A new study shows that we have been underestimating alcohol related liver disease.
Published this week in The Lancet Gastroenterology and Hepatology by members of the Global NASH MASH Council, this large US study using NHANES data from 1988 to 2023 and including 41,100 adults highlights a major issue. Underreporting alcohol use is leading to widespread misclassification of liver disease. Many patients labeled as MASLD may in fact have ALD or MetALD. After adjusting for underreporting, the prevalence of both ALD and MetALD nearly doubled.
The mortality signal is striking. Binge drinking drives most premature deaths in ALD at 92.9 percent and contributes significantly in MetALD at 21 percent, while type 2 diabetes remains a major driver in MASLD at up to 44.8 percent. The highest risk occurs when these factors coexist, particularly binge drinking combined with diabetes or hypertension, which is associated with up to a seventeen-fold increase in mortality.
The bottom line is clear. We need to move beyond self-reported alcohol intake. Routine assessment of underreported alcohol use with tools such as AUDIT or biomarkers such as PEth, along with careful evaluation of binge drinking patterns, should become standard clinical practice. Misclassification is not benign; it leads to missed opportunities for intervention and underestimates the true burden of disease.
