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

Background: 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 (LRE) risk in East Asian men with MASLD.

Methods: This South Korean nationwide cohort study included 1,087,803 men (age ≥40 years) with MASLD identified from the 2011-2012 national health examinations. Alcohol intake was categorized as none, <70g, 70∼140g, 140∼210g, and ≥210g/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.

Results: During a median follow-up of 11 years, 26,742 participants (2.5%) developed LREs. Compared to no alcohol, increased LRE risk was observed with alcohol intake of 140-210 g/week (adjusted hazard ratio [aHR] 1.10; 95% confidence interval [CI] 1.05-1.14), with a further increase at ≥210 g/week (aHR 1.30; 95% CI 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 2009-2010 and 2011-2012 examinations.

Conclusion: East Asian men with MASLD had increased LRE risk at thresholds substantially.