Obesity negatively affects LS and CAP resolution after alcohol detoxification in heavy drinkers

Background & Aim:

Excessive alcohol intake and obesity are the two major causes for liver disease in the Western world and often co-exist. Here we investigate the influence of obesity on the resolution of liver stiffness (LS) and steatosis (CAP) after alcohol detoxification in patients with ALD.

Methods:

553 ALD patients were prospectively enrolled for alcohol detoxification and stratified based on BMI into a lean (BMI≤25 kg/m2, n = 309) and severely obese (BMI≥30 kg/m2, n = 82) group. In all patients, morphological data, fibrosis (LS using Fibroscan) and steatosis (CAP) were measured non-invasively before and after alcohol detoxification. In addition, abdominal ultrasound, clinical laboratory parameters and M30/M65 levels were obtained in all patients.

Results:

72% were male, mean age was 52 years, mean daily alcohol consumption was 182 g/day and mean duration of detoxification was 6.3 days. In the overall cohort, BMI was significantly correlated with steatosis (r = 0.32, P < 0.001), and fibrosis stage (r = 0.23, P < 0.001). Between the two groups (lean vs. severely obese), no statistical differences in age, gender, daily alcohol consumption and duration of heavy drinking were observed. The severely obese group showed significantly higher degrees of steatosis (CAP 283 vs. 323 dB/m, P < 0.001) and, but non-significantly, more fibrosis (LS 14.6 vs. 18.5 kPa, P = 0.15). After alcohol detoxification, transaminase levels, CAP and LS significantly decreased in the lean group. In contrast, in the severely obese group, only AST (79 vs. 63 U/L, P < 0.01) decreased significantly while no significant change was observed in ALT levels (59 vs. 64 U/L), LS (18.5 vs. 18.7 kPa) and CAP (323 vs. 315 dB/m). Additionally, LS was significantly higher in the obese group after detoxification in comparison to the lean group (18.7 vs. 12.5 kPa, P < 0.01). Of note, apoptotic serum markers (M30 and M65 levels) significantly increased in the severely obese group (from 437 to 631 U/L, P < 0.05 and 822 to 1249 U/L, P < 0.05, respectively). Finally, in multivariate analysis, BMI and CAP were the only significant independent negative predictors (P < 0.05 and P < 0.001) for LS resolution after alcohol detoxification.

Conclusion:

Severe obesity not only aggravates all liver stages of heavy drinkers (steatosis, injury, fibrosis) but also prevents rapid resolution of steatosis, inflammation and liver stiffness in response to alcohol withdrawal.