What is the relationship between metabolic syndrome and alcohol consumption and substance use?

From the Guidelines

Alcohol consumption and drug use are strongly linked to the development of metabolic syndrome, and individuals should limit their alcohol intake to moderate levels and avoid recreational drugs to minimize this risk. Metabolic syndrome is a cluster of conditions including high blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol levels, which together increase the risk of heart disease, stroke, and type 2 diabetes 1. According to a recent study published in Liver International in 2022, managing components of metabolic syndrome is crucial in the course of alcohol-related liver disease (ARLD), and investigation and management of these elements are likely to be useful 1.

The relationship between alcohol consumption and metabolic syndrome appears to be dose-dependent, with moderate drinking showing less impact than heavy drinking 1. A study published in the Journal of Hepatology in 2018 found that binge drinking, defined as heavy episodic alcohol intake, is becoming highly prevalent in young individuals and can accelerate the progression to advanced ARLD, especially in those with features of metabolic syndrome 1.

Key factors that contribute to the development of metabolic syndrome in individuals who consume alcohol and use drugs include:

• Excessive weight and obesity, which are important risk factors for liver fibrosis progression in individuals consuming alcohol 1
• The pattern of binge drinking, which can accelerate the progression to advanced ARLD 1
• The use of certain drugs, such as methotrexate, which can increase the risk of liver fibrosis in association with alcohol consumption 1
• Host genetic factors, such as polymorphisms in the PNPLA3 gene, which can increase the risk of alcoholic liver injury lesions in Caucasian individuals 1

To minimize the risk of developing metabolic syndrome, individuals should limit their alcohol intake to moderate levels (up to 1 drink daily for women, 2 for men) and avoid recreational drugs. Those with existing metabolic syndrome should consider abstaining from alcohol completely and work with healthcare providers to address any substance use issues as part of their comprehensive treatment plan 1. Additionally, managing components of metabolic syndrome, such as weight loss and lifestyle changes, is crucial in the course of ARLD 1.

From the Research

Metabolic Syndrome and Alcohol Consumption

• The relationship between alcohol consumption and metabolic syndrome is complex, with both protective and detrimental associations reported 2, 3, 4.
• A study published in 2008 found that increased risk of metabolic syndrome was associated with daily consumption that exceeded U.S. dietary guideline recommendations and binge drinking once per week or more 2.
• Another study published in 2019 found that moderate alcohol consumption was associated with a lower risk of metabolic syndrome, but high alcohol consumption was associated with a higher risk of metabolic syndrome and its components, such as high blood pressure and abdominal obesity 3.
• A review published in 2011 discussed the controversy surrounding the association between alcohol consumption and metabolic syndrome, highlighting the need for prospective studies to confirm the relationship and assess the influence of alcohol drinking patterns and other factors 4.

Metabolic Syndrome and Drug Use

• There is limited evidence on the link between metabolic syndrome and drug use, but it is known that certain medications can increase the risk of metabolic syndrome components, such as weight gain and insulin resistance.
• A study published in 2007 discussed the treatment of hypertensive patients with metabolic syndrome, highlighting the importance of a multi-targeted, integrated therapeutic approach to simultaneously treat high blood pressure, obesity, lipid disorders, and type 2 diabetes 5.
• Another study published in 2024 provided an updated review on the diagnosis and treatment of metabolic syndrome, emphasizing the need to address individual components of the syndrome to reduce cardiovascular risk and prevent diabetes and its complications 6.

Key Findings

• Alcohol consumption patterns, such as binge drinking and excessive drinking, are associated with an increased risk of metabolic syndrome and its components 2, 3.
• Moderate alcohol consumption may be associated with a lower risk of metabolic syndrome, but the relationship is complex and influenced by various factors, including drinking patterns and individual characteristics 3, 4.
• Treatment of metabolic syndrome should focus on addressing individual components, such as high blood pressure, obesity, and insulin resistance, through lifestyle changes and medication 6, 5.