To determine whether quantity, binge pattern consumption or type of alcohol was associated with liver fibrosis in patients with NAFLD, previous and current alcohol consumption was assessed in NAFLD patients undergoing liver biopsy. All subjects currently consumed less than 210 grams per week (male), or less than 140 grams per week (female). Binge consumption was defined as greater than 4 standard drinks (female), or greater than five standard drinks (male), in one sitting. Liver biopsies were scored according to the NASH CRN system with F3/4 fibrosis defined as advanced.

Among the 187 patients (24% with advanced fibrosis), the median weekly alcohol consumption was 20 (2.3-60)g over an average of 18 years. Modest consumption (1-70 g per week), was associated with lower mean fibrosis stage compared to lifetime abstainers and a decreased risk of advanced fibrosis (OR 0.33). The association with reduced fibrosis was not seen in subjects drinking in a binge-type fashion. Exclusive wine drinkers, but not exclusive beer drinkers, had lower mean fibrosis stage and lower odds of advanced fibrosis (OR 0.20), compared to lifetime abstinent subjects. No interaction between gender and alcohol quantity, type, or binge consumption on fibrosis was observed.

It was concluded that modest alcohol consumption, particularly wine in a non-binge pattern is associated with lower fibrosis in patients with NAFLD. Prospective longitudinal studies into fibrosis progression, cardiovascular outcomes and mortality are required before clinical recommendation can be made.

Mitchell, C., Jeffrey, G., Boer, B., et al. “Type and Pattern of Alcohol Consumption Liver Fibrosis in Patients with Non-Alcoholic Fatty Liver Disease.” American Journal of Gastroenterology; Vol. 113, pp. 1484-1493