Even Lower Alcohol Intake Might Be Harmful for East Asian Males With MASLD Spectrum

Current alcohol guidelines for metabolic dysfunction-associated steatotic liver disease (MASLD) developed in Europe/North America may be unsuitable for East Asians, who often possess ALDH2 genetic variants that increase sensitivity to alcohol. We determined ethnicity-specific alcohol thresholds using liver-related events (LREs) risk in East Asian men with MASLD.

This South Korean nationwide cohort study included 1,087,803 men (age ≥40 years) with MASLD identified from the 2011 to 2012 national health examinations. Alcohol intake was categorized as none, <70 g, 70 to 140 g, 140 to 210 g, and ≥210 g/week. The primary outcome was LREs, defined as newly diagnosed hepatocellular carcinoma, liver cirrhosis (with or without decompensation), or liver-related mortality. Cox proportional hazards models were used to assess the risk of LREs. Subgroup and restricted cubic spline analyses were further performed.

During a median follow-up of 11 years, 26,742 participants (2.5%) developed LREs. Compared with no alcohol, increased LRE risk was observed with alcohol intake of 140 to 210 g/week (adjusted hazard ratio, 1.10; 95% confidence interval, 1.05-1.14), with a further increase at ≥210 g/week (adjusted hazard ratio, 1.30; 95% confidence interval, 1.25-1.34). In vulnerable subgroups (diabetes, body mass index <25 kg/m², abnormal alanine aminotransferase levels), LRE risk significantly increased with even lower threshold (70∼140 g/week). Spline analysis confirmed a nonlinear, generally J-shaped, dose-response relationship between alcohol consumption and LRE risk. Similar trends were observed with alcohol intake averages from the 2009 to 2010 and 2011 to 2012 examinations.

East Asian men with MASLD had increased LRE risk at thresholds substantially lower than those in standard European and North American guidelines. Ethnicity-specific alcohol recommendations are needed to prevent LRE.