do not inform decision-making concerning policies and clinical guidelines, which are of greater interest to health policymakers and clinician-scientists. Additionally, recommendations on the types of alcoholic beverages are not available. Usually, assessing the effects of two or more hypothetical alcohol consumption interventions on hepatic steatosis provides answers to questions concerning the population risk of hepatic steatosis if everyone changes from heavy drinking to abstinence, or if everyone keeps on drinking moderately, or if everyone of the drinking population switches from red wine to beer? Thus, we simulated a target trial to estimate the effects of several hypothetical interventions, including changes in the amount of alcohol consumption or the types of alcoholic beverages consumed, on hepatic steatosis using longitudinal data, to inform decisions about alcohol-related policymaking and clinical care.
UNASSIGNED: This longitudinal study included 12687 participants from the UK Biobank (UKB), all of whom participated in both baseline and repeat surveys. We excluded participants with missing data related to components of alcohol consumption and fatty liver index (FLI) in the baseline and the repeat surveys, as well as those who had reported liver diseases or cancer at the baseline survey. We used FLI as an outcome indicator and divided the participants into non-, moderate, and heavy drinkers. The surrogate marker FLI has been endorsed by many international organizations\' guidelines, such as the European Association for the Study of the Liver. The calculation of FLI was based on laboratory and anthropometric data, including triglyceride, gamma-glutamyl transferase, body mass index, and waist circumference. Participants responded to questions about the types of alcoholic beverages, which were defined in 5 categories, including red wine, white wine/fortified wine/champagne, beer or cider, spirits, and mixed liqueurs, along with the average weekly or monthly amounts of alcohol consumed. Alcohol consumption was defined as pure alcohol consumed per week and was calculated according to the amount of alcoholic beverages consumed per week and the average ethanol content by volume in each alcoholic beverage. Participants were categorized as non-drinkers, moderate drinkers, and heavy drinkers according to the amount of their alcohol consumption. Moderate drinking was defined as consuming no more than 210 g of alcohol per week for men and 140 g of alcohol per week for women. We defined the following hypothetical interventions for the amount of alcohol consumed: sustaining a certain level of alcohol consumption from baseline to the repeat survey (e.g., none to none, moderate to moderate, heavy to heavy) and changing from one alcohol consumption level to another (e.g., none to moderate, moderate to heavy). The hypothetical interventions for the types of alcoholic beverages were defined in a similar way to those for the amount of alcohol consumed (e.g., red wine to red wine, red wine to beer/cider). We applied the parametric g-formula to estimate the effect of each hypothetical alcohol consumption intervention on the FLI. To implement the parametric g-formula, we first modeled the probability of time-varying confounders and FLI conditional on covariates. We then used these conditional probabilities to estimate the FLI value if the alcohol consumption level of each participant was under a specific hypothetical intervention. The confidence interval was obtained by 200 bootstrap samples.
UNASSIGNED: For the alcohol consumption from baseline to the repeat surveys, 6.65% of the participants were sustained non-drinkers, 63.68% were sustained moderate drinkers, and 14.74% were sustained heavy drinkers, while 8.39% changed from heavy drinking to moderate drinking. Regarding the types of alcoholic beverages from baseline to the repeat surveys, 27.06% of the drinkers sustained their intake of red wine. Whatever the baseline alcohol consumption level, the hypothetical interventions for increasing alcohol consumption from the baseline alcohol consumption were associated with a higher FLI than that of the sustained baseline alcohol consumption level. When comparing sustained non-drinking with the hypothetical intervention of changing from non-drinking to moderate drinking, the mean ratio of FLI was 1.027 (95% confidence interval [CI]: 0.997-1.057). When comparing sustained non-drinking with the hypothetical intervention of changing from non-drinking to heavy drinking, the mean ratio of FLI was 1.075 (95% CI: 1.042-1.108). When comparing sustained heavy drinking with the hypothetical intervention of changing from heavy drinking to moderate drinking, the mean ratio of FLI was 0.953 (95% CI: 0.938-0.968). The hypothetical intervention of changing to red wine in the UKB was associated with lower FLI levels, compared with sustained consumption of other types of alcoholic beverages. For example, when comparing sustaining spirits with the hypothetical intervention of changing from spirits to red wine, the mean ratio of FLI was 0.981 (95% CI: 0.948-1.014).
