Moderate alcohol consumption and clinical outcomes in MASLD: a systematic review and meta-analysis of longitudinal cohorts

BACKGROUND AND AIM: Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) remains controversial regarding the impact of moderate alcohol consumption on disease progression and clinical outcomes. This systematic review aimed to evaluate the