Protective effect of alcohol consumption for fatty liver but not metabolic syndrome

Table 1 The adjusted odds ratio (95% CI) for the metabolic syndrome and fatty liver

	Men odds ratio (95% CI)	P value	Women odds ratio (95% CI)	P value
For MetS defined by rATP III
The grade of alcohol consumption
Light	0.98 (0.83-1.15)	0.77	0.48 (0.27-0.82)	0.008
Moderate	0.88 (0.75-1.04)	0.14	0.9 (0.5-1.65)	0.74
Excess	1.18 (1.01-1.39)	0.043	0.96 (0.37-2.48)	0.93
Age	1.01 (1-1.02)	< 0.001	1.08 (1.05-1.1)	< 0.001
The usage of drugs	4.95 (4.3-5.69)	< 0.001	7.46 (4.96-11.24)	< 0.001
Wine consumers	1.13 (0.67-1.9)	0.66	0.52 (0.24-1.15)	0.11
Regular exercisers	0.6 (0.51-0.71)	< 0.001	0.6 (0.38-0.94)	0.027
Smoking states
Ex smoker/non smoker	1.21 (1.03-1.41)	0.017	0.89 (0.48-1.65)	0.72
Current smoker/non smoker	1.13 (0.97-1.33)	0.12	1.07 (0.58-1.98)	0.83
For MetS defined by IDF
The grade of alcohol consumption	0.93 (0.75-1.14)	0.46	0.36 (0.19-0.69)	< 0.001
Light	0.78 (0.63-0.97)	0.029	0.61 (0.3-1.25)	0.18
Moderate	1.08 (0.87-1.33)	0.48	1.14 (0.45-2.9)	0.78
Excess	1 (0.99-1.01)	0.66	1.08 (1.05-1.1)	< 0.001
Age	3.64 (3.05-4.34)	< 0.001	4.85 (3.09-7.63)	< 0.001
The usage of drugs	0.78 (0.37-1.65)	0.52	0.6 (0.26-1.35)	0.22
Wine consumers	0.64 (0.51-0.79)	< 0.001	0.55 (0.34-0.92)	0.021
Regular exercisers
Smoking states	1.3 (1.06-1.59)	0.01	1.03 (0.54-1.97)	0.93
Ex smoker/non smoker	1.09 (0.89-1.35)	0.39	1.07 (0.54-2.1)	0.85
Current smoker/non smoker
For fatty liver
The grade of alcohol consumption
Light	0.69 (0.6-0.79)	< 0.001	0.54 (0.34-0.88)	0.012
Moderate	0.72 (0.63-0.83)	< 0.001	0.43 (0.21-0.88)	0.021
Excess	0.74 (0.64-0.85)	< 0.001	1.02 (0.44-2.35)	0.97
Age	1 (0.99-1)	0.21	1.06 (1.04-1.08)	< 0.001
The usage of drugs	2.09 (1.83-2.38)	< 0.001	2.17 (1.4-3.38)	< 0.001
Wine consumers	0.85 (0.53-1.35)	0.48	0.59 (0.3-1.15)	0.12
Regular exercisers	0.67 (0.59-0.77)	< 0.001	0.76 (0.52-1.13)	0.17
Smoking states
Ex smoker/non smoker	1.24 (1.09-1.41)	< 0.001	0.38 (0.18-0.79)	0.01
Current smoker/non smoker	0.92 (0.81-1.05)	0.21	1 (0.57-1.74)	1
For high BMI
The grade of alcohol consumption
Light	0.86 (0.75-0.99)	0.034	0.64 (0.43-0.97)	0.036
Moderate	0.85 (0.73-0.98)	0.026	0.59 (0.33-1.06)	0.077
Excess	0.9 (0.78-1.05)	0.18	1.1 (0.53-2.31)	0.8
Age	0.99 (0.98-0.99)	< 0.001	1.04 (1.02-1.06)	< 0.001
The usage of drugs	2.19 (1.91-2.51)	< 0.001	1.77 (1.15-2.74)	0.01
Wine consumers	0.79 (0.48-1.29)	0.34	0.68 (0.39-1.21)	0.19
Regular exercisers	0.93 (0.81-1.06)	0.29	0.69 (0.48-0.99)	0.047
Smoking states
Ex smoker/non smoker	1.19 (1.04-1.36)	0.013	0.56 (0.32-0.97)	0.037
Current smoker/non smoker	0.99 (0.87-1.14)	0.92	0.95 (0.58-1.57)	0.85
For high waist circumferences
The grade of alcohol consumption
Light	0.96 (0.81-1.13)	0.61	0.71 (0.51-0.97)	0.03
Moderate	0.89 (0.75-1.06)	0.21	0.57 (0.36-0.9)	0.016
Excess	1.06 (0.89-1.27)	0.5	1.06 (0.58-1.93)	0.85
