Pavel Strnad, MD: Considerations for Safe Alcohol Consumption in AATD

Although alcohol abstinence is generally recommended for individuals with liver disease, recent research suggests moderate alcohol intake may be tolerable in patients with the heterozygous/homozygous Pi*Z alpha-1 antitrypsin variant of alpha-1 antitrypsin deficiency (AATD).

Leveraging data from the UK Biobank and the European Alpha 1 liver consortium, the study found moderate alcohol intake resulted in a minor increase in elevated transaminases in Pi*MZ individuals and noncarriers, and had no impact on liver enzymes in Pi*ZZ participants.

Acknowledging patients with AATD are a “very fragile population liver-wise,” Pavel Strnad, MD, full professor and senior physician at University Hospital Rheinisch–Westfälisch Technische Hochschule Aachen in Germany, explained to HCPLive how he and a group of researchers sought to determine whether individuals with AATD could safely consume alcohol.

“We hear [those questions] a lot in our everyday patient counseling,” he explained. “Fortunately, normal social level consumption seems to be tolerated fairly well in the majority of alpha 1 antitrypsin patients, even patients with a severe alpha 1 antitrypsin deficiency, which is obviously a sigh of relief for many people.”

Despite study results suggesting a negligible impact on liver-related parameters with moderate alcohol consumption, Strnad was careful to note that some patients may react differently to alcohol than others. With this in mind, he recommends careful monitoring of liver stiffness and liver enzymes to determine whether patients should limit their alcohol consumption or if they can safely continue to drink moderate amounts of alcohol.

Beyond demonstrating the tolerability of moderate alcohol consumption in this patient population, Strnad acknowledged another notable finding from this study related to differences in reported alcohol consumption versus the level of consumption suggested by objective biomarkers. Describing alcohol as “one of the most difficult things to study,” he explained how many patients either lie about their alcohol consumption or provide an inaccurate estimate because they do not know the actual answer.

“I think you need to always combine an objective measurement of alcohol consumption with the anamnestic data because not everybody tells you information that you can 100% trust,” Strnad concluded.

Reference

^{Brooks, A. Study Suggests Tolerability of Moderate Alcohol Consumption in Pi*MZ, Pi*ZZ AATD. HCPLive. August 17, 2024. Accessed August 21, 2024. https://www.hcplive.com/view/study-suggests-tolerability-moderate-alcohol-consumption-pi-mz-pi-zz-aatd}