Alcohol use is prevalent among adults with the fontan circulation but does not correlate with liver disease

Alcohol consumption is associated with an increased risk of liver disease. There are limited studies on the epidemiology of alcohol use and its effects on Fontan-associated liver disease (FALD) in adulthood.

In this single-center prospective cohort study, patients were enrolled from the Fontan clinic between November 2019 and November 2020, excluding those with chronic hepatitis C or B. Alcohol consumption was quantified by Alcohol Use Disorders Identification Test (AUDIT) questionnaire and a supplementary questionnaire. Participants were stratified into alcohol consumers and non-consumers. Alcohol consumption was correlated to the magnitude of fibrosis on liver biopsy and the varices, ascites, splenomegaly, and thrombocytopenia (VAST) score.

Forty-three patients (age 30 ​± ​6.5 years) were enrolled, and most were in NYHA FC 1 or 2. Twenty-six (60.5%) participants consumed alcohol regularly in the past year (twenty with low-risk consumption and six with hazardous consumption). Alcohol consumers were more likely to have better NYHA FC. Of those, half reported alcohol consumption for longer than one year before enrollment. Eleven (25.6%) participants reported underage drinking. After multivariable adjustment, male sex was associated with increased severity of liver fibrosis (OR 3.7 [1.0 to 13.6]). Alcohol consumption was not associated with liver fibrosis (OR 1.2 [0.3 to 4.9]) or VAST scores (OR 1.2 [0.01 to 2.2]).

Alcohol consumption is prevalent among adults with the Fontan circulation but does not correlate with FALD. However, further studies are required to validate the results in cohorts with heavier alcohol consumption. Underage drinking was prevalent and warrants screening in pediatrics.