Age	1 (0.99-1.01)	0.85	1.07 (1.06-1.09)	< 0.001
The usage of drugs	2.35 (2.01-2.74)	< 0.001	1.64 (1.14-2.36)	0.007
Wine consumers	0.63 (0.32-1.23)	0.18	0.68 (0.43-1.07)	0.095
Regular exercisers	0.71 (0.6-0.84)	< 0.001	0.69 (0.52-0.92)	0.012
Smoking states
Ex smoker/non smoker	1.26 (1.07-1.49)	0.005	0.93 (0.64-1.35)	0.69
Current smoker/non smoker	1.04 (0.88-1.23)	0.67	0.91 (0.6-1.37)	0.64
For high blood pressure
The grade of alcohol consumption
Light	1.33 (1.16-1.53)	< 0.001	1.22 (0.85-1.75)	0.27
Moderate	1.47 (1.27-1.7)	< 0.001	1.97 (1.26-3.07)	< 0.001
Excess	2.24 (1.93-2.59)	< 0.001	3.13 (1.71-5.72)	< 0.001
Age	1.04 (1.03-1.05)	< 0.001	1.07 (1.06-1.09)	< 0.001
The usage of drugs	6.16 (5.33-7.13)	< 0.001	16.09 (10.87-23.83)	< 0.001
Wine consumers	1.09 (0.68-1.73)	0.73	0.72 (0.42-1.23)	0.23
Regular exercisers	0.81 (0.71-0.93)	< 0.001	0.8 (0.57-1.12)	0.19
Smoking states
Ex smoker/non smoker	1.01 (0.88-1.15)	0.93	0.78 (0.5-1.23)	0.28
Current smoker/non smoker	0.67 (0.59-0.77)	< 0.001	0.73 (0.45-1.18)	0.2
For high plasma glucose
The grade of alcohol consumption
Light	1 (0.88-1.13)	0.94	1.52 (1.11-2.08)	0.009
Moderate	1.23 (1.08-1.4)	< 0.001	1.46 (0.95-2.25)	0.085
Excess	1.38 (1.2-1.58)	< 0.001	2.66 (1.49-4.76)	< 0.001
Age	1.03 (1.03-1.04)	< 0.001	1.07 (1.06-1.09)	< 0.001
The usage of drugs	2.05 (1.79-2.33)	< 0.001	1.88 (1.29-2.72)	< 0.001
Wine consumers	1.78 (1.17-2.72)	0.007	0.56 (0.33-0.96)	0.034
Regular exercisers	0.76 (0.68-0.86)	< 0.001	0.92 (0.68-1.24)	0.58
Smoking states
Ex smoker/non smoker	1.22 (1.08-1.38)	< 0.001	0.68 (0.44-1.05)	0.083
Current smoker/non smoker	0.94 (0.83-1.06)	0.31	0.67 (0.42-1.06)	0.087
For low HDL-c
The grade of alcohol consumption
Light	0.7 (0.61-0.8)	< 0.001	0.58 (0.42-0.79)	< 0.001
Moderate	0.49 (0.42-0.57)	< 0.001	0.43 (0.27-0.69)	< 0.001
Excess	0.41 (0.35-0.48)	< 0.001	0.48 (0.24-0.96)	0.039
Age	1.01 (1-1.01)	0.082	1.01 (1-1.02)	0.055
The usage of drugs	3.4 (2.96-3.9)	< 0.001	4.24 (2.97-6.03)	< 0.001
Wine consumers	0.79 (0.47-1.32)	0.37	0.9 (0.6-1.35)	0.61
Regular exercisers	0.71 (0.62-0.82)	< 0.001	0.68 (0.52-0.91)	0.009
Smoking states
Ex smoker/non smoker	1.06 (0.92-1.22)	0.45	0.64 (0.43-0.95)	0.027
Current smoker/non smoker	1.65 (1.44-1.9)	< 0.001	1.47 (1.03-2.11)	0.036
For high triglycerides
The grade of alcohol consumption
Light	0.89 (0.76-1.03)	0.11	0.37 (0.19-0.74)	0.005
Moderate	1.01 (0.87-1.18)	0.88	1.27 (0.68-2.35)	0.45
Excess	1.34 (1.16-1.56)	< 0.001	1.2 (0.45-3.2)	0.72
Age	1 (0.99-1)	0.19	1.06 (1.04-1.09)	< 0.001
The usage of drugs	3.06 (2.67-3.51)	< 0.001	11.13 (7.07-17.53)	< 0.001
Wine consumers	0.83 (0.49-1.4)	0.48	0.92 (0.43-1.99)	0.83
Regular exercisers	0.68 (0.59-0.79)	< 0.001	0.73 (0.44-1.21)	0.22
Smoking states
Ex smoker/Non smoker	1.26 (1.09-1.46)	< 0.001	0.99 (0.49-2.01)	0.98
Current smoker/Non smoker	1.44 (1.24-1.66)	< 0.001	1.91 (1.02-3.55)	0.042