UNASSIGNED: Regardless of the current level of alcohol consumption, interventions that increase alcohol consumption could raise the risk of hepatic steatosis in Western populations. The findings of this study could inform the formulation of future practice guidelines and health policies. If quitting drinking is challenging, red wine may be a better option than other types of alcoholic beverages in Western populations.
UNASSIGNED: This longitudinal study included 12687 participants from the UK Biobank (UKB), all of whom participated in both baseline and repeat surveys. We excluded participants with missing data related to components of alcohol consumption and fatty liver index (FLI) in the baseline and the repeat surveys, as well as those who had reported liver diseases or cancer at the baseline survey. We used FLI as an outcome indicator and divided the participants into non-, moderate, and heavy drinkers. The surrogate marker FLI has been endorsed by many international organizations\' guidelines, such as the European Association for the Study of the Liver. The calculation of FLI was based on laboratory and anthropometric data, including triglyceride, gamma-glutamyl transferase, body mass index, and waist circumference. Participants responded to questions about the types of alcoholic beverages, which were defined in 5 categories, including red wine, white wine/fortified wine/champagne, beer or cider, spirits, and mixed liqueurs, along with the average weekly or monthly amounts of alcohol consumed. Alcohol consumption was defined as pure alcohol consumed per week and was calculated according to the amount of alcoholic beverages consumed per week and the average ethanol content by volume in each alcoholic beverage. Participants were categorized as non-drinkers, moderate drinkers, and heavy drinkers according to the amount of their alcohol consumption. Moderate drinking was defined as consuming no more than 210 g of alcohol per week for men and 140 g of alcohol per week for women. We defined the following hypothetical interventions for the amount of alcohol consumed: sustaining a certain level of alcohol consumption from baseline to the repeat survey (e.g., none to none, moderate to moderate, heavy to heavy) and changing from one alcohol consumption level to another (e.g., none to moderate, moderate to heavy). The hypothetical interventions for the types of alcoholic beverages were defined in a similar way to those for the amount of alcohol consumed (e.g., red wine to red wine, red wine to beer/cider). We applied the parametric g-formula to estimate the effect of each hypothetical alcohol consumption intervention on the FLI. To implement the parametric g-formula, we first modeled the probability of time-varying confounders and FLI conditional on covariates. We then used these conditional probabilities to estimate the FLI value if the alcohol consumption level of each participant was under a specific hypothetical intervention. The confidence interval was obtained by 200 bootstrap samples.
UNASSIGNED: For the alcohol consumption from baseline to the repeat surveys, 6.65% of the participants were sustained non-drinkers, 63.68% were sustained moderate drinkers, and 14.74% were sustained heavy drinkers, while 8.39% changed from heavy drinking to moderate drinking. Regarding the types of alcoholic beverages from baseline to the repeat surveys, 27.06% of the drinkers sustained their intake of red wine. Whatever the baseline alcohol consumption level, the hypothetical interventions for increasing alcohol consumption from the baseline alcohol consumption were associated with a higher FLI than that of the sustained baseline alcohol consumption level. When comparing sustained non-drinking with the hypothetical intervention of changing from non-drinking to moderate drinking, the mean ratio of FLI was 1.027 (95% confidence interval [CI]: 0.997-1.057). When comparing sustained non-drinking with the hypothetical intervention of changing from non-drinking to heavy drinking, the mean ratio of FLI was 1.075 (95% CI: 1.042-1.108). When comparing sustained heavy drinking with the hypothetical intervention of changing from heavy drinking to moderate drinking, the mean ratio of FLI was 0.953 (95% CI: 0.938-0.968). The hypothetical intervention of changing to red wine in the UKB was associated with lower FLI levels, compared with sustained consumption of other types of alcoholic beverages. For example, when comparing sustaining spirits with the hypothetical intervention of changing from spirits to red wine, the mean ratio of FLI was 0.981 (95% CI: 0.948-1.014).
