Alcohol and Steatosis: The Japanese Paradox

In this issue of EBioMedicine, Roerecke and Colleagues report that, in Japan, alcohol consumption as low as b20 g daily was associated with significant protection from incident and prevalent fatty liver; however, no such association was found in countries other than Japan (Roerecke et al., 2016). This systematic review is based on the analysis of 18 articles (11 of which are from Japan) which recruited, overall, 99,370 participants, 25,662 of whom had steatosis. Moreover, sex was an important modifier of the risk of fatty liver when the whole range of alcohol consumption was considered. Indeed, while in men a non-linear and inverse dose-response risk relationship was reported, in women the risk curve was J-shaped and turned to a detrimental association with increasing alcohol consumption. Finally, binge drinking was consistently associated with higher risk of liver steatosis.