BMI: Body mass index; HDL-c: High density lipoprotein cholesterol; rATP III: Revised National Cholesterol Education Program Adult Treatment Panel III; IDF: International Diabetes Federation.

Table 2 The correlation between components for the metabolic syndrome, liver associated enzymes and alcohol consumptions in participants free from drugs

	Men				Women
	Non or minimal	Light	Moderate	Excess	Non or minimal	Light	Moderate	Excess
No. of subjects	6154	1734	1616	1478	6893	406	207	84
Age, yr	46.3 (10)	47.5 (9.4)	49.3 (9.4)	49.4 (8.9)	45.1 (9.9)	45.2 (8.8)	45.5 (8.5)	45 (9.3)
Aspartate aminotransferase, IU/L	20.2 (8.7)	19.6 (7.1)	20.8 (10.2)	23.2 (11.6)	17.2 (9)	17.1 (4.9)	17.5 (5.8)	19 (6.2)
Alanine aminotransferase, IU/L	26.1 (16.9)	23.7 (13.3)	23.8 (14.1)	25.5 (14.7)	15.9 (13.1)	15.2 (6.7)	15.6 (6.7)	16 (7)
Gamma-glutamyltransferase, IU/L	24.3 (21.9)	28.9 (24.6)	36 (34.5)	48.8 (51)	13.8 (9.5)	15.8 (12.1)	17.1 (10.6)	22.6 (21.8)
BMI, kg/m2	23.5 (3.3)	23.2 (2.9)	23.3 (2.7)	23.4 (2.9)	21.4 (3.2)	20.9 (2.7)	20.9 (3.1)	21.3 (3.2)
Waist circumference, cm	81.8 (8.6)	81.5 (7.7)	82.2 (7.5)	82.9 (7.7)	72.3 (8.8)	71.5 (7.9)	71.5 (8.6)	73.9 (9.4)
Systolic blood pressure, mmHg	120.1 (15.6)	121.7 (15.8)	123.9 (15.8)	127.4 (16.1)	111.2 (16.2)	111.2 (15.6)	114.3 (19.4)	116.7 (17)
Diastolic blood pressure, mmHg	75.9 (10.3)	77.2 (10.2)	79 (10.4)	81.3 (10.1)	69.1 (10.3)	69.6 (10.6)	72.2 (11.9)	72.9 (10.9)
Fasting plasma glucose, , mg/dL	100.5 (19.3)	100 (16.4)	102.4 (19.9)	103.5 (19.1)	91.3 (12.7)	91.8 (10.1)	91.5 (9.8)	96.1 (18.7)
HDL-c, mg/dL	46 (11.4)	49.6 (12.5)	52 (13.4)	53.3 (14.2)	59.9 (13.3)	65.7 (14.1)	69 (14.9)	68.6 (14)
LDL-c, mg/dL	128 (30)	122.8 (29.6)	121.5 (29.5)	116.6 (31.6)	118.1 (31.1)	108.4 (29.6)	105.6 (27.7)	102 (26.5)
nonHDL-c, mg/dL	155.4 (33.9)	150.1 (33.4)	150.6 (33)	149.2 (34.7)	139.3 (34.8)	129 (32.2)	127.3 (31.8)	124.4 (28.1)
LDL-c/HDL-c ratio	3 (1)	2.6 (0.9)	2.5 (0.9)	2.4 (0.9)	2.1 (0.8)	1.7 (0.7)	1.6 (0.6)	1.6 (0.6)
Triglycerides, mg/dL	109.5 (83)	108.6 (100.2)	117.7 (107.7)	135.5 (116.7)	64.6 (44.5)	60 (31.9)	69 (53.4)	67.2 (42.2)

