Young adults with metabolic dysfunction-associated steatotic liver disease (MASLD)who drink alcoholic beverages are at greater risk of mortality and of having an unhealthy liver, reports a study presented at AASLD 2024. 

“This study does not imply that older adults are exempt from these risks; rather, the effects are simply less pronounced,” said presenting author Dr Jesse Pustjens, Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, Netherlands. 

“Regardless of age, the harmful impact of alcohol consumption largely depends on an individual’s overall health and genetic predisposition. In fact, to optimize health, one should aim to abstain from alcohol consumption whatsoever,” he added. 

Pustjens and his team analysedthe population-based cohort of National Health and Nutrition Survey III to explore the association between MASLD and modest alcohol consumption and all-cause mortality. They performed multivariable analyses adjusted for age, sex, race, marital status, education, and smoking and stratified results by age groups (20?40, 40?60, and 60?80 years). 

The research team conducted further analyses using the >20/30 grams daily threshold for females/males (F/M), respectively, in line with current SLD definitions. SLD was defined as hepatic steatosis on abdominal ultrasound and modest alcohol consumption as >10/20 grams (F/M) daily. 

A total of 12,940 participants (44.8 percent males) were included, of whom 4,104 (31.7 percent) had MASLD and 2,187 (16.9 percent) had modest alcohol intake.Nearly a third of them (n=3,993, 31 percent) died during a median follow-up of 23 years. [AASLD 2024, abstract 2342] 

The presence of MASLD significantly impacted survival in all age groups: 20?40 years (adjusted hazard ratio [aHR], 1.25, 95 percent confidence interval [CI], 1.01?1.56), 40?60 years (aHR, 1.25, 95 percent CI, 1.09?1.43), and 60?80 years (aHR, 1.13, 95 percent CI, 1.03?1.23). 

Notably, modest alcohol consumption was significantly associated with all-cause mortality in the younger age group: 20?40 years (aHR, 1.25, 95 percent CI, 1.01?1.56). However, when analyses were performed with the 20/30 grams (F/M) daily cutoff, the association between alcohol use and survival was no longer significant in any age group. 

“Our findings suggest that physicians should consider age when assessing liver disease and alcohol consumption risks,” said Pustjens. “Younger patients with liver fat accumulation should be screened and counseled on the dangers of even modest alcohol intake to improve long-term outcomes.” 

Furthermore, the results could guide screening for liver disease in the general population and challenge the validity of the 20/30 grams (F/M) daily threshold used in the current nomenclature. Guidelinesfor the safe level of alcohol intake vary for different countries, but the World Health Organization states that “no level of alcohol consumption is safe for our health.” 

“Many people, however, still believe that a few drinks a day improves cardiovascular health. This is ... not true,” Pustjens said. “Our findings suggest that guidelines should be revised to recommend strict limits or even abstinence in at-risk populations.”