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Overweight and obesity exacerbates liver-damaging impact of alcohol

Thu, 06/03/2021 - 09:36
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A study led by the University of Sydney's Charles Perkins Center that included nearly half a million people, has found having overweight or obesity considerably amplified the harmful effects of alcohol on liver disease and mortality. The researchers suggested future alcohol guidelines need to place more emphasis on Australia's growing waistlines.

"People in the overweight or obese range who drank were found to be at greater risk of liver diseases compared with participants within a healthy weight range who consumed alcohol at the same level," said senior author and research program director, Professor Emmanuel Stamatakis from the Charles Perkins Center and the Faculty of Medicine and Health. "Even for people who drank within alcohol guidelines, participants classified as obese were at over 50 percent greater risk of liver disease."

The researchers drew upon data from the UK Biobank - a large-scale biomedical cohort study containing in-depth biological, behavioural and health information from participants in the United Kingdom (UK) - however they claim the findings can safely be applied to the Australian population.

According to the researchers, this is one of the first and largest studies looking at increased adiposity (overweight or obesity) and level of alcohol consumption together, in relation to future liver disease. The findings, ‘Joint associations of adiposity and alcohol consumption with liver disease-related morbidity and mortality risk: findings from the UK Biobank’, were published in the European Journal of Clinical Nutrition.

Lead author, Dr Elif Inan-Eroglu, a postdoctoral research fellow with the Charles Perkins Center, said the results suggest people carrying excess weight may need to be more aware of risks around alcohol consumption: "With the most recent data suggesting two in three people - or 67 percent of the Australian population are in the overweight or obesity range, this is obviously a very topical issue."

Data was examined from 465,437 people aged 40 to 69 years, with medical and health details collected over an average of 10.5 years From participants classified as overweight/obese based on their body mass index (BMI) and waist circumference, self-reported alcohol consumption according to UK alcohol guidelines, and liver disease incidence and liver disease as cause of death.

They reported that ,people who drank above UK alcohol guidelines had, compared to within guideline drinkers:

  • A nearly 600 percent higher risk of being diagnosed with alcoholic fatty liver disease (5.83 hazard ratio).
  • A nearly 700 percent higher risk of death caused by alcoholic fatty liver disease (6.94 hazard ratio).
  • People with overweight or obesity who drank within or above alcohol guidelines had over 50 percent greater risk of developing liver disease compared to normal weight participants who consumed alcohol at the same level.

The researchers say the findings of the study emphasise how alcohol drinking guidelines and doctor's advice may need to consider the year-on-year increasing trend of obesity and overweight prevalence in Australia and its compounding health impacts.

Current National Health and Medical Research Council (NHMRC) alcohol guidelines, last updated in 2020, state healthy adults should drink no more than ten standard drinks a week, and no more than four on any one day.

The guidelines acknowledge that alcohol could worsen pre-existing health conditions, such as liver diseases, hepatitis B and C, and obesity. However, they do not acknowledge that more than one-third of Australians are affected by obesity; and do not specifically cover the combined harm of alcohol and lower levels of unhealthy adiposity (such as being overweight) on liver disease.

"The current alcohol guidelines are based on reviews of available evidence, but future updates must take into account overweight as a liver disease risk amplifying factor,” added Stamatakis. “Briefly mentioning obesity in the current guidelines may not be enough. Overweight and obesity affect over two-thirds of Australians, which raises the need to develop a specific alcohol drinking recommendation for this population majority group. Based on our study's findings, people who are in the overweight range, not only obese, should consume alcohol cautiously, and perhaps aim for an amount well below the generic NHMRC guidelines."