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

Abstract

OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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. Copyright © 2025 AGA Institute. Published by Elsevier Inc. All rights reserved.