P0936 - High-Risk Alcohol Use Is Associated With Significantly Greater Risk of Incident Hepatocellular Carcinoma in a National Cohort of U.S. Veterans With Metabolic Dysfunction Associated Fatty Liver Disease

Award: Presidential Poster Award

Robert J.. Wong, MD, MS, FACG¹, Zeyuan Yang, MSc², Ramsey Cheung, MD¹, Ashwani K. Singal, MD, MS, FACG³, Albert Do, MD, MPH⁴, Aijaz Ahmed, MD⁵, Aaron Yeoh, MD^5
1Stanford/VA Palo Alto, Palo Alto, CA; ²VA Palo Alto, Palo Alto, CA; ³University of South Dakota, Sioux Falls, SD; ⁴Yale School of Medicine, New Haven, CT; ⁵Stanford, Palo Alto, CA

Introduction: Metabolic dysfunction associated fatty liver disease (MAFLD) is highly prevalent among U.S. Veterans, a population enriched in metabolic co-morbidities. Conflicting data exists on the impact of different levels of alcohol use on risk of disease progression in fatty liver; few data have specifically evaluated this in MAFLD. We evaluated the association between levels of alcohol use and risk of hepatocellular carcinoma (HCC) among a national cohort of Veterans with MAFLD.

Methods: We evaluated the Veterans Affairs database from 1/1/2010 to 12/31/2022 to identify Veterans with MAFLD using established definitions. Patients with cirrhosis or HCC at baseline or within 6 months after index date of MAFLD diagnosis were excluded. Baseline AUDIT-C scores were used to categorize patients into no alcohol (AUDIT-C=0), low-risk alcohol (AUDIT-C= 1-2 for women and 1-3 for men), and high-risk alcohol (AUDIT-C >3 for women and >4 for men). Incidence of HCC (per 1000 person-years) was stratified by alcohol use and evaluated using Nelson-Aalen methods for estimating cumulative hazards rates. We applied competing risks methods that censored for death. Adjusted multivariate Cox proportional hazards models evaluated for predictors of HCC.

Results: Among 1,156,189 Veterans with MAFLD, 54.2% reported no alcohol use, 34.6% low-risk alcohol, and 11.2% high-risk alcohol. Compared to patients with no alcohol, high-risk alcohol users were younger (59.9y vs. 64.0y, p< 0.01), had lower proportion with diabetes (42.5% vs. 62.4%, p< 0.01), but had higher FIB-4 scores at baseline (proportion with FIB-4 >2.67: 15.0% vs. 11.1%, p< 0.01). Compared to MAFLD patients with no alcohol use, HCC incidence was significantly higher in patients with high-risk alcohol (1.29 vs. 1.09 per 1000 person-years, p< 0.01), but lower in patients with low-risk alcohol (0.89 vs. 1.09 per 1000 person-years, p< 0.01). On adjusted multivariate regression, compared to MAFLD patients with no alcohol, those with high-risk alcohol use had greater risk of HCC (HR 1.15, 95% CI 1.06-1.24); there was a trend towards slightly lower HCC risk in patients with low-risk alcohol use (HR 0.95, 95% CI 0.89-1.00).

Discussion: Among a national cohort of U.S. veterans with non-cirrhotic MAFLD, high-risk alcohol use was associated with significantly greater risk of developing HCC. However, we did not observe similar patterns with low-risk alcohol; low-risk alcohol use may not carry the same degree of negative effect on long-term risks of HCC in patients with MAFLD.



Disclosures:


Robert J.. Wong, MD, MS, FACG¹, Zeyuan Yang, MSc², Ramsey Cheung, MD¹, Ashwani K. Singal, MD, MS, FACG³, Albert Do, MD, MPH⁴, Aijaz Ahmed, MD⁵, Aaron Yeoh, MD⁵. P0936 - High-Risk Alcohol Use Is Associated With Significantly Greater Risk of Incident Hepatocellular Carcinoma in a National Cohort of U.S. Veterans With Metabolic Dysfunction Associated Fatty Liver Disease, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.