Mallet V, Parlati L, Martinino A, et al. - Alcohol use disorders, rather than obesity, were responsible for the majority of the liver burden in this study of data from two hospital-based cohorts of patients with type 2 diabetes (T2D). Such findings imply that patients with T2D should be instructed to drink minimal amounts of alcohol.

• In a retrospective, bicentric, longitudinal cohort of 52,066 hospitalized T2D patients [mean age was 64 ± 14 years; 58% were men] from 2010 to 2020, the researchers calculated adjusted hazard ratios of liver disease progression to hepatocellular cancer and/or decompensated cirrhosis.

• Alcohol use disorders were linked to all liver-related risk factors and accounted for 57% of liver-related complications.

• Non-metabolic liver-related risk factors were responsible for 37% of the liver burden.

• T2D control was not linked to the progression of liver disease.

• The rate of liver-related complications and of competing mortality were 3.9 and 27.8 per 1000 person-years at risk.

• Only in the presence of well-identified risk factors for liver disease progression, such as alcohol use, did the cumulative incidence of liver disease progression exceed the cumulative incidence of competing mortality.

• In obese patients, the incidence of hepatocellular cancer was 0.3 per 1,000 person-year, and it increased with age.

• The adjusted hazard ratios of liver disease progression for alcoholic liver disease, alcohol use disorders without alcoholic liver disease, non-metabolic liver-related risk factors, and obesity, respectively, were 55.7, 3.5, 8.9, and 1.5.

• Alcohol use disorders, non-metabolic liver risk-related risk factors, and obesity were each responsible for 55%, 14%, and 7% of the liver burden, respectively.