What is the relationship between chronic alcohol consumption and liver function markers in adult ? : A Systematic Review
Keywords:
Chronic Alcohol Consumption, Liver Function Markers, Gamma-Glutamyl Transferase, AST/ALT Ratio, Dose-Response, Systematic ReviewAbstract
Introduction: Chronic alcohol consumption is a leading cause of preventable liver disease globally. This systematic review synthesizes and evaluates current evidence on the significant relationship between chronic alcohol consumption and liver function markers in adults. Methods: Following PRISMA guidelines , a systematic search was conducted across PubMed, Semantic Scholar, Springer, and Google Scholar. Inclusion criteria targeted observational studies, systematic reviews, and meta-analyses that quantified alcohol intake and measured liver function markers (e.g., ALT, AST, GGT) in adults without pre-existing non-alcoholic liver disease. After screening, 24 studies were selected for data extraction and synthesis. Results: The findings demonstrate a significant dose-dependent relationship, where increasing alcohol consumption corresponds with elevated liver enzymes, particularly AST, ALT, and GGT. GGT was identified as the most sensitive marker for alcohol-related liver stress. An AST/ALT ratio greater than one was a strong and significant indicator of alcohol-specific liver injury. Liver damage was cumulative, with longer duration of consumption leading to progressively worse outcomes. Binge drinking emerged as a significant risk factor for hepatic steatosis, independent of average weekly intake. Significant population variability was observed; women are more susceptible at lower doses , and a potential protective effect of light drinking on fatty liver was noted uniquely in Japanese cohorts. Conclusion: Chronic alcohol consumption is conclusively linked to impaired liver function in a dose- and duration-dependent manner. Susceptibility is significantly modulated by sex, genetics, ethnicity, and comorbidities like obesity. While methodological reliance on self-reported intake is a common limitation , the evidence strongly supports using GGT for early screening and the AST/ALT ratio for diagnostics.References
A. Britton, G. Mehta, D. O’Neill, and S. Bell. “Association of Thirty-Year Alcohol Consumption Typologies and Fatty Liver: Findings from a Large Population Cohort Study.” Drug and Alcohol Dependence, 2019.
A. Lonardo, S. Ballestri, D. Romagnoli, and F. Nascimbeni. “Alcohol and Steatosis: The Japanese Paradox.” EBioMedicine, 2016.
Agustina W. Djuma, and Yofita Weo Kapa. “Perbandingan Kadar Bilirubin Direk Pada Pengkonsumsi Alkohol Dan Yang Tidak Mengkonsumsi Alkohol,” 2017.
Aishwarya Thakurdesai, Suman Kumar Jha, Iyabo Erinkitola, Aula Said, Thwisha Joshi, Melanie L Schwandt, D. Parajuli, et al. “The Gut-Immune-Liver Axis in Patients with Alcohol Use Disorder and Clinically Low Serum Zinc Levels.” Alcohol, Clinical & Experimental Research, 2024.
Akio Moriya, Y. Iwasaki, S. Ohguchi, E. Kayashima, T. Mitsumune, H. Taniguchi, M. Ando, and Kazuhide Yamamoto. “Roles of Alcohol Consumption in Fatty Liver: A Longitudinal Study.” Journal of Hepatology, 2015.
Akio Moriya, Y. Iwasaki, S. Ohguchi, and Kazuhide Yamamoto. “Reply to: ”Protective Effects of Moderate Alcohol Consumption on Fatty Liver: A Spurious Association?”.” Journal of Hepatology, 2015.
B. Vikram, S. Mohanty, and A. Dharwadkar. “Biomarkers to Assess Chronic Alcohol Consumption: Car- bohydrate Deficient Transferrin (CDT) a Reliable Biomarker.” International Journal of Advanced Bio- chemistry Research, 2018.
Charles J. Kahi. “Blue Notes.” Clinical Gastroenterology and Hepatology, 2023.
Ekpenyong, Christopher Edet, Ufot, and Blessing Gabriel. “Habitual Alcohol Consumption and Changes in Markers of Insulin Resistance and Cardio-Renal Function.” Archives of Nephrology, 2019.
G. Askgaard, J. Tolstrup, and David A. Leon. “A Measure of Alcohol Consumption in Late Adolescence Associated with Liver Disease After 39 Years of Follow-up Is Insufficient to Guide Alcohol Safe Limits.” Journal of Hepatology, 2018.
