Improvement in hepatic steatosis but worse lipid profile after alcohol cessation

A study conducted among patients with alcohol use disorder enrolled in an alcohol detoxification programme showed that hepatic steatosis improved rapidly after drinking was stopped. Unfortunately, this was accompanied by a significant change from an athero-protective profile (high HDL, low LDL) to an atherogenic one.

The study, including 93 patients, categorised lipoprotein (LP) changes and the association between LP-Insulin Resistance Index (LP-IR) and hepatic steatosis following alcohol detoxification [1]. Patients that were enrolled in a 4-week alcohol detoxification programme at the National Institute of Health and with the last drink within 3 days of admission were registered.

Laboratory values and NMR LipoProfile Testing® were collected upon admission and during the first and third weeks. Fibroscan® with controlled attenuation parameter (CAP) was performed during the first, second, and fourth week. The Area Under Receiver Operator Characteristic (AUROC) was used to distinguish responders and non-responders, defined as a decrease or increase in liver CAP between week 1 and week 4.

A significant decrease was measured in CAP and aspartate aminotransferase over time. LP analysis showed a decrease in Apolipoprotein (Apo) A1 and an increase in ApoB and an initial decrease in LP-IR. A decrease in HDL particle number was detected, which was also seen in medium and large but not small HDL-P, as well as a decrease in HDL size. In comparison, an increase in LDL particle number was detected, with an increase in small and a decrease in large LDL particles, as well as a decrease in LDL size. Lastly, an increase in total triglyceride-rich LP particle number was observed.

As the liver is a key producer of ApoA1 and ApoB100, the authors hypothesised that with alcohol, ApoA1 is upregulated resulting in increased HDL and ApoB is downregulated, resulting in decreased LDL and triglycerides with lipids unable to leave the liver. Initial LP-IR was found to predict CAP improvement. Further studies are needed to elucidate the mechanisms of hepatic influx and efflux of lipids and the interplay between insulin resistance and alcoholic steatosis.

1. Rapoport EA, et al. Adverse events in fecal microbiota transplantation: a systematic review and meta-analysis. Poster Su1602, Digestive Disease Week 2022, 21‒24 May, San Diego, CA, USA.

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Posted on 14 June 2022