Risks of light and moderate alcohol use in fatty liver disease: follow-up of population cohorts
Open accessAbstract
BACKGROUND AND AIMS: The effects of alcohol use in nonalcoholic fatty liver disease are unclear. We investigated the impact of alcohol use in fatty liver disease on incident liver, cardiovascular, and malignant disease, as well as death. APPROACH AND RESULTS: Our study comprised 8,345 persons with hepatic steatosis (fatty liver index >60) who participated in health-examination surveys (FINRISK 1992-2012 or Health 2000), with available data on baseline alcohol intake. Main exclusions were baseline clinical liver disease, viral hepatitis, ethanol intake >50 g/day, and current abstainers. Data were linked with national registers for hospital admissions, malignancies, and death regarding liver, cardiovascular, and malignant disease, as well as all-cause death. Adjustment were for multiple confounders. Alcohol consumption showed a dose-dependent risk increase for incident advanced liver disease and malignancies. Consuming 10-19 g/day of alcohol in general or 0-9 g/day as nonwine beverages doubled the risk for advanced liver disease compared to lifetime abstainers. In contrast, alcohol intake up to 49 g/day was associated with a 22%-40% reduction of incident cardiovascular disease (CVD). We observed a J-shaped association between alcohol intake and all-cause death with a maximal risk reduction of 21% (95% confidence interval, 5%-34%) at alcohol intake of 0-9 g/day compared to lifetime abstainers. However, these benefits on CVD and mortality were only observed in never smokers. Alcohol intake >30 g/day yielded increased risk estimates for mortality compared to lifetime abstainers. In a subpopulation with longitudinal data, alcohol intake remained stable over time in >80% of subjects. CONCLUSIONS: Even low alcohol intake in fatty liver disease is associated with increased risks for advanced liver disease and cancer. Low to moderate alcohol use is associated with reduced mortality and CVD risk but only among never smokers.
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The earlier findings on low-moderate alcohol consumption in non-cirrhotic MASLD have been challenged by emerging data from longitudinal studies.
“However, this has been challenged by emerging data from longitudinal studies.”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [91]
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References 46 · Cited by 176
- Authors
- Åberg, F., Puukka, P., Salomaa, V., Männistö, S., Lundqvist, A., Valsta, L., Perola, M., Färkkilä, M., & Jula, A.
- Affiliations
- University of Helsinki (FI)
- Corresponding author
- Åberg, Fredrik
- ORCID
- Venue
- Hepatology
- Published
- 2019-10-08
- Volume
- 71
- Issue
- 3
- Pages
- 835-848
- ISSN
- 0270-9139 (ISSN-L)
- 1527-3350
- OpenAlex
- W2963978781
- Cited by
- 176
- References
- 46
- Citations by year
- 2026: 10 · 2025: 26 · 2024: 38 · 2023: 20 · 2022: 31 · 2021: 25 · 2020: 19 · 2019: 7
- FWCI
- 15.07
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Licence
- Locations
- Hepatology (publishedVersion)
- PubMed (publishedVersion)
- Työväentutkimus Vuosikirja (submittedVersion, other-oa)
- Funders
- Wilhelm och Else Stockmanns Stiftelse
- Medicinska Understödsföreningen Liv och Hälsa
- Finska Läkaresällskapet
- 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, hepatic steatosis, advanced liver disease, cardiovascular disease, cancer incidence, all-cause mortality, J-shaped association, never smokers, dose-response relationship
- MeSH terms
- Adult, Aged, Alcohol Drinking, Cardiovascular Diseases, Cause of Death, Fatty Liver, Female, Follow-Up Studies, Humans, Male, Middle Aged, Risk Factors, Cohort Studies
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