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Changes in metabolic complications in patients with alcoholic fatty liver disease monitored over two decades: NAGALA study
  1. Masahide Hamaguchi1,
  2. Akihiro Obora2,
  3. Takuro Okamura1,
  4. Yoshitaka Hashimoto1,
  5. Takao Kojima2,
  6. Michiaki Fukui1
  1. 1Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
  2. 2Gastroenterology, Asahi University Hospital, Gifu, Japan
  1. Correspondence to Dr Masahide Hamaguchi; mhama{at}


Objective The social conditions are changing in the world, which may contribute to the change in lifestyle, including alcohol consumption and dietary intake; however, changes in metabolic complications in patients with alcoholic fatty liver disease (AFLD) have never been reported. Therefore, here we compare the metabolic complications in current AFLD with those of two decades ago.

Methods We performed this cross-sectional study in a Japanese health check-up centre. Consecutive participants who visited the facilities between June 1994 and December 1997 or between January 2014 and December 2017 were enrolled. A total of 7499 participants (4804 men, 2695 women) in the past cohort and 20 029 participants (11 676 men, 8353 women) in the current cohort were entered to this study.

Results The prevalence of drinkers in the current cohort was significantly lower (4.7%) than that in the past cohort in men (5.9%, p<0.001) but significantly higher in women (1.9% in the current vs 1.1% in the past, p<0.001). The prevalence of fatty liver in drinkers has increased in men (22.3% in the past cohort, 36.6% in the current cohort; p<0.001) but not in women (13.3% in the past cohort, 14.7% in the current cohort; p=1.0), while the prevalence of all fatty liver has increased in men and women (men: 24.0% in the past cohort, 36.2% in the current cohort, p<0.001; women: 9.3% in the past cohort, 12.8% in the current cohort, p<0.001). Regarding metabolic abnormalities, the prevalence of hyperglycaemia increased from 25.4% to 43.0% in men with AFLD (p<0.001) and from 25.1% to 39.1% in women with AFLD (p=1.0).

Conclusions AFLD currently tends to be accompanied by hyperglycaemia. The prevalence of fatty liver in drinkers increased in men, although alcoholic consumptions did not increase. We should pay attention to fatty liver combined with hyperglycaemia for individuals who consume alcohol today.

  • alcohol
  • fatty liver
  • epidemiology

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  • Contributors All authors thank the medical staff of Asahi University Hospital and Editage ( for English language editing.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests MH and MF received grants, honoraria, and research support from AstraZeneca plc, Astellas Pharma Inc, Nippon Boehringer Ingelheim Co, Ltd, Daiichi Sankyo Co, Ltd, Eli Lilly Japan KK, Kyowa Hakko Kirin Company Ltd, Kissei Pharmaceutical Co, Ltd, MSD KK, Kowa Company, Ltd, Mitsubishi Tanabe Pharma Corporation, Novo Nordisk Pharma Ltd, Sanwa Kagaku Kenkyusho Co, Ltd, Sanofi KK, Ono Pharmaceutical Co, Ltd, Taisho Toyama Pharmaceutical Co, Ltd, and Takeda Pharmaceutical Co, Ltd. The sponsors were not involved in the study design; data collection, analysis, and interpretation; writing of this manuscript; or the decision to submit the article for publication. The authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article. The authors declare that, although they are affiliated with a department that is supported financially by a pharmaceutical company, they received no funding for this study, which does not alter their adherence to all the journal policies on sharing data and materials. The other authors have nothing to disclose.

  • Patient consent for publication Not required.

  • Ethics approval The current version of NAFLD in the Gifu Area, Longitudinal Analysis was approved by the medical ethics committee of Asahi University Hospital; the study design was opt-out sampling (ID 2018-09-01).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement The data-sets of the current study are available from the corresponding author on reasonable request.

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