PATIENTS with metabolic dysfunction-associated steatotic liver disease (MASLD) who engage in heavy drinking at least once a month face a threefold higher risk of advanced liver fibrosis, a 2026 cross-sectional study from the USA has found.
The National Health and Nutrition Examination Survey
Researchers used the 2017–2023 National Health and Examination Survey to analyse the relationship between episodic heavy drinking and liver fibrosis in populations with steatotic liver disease (SLD).
They defined episodic heavy drinking as at least 4 or 5 drinks for women and men, respectively, on any day, at least once per month.
A total of more than 8,000 people were analysed: 4,571 had SLD, 3,969 had MASLD, 373 had MASLD with increased alcohol (MetALD), and 144 had alcohol-associated liver disease (ALD).
Significant and advanced fibrosis were identified by liver stiffness measurements of 8 kPa and 12 kPa or above, respectively.
Populations at Risk
Researchers found that patients with MASLD who engage in episodic heavy drinking are three times more likely to develop advanced liver fibrosis than those who spread out the same alcohol intake over time.
Among patients with MASLD, 15.9% had episodic heavy drinking. This was associated with approximately 1.69 and 2.76 times higher odds of developing significant and advanced liver fibrosis, respectively.
The more drinks consumed at one time, the more liver fibrosis people tended to have. Younger adults and men were more likely to report episodic heavy drinking.
Liver Disease Classification
Researchers reported that SLD nomenclature only captures average alcohol consumption to define subcategories, limiting analysis of the impact of binge drinking on SLD classification.
In line with findings, authors said that reclassifying the MASLD patients engaging in episodic heavy drinking would more than double the estimated prevalence of MetALD in the USA.
This carries implications for improving risk stratification in populations with SLD, they concluded.
Reference
Su Y et al. Episodic heavy drinking and implications for steatotic liver disease nomenclature: a national cross-sectional survey. Clin Gastroenterol Hepatol. 2026;DOI:10.1016/j.cgh.2026.03.004.
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