Association of High-Intensity Binge Drinking With Lipid and Liver Function Enzyme Levels

Abstract

Importance: The prevalence of high-intensity binge drinking (HIBD), defined as consuming 2 or more times the binge threshold defined by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), is rapidly increasing in the United States. While the relationship between alcohol consumption and lipid and liver function enzyme (LFT) biomarkers has been previously examined, the associations of HIBD with those biomarkers remain unknown.

Objective: To examine associations of HIBD with lipid and LFT levels in a cross-sectional sample enriched with participants who engage in HIBD.

Design, setting, and participants: Cross-sectional study using data from the NIAAA clinical sample collected from March 3, 2005, to August 21, 2017, with participants recruited for either the NIAAA screening protocols or inpatient alcohol treatment program. For this study, participants were stratified by self-reported alcohol consumption into 4 sex-specific binge levels: nonbinge and 1, 2, and 3 or more times the binge threshold (levels I, II, and III). Multivariable analyses examined the odds of clinically high levels of lipids and LFTs across binge levels. Analyses were performed from December 3, 2018, to January 30, 2019.

Main outcomes and measures: Serum levels of high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol, total cholesterol, triglycerides, alanine aminotransferase, aspartate aminotransferase, and γ-glutamyltransferase.

Results: A total of 2065 participants underwent protocol screening; 1519 with data available on alcohol consumption, body mass index, lipid levels, and LFT levels were included in the final analyses. Mean (SD) age was 39.7 (12.1) years; mean (SD) body mass index was 26.6 (5.1); 978 (64.4%) were male; 718 (47.3%) were white; and 578 (31.1%) consumed alcohol at the nonbinge level, 321 (21.2%) at level I, 239 (15.7%) at level II, and 318 (25.1%) at level III. High-intensity binge drinking was associated with 2- to 8-fold increased odds for clinically high levels of HDL-C, total cholesterol, triglycerides, and all LFTs (eg, for HDL-C: level III odds ratio [OR], 8.65; 95% CI, 4.75-15.77 and for γ-glutamyltransferase: level III OR, 8.21; 95% CI, 5.90-11.43). Increased HIBD frequency (days consuming at levels II and III) was associated with increased odds for clinically high levels of HDL-C, total cholesterol, and all LFTs (per unit increase in days consuming at the respective binge level) (eg, for HDL-C: level II OR, 1.025; 95% CI, 1.014-1.036 and level III OR, 1.033; 95% CI, 1.019-1.047 and for γ-glutamyltransferase: level II OR, 1.028; 95% CI, 1.019-1.037 and level III OR, 1.033; 95% CI, 1.019-1.047).

Conclusions and relevance: High-impact binge drinking was significantly associated with increased odds for clinically high levels of lipids and LFTs. Given that HIBD is increasingly common among US adults, targeted interventions aimed at reducing HIBD may have important health benefits.

Figure 1.. Means Levels of Lipid and Liver Function Test (LFT) Biomarkers by Alcohol Binge Levels

Error bars indicate unadjusted 95% confidence intervals; ALT, alanine aminotransferase; AST, aspartate aminotransferase; GGT, γ-glutamyltransferase; HDL, high-density lipoprotein; and LDL, low-density lipoprotein.

Figure 2.. Odds Ratios (ORs) With 95% CIs for Clinically High Lipid and Liver Function Test Biomarkers by Alcohol Binge Levels

Significance was set at adjusted Bonferroni threshold P < .001. Regression statistics are presented in eTable 2 in the Supplement. ALT indicates alanine aminotransferase; AST, aspartate aminotransferase; GGT, γ-glutamyltransferase; HDL, high-density lipoprotein; and LDL, low-density lipoprotein.

Figure 3.. Odds Ratios (ORs) With 95% CIs for Clinically High Lipid and Liver Function Test Biomarkers by Alcohol Binge Levels Controlling for Total Alcohol Consumption

Controlling for total alcohol consumption and other binge level frequencies. Significance was set at adjusted Bonferroni threshold P < .001. Regression statistics are presented in eTable 3 in the Supplement. ALT indicates alanine aminotransferase; AST, aspartate aminotransferase; GGT, γ-glutamyltransferase; HDL, high-density lipoprotein; and LDL, low-density lipoprotein. To convert cholesterol to millimoles per liter, multiply by 0.0259.