Low to moderate alcohol intake is not associated with increased liver stiffness or cardiometabolic risk in MASLD: a cross-sectional analysis from NHANES 2017-2018.

BACKGROUND AND AIM: Steatotic liver disease is subdivided into metabolic dysfunction-associated steatotic liver disease (MASLD), alcohol-related liver disease (ALD), and metabolic dysfunction- and alcohol-related liver disease (MetALD) based on alcohol intake. However, the diagnostic thresholds for alcohol consumption between subgroups are debatable. We aimed to determine whether low to moderate alcohol consumption compatible with the diagnosis of MASLD is associated with worsened cardiometabolic parameters and severity of liver injury.

METHODS: We conducted a cross-sectional analysis using data from the 2017-2018 cycle of the National Health and Nutrition Examination Survey. Demographic variables, cardiometabolic parameters, and liver health indicators were compared between groups and within MASLD individuals stratified by level of alcohol consumption.

RESULTS: Of 3,628 study participants, 1,498 (41.2%) met the criteria for MASLD diagnosis. Anthropometric parameters, including body mass index and waist circumference, as well as liver injury parameters such as liver stiffness and transaminase values, were significantly higher in individuals with MASLD compared to those without MASLD, despite similar reported alcohol consumption in both groups. However, there was no significant difference in the severity of liver injury or presence of cardio-metabolic risk factors when MASLD individuals were subdivided into 0, 1, and 2 alcoholic drinks per day for males, and 0 and 1 drinks for females.

CONCLUSIONS: Low to moderate alcohol consumption did not increase the liver injury or cardiometabolic risk among MASLD individuals. Further longitudinal cohorts are warranted using narrower ranges for alcohol consumption to ensure that the alcohol consumption thresholds in MASLD properly stratify risk.