Calorie and alcohol consumption in nonalcoholic fatty liver disease

Most definitions of nonalcoholic fatty liver disease (NAFLD) allow some intake of alcohol but little attention has been paid to the possible contribution of alcohol-derived calories in the overall daily intake. The aim of the present study was to determine whether, in a group of 144 patients referred to liver outpatients with NAFLD, a more structured questioning of dietary habits and alcohol consumption would provide better information on alcohol-derived and dietary-derived calorie intake and the relationship with the BMI.

Both food intake and calories resulting from alcohol ingestion were frequently underestimated as was the percentage of patients who were drinking excessively (>30 U a week), which was surprisingly high at 40%. The substantial calorie intake resulting from alcohol consumption in this group was associated with a reduction in dietary calorie intake, so that the total daily calorie intake remained similar to those with low-to-moderate or no alcohol consumption. The findings also showed that the BMI, although still elevated, was significantly reduced in those drinking heavily compared with low and nondrinkers.

Patients with NAFLD can have substantially higher levels of alcohol consumption than usually recognized. The additional calorie intake resulting from this is to some extent balanced by a reduction in dietary calorie intake with less elevation in BMI, and a clear distinction from an alcohol-induced steatosis may be difficult.