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Increased Prevalence of Obesity and Metabolic Syndrome in Patients with Alcoholic Fatty Liver Disease

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Abstract

Background and Aims

Obesity and diabetes are risk factors for advanced alcoholic liver disease, and both are components of the metabolic syndrome. We aimed to assess the prevalence of metabolic syndrome and its components in a contemporary US cohort of adults with alcoholic liver disease and compare it to a historic cohort to assess changes over time.

Method

Individuals 18 years or older who participated in the National Health and Nutrition Examination Survey during 2009–2014 and 1999–2001 were used as the contemporary and historic cohort, respectively. Alcoholic liver disease was defined as excessive alcohol consumption (men: ≥ 3 drinks/day; women: ≥ 2 drinks/day) and elevated alanine aminotransferase. Metabolic syndrome definition was based on the updated International Diabetes Federation criteria. Data are presented as mean ± standard error or unweighted frequency. A logistic regression analysis was performed to assess differences in metabolic syndrome components between the two period cohorts while adjusting for central obesity.

Results

The mean age for our contemporary cohort was 41.9, 66.1% being male. Central obesity was present in 66.3%, type 2 diabetes in 18.7%, low high-density lipoprotein in 28.3%, hypertriglyceridemia in 44.8%, and hypertension in 54.7%. 36.9% met the criteria for metabolic syndrome. Compared to the historic cohort, patients in the contemporary cohort were more likely to have central obesity (50% vs. 66%, p = 0.002), metabolic syndrome (26% vs. 37%, p = 0.044), and type 2 diabetes (12% vs. 19%, p = 0.099).

Conclusions

Prevalence of both obesity and metabolic syndrome is increasing in alcoholic liver disease patients. Further studies are required to investigate effective interventions to avoid disease progression in these high-risk patients.

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Abbreviations

AF:

Advanced fibrosis

AST:

Aspartate aminotransferase

ALT:

Alanine aminotransferase

APRI:

AST to Platelet Ratio Index

BMI:

Body mass index

CDC:

Centers for Disease Control and Prevention

DALYs:

Disability-adjusted life years

FIB-4:

Fibrosis-4

GGT:

γ-Glutamyl transpeptidase

HDL:

High-density lipoprotein

HbA1c:

Hemoglobin A1c

HCC:

Hepatocellular carcinoma

IDF:

International Diabetes Federation

LDL:

Low-density lipoprotein

LD:

Liver disease

LT:

Liver transplantation

MetS:

Metabolic syndrome

NHANES:

National Health and Nutrition Examination Survey

NAFLD:

Nonalcoholic fatty liver disease

NCHS:

National Center for Health Statistics

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Funding

This work was not supported by any grants from any organization.

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Authors

Contributions

AS, NA, and AM contributed to study concept and design; AS performed acquisition of data; AS and RL analyzed and interpreted the data; all authors drafted and critically revised the manuscript for important intellectual content; RL, AS, NA, and AM performed statistical analysis; all authors provided administrative, technical, or material support; NA and AM supervised the study.

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Correspondence to Amandeep Singh.

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Amandeep Singh, Hina Amin, Mohit Gupta, Rocio Lopez, and Naim Alkhouri have no conflict of interest and nothing to disclose.

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Singh, A., Amin, H., Garg, R. et al. Increased Prevalence of Obesity and Metabolic Syndrome in Patients with Alcoholic Fatty Liver Disease. Dig Dis Sci 65, 3341–3349 (2020). https://doi.org/10.1007/s10620-020-06056-1

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