No Safe Alcohol Limit for Metabolic Liver Disease: Study

TOPLINE:

Even moderate alcohol consumption in patients with metabolic dysfunction-associated steatotic liver disease (MASLD) increases the odds of significant fibrosis and disease progression, a new study suggests. The presence of additional cardiometabolic risk factors may increase this risk exponentially.

METHODOLOGY:

• Researchers conducted a prospective study using transient elastography data from 2227 patients with MASLD and 76 with MASLD and alcohol-related liver disease (MetALD) from Spain (derivation cohort). Findings were validated in an independent cohort of 1732 patients with MASLD from the United States.
• Significant fibrosis was defined as a liver stiffness measurement ≥ 8 kPa and at-risk metabolic dysfunction-associated steatohepatitis (MASH) as a FibroScan-aspartate aminotransferase score ≥ 0.35.
• In patients with MASLD, alcohol consumption (drinks/wk) was categorized as very low (0-4), low (5-9), or moderate (10-13 for women; 10-20 for men). Women and men who had 14-35 and 21-42 drinks/wk, respectively, were considered patients with MetALD.
• The primary objective was the estimation of the prevalence of alcohol consumption, assessment of its association with significant fibrosis, and its impact on the risk for MASH based on its interplay with cardiometabolic risk factors.

TAKEAWAY:

• In the patients with MASLD, the prevalence of low and moderate alcohol intake was 9% and 14%, respectively, in the derivation cohort, and 39% and 31%, respectively, in the validation cohort.
• Moderate alcohol consumption was linked to a 2.71-fold increase in the odds of significant fibrosis and a 3.84-fold increase in the odds of at-risk MASH, compared with very low alcohol consumption in the derivation cohort (P < .001 for both).
• The association between moderate alcohol consumption and at-risk MASH was confirmed in the validation cohort (odds ratio, 1.69; P = .031).
• The prevalence of significant fibrosis increased as alcohol intake and the number of cardiometabolic risk factors rose, ranging from 2.2% in patients with one risk factor and very low alcohol consumption to 28.6% in those with four to five risk factors and MetALD. The prevalence of at-risk MASH also increased in stepwise fashion, from 7.1% in patients with one cardiometabolic risk factor to 57.1% in those with four to five risk factors and MetALD.

IN PRACTICE:

“The pathogenic role of alcohol acts in a supra-additive manner with the number of cardiometabolic risk factors. Accurate assessment of alcohol consumption is therefore important to accurately manage MASLD patients in both clinical practice and therapeutic trials,” the authors wrote.

SOURCE:

The study, led by David Marti-Aguado, MD, PhD, from the Clinic University Hospital, INCLIVA Health Research Institute, Valencia, Spain, and José Luis Calleja, MD, PhD, from the Hospital Universitario Puerta de Hierro, Puerta de Hierro Health Research Institute (IDIPHIM), Majadahonda, Spain, was published online in the Journal of Hepatology.

LIMITATIONS:

The cross-sectional design of the study limited the ability to establish causality between alcohol consumption and liver fibrosis. Information on alcohol intake came from patient self-reports, which may have led to underreporting. The precision of the estimates for significant fibrosis was limited to the high sensitivity cutoffs due to a lower number of cases within the transient elastography high specificity thresholds.

DISCLOSURES:

The study was funded by Merck Sharp & Dohme and partially supported by the Spanish government. Some authors reported receiving grants and consultancy and/or lecture fees from various pharmaceutical companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.