Excessive drinking may heighten liver disease risk in metabolic syndrome

Metabolic syndrome is a cluster of conditions that can increase the risk for a number of poor health outcomes. It affects around one in three people in the U.S.

When individuals have three or more of the following conditions, doctors may diagnose them with metabolic syndrome:

W​hen people have metabolic syndrome, it can increase their chances of developing diabetes, having a stroke, or developing coronary heart disease.

The risks of conditions associated with metabolic syndrome may increase due to genetic factors or lifestyle choices.

Researchers are still working to understand how metabolic syndrome relates to other health conditions and how people could minimize their risk for adverse health outcomes.

One area of interest is how metabolic syndrome may lead to liver damage.

For the current study, researchers looked at the relationship between metabolic syndrome and alcohol use.

The researchers noted a surge in deaths from alcohol-associated liver disease (ADL) from 2009 to 2018 despite an overall decline in alcohol use.

To better understand the association, they looked at data from 1999 to 2018 from more than 40,000 respondents who participated in the National Health and Nutrition Examination Survey.

All respondents were adults 20 years old or older, non-institutionalized, and did not have viral hepatitis.

Researchers had specific parameters for measuring heavy alcohol use and metabolic syndrome. They defined heavy alcohol use with the following criteria:

• more than 28 grams (2 drinks) daily for women
• more than 42 grams (4 drinks) daily for men.

Researchers determined how much alcohol respondents were consuming by examining average alcohol intake over a year.

The data allowed them to look at specific trends in alcohol use, metabolic syndrome, and how these factors related to advanced liver disease.

The researchers found that the risk of developing advanced liver disease was highest for participants who were both heavy drinkers and who had metabolic syndrome.

Study author Dr. Brian P. Lee, transplant hepatologist and assistant professor of medicine at Keck School of Medicine of USC, explained the key findings of the study to Medical News Today:

“We found that your risk of advanced liver disease from drinking is more than doubled if you have metabolic syndrome; [and that] it was unclear why national deaths from alcohol liver disease surged between 2009-2018 when drinking rates were unchanged — rising rates of metabolic syndrome, which is tied to obesity, diabetes, high blood pressure, and high cholesterol, may be an important piece to this puzzle.”

T​hese data did face certain limitations. First, the study cannot establish a causal relationship between the factors examined. The research also relied on self-reporting for alcohol use which has certain error risks.

Researchers acknowledge that they collected data on advanced fibrosis, an indicator of liver damage, via surrogate biomarkers. This might not accurately reflect the number of advanced fibrosis cases.

T​here is a risk for residual confounding, and researchers had limited data from subgroups. The number of people who respond to this particular survey has declined over time, so there might be bias based on who responded and who did not. Researchers also did not distinguish between alcoholic-associated liver disease and non-alcoholic fatty liver disease.

Overall, the data indicate a need for managing metabolic syndrome and highlight the dangers of heavy drinking.

D​r. Lee explained to MNT:

“Clinicians need to aggressively screen and treat both alcohol use and metabolic syndrome in an integrated fashion to successfully address the growing number of liver-related deaths in this country. Further research needs to identify how alcohol and metabolic syndrome combine to cause damage in the liver, and how best to screen, prevent, and treat unhealthy alcohol use, metabolic syndrome, and liver disease.”

Individual risk for advanced liver disease will vary, but the study indicates that managing both metabolic syndrome and alcohol may provide certain benefits.

Current guidelines for alcohol consumption are 2 drinks a day or less for men and 1 drink a day or less for women.

People can adopt strategies to cut back on their alcohol intake, including keeping track of the number of drinks they consume and setting personal limits on how much alcohol they drink in a week.

Management of metabolic syndrome may include medications, such as those that help manage cholesterol levels, blood sugar, or blood pressure. People could also make lifestyle changes, including quitting smoking and following a heart-healthy diet.

Individuals living with metabolic syndrome may also seek help from medical professionals and specialists for guidance on specific strategies.

N​on-study author and contracted medical advisor Dr. James Walker, a physician and medical advisor at Welzo, offered further insight to MNT:

“Managing metabolic syndrome and reducing alcohol consumption are crucial for preventing or mitigating the risk of liver disease. Lifestyle modifications, including weight loss, regular physical activity, and a healthy diet, can help improve metabolic syndrome components and reduce liver fat accumulation. Additionally, reducing or eliminating alcohol intake is essential for preventing alcohol-related liver damage.”