Among 18 571 participants (10 982 men and 7589 women), we separate men and women into the following four grades: non or minimal alcohol consumption, < 40 g/wk; light alcohol consumption, 40-140 g/wk; moderate alcohol consumption, 140-280 g/wk; and excess alcohol consumption. Data was expressed as mean (SD). BMI: Body mass index; HDL-c: High density lipoprotein cholesterol; LDL-c: Low density lipoprotein cholesterol.

Table 3 The linear association between the amount of alcohol consumption and several parameters associated with the metabolic syndrome

	Men		Women
	ρ	P value	ρ	P value
Age, yr	0.11	< 0.001	-0.09	< 0.001
Aspartate aminotransferase, IU/L	0.09	< 0.001	0	0.77
Alanine aminotransferase, IU/L	-0.02	0.08	-0.02	0.05
Gamma-glutamyltransferase, IU/L	0.34	< 0.001	0.08	< 0.001
BMI, kg/m2	-0.01	0.16	-0.02	0.1
Waist circumference, cm	0.04	< 0.001	-0.01	0.32
Systolic blood pressure, mmHg	0.14	< 0.001	-0.04	< 0.001
Diastolic blood pressure, mmHg	0.17	< 0.001	-0.02	0.18
Fasting plasma glucose, mg/dL	0.08	< 0.001	-0.01	0.28
HDL-c, mg/dL	0.23	< 0.001	0.13	< 0.001
LDL-c, mg/dL	-0.13	< 0.001	-0.13	< 0.001
nonHDL-c, mg/dL	-0.08	< 0.001	-0.13	< 0.001
LDL-c/HDL-c ratio	-0.25	< 0.001	-0.17	< 0.001
Triglycerides, mg/dL	0.06	< 0.001	-0.06	< 0.001

The liner association between alcohol consumption and several factors associated with the metabolic syndrome were evaluated by Spearman’s rank correlation in 10 982 men and 7589 women, respectively, and a P value of < 0.05 was accepted as a significant level. BMI: Body mass index; HDL-c: High density lipoprotein cholesterol; LDL-c: Low density lipoprotein cholesterol.

