Study reveals beneficial effects of diet and exercise on alcohol-related adverse liver health

A novel study investigating how physical activity and diet quality interact with different levels and patterns of alcohol consumption shows that healthy eating and increased levels of physical activity significantly lower the risk of alcohol-attributable liver-related mortality. The findings from this comprehensive new study in the Journal of Hepatology, published by Elsevier, use data from a large multi-ethnic US cohort and highlight the importance of considering other lifestyle behaviors when estimating the risk of death from alcohol-related liver disease at a population level.

In the US, more than half (53%) of adults over 18 years of age regularly consume alcohol, and approximately 178,000 people die from excessive alcohol use each year. The risks of alcohol consumption are well documented, with strong evidence linking heavy and binge drinking to higher all-cause and cause-specific mortality (e.g., cancer, liver disease, cardiovascular disease [CVD]).

Prior epidemiological studies have suggested that low-level drinking (one to two drinks per day) could be associated with lower risks of CVD-, cancer-, and liver-related outcomes. However, these findings require cautious interpretation due to residual confounding and unmeasured lifestyle behaviors that may differ substantially between nondrinkers and light-to-moderate drinkers, thereby influencing health risks.

“A significant knowledge gap exists regarding the interplay of dietary patterns and physical activity with alcohol-attributable liver-specific mortality. It is not well understood whether healthy diets or increased physical activity levels explain differences in liver-specific mortality risks between lifetime abstainers and light-to-moderate alcohol consumers,” explains lead investigator Naga Chalasani, MD, Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine. “More importantly, it remains unclear whether a healthy diet and physical activity can lower liver-specific mortality in individuals engaging in high-risk alcohol consumption, such as heavy or binge drinking,“

This study analyzed data from 60,334 adults in NHANES (the US National Health and Nutrition Examination Survey) and linked these to the National Death Index, self-reported alcohol use (classified as light, moderate, or heavy drinkers based on National Institute on Alcohol Abuse and Alcoholism guidelines), the Healthy Eating Index, and information on physical activity levels.

Key findings of the study include:

• Any amount of daily alcohol intake or binge drinking is associated with an increased risk of liver mortality.
• A healthy diet and increased physical activity lower the risk of liver-related death across all drinking patterns, even among heavy or binge drinkers.
• While women face a significantly higher risk of alcohol-related liver death than men, they also gain greater liver protection from physical activity and a healthy diet, even if they drink.
• A diet rich in vegetables, fruits, grains, seafood, plant-based proteins, and healthy fats, while reducing the intake of "empty calories" from solid fats, alcohol, and added sugars, is strongly associated with a lower risk of liver-related death.
• Economically disadvantaged populations are exposed to high-risk alcohol use, unhealthy diet, and physical inactivity, and therefore increased liver mortality.

“We found that adherence to high levels of physical activity and/or diet quality was associated with a lower risk of liver-related death across all drinking patterns, including 36% and 69% liver mortality risk reduction from physical activity and 86% and 84% liver mortality risk reduction from healthier eating among heavy and binge drinkers, respectively,” says Dr. Chalasani. “The uniqueness of our study lies in its ability to simultaneously assess the moderating effects of two important lifestyle behaviors on liver mortality risk across different levels and patterns of alcohol consumption in a representative US population, offering a more nuanced and complete view of the risks of drinking.”

Reference:

Vilar-Gomez, Eduardo et al., Healthy eating and physical activity significantly lower sex-specific alcohol-attributable liver mortality in the United States, Journal of Hepatology, DOI:10.1016/j.jhep.2025.06.033