On the other hand, excessive alcohol consumption is an established risk factor for liver disease, with various cofactors influencing liver disease development in patients with excessive alcohol use ( Fig.
In addition, moderate alcohol consumption also appears to reduce the risk of coronary heart disease. Modification of cardiovascular risk factors includes lifestyle interventions, such as regular physical exercise, and weight loss. Patients with NAFLD are at high risk for cardiovascular disease and are more likely to die from coronary heart disease than hepatic disease indeed, cardiovascular disease is the most common cause of death in this population. NAFLD can progress from isolated steatosis to nonalcoholic steatohepatitis (NASH), which encompasses, besides steatosis, ballooning hepatocellular injury, inflammation and liver fibrosis, and might evolve to cirrhosis or even to hepatocellular carcinoma (HCC). NAFLD diagnosis requires that the patient does not exhibit daily alcohol consumption of ≥30 g for men or ≥20 g for women. It affects as many as one-fourth of the general population worldwide, being more frequent in patients with metabolic syndrome (MetS) or its components than in the general population. Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease. As the research field focusing on NAFLD keeps widening, more prospective studies regarding this specific subject are expected, and may provide a basis for less ambiguous recommendations. On the other hand, only light alcohol consumption (<10 g/day) might be permitted in patients without significant hepatic fibrosis, provided that they are carefully followed-up. Therefore, patients with nonalcoholic steatohepatitis or advanced fibrosis should be advised against consuming alcohol.
Nonetheless, even light alcohol intake appears to aggravate liver disease and increase the risk of hepatocellular cancer. Some studies have shown beneficial effects of alcohol on cardiovascular and overall mortality in this specific subset of patients. Accordingly, recommendations for alcohol intake in patients with nonalcoholic fatty liver disease (NAFLD), who are at increased risk for liver-related and cardiovascular events, are a point of debate. At the same time, moderate alcohol intake appears to reduce cardiovascular morbidity. Excessive alcohol intake is an established risk factor for chronic liver disease.
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