Heavy episodic drinking raises odds of liver scarring in MASLD patients
Study finds binge-like drinking linked to advanced fibrosis risk
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People with metabolic dysfunction-associated steatotic liver disease (MASLD) who drink heavily at least once a month face higher odds of advanced liver scarring than those who spread out the same total alcohol intake over time, a new study has found.
“This study is a huge wake-up call because traditionally, physicians have tended to look at the total amount of alcohol consumed, not how it is consumed, when determining the risk to the liver,” Brian P. Lee, MD, the study’s senior author and a hepatologist and liver transplant specialist with Keck Medicine of USC, said in a university news story. “Our research suggests that the public needs to be much more aware of the danger of occasional heavy drinking and should avoid it even if they drink moderately the rest of the time.”
Study examines how drinking patterns affect liver disease risk
The study, “Episodic Heavy Drinking and Implications for Steatotic Liver Disease Nomenclature: A National Cross-Sectional Study,” was published in Clinical Gastroenterology and Hepatology.
Steatotic liver disease (SLD), previously known as fatty liver disease, is a group of disorders marked by an abnormally high amount of fat in the liver.
SLD includes several subtypes, including alcohol-associated liver disease (ALD), caused by excess alcohol consumption, and MASLD, which is typically linked to metabolic risk factors, such as obesity, type 2 diabetes, and elevated blood pressure.
In MASLD and ALD, fat can build up in the liver and lead to scarring, or fibrosis, which impairs the organ’s function and can eventually progress to cirrhosis, a severe form of liver scarring, and lasting damage.
People with MASLD who also drink higher amounts of alcohol are said to have metabolic and alcohol-associated liver disease, or MetALD. This category, defined in 2023, includes people with MASLD who drink around 140 grams of alcohol per week (about 10 standard drinks in the U.S.) for women and 210 grams (about 15 drinks) for men.
However, by focusing solely on average alcohol use over time, these criteria do not assess episodes of heavy alcohol consumption. In this study, episodic heavy drinking was defined as having four or more drinks for women or five or more drinks for men on any given day at least once per month, a pattern that can include binge drinking.
Researchers analyze national data on alcohol use and liver health
To investigate, Lee and colleagues collected data from more than 8,000 U.S. adults between 2017 and 2023 who participated in the National Health and Nutrition Examination Survey, a large, representative health survey. All had undergone elastography, a non-invasive imaging test that measures liver stiffness as an indicator of fibrosis.
Of the 4,571 adults with SLD, 3,969 were diagnosed with MASLD, 373 met the criteria for MetALD, and 144 had ALD.
More than half of participants (53.2%) reported episodic heavy drinking, as defined in the study. Among those with MASLD, about one in six (15.9%) reported this pattern of drinking.
Statistical analyses adjusted for potential influencing factors — including age, sex, and average alcohol quantity per week — showed that the rate of significant liver fibrosis was higher among MASLD patients who engaged in episodic heavy drinking compared with those who did not (23.6% vs. 15.6%).
No significant differences were seen between those with and without episodic heavy drinking among people with MetALD and ALD when analyzed together.
Episodic heavy drinking linked to higher odds of advanced fibrosis
Further analyses on MASLD patients showed that episodic heavy drinkers had 1.69 times higher odds of having significant fibrosis compared with non-episodic heavy drinkers. For advanced fibrosis, the odds were 2.76 times higher among those with episodic heavy drinking.
Because these analyses were adjusted for average alcohol consumption, the higher odds linked to episodic heavy drinking were seen even after accounting for how much a person drank overall throughout the week.
Episodic heavy drinking was not associated with significant changes in the odds of liver fibrosis among those with MetALD or ALD.
This association between episodic heavy drinking and advanced liver fibrosis in MASLD patients remained significant even after adjusting for other potential influencing factors, including race-ethnicity, education, smoking, and the number of metabolic risk factors, with odds ranging from 2.82 to 3.35 times higher.
Findings may reshape how liver disease categories are defined
Lastly, the researchers reclassified MASLD patients who met the episodic heavy drinking definition into the MetALD category. After that, the prevalence of MASLD dropped from 48% to 40.4% — accounting for about 108 million adults in the U.S. — while the prevalence of MetALD more than doubled, rising from 5.3% to 12.9%, representing about 34 million U.S. adults.
The prevalence of ALD remained largely unchanged, moving from 1.9% to 2.1%, representing about 5.6 million adults in the U.S.
“These findings emphasize the potential for refinement of consensus nomenclature to include episodic heavy drinking with MASLD as MetALD in classifications,” the team wrote.
“Although this study focused on patients with MASLD, these findings may also be pertinent to a broader patient population,” Lee added. “With more than half of adults reporting some episodic heavy drinking, this issue deserves further attention from both physicians and researchers to help better understand, prevent and treat liver disease.”
