Effect of alcohol consumption on survival in nonalcoholic fatty liver disease: a national prospective cohort study
Open accessAbstract
Nonalcoholic fatty liver disease (NAFLD) comprises more than two thirds of patients with chronic liver disease in the United States. The effect of alcohol consumption on survival in patients with NAFLD is not clear. We gathered data on National Health and Nutrition Examination Survey participants from 1988 to 2010, and linked them to the National Death Index for follow-up of their survival. We diagnosed NAFLD based on a previously validated biochemical model (Hepatic Steatosis Index). We built multivariate Cox proportional hazards models to evaluate the effect of alcohol consumption on survival of patients with NAFLD. After excluding participants with significant alcohol use, viral hepatitis, or increased transferrin saturation, 4,568 participants with NAFLD were included in the analysis. In a Cox model adjusted for age, sex, and smoking history, drinking 0.5-1.5 drinks per day decreased the risk of overall mortality by 41% (hazard ratio [HR] = 0.59, 95% confidence interval [CI] 0.40-0.85, P = 0.005) compared with not drinking. Drinking ≥1.5 drinks per day showed a trend toward harm (HR = 1.16, 95% CI 0.99-1.36, P = 0.119). After further adjustment for race, physical activity, education level, diabetes, and fiber and polyunsaturated fatty acid intake, drinking 0.5-1.5 drinks per day continued to show a significant protective effect (HR = 0.64, 95% CI 0.42-0.97, P = 0.035), and drinking ≥1.5 drinks per day showed a significant harmful effect on mortality (HR = 1.45, 95% CI 1.01-2.10, P = 0.047). Among patients with NAFLD, modest alcohol consumption is associated with a significant decrease in all-cause mortality, whereas drinking ≥1.5 drinks per day is associated with an increase in mortality. These results help to inform the discussion of potential risks and benefits of alcohol use in patients with NAFLD.
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In people with non-cirrhotic MASLD the evidence for low or moderate alcohol consumption is conflicting.
“In people with non-cirrhotic MASLD the evidence for low or moderate alcohol consumption is con fl icting.”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [88]
The Introduction says prior evidence conflicted on whether modest alcohol consumption benefits or harms people with NAFLD (now termed MASLD). It does not specifically limit that assessment to people without cirrhosis; the Results instead distinguish patients by predicted fibrosis risk. (LLM, conf=0.83)
Experimental — accuracy not yet measuredEarlier cohort and cross-sectional studies on individuals with non-cirrhotic MASLD showed no effect or even protective effects of low-moderate alcohol consumption on overall mortality, MASLD and steatohepatitis.
“Earlier cohort and cross-sectional studies on individuals with non-cirrhotic MASLD showed no effect or even protective effects of lowmoderate alcohol consumption on overall mortality, MASLD and steatohepatitis.”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [88]
The Results report lower all-cause mortality with modest alcohol consumption in patients with NAFLD at low risk of fibrosis. The Discussion also reports earlier studies associating modest drinking with less fatty liver and less fibrosis or hepatocellular ballooning. It does not report a direct finding of reduced steatohepatitis, so that part of the claim is not established by this source. (LLM, conf=0.84)
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- Authors
- Hajifathalian, K., Torabi Sagvand, B., & McCullough, A. J.
- Affiliations
- NewYork–Presbyterian Hospital (US)
- Department of Internal Medicine,Cleveland Clinic Foundation,Cleveland,OH
- Cleveland Clinic (US)
- Corresponding author
- Hajifathalian, Kaveh
- Venue
- Hepatology
- Published
- 2018-10-02
- Volume
- 70
- Issue
- 2
- Pages
- 511-521
- ISSN
- 0270-9139 (ISSN-L)
- 1527-3350
- PMC
- PMC6380949
- OpenAlex
- W2888285558
- Cited by
- 128
- References
- 50
- Citations by year
- 2026: 5 · 2025: 5 · 2024: 20 · 2023: 20 · 2022: 16 · 2021: 24 · 2020: 20 · 2019: 15 · 2018: 2 · 2017: 1
- FWCI
- 11.60
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- Locations
- Hepatology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Foundation for the National Institutes of Health (NIH UDK 505, NIAA1 U01 AA021893, 1P50AA024333, NIH U11020821)
- National Institutes of Health (U11020821, 4u01aa021893-05, UDK 505)
- National Institute on Alcohol Abuse and Alcoholism (U01-AA021893, P50AA024333)
- National Institute of Diabetes and Digestive and Kidney Diseases (U01DK061732)
- 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
- non-alcoholic fatty liver disease, alcohol consumption, mortality, survival, all-cause mortality, hepatic steatosis index, chronic liver disease, drinking patterns, protective effect of alcohol
- MeSH terms
- Adult, Aged, Alcohol Drinking, Female, Humans, Male, Middle Aged, Prospective Studies, United States, Cohort Studies, Survival Rate, Non-alcoholic Fatty Liver Disease
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