Monthly binge drinking increases advanced liver fibrosis risk in women

Women who consume four or more alcohol drinks on a single occasion once a month or more have increased odds of advanced liver fibrosis, a new study suggests. Steatotic liver disease (SLD)-formerly known as fatty liver disease-includes several liver conditions linked to alcohol consumption and/or metabolic dysfunction. SLD phenotypes are identified based partly on daily or weekly alcohol intake. Although research has linked heavy episodic (binge) drinking to increased risk for certain liver conditions and liver-related death, its role in SLD is undefined.

For the study in Alcohol: Clinical & Experimental Research, investigators aimed to determine risk thresholds of binge drinking frequency linked to advanced liver fibrosis, a key predictor of SLD outcomes and mortality, and whether those differ by sex.The researchers drew on the National Health Nutrition Examination Survey (NHANES), using data from 43,447 nationally representative adult participants over two decades (until 2020). Binge drinking was defined as 4+ drinks per occasion for women and 5+ for men. Among 43,447 participants, 72% reported no binge drinking, 14% reported binge drinking less than once a month, 6% reported it more than once a month but less than weekly, and 8% at least weekly.

The odds of advanced fibrosis increased with reported binge drinking. This association was maintained after adjusting for demographics, other illnesses, and additional factors. The association strengthened among participants who reported binge drinking at least monthly, especially women. When average daily alcohol consumption was accounted for, however, binge drinking did not seem linked to advanced fibrosis in men, implying that cumulative alcohol exposure is more relevant than binge drinking specifically. But binge drinking frequency remained significant in women, suggesting its greater independent influence.

The study identified for the first time that more than monthly binge drinking among women presented similar odds of advanced fibrosis as the level of alcohol use implicated in metabolic dysfunction and alcohol-associated liver disease (MetALD). The findings add to evidence of the link between binge drinking and advanced fibrosis, and to the sex-specific impacts of alcohol use patterns. The researchers recommend including binge-drinking history in clinical evaluation. The study methodology prevented conclusions about causation.