Is moderate alcohol use in nonalcoholic fatty liver disease good or bad? A critical review
Open accessAbstract
Moderate alcohol consumption in patients with nonalcoholic fatty liver disease (NAFLD) is common, yet the effects on cardiovascular and liver health are unclear. Moderate alcohol use is associated with improved insulin sensitivity and decreased cardiovascular mortality in the general population, but whether similar benefits would be observed in persons with NAFLD remains largely unstudied. There is significant overlap in the pathogenesis of alcoholic liver disease (ALD) and NAFLD, although studies of ALD have focused on pathological alcohol intake and few mechanistic studies of moderate alcohol use in NAFLD exist. We undertook a critical review of the effect of moderate alcohol use on cardiovascular and liver disease in patients with NAFLD. A total of seven observational studies met the criteria for inclusion (one for cardiovascular endpoints and six for liver endpoints). Insufficient studies have assessed the association of moderate alcohol use with cardiovascular outcomes. There was a positive association between moderate alcohol use and decreased NASH and fibrosis; however, heavy episodic drinking may accelerate fibrosis progression and moderate alcohol use may increase the risk of hepatocellular carcinoma in patients with advanced fibrosis. Significant methodological limitations were present, including incomplete adjustment for confounding factors and failure to measure lifetime use or the pattern of alcohol intake. Thus, a strong recommendation of benefit of moderate alcohol use in NAFLD cannot be made. There remains a need for additional high-quality longitudinal studies that evaluate both cardiovascular and liver outcomes among NAFLD patients with moderate or lesser degrees of alcohol use. (Hepatology 2017;65:2090-2099).
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Factors associated with a higher risk of HCC occurrence in MASLD include presence and duration of T2D, obesity or both, older age, concurrent alcohol intake and/or smoking, FIB-4 > 3.25, and LSM > 10 kPa and increasing change in LSM.
“Table 8. Factors associated with a higher risk of HCC occurrence in MASLD.”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [533]
In “Liver-Related Outcomes: Severity of NAFLD and HCC” (page unavailable), the review reports an association between moderate alcohol use and increased HCC risk, but only among patients with NASH cirrhosis. The cited passages do not support the other listed HCC risk factors—T2D duration, obesity, older age, smoking, FIB-4 >3.25, or LSM thresholds and change—or extend the alcohol finding to all MASLD patients. (LLM, conf=0.89)
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- Authors
- Ajmera, V. H., Terrault, N. A., & Harrison, S. A.
- Affiliations
- University of California, San Francisco (US)
- Brooke Army Medical Center (US)
- Corresponding author
- Ajmera, Veeral H.
- Venue
- Hepatology
- Published
- 2017-04-28
- Volume
- 65
- Issue
- 6
- Pages
- 2090-2099
- ISSN
- 0270-9139 (ISSN-L)
- 1527-3350
- PMC
- PMC5444963
- OpenAlex
- W2573357558
- Cited by
- 137
- References
- 49
- Citations by year
- 2026: 4 · 2025: 12 · 2024: 18 · 2023: 9 · 2022: 16 · 2021: 13 · 2020: 19 · 2019: 22 · 2018: 17 · 2017: 7
- FWCI
- 2.84
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Hepatology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- U.S. Department of Defense
- National Institute of Diabetes and Digestive and Kidney Diseases (T32 5T32DK060414, T32DK060414)
- U.S. Army Medical Department
- Topics
- Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
- Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Keywords
- moderate drinking, non-alcoholic fatty liver disease, nonalcoholic steatohepatitis, liver fibrosis, hepatocellular carcinoma, cardiovascular mortality, insulin sensitivity, binge drinking, alcoholic liver disease, alcohol and liver disease
- MeSH terms
- Alcohol Drinking, Biopsy, Needle, Cardiovascular Diseases, Female, Carcinoma, Hepatocellular, Humans, Immunohistochemistry, Liver Diseases, Alcoholic, Liver Neoplasms, Longitudinal Studies, Male, Middle Aged, Prognosis, Severity of Illness Index, Disease Progression, Risk Assessment, Needs Assessment, Non-alcoholic Fatty Liver Disease
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