Table 4 Alcohol consumptions of new and repeat participants

	Men			Women
	n	Alcohol consumption (g/wk)	P value	n	Alcohol consumption (g/wk)	P value
New participants without fatty liver	4417	113.02 (161.03)	< 0.0012	4662	21.37 (67.57)	0.0922
New participants with fatty liver	2130	96.14 (157.95)	0.71	476	13.99 (68.47)	0.8411
Repeat participants without fatty liver	2986	125.79 (157.24)	< 0.0013	2154	21.48 (58.33)	0.8533
Repeat participants with fatty liver	1448	102.02 (155.3)		281	18.09 (75.15)

¹New participants with fatty liver vs repeat participants with fatty liver;

²New participants with fatty liver vs new participants without fatty liver;

³Repeat participants with fatty liver vs repeat participants without fatty liver.

Table 5 Changed alcohol consumption habits among four groups

Previous fatty liver	Present fatty liver	Men		Women
		n	Change of alcohol consumption (g/wk)	n	Change of alcohol consumption (g/wk)
Negative	Negative	2784	–1.69 (109.95)	2112	–5.38 (48.13)
Negative	Positive	269	4.07 (116.14)	75	–20.69 (142.71)
Positive	Negative	202	6.07 (104.09)	42	–20.9 (56.96)
Positive	Positive	1179	–4.45 (100.32)	206	–5.56 (31.87)

Change in alcohol consumption (g/wk) was calculated by present alcohol consumption minus previous alcohol consumption, and expressed as mean (SD). We performed a Tukey test to investigate the statistical significance of the difference between two groups. No significant difference was identified.

Table 6 Positive prevalence of parameters for four levels of alcohol consumption n (%)