UNASSIGNED: Regardless of the current level of alcohol consumption, interventions that increase alcohol consumption could raise the risk of hepatic steatosis in Western populations. The findings of this study could inform the formulation of future practice guidelines and health policies. If quitting drinking is challenging, red wine may be a better option than other types of alcoholic beverages in Western populations.
摘要：
非酒精性脂肪性肝病（NAFLD）和酒精相关性脂肪性肝病（ALD）是最常见的慢性肝病。肝脏脂肪变性是NAFLD和ALD的早期组织学亚型。众所周知，过量饮酒会导致肝脂肪变性和随后的肝损伤。然而,关于适度饮酒与肝性脂肪变性之间关联的报道结果仍然不一致.值得注意的是,酒精消费作为一种可改变的生活方式行为可能会随着时间的推移而改变，但大多数以前的研究仅在基线时涵盖一次酒精摄入量.这些来自现有研究的不一致的发现并不能为有关政策和临床指南的决策提供信息。这对卫生政策制定者和临床医生更感兴趣。此外,没有关于酒精饮料类型的建议。通常,评估两种或两种以上假设的饮酒干预措施对肝性脂肪变性的影响，可以回答如果每个人都从大量饮酒转变为禁欲，则有关肝性脂肪变性人群风险的问题。或者如果每个人都适度饮酒，或者如果每个饮酒人口都从红酒转向啤酒？因此，我们模拟了一项目标试验，以估计几种假设干预措施的效果，包括饮酒量或饮用酒精饮料类型的变化，使用纵向数据对肝脏脂肪变性，告知有关酒精相关政策制定和临床护理的决定。
■这项纵向研究包括来自英国生物库（UKB）的12687名参与者，所有参与者都参与了基线和重复调查.我们排除了基线和重复调查中与饮酒和脂肪肝指数（FLI）相关数据缺失的参与者，以及在基线调查中报告肝脏疾病或癌症的人。我们使用FLI作为结果指标，并将参与者分为非，中度,酗酒者。替代标记FLI已得到许多国际组织的认可，例如欧洲肝脏研究协会。FLI的计算是基于实验室和人体测量数据，包括甘油三酯，γ-谷氨酰转移酶，身体质量指数,和腰围。参与者回答了有关酒精饮料类型的问题，分为5类，包括红酒,白葡萄酒/强化葡萄酒/香槟，啤酒或苹果酒，精神，和混合利口酒，以及每周或每月平均饮酒量。酒精消耗量定义为每周消耗的纯酒精，并根据每周消耗的酒精饮料量和每种酒精饮料中按体积计的平均乙醇含量进行计算。参与者被归类为非饮酒者，适度饮酒者,和重度饮酒者根据他们的饮酒量。适度饮酒被定义为男性每周饮酒不超过210克，女性每周饮酒不超过140克。我们对饮酒量定义了以下假设干预措施：从基线到重复调查维持一定水平的饮酒量（例如，从没有到没有，中度到中度，重到重)，并从一个酒精消费水平改变到另一个(例如，没有到适度，中度到重度)。对酒精饮料类型的假设干预措施的定义与对酒精消耗量的定义类似（例如，红酒到红酒，红酒到啤酒/苹果酒)。我们应用参数g公式来估计每个假设的饮酒干预对FLI的影响。要实现参数化g公式，我们首先对协变量条件下的时变混杂和FLI的概率进行建模。然后，如果每个参与者的酒精消费水平处于特定的假设干预之下，我们使用这些条件概率来估计FLI值。置信区间由200个bootstrap样本获得。
