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Alcohol, adipose tissue and liver disease: mechanistic links and clinical considerations

Key Points

  • Alcohol consumption, even at moderate levels, affects the function of adipose tissue

  • Hazardous alcohol consumption causes marked adipose tissue inflammation, similar to changes seen in obesity

  • Adipose tissue inflammation caused by alcohol contributes to the progression of liver disease through effects on liver function, inflammation and fibrosis

  • If alcohol abuse and obesity are both present, risk of liver-related morbidity and mortality is increased

  • Hazardous drinkers are at increased risk of the clinical sequelae of adipose tissue inflammation, particularly type 2 diabetes mellitus

  • In addition to abstinence from alcohol, addressing adipose tissue inflammation through exercise or medications could improve liver disease

Abstract

Adipose tissue represents a large volume of biologically active tissue that exerts substantial systemic effects in health and disease. Alcohol consumption can profoundly disturb the normal functions of adipose tissue by inducing adipocyte death and altering secretion of adipokines, pro-inflammatory mediators and free fatty acids from adipose tissue, which have important direct and indirect effects on the pathogenesis of alcoholic liver disease (ALD). Cessation of alcohol intake quickly reverses inflammatory changes in adipose tissue, and pharmacological treatment that normalizes adipose tissue function improves experimental ALD. Obesity exacerbates liver injury induced by chronic or binge alcohol consumption, and obesity and alcohol can synergize to increase risk of ALD and progression. Physicians who care for individuals with ALD should be aware of the effects of adipose tissue dysfunction on liver function, and consider strategies to manage obesity and insulin resistance. This Review examines the effect of alcohol on adiposity and adipose tissue and the relationship between alcohol, adipose tissue and the liver.

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Figure 1: Adipose tissue in alcoholic liver disease.

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Acknowledgements

The work from the lab of B.G. described in this Review was supported by the intramural program of National Institute on Alcohol Abuse and Alcoholism, NIH.

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R.P. researched data for the article. All of the authors discussed content, wrote the article, and reviewed and edited the manuscript before submission.

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Correspondence to Richard Parker.

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Parker, R., Kim, SJ. & Gao, B. Alcohol, adipose tissue and liver disease: mechanistic links and clinical considerations. Nat Rev Gastroenterol Hepatol 15, 50–59 (2018). https://doi.org/10.1038/nrgastro.2017.116

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