Some Patients With Fatty Liver Disease May Tolerate Small Amounts of Alcohol Without Getting Sicker: JAMA

Patients diagnosed with steatotic liver disease (formerly called fatty liver disease) are usually advised to stop drinking alcoholic beverages. But a new study led by Cedars-Sinai found that drinking, on average, a small amount of alcohol a day did not lead to further liver damage in patients with mild disease.

The study is published in JAMA Network Open.

“We found that patients in the early stages of steatotic liver disease could consume less than 7.4 grams of alcohol a day without elevating their risk for advanced liver fibrosis which is associated with severe health problems including liver cancer, organ failure and even death,” said Yee Hui Yeo, MD, first author of the study and a clinical fellow in the Karsh Division of Gastroenterology and Hepatology at Cedars-Sinai.

“That amount is equivalent to about 6 ounces of beer, 2.5 ounces of wine and less than 1 ounce of a distilled spirit, like vodka or tequila,” Yeo said.

Steatotic liver disease is the most common chronic liver condition in the U.S., according to the American Liver Foundation, which estimates that 1 in 4 adults have the condition, which is often undiagnosed. Patients are advised to abstain from alcohol consumption, which can further damage the organ. But abstinence can be challenging for many people, even those who are light drinkers and or who have alcohol use disorder, according to the study authors.

“A critical gap in our understanding of steatotic liver disease progression has been the lack of concrete data to define a 'safe' level of alcohol consumption for those patients who can’t quit drinking. Our study addresses this unmet need by providing empirical evidence on the relationship between alcohol intake levels and the progression of early-stage disease,” Yeo said.

In the cohort study, Yeo-working with medical scientists in China-evaluated data from the U.S. National Health and Nutrition Examination Survey III. Investigators reviewed the health surveys from nearly 3,000 people with steatotic liver disease to identify a safe threshold for alcohol consumption.

Yeo emphasizes the findings are not a recommendation that patients with steatotic liver disease continue to drink but are intended to guide their care if abstinence is challenging.

“There has been ambiguity about the extent to which alcohol consumption exacerbates steatotic liver disease. We want to reduce this uncertainty by providing evidence-based information. We favor abstinence as the safest course of action for these patients. But for those who are not able to stop drinking, these findings provide concrete guidelines for making decisions about their health and lifestyle,” Yeo said.

In addition to limiting alcohol consumption, Yeo advises patients with steatotic liver disease improve their diet, get regular physical exercise and manage risk factors, which include hypertension, obesity, diabetes and prediabetes.

“While it is still best to counsel abstinence for patients with this liver disease, the study defines a threshold beyond which alcohol consumption can increase mortality. The results provide new guidance for clinicians and patients,” said Shelly Lu, MD, the Women's Guild Chair in Gastroenterology and director of the Division of Digestive and Liver Diseases at Cedars-Sinai.

Reference:

Yeo YH, Zhu Y, Arab JP, et al. Alcohol Intake Thresholds Among Individuals With Steatotic Liver Disease. JAMA Netw Open. 2023;6(12):e2347548. doi:10.1001/jamanetworkopen.2023.47548.