There is no safe level of alcohol intake for individuals with metabolic dysfunction, according to a study published online in the Journal of Hepatology on July 4. Metabolic dysfunction includes conditions such as being overweight, diabetes, and other metabolic risk factors. The findings reveal that even low-to-moderate alcohol consumption can greatly increase the risk of liver fibrosis in individuals with metabolic dysfunction-associated steatotic liver disease (MASLD). ALSO READ: Concern as alcohol consumption surges in Rwanda The study, which used data from participants in Spain and the U.S., highlights the complex relationship between alcohol consumption and liver disease in people already at risk due to metabolic factors. It challenges the existing notion that moderate alcohol intake might be relatively harmless for those without major health conditions. Researchers found that alcohol consumption, when combined with metabolic risk factors like diabetes, obesity, and dyslipidemia, contributes to liver damage in a dose-dependent manner. ALSO READ: Alcoholism among the youth is a major threat MASLD, a condition closely linked to metabolic dysfunction, involves the accumulation of fat in the liver. While it is primarily driven by metabolic factors, alcohol consumption can exacerbate the condition, increasing the risk of liver damage. The study indicates that even small amounts of alcohol can worsen liver fibrosis when metabolic risk factors are present, suggesting that the threshold for safe drinking is much lower than previously thought. ALSO READ: No alcohol is the best choice, warns UN health agency In this population-based study, researchers assessed liver fibrosis severity using advanced diagnostic methods, including transient elastography, which measures liver stiffness. They defined fibrosis as a liver stiffness measurement (LSM) greater than 8 kPa, a level typically associated with advanced liver disease. The study categorized alcohol consumption into low, moderate, and high levels, based on weekly intake. Low alcohol consumption was defined as 5-9 drinks per week, moderate consumption as 10-13 drinks per week for women and 10-20 drinks per week for men, and high alcohol intake as 14-35 drinks per week for women and 21-42 drinks per week for men. Among the 2,227 individuals in the derivation cohort with MASLD, 9% reported low alcohol consumption, 14% moderate consumption, and 76 cases met the criteria for MetALD (alcoholic liver disease). The study found that those with MASLD who consumed alcohol at any level had an expressively higher prevalence of liver fibrosis, with a particularly stark increase in risk when combined with multiple cardiometabolic factors. The multivariable analysis revealed a dose-dependent increase in fibrosis prevalence as both alcohol intake and the number of risk factors rose. The validation cohort, comprising 1,732 participants with MASLD, confirmed the association between moderate alcohol consumption and the risk of progressing to advanced liver disease. Moderate alcohol intake was shown to have a supra-additive effect with metabolic risk factors, meaning that the combined impact of alcohol and these risk factors was greater than the sum of their individual effects. Individuals with both moderate alcohol intake and metabolic risk factors had an odds ratio of 1.69 for fibrosis, a finding that highlights the serious implications of alcohol consumption in this population. These results suggest that there is no point at which alcohol can be considered safe for individuals with metabolic dysfunction. Even moderate drinking, when combined with factors like obesity or diabetes, can lead to severe liver damage. Researchers warn that this study calls for a rethinking of alcohol consumption guidelines, especially for those already vulnerable due to their metabolic health.
