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Additive interaction among rs738409, obesity, and alcohol towards NAFLD

The latest issue of the American Journal of Gastroenterology examines the interaction of rs738409, obesity, and alcohol.

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Dr Winston Dunn and colleagues from Kansas, USA studied the prevalence of alcoholic liver disease and nonalcoholic fatty liver disease (NAFLD) histology in the general population, which had been otherwise difficult to access because of inherent misclassification bias in surrogate marker studies and referral bias in patient case series.

The interaction among rs738409, obesity, and alcohol remains controversial.

The research team investigated the histological prevalence of alcoholic liver disease and NAFLD, and interactions among rs738409, obesity, and alcoholism.

A total of 170 alcoholic and 235 nonalcoholic cases were selected from 1,034 adult car accident autopsies in 17 Kansas and Missouri counties from 2000 to 2010. 

The research team found that the nonalcoholic group had undetectable blood alcohol concentration, while the alcoholic group had a blood alcohol concentration 0.08% or more.
 
The age-standardized prevalences of hepatic steatosis, steatohepatitis, and advanced fibrosis were 56%, 6%, and 18% among alcoholics and 36%, 4%, and 6% in nonalcoholics, respectively. 
Every 5-unit increase in BMI had 2-fold odds of fibrosis among nonalcoholics
American Journal of Gastroenterology

The team found that the interaction terms among alcohol, body mass index (BMI), and genotype were not significant. 

rs738409 GC or GG genotype was associated with 1.9-fold odds of a higher NAFLD Activity Score (NAS). 
 
The doctors reported that alcohol had a 3.5-fold odds while every 5-unit increase in BMI had 1.9-fold odds. 
 
A negative interaction between alcohol and BMI towards fibrosis had been observed. 
 
The team found that every 5-unit increase in BMI had 2-fold odds of fibrosis among nonalcoholics, but not in alcoholics.

Dr Dunn's team concludes, "This study assessed the prevalence of fatty liver histology in the general population from an autopsy study perspective. 
 
"The finding of an additive interaction among rs738409, obesity, and alcohol towards NAFLD Activity Score may be useful in targeting preventative care to patients at highest risk for alcoholic liver disease."  
 
"The negative interaction between alcohol and obesity towards fibrosis supported previous findings and suggests the need for future research to explore potential mechanisms that may improve treatment of nonalcoholic steatohepatitis-related fibrosis."

Am J Gastroenterol 2012; 107:16681674

30 November 2012

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