Weight Loss and Alcohol Reduction Boost Fatty Liver Remission in Older Adults With MetALD: Study
China: A study of 46,570 adults aged ≥65 years with metabolic dysfunction-associated steatotic liver disease and alcohol-related liver disease (MetALD) found that weight loss was the strongest predictor of hepatic steatosis remission.
More than 5% weight loss increased hepatic steatosis remission to 34.34% (OR 2.15), while >5% weight gain reduced the likelihood of remission (OR 0.67). Alcohol reduction alone showed no significant benefit, but combined with >1% weight loss, it had a synergistic effect (OR 1.88). The highest remission rate (37.66%) occurred with alcohol cessation plus >5% weight loss, highlighting the benefit of addressing both weight and alcohol intake.
The findings were reported in the International Journal of Obesity by Tianxiang Lin, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China, and colleagues.
MetALD is characterized by the coexistence of metabolic dysfunction and alcohol consumption and is increasingly recognized as an important contributor to liver disease. However, evidence regarding lifestyle modification among older adults with the condition remains limited.
To investigate the relationship between changes in body weight, alcohol consumption and liver fat, researchers conducted a population-based retrospective cohort study using health data from Zhejiang Province, China, collected between 2021 and 2023. Participants were aged 65 years or older and had MetALD.
The researchers evaluated changes in alcohol intake and body weight over two years and assessed whether participants experienced remission of hepatic steatosis. Statistical analyses were performed after accounting for potential factors that could influence the outcomes.
The study led to the following findings:
- Overall, 22.64% (10,543 participants) achieved remission of hepatic steatosis during the two-year follow-up.
- Weight loss was the strongest factor associated with remission, with 34.34% of participants who lost more than 5% of body weight achieving remission.
- Among those who lost 1–5% of body weight, the hepatic steatosis remission rate was 24.07%.
- Weight gain of more than 5% was associated with a lower likelihood of hepatic steatosis remission.
- Alcohol reduction or complete cessation alone was not significantly associated with a higher likelihood of remission compared with stable alcohol consumption.
- In contrast, increased alcohol consumption was associated with a reduced likelihood of hepatic steatosis remission.
- A synergistic benefit was observed when more than 1% weight loss was combined with alcohol reduction or cessation, producing better remission outcomes than either change alone.
- The highest remission rate of 37.66% was observed among participants who stopped alcohol consumption and lost more than 5% of their body weight.
The authors noted that moderate, sustainable weight loss combined with reduced alcohol intake may be more suitable for older adults, given concerns about muscle loss and malnutrition associated with aggressive weight reduction.
The study had several limitations, including reliance on abdominal ultrasonography for liver fat assessment, limited data on lifestyle changes and counselling, potential selection bias due to missing data, and an observational design that prevents causal conclusions. Conducting the study in a single Chinese province may also limit the generalizability of the findings.
The researchers called for prospective studies to validate these associations and help develop personalized lifestyle strategies for older adults with MetALD.
Reference:
Lin, T., Yuan, X., Zhao, Y., Wang, W., Wu, C., Yang, S., & Qiu, Y. (2026). Weight loss and alcohol reduction synergize for hepatic steatosis remission in elderly patients with metabolic alcohol-associated liver disease (MetALD): A retrospective cohort study. International Journal of Obesity, 1-10. https://doi.org/10.1038/s41366-026-02155-7
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