Alcohol consumption and dementia risk in steatotic liver disease: a nationwide cohort study

The relationship between steatotic liver disease (SLD) and dementia remains unclear, particularly regarding alcohol consumption patterns. We investigated the risk of dementia across SLD subtypes classified by alcohol consumption.

We analyzed 3,071,829 adults without baseline dementia who underwent health examinations in 2012. Participants were classified into No SLD, metabolic dysfunction-associated steatotic liver disease (MASLD), metabolic dysfunction-associated alcohol-related liver disease (MetALD), and ALD groups. Primary outcomes were newly diagnosed all-cause dementia, Alzheimer's disease (AD), and vascular dementia (VD).

Over a median follow-up of 5.4 years, 72,545 all-cause dementia, 56,999 AD, and 8923 VD cases occurred. The risk of dementia significantly increased across all dementia outcomes in SLD (all p < 0.05). Across the SLD subtypes, ALD showed the highest risk of dementia, followed by MASLD, whereas MetALD showed largely neutral associations except for a modestly increased risk of VD. When MASLD was further stratified by alcohol consumption, the MASLD-no alcohol group showed consistently increased risk of all dementia outcomes (all p < 0.05). In contrast, MASLD with within-threshold alcohol intake showed heterogeneous associations across dementia outcomes.

The association between SLD and dementia differed according to SLD phenotype and alcohol consumption pattern. These findings should be interpreted as observational associations and warrant further validation in studies with longitudinal assessment of SLD status and alcohol exposure.