Endogenous Ethanol Production and Its Association with Disease Activity and Fibrosis in Non-Alcoholic Fatty Liver Disease
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background: Non-alcoholic fatty liver disease (NAFLD) affects populations worldwide and is an increasingly important cause of advanced liver disease. Emerging evidence suggests that endogenous ethanol production may be associated with disease progression. This study aimed to assess endogenous ethanol production and its relationship with histological disease activity and fibrosis in patients with NAFLD. Methods: This is an observational study conducted at the Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Bangladesh. Forty patients with ultrasonographically diagnosed NAFLD underwent liver biopsy and 40 healthy controls were enrolled. Histological evaluation of NAFLD patients classified them as non-NASH (NAFLD Activity Score [NAS] <5; n=29) and NASH (NAS ≥5; n=11). Serum endogenous ethanol concentrations were measured and correlated with histological disease activity, severity of fibrosis and metabolic parameters. Correlation analysis, binary logistic regression and receiver operating characteristic (ROC) curve analysis were performed. Results: Patients with NASH had significantly higher serum ethanol levels compared with patients with non-NASH NAFLD (1.91±1.22 mg/dL vs. 0.93±1.38 mg/dL, p=0.018). Serum ethanol levels correlated significantly and positively with NAS (r=0.454, p=0.003) and fibrosis score (r=0.359, p=0.023). Serum ethanol increased progressively with fibrosis stages but the difference was not significant (p=0.122). Serum ethanol ≥1.50 mg/dL was an independent predictor of NASH (OR 7.877, 95% CI 1.499–41.383; p=0.015) by binary logistic regression. ROC analysis showed fair diagnostic performance for the identification of NASH with an area under the curve of 0.741 (95% CI 0.563-0.920; p=0.020). Sensitivity, specificity and accuracy were 72.7%, 79.3% and 77.5% respectively at a cut-off value of >/= 1.50 mg/dL. Conclusions: We demonstrate a strong association between endogenous ethanol production and histologic activity of disease in NAFLD. Serum ethanol levels were higher in patients with NASH and positively correlated with disease activity and fibrosis scores. Serum ethanol may serve as a useful non-invasive biomarker to identify patients at increased risk of steatohepatitis.
Source: Barind Medical College Journal
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W7163991663
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