Impact of diabetes and obesity on patient outcomes in alcohol-associated liver disease: Analysis of 3 databases

Background and Aim: Alcohol and metabolic risk factors have an additive effect on the progression of steatotic liver diseases. The aim of this study is to examine the impact of T2DM and obesity on outcomes in patients with ALD. Methods and Results: We performed a retrospective cohort study of US adults with ALD using NHANES (2017–2020), Nationwide Inpatient Sample (2016-2019), and UNOS (2016-2023) databases. In the NHANES database, patients with ALD and T2DM had higher rates of fibrosis defined by FIB-4 ≥2.67 than patients with ALD without T2DM or obesity, and ALD with obesity, with 17.1% vs. 9.8% vs. 2.3%, respectively (p<0.001). There were no differences in advanced fibrosis between groups. In the NIS database, patients with ALD with obesity and those with T2DM had lower inpatient mortality vs. ALD without obesity or T2DM by 29% and 4% respectively. The length of hospital stay in days was higher in patients with ALD and obesity vs. ALD without T2DM or obesity vs. ALD with T2DM (5 ± 7.8 vs 4±7.7 vs. 4±6.8, p<0.001). In the UNOS registry, patients with ALD with T2DM had 38% higher 90-d waitlist mortality vs. ALD without T2DM or obesity. Among liver transplant recipients, patient survival at 3 yrs. was 40% and 17% worse in patients with T2DM and in those with obesity respectively vs. ALD patients without T2DM or obesity. Conclusions: Diabetes and obesity comorbidities are differently associated with patient outcomes across the spectrum of liver disease in patients with ALD.