No level of alcohol intake is safe in MASLD patients, says study

Even modest alcohol consumption is associated with a higher risk of liver fibrosis in patients with metabolic dysfunction-associated steatotic liver disease (MASLD), according to a study. 

This population-based study used transient elastography data from participants in Spain (derivation cohort) and the US (validation cohort). SLD was defined using a controlled attenuation parameter ≥275 dB/m. At least one cardiometabolic risk factor was required to define MASLD. 

Among MASLD patients, low alcohol intake was defined as an average of 5 to 9 drinks/week, moderate consumption as 10 to 13 drinks/week for females and 10 to 20 drinks/week for males, and increased alcohol intake (MetALD) as 14 to 35 drinks/week for females and 21 to 42 drinks/week for males. 

Moreover, significant fibrosis was defined as liver stiffness ≥8 kPa and at-risk metabolic dysfunction-associated steatohepatitis (MASH) as FAST score ≥0.35. 

A total of 2,227 patients with MASLD (9 percent and 14 percent reported low and moderate alcohol consumption, respectively) and 76 individuals with MetALD formed the derivation cohort. The overall prevalence of significant fibrosis was 7.6 percent and of at-risk MASH 14.8 percent. 

Multivariable analysis revealed the independent association of alcohol use with significant fibrosis and at-risk MASH. A dose-dependent increase was noted in the prevalence of significant fibrosis and at-risk MASH between the number of drinks/week and the number of cardiometabolic factors. 

In the validation cohort which consisted of 1,732 individuals with MASLD, 17 percent had significant fibrosis and 13 percent at-risk MASH. The association between moderate alcohol intake and MASLD at risk of progression persisted in this cohort (odds ratio, 1.69, 95 percent confidence interval, 1.06–2.71). 

“We show that moderate alcohol consumption has a supra-additive effect with metabolic risk factors, exponentially increasing the risk of liver fibrosis,” the researchers said. “These results suggest that there are no safe limits of daily alcohol intake in patients with unhealthy metabolic status and MASLD.”