Guo-li Cao, Ting-Zhuang Yi, Qian Liu, Min Wang, and Shaohui Tang. “Alcohol Consumption and Risk of Fatty Liver Disease: A Meta-Analysis.” PeerJ, 2016.
Joseph C. Ahn, and V. Shah. “A Model to Predict Liver Disease Progression in Heavy Drinkers: Clinical Utility for Today and Deep Learning for the Future.” Clinical Gastroenterology and Hepatology, 2020.
K. S. Vimaleswaran, A. Cavadino, N. Verweij, I. Nolte, Irene Mateo Leach, J. Auvinen, J. Veijola, et al. “Interactions Between Uncoupling Protein 2 Gene Polymorphisms, Obesity and Alcohol Intake on Liver Function: A Large Meta-Analysed Population-Based Study.” European Journal of Endocrinology, 2015.
Kate Glyn-Owen, D. Böhning, J. Parkes, P. Roderick, and R. Buchanan. “The Combined Effect of Alcohol and Body Mass Index on Risk of Chronic Liver Disease: A Systematic Review and Meta‐analysis of Cohort Studies.” Liver International (Print), 2020.
M. Roerecke, R. Nanau, J. Rehm, and M. Neuman. “Ethnicity Matters: A Systematic Review and Meta- Analysis of the Non-Linear Relationship Between Alcohol Consumption and Prevalence and Incidence of Hepatic Steatosis.” EBioMedicine, 2016.
M. Sogabe, T. Okahisa, Miwako Kagawa, Hiroyuki Ueda, Kaizo Kagemoto, Hironori Tanaka, Y. Kida, et al. “Influence of Alcohol on Newly Developed Metabolic Dysfunction-Associated Fatty Liver Disease in Both Sexes: A Longitudinal Study.” Clinical Nutrition, 2023.
Mengfan Jiao, Su-ying Yan, Qing-miao Shi, Ying Liu, Yaoguang Li, Jun Lv, S. Ding, and Ang Li. “Alcohol- Related Elevation of Liver Transaminase Is Associated With Gut Microbiota in Male.” Frontiers in Medicine, 2022.
Mudassir Anis Siddiqui, D. Srivastava, and S. Choudhary. “Study of Brainstem Auditory Evoked Response and Biochemical Markers in Patients of Alcohol Use Disorder.” Indian Journal of Physiology and Phar- macology, 2021.
N. Igboh, D. Onwubiko, E. Agomuo, I. Onyesom, C. A. Maduagwunal, and U. Uzuegbu. “Synergistic Effect of Alcohol and Antiretroviral Drugs on Hepatic Function,” 2016.
Ning Zhang, Jingzhong Li, Xiaofen Xie, Yifan Hu, Hongxiang Chen, Yuan Zhang, Yujie Liu, et al. “Changes in Drinking Levels and Metabolic Dysfunction-Associated Steatotic Liver Disease: A Longitudinal Study from the China Multi-Ethnic Cohort Study.” BMC Public Health, 2025.
S. Agarwal, H. Lieberman, and V. Fulgoni. “Effects of Moderate Alcohol Intake on Markers of Liver Function in a Large Representative Sample of the U.S. Population,” 2015.
S. Agarwal, V. Fulgoni, and H. Lieberman. “Assessing Alcohol Intake & Its Dose-Dependent Effects on Liver Enzymes by 24-h Recall and Questionnaire Using NHANES 2001-2010 Data.” Nutrix Journal, 2015.
Y. Denkok, Vincent Gambo Linus, K. Oyebade, Abara S. Ukeme, S. Gazuwa, and I. Longdet. “An Investi- gation on Some Hepatic Enzymes and Haematological Variables Among Alcoholic Volunteers in Kadima District of Jos South Local Government Area of Plateau State, Nigeria.” Journal of Applied Life Sciences International, 2021.
Y. Sutoh, Tsuyoshi Hachiya, Yuji Suzuki, Shohei Komaki, Hideki Ohmomo, Keisuke Kakisaka, Ting Wang, Y. Takikawa, and A. Shimizu. “ALDH2 Genotype Modulates the Association Between Alcohol Consumption and AST/ALT Ratio Among Middle-Aged Japanese Men: A Genome-Wide G × E Interaction Analysis.” Scientific Reports, 2020.
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