	Non or minimal	Light	Moderate	Excess	Non or minimal vs light	Light vs moderate	Moderate vs excess
Men
Fatty liver	2248 (36.5)	457 (26.4)	449 (27.8)	424 (28.7)	< 0.001	< 0.001	< 0.001
MS defined by rATP III	1282 (20.8)	331 (19.1)	317 (19.6)	373 (25.2)	0.12	0.33	< 0.001
MS defined by IDF	668 (10.9)	165 (9.5)	143 (8.8)	182 (12.3)	0.12	0.04	0.15
Fatty liver among men with MS defined by rATP III	923 (72)	204 (61.6)	188 (59.3)	206 (55.2)	< 0.001	< 0.001	< 0.001
Fatty liver among men with MS defined by IDF	568 (85)	118 (71.5)	100 (69.9)	127 (69.8)	< 0.001	< 0.001	< 0.001
MS defined by rATP III among men with fatty liver	923 (41.1)	204 (44.6)	188 (41.9)	206 (48.6)	0.17	0.79	0.005
MS defined by IDF among men with fatty liver	568 (25.3)	118 (25.8)	100 (22.3)	127 (30)	0.85	0.22	0.058
Components of MS
High waist circumference	968 (15.7)	257 (14.8)	236 (14.6)	257 (17.4)	0.38	0.32	0.15
High blood pressure	1766 (28.7)	591 (34.1)	626 (38.7)	707 (47.8)	< 0.001	< 0.001	< 0.001
High fasting plasma glucose	2332 (37.9)	681 (39.3)	749 (46.3)	729 (49.3)	0.31	< 0.001	< 0.001
Low HDL-C	2133 (34.7)	425 (24.5)	333 (20.6)	284 (19.2)	< 0.001	< 0.001	< 0.001
High triglycerides	1385 (22.5)	360 (20.8)	394 (24.4)	459 (31.1)	0.13	0.14	< 0.001
High BMI (> 25 kg/m2)	1731 (28.1)	417 (24)	388 (24)	379 (25.6)	< 0.001	< 0.001	0.07
Smoking status
Current smoker	2012 (32.7)	602 (34.7)	657 (40.7)	740 (50.1)	0.12	< 0.001	< 0.001
Never smoker	2220 (36.1)	446 (25.7)	308 (19.1)	180 (12.2)	< 0.001	< 0.001	< 0.001
Ex smoker	3933 (63.9)	1288 (74.3)	1308 (80.9)	1298 (87.8)	< 0.001	< 0.001	< 0.001
Usage of drugs	938 (15.2)	249 (14.4)	307 (19)	326 (22.1)	0.38	0.00	0.00
Regular exerciser	1096 (17.9)	361 (20.9)	326 (20.3)	272 (18.5)	0.01	0.04	0.64
Wine consumer	45 (0.7)	18 (1)	17 (1.1)	14 (0.9)	0.26	0.30	0.52
Women
Fatty liver	719 (10.5)	22 (5.4)	9 (4.3)	7 (8.3)	< 0.001	0.01	0.65
MS defined by rATP III	632 (9.2)	19 (4.7)	17 (8.2)	6 (7.1)	< 0.001	0.73	0.65
MS defined by IDF	494 (7.2)	12 (3)	10 (4.8)	6 (7.1)	< 0.001	0.25	0.84
Fatty liver among women with MS defined by rATP III	322 (50.9)	4 (21.1)	3 (17.6)	2 (33.3)	0.020	0.013	0.65
Fatty liver among women with MS defined by IDF	284 (57.5)	3 (25)	3 (30)	2 (33.3)	0.051	0.16	0.44
MS defined by rATP III among women with fatty liver	322 (44.8)	4 (18.2)	3 (33.3)	2 (28.6)	0.024	0.73	0.63
MS defined by IDF among women with fatty liver	284 (39.5)	3 (13.6)	3 (33.3)	2 (28.6)	0.026	0.97	0.84
Components of MS
High waist circumference	1257 (18.2)	61 (15)	26 (12.6)	16 (19)	0.12	0.05	0.96
High blood pressure	1026 (14.9)	65 (16)	45 (21.7)	22 (26.2)	0.58	0.01	0.01
High fasting plasma glucose	906 (13.1)	70 (17.2)	33 (15.9)	19 (22.6)	0.02	0.29	0.02
Low HDL-C	1772 (25.7)	58 (14.3)	25 (12.1)	10 (11.9)	< 0.001	< 0.001	0.01
High triglycerides	507 (7.4)	12 (3)	18 (8.7)	6 (7.1)	0.00	0.56	0.89
High BMI (> 25 kg/m2)	792 (11.5)	30 (7.4)	14 (6.8)	9 (10.7)	0.01	0.05	0.96
Smoking status
Current smoker	372 (5.4)	50 (12.3)	57 (27.5)	25 (29.8)	< 0.001	< 0.001	< 0.001
Never smoker	6086 (88.3)	291 (71.7)	106 (51.2)	37 (44)	< 0.001	< 0.001	< 0.001
Ex smoker	804 (11.7)	115 (28.3)	101 (48.8)	47 (56)	< 0.001	< 0.001	< 0.001
Usage of drugs	575 (8.3)	36 (8.9)	22 (10.6)	6 (7.2)	0.78	0.30	0.87
Regular exerciser	1179 (17.2)	82 (20.3)	34 (16.7)	19 (22.6)	0.13	0.91	0.25
Wine consumer	140 (2)	30 (7.4)	17 (8.2)	11 (13.1)	< 0.001	< 0.001	< 0.001

This table indicates the positive prevalence of parameters for four levels of alcohol consumption: non or minimal, < 40 g/wk; light, 40–140 g/wk; moderate, 140–280 g/wk; and excess, > 280 g/wk. Two groups of subjects were compared by using the unpaired t test and χ² test. The significance of differences between two side-by-side groups among the four groups was determined by two-tailed, multiple χ² tests with Bonferroni correction (P < 0.016 for three comparisons in four groups). Smoking status was also categorized into three groups; never smoker, ex smoker and current smoker. Regular exercisers were defined as participants who performed any kind of sports at least once a week. Usage of drugs was defined as participants who receive any drugs that potentially affected metabolic syndrome (MS). HDL-c: High-density lipoprotein-cholesterol; rATP III: Revised National Cholesterol Education Program Adult Treatment Panel III; IDF: International Diabetes Federation; BMI: Body mass index.