Weight loss and alcohol reduction synergize for hepatic steatosis remission in elderly patients with metabolic alcohol-associated liver disease (MetALD): a retrospective cohort study.

INTRODUCTION

This study aimed to determine the independent and interactive effects of changes in alcohol intake and body weight on hepatic steatosis remission in elderly patients with Metabolic Alcohol-associated Liver Disease (MetALD).

METHODS

This population-based retrospective cohort study included 46,570 elderly individuals (≥65 years) with MetALD in Zhejiang Province, China (2021-2023). Changes in alcohol consumption and body weight were assessed. The primary outcome was remission of hepatic steatosis. Multivariable logistic regression was used to evaluate the associations between hepatic steatosis remission and changes in weight and alcohol consumption, with adjustment for potential confounders. Interaction effects between weight loss and alcohol reduction were also assessed.

RESULTS

Over two years, 12.43% (n = 5789) achieved >5% weight loss, and 2.54% (n = 1181) achieved alcohol cessation. The overall remission rate for hepatic steatosis was 22.64% (n = 10,543). Weight loss was the primary driver: remission rates were 34.34% for >5% loss (Odds ratios 2.15, 95% confidence interval [CI] 1.99-2.32) and 24.07% for 1-5% loss (1.26, [1.18-1.34]). Weight gain >5% was associated with lower remission likelihood (0.67, [0.61-0.74]). Compared with the stable consumption group, neither alcohol reduction (1.02, [0.96-1.08]) nor cessation (1.13, [0.98-1.29]) alone was significantly associated with increased remission likelihood, whereas increased consumption was associated with decreased likelihood (0.83, [0.78-0.89]). Notably, a supra-additive synergistic interaction was observed between weight loss (>1%) and alcohol reduction (including cessation) (1.88, [1.74-2.03]). The remission rate reached 37.66% (2.67, [1.69-4.29]) in the alcohol cessation group with >5% weight loss.

CONCLUSION

In elderly patients with MetALD, weight loss >5% is strongly correlated with hepatic steatosis remission, while alcohol reduction exhibits a supra-additive synergistic association with weight loss for steatosis improvement. Clinical strategies should prioritize weight loss of 1-5%-a feasible and safe target in older adults-alongside alcohol reduction, as this combination is associated with optimized clinical outcomes.