Synergistic effects of metabolic syndrome and hazardous alcohol use on liver injury among Asian Americans

AIMS: Explore the combined effects of alcohol use and metabolic syndrome (MetS) on liver injury in Asian Americans. METHODS: We conducted a cross-sectional analysis of self-reported Asian Americans aged ≥21 years from the NIH All of Us database. MetS was defined using Adult Treatment Panel III criteria and operationalized as a binary diagnosis and severity score. Alcohol use was assessed using the Alcohol Use Disorders Identification Test-Concise (AUDIT-C) questionnaire. Participants were categorized into four groups based on hazardous drinking status and MetS presence. Primary outcomes include liver injury (alanine aminotransferase >33 U/l for men, >25 U/l for women). Multivariable logistic regression models adjusted for age, sex, smoking, and socioeconomic status were used. RESULTS: Among 799 participants, 132 (16.5%) had MetS only, 190 (23.8%) had hazardous drinking only, and 41 (5.1%) had both exposures. Overall, 25.8% met criteria for liver injury, with prevalence differing across groups (P < .05): 32.6% of MetS only, 22.1% of hazardous drinking only, and greater than 35% in the combined-exposure group. Elevated triglycerides, waist circumference, MetS severity, MetS binary, and low high-density lipoprotein independently increased odds of liver injury. Significant interactions were observed between hazardous drinking and MetS severity [odds ratio (OR) 1.40; confidence interval (CI) 1.04-1.88], triglycerides (OR 3.62; CI 1.72-7.66), and blood pressure (OR: 2.09; CI 1.02-4.28). CONCLUSIONS: Metabolic dysfunction, particularly hypertriglyceridemia, synergistically interacts with hazardous alcohol use to increase liver injury risk in Asian Americans, underscoring the need for combined metabolic and alcohol reduction strategies.