How safe is Moderate Alcohol Consumption in Overweight and Obese Individuals?

SILVIA SOOKOIAN; CARLOS J PIROLA

GASTROENTEROLOGY

W B SAUNDERS CO-ELSEVIER INC

Lugar: Philadelphia; Año: 2016 vol. 150 p. 1698 - 1703

0016-5085

The future research agenda is open: More questions than answers The effect of MAC on NAFLD, and its association with obesity or overweightness are not only complex and multifaceted, but also difficult to measure. To strengthen the evidence and translate the results into clinical-decision making, we need answer various questions that would probably delineate a future patient-oriented research agenda. For example, the definition of MAC is arbitrary; so, we need to know exactly how much is safe, and how much is not in patients with NASH and fibrosis; further necessary definitions include the potential effect of drinking patterns and alcohol types, and whether the window between maximum protection and harm is the same in men and women. On the other hand, the potential ?cumulative-effect? of MAC on the modulation of factors involved in the pathogenesis of NAFLD should be carefully addressed; these include the inflammasome, gut microbiota and intestinal permeability, and obesity-related carcinogenesis. An additional challenge concerns the putative synergic effect of MAC and ?endogenous ethanol-synthesis in the gastrointestinal tract?, which could ameliorate the ?benefits? in specific clinical scenarios, such as obese patients with NASH and fibrosis {Engstler, 2015 ENGSTLER2015 /id}.In summary, the future research agenda still remains open, looking for answers from cohort prospective studies elucidating the exact role of MAC on the disease progression of obese patients with NAFLD. In addition, further mechanistic studies are required to bring robust biological evidence on the long-term effects of MAC on the natural history of NAFLD and MetS.