■对于从基线到重复调查的饮酒量，6.65%的参与者是持续不饮酒者，63.68%为持续适度饮酒者，14.74%是持续酗酒者，8.39%由大量饮酒转为适度饮酒。关于从基线到重复调查的酒精饮料类型，27.06％的饮酒者持续摄入红酒。无论基线酒精消费水平如何，与持续基线饮酒水平相比,从基线饮酒增加饮酒的假设干预措施与更高的FLI相关.将持续不饮酒与从不饮酒改为适度饮酒的假设干预进行比较时，FLI的平均比率为1.027（95％置信区间[CI]：0.997-1.057）。将持续不饮酒与从不饮酒改为大量饮酒的假设干预措施进行比较时，FLI的平均比率为1.075（95％CI：1.042-1.108）。将持续大量饮酒与从大量饮酒改为适度饮酒的假设干预进行比较时，FLI的平均比率为0.953(95%CI:0.938-0.968)。在UKB中更改为红葡萄酒的假设干预与较低的FLI水平有关，与持续消费其他类型的酒精饮料相比。例如,当将持续的烈酒与从烈酒改为红酒的假设干预进行比较时，FLI的平均比率为0.981(95%CI:0.948-1.014)。
■无论目前的饮酒量如何，增加饮酒的干预措施可能会增加西方人群中肝脂肪变性的风险.这项研究的结果可以为制定未来的实践指南和卫生政策提供信息。如果戒酒具有挑战性，在西方人群中，红酒可能比其他类型的酒精饮料更好。
■这项纵向研究包括来自英国生物库（UKB）的12687名参与者，所有参与者都参与了基线和重复调查.我们排除了基线和重复调查中与饮酒和脂肪肝指数（FLI）相关数据缺失的参与者，以及在基线调查中报告肝脏疾病或癌症的人。我们使用FLI作为结果指标，并将参与者分为非，中度,酗酒者。替代标记FLI已得到许多国际组织的认可，例如欧洲肝脏研究协会。FLI的计算是基于实验室和人体测量数据，包括甘油三酯，γ-谷氨酰转移酶，身体质量指数,和腰围。参与者回答了有关酒精饮料类型的问题，分为5类，包括红酒,白葡萄酒/强化葡萄酒/香槟，啤酒或苹果酒，精神，和混合利口酒，以及每周或每月平均饮酒量。酒精消耗量定义为每周消耗的纯酒精，并根据每周消耗的酒精饮料量和每种酒精饮料中按体积计的平均乙醇含量进行计算。参与者被归类为非饮酒者，适度饮酒者,和重度饮酒者根据他们的饮酒量。适度饮酒被定义为男性每周饮酒不超过210克，女性每周饮酒不超过140克。我们对饮酒量定义了以下假设干预措施：从基线到重复调查维持一定水平的饮酒量（例如，从没有到没有，中度到中度，重到重)，并从一个酒精消费水平改变到另一个(例如，没有到适度，中度到重度)。对酒精饮料类型的假设干预措施的定义与对酒精消耗量的定义类似（例如，红酒到红酒，红酒到啤酒/苹果酒)。我们应用参数g公式来估计每个假设的饮酒干预对FLI的影响。要实现参数化g公式，我们首先对协变量条件下的时变混杂和FLI的概率进行建模。然后，如果每个参与者的酒精消费水平处于特定的假设干预之下，我们使用这些条件概率来估计FLI值。置信区间由200个bootstrap样本获得。
■对于从基线到重复调查的饮酒量，6.65%的参与者是持续不饮酒者，63.68%为持续适度饮酒者，14.74%是持续酗酒者，8.39%由大量饮酒转为适度饮酒。关于从基线到重复调查的酒精饮料类型，27.06％的饮酒者持续摄入红酒。无论基线酒精消费水平如何，与持续基线饮酒水平相比,从基线饮酒增加饮酒的假设干预措施与更高的FLI相关.将持续不饮酒与从不饮酒改为适度饮酒的假设干预进行比较时，FLI的平均比率为1.027（95％置信区间[CI]：0.997-1.057）。将持续不饮酒与从不饮酒改为大量饮酒的假设干预措施进行比较时，FLI的平均比率为1.075（95％CI：1.042-1.108）。将持续大量饮酒与从大量饮酒改为适度饮酒的假设干预进行比较时，FLI的平均比率为0.953(95%CI:0.938-0.968)。在UKB中更改为红葡萄酒的假设干预与较低的FLI水平有关，与持续消费其他类型的酒精饮料相比。例如,当将持续的烈酒与从烈酒改为红酒的假设干预进行比较时，FLI的平均比率为0.981(95%CI:0.948-1.014)。
■无论目前的饮酒量如何，增加饮酒的干预措施可能会增加西方人群中肝脂肪变性的风险.这项研究的结果可以为制定未来的实践指南和卫生政策提供信息。如果戒酒具有挑战性，在西方人群中，红酒可能比其他类型的酒精饮料更好。
