Liver and Bile
J Hepatol. 2022;77(4):918–30
Ethylglucuronide in hair detects a high rate of harmful alcohol consumption in presumed non-alcoholic fatty liver disease
Background and aims: Non-alcoholic fatty liver disease (NAFLD) and alcohol-related liver disease (ALD) cannot reliably be distinguished by routine diagnostics, and the role of alcohol consumption in metabolic dysfunction-associated fatty liver disease (MAFLD) remains unclear. The authors investigated alcohol consumption in patients with presumed NAFLD and ALD using novel objective alcohol markers.
Methods: In total, 184 consecutive patients were included in this prospective observational study. Alcohol intake was assessed by ethylglucuronide in hair (hEtG) and urine (uEtG); the utility of these measures for alcohol detection was compared to Alcohol Use Disorders Identification Test-Consumption (AUDIT-C), carbohydrate-deficient transferrin (CDT), mean corpuscular volume (MCV), gamma-glutamyltransferase (GGT), and ALD/NAFLD index (ANI). Clinical characteristics of patients with NAFLD and ALD were re-assessed after reclassification based on repeated moderate (≥ 10 g < 60 g ethanol [EtOH]/day) and excessive (≥ 60 g EtOH/day) alcohol consumption, and patients were retrospectively reclassified based on MAFLD criteria.
Results: Repeated moderate to excessive alcohol consumption was detected in 28.6%, 28.5%, and 25.0% of patients with presumed NAFLD, ALD or MAFLD, respectively. ANI score, AUDIT-C, uEtG, and hEtG showed AUCs of 0.628, 0.733, 0.754, and 0.927 for the detection of repeated moderate to excessive alcohol consumption, respectively. The indirect markers CDT, MCV and GGT were not reliable. Patients with repeated moderate or excessive alcohol consumption were significantly more often male, had a significantly lower body mass index, and suffered significantly less often from type 2 diabetes or impaired glucose tolerance.
Conclusions: In total, 28.6% of patients with presumed non-alcoholic fatty liver disease, and 25.0% with metabolic dysfunction-associated fatty liver disease are at risk of alcohol-related liver damage. AUDIT-C, ethylglucuronide in urine and hair should be used to screen for alcohol consumption in patients with fatty liver disease.