People with fatty liver disease who are at lower risk for advanced fibrosis should drink at most half a glass of wine or beer if they do not wish to abstain completely, according to study findings published in JAMA Network Open.

Arising from the accumulation of fat in the liver, metabolic dysfunction-associated steatotic liver disease (MASLD), the new name for non-alcoholic fatty liver disease (NAFLD), is responsible for a growing proportion of advanced liver disease worldwide. MASLD is often associated with obesity, diabetes and other risk factors for cardiovascular disease. Over time, the buildup of fat in the liver can lead to liver fibrosis, cirrhosis and even liver cancer. Alcohol consumption both raises the risk for metabolic dysfunction and worsens liver disease progression.

Yee Hui Yeo, MD, of Cedars-Sinai Medical Center, and colleagues sought to understand the relationship between alcohol intake and progression of steatotic liver disease (SLD). SLD includes MASLD and alcohol-related liver disease (ALD). It is known that people with severe liver disease should not drink alcohol at all, but there is little evidence about acceptable intake for people with earlier stages of SLD who do not wish to abstain.

The researchers accessed data from the U.S. National Health and Nutrition Examination Survey III (1988–1994) database, with follow-up through December 31, 2019. They included 2,834 people with SLD. About half were men, the median age was 42 years and 21% had FIB-4 test scores indicating an intermediate or high risk for advanced fibrosis.

Over 66,299 person-years of follow-up, people at intermediate or high risk for advanced fibrosis had a mortality rate of 4,342 per 100,000 people compared with 1,099 per 100,000 for those at low risk.

After adjusting for other relevant factors, the researchers saw a nonlinear increase in mortality for people at low risk for advanced fibrosis who reported a daily alcohol intake of 7.4 grams of alcohol, about the amount in half a glass of wine or half a beer. In the intermediate- or high-risk group, they observed a linear association between daily alcohol consumption and greater mortality risk.

“Notably, 7.4 grams/day corresponds to half a standard U.S. drinking unit and three fourths of a traditional European drink, emphasizing modest ranges of acceptable alcohol consumption per individual,” wrote the researchers. “Individuals with SLD should be advised to maintain regular health monitoring and lifestyle management.”

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