S2822 Interaction of Metabolic Syndrome and Alcohol Consumption on Liver Injury in Asian Americans

Introduction: The combined effects of alcohol use and metabolic syndrome (MetS) on liver injury remain understudied, particularly in Asian Americans (AA). This study examined the potential synergistic effects of alcohol and MetS on liver injury using the NIH All of Us (AoU) database. Methods: We conducted a cross-sectional analysis of Asian American adults (>21 years old) from the AoU database, including data on triglycerides (TG), HDL, SBP, DBP, fasting blood glucose (FBG), waist circumference (WC), alcohol use (AUDIT-C score), and liver enzymes (alanine aminotransferase [ALT], aspartate aminotransferase [AST]). MetS was assessed using ATP III criteria, represented categorically (MetS_binary, ≥3 criteria), diagnostically (METS code), and as a severity score (Met_S, 0-5). Participants were divided into 4 groups based on MetS and hazardous drinking (AUDIT-C Score ≥4 in men or ≥3 in women): MetS only, hazardous drinking only, both, or neither. The primary outcomes were ALT levels and presence of liver injury as defined by ALT >33 U/L for men or >25 U/L for women. Logistic and linear regression models for each predictor were performed, and adjusted for age and sex. Results: Of the 1,168 participants, 15.3% had MetS only, 22.5% had hazardous drinking only, and 4.5% had both; age, sex, ethnicity, ALT levels, and presence of liver injury were different between groups (P < 0.05). Regression analyses indicated that higher TG and WC, and lower HDL, individually increased odds of liver injury and were associated with higher ALT levels. MetS (MetS_binary) conferred a 50% increased odds of liver injury (OR 1.50; CI 1.09-2.07, P = 0.01), and increase in MetS severity score was associated with a 36% higher odds of liver injury (OR 1.36; CI 1.22-1.52, P < 0.001). There was a significant interaction between MetS severity and AUDIT-C score (OR 1.08; CI 1.01-1.16, P = 0.03); however, AUDIT-C score alone was not significantly associated with liver injury (OR 1.01; CI 0.93-1.10, P = 0.80) or ALT levels (Coefficient: -0.23, P = 0.54). Conclusion: Our findings highlight a synergistic impact of alcohol use and MetS severity on liver injury among AA. Although alcohol use does not independently predict liver injury risk in our cohort, it may be due to generally low alcohol use in the cohort (mean AUDIT-C = 2.34). This highlights the importance of evaluating both metabolic and alcohol-related risk factors in assessing liver injury and disease risk in AA populations. Future studies should prioritize data disaggregation to identify specific risk profiles among Asian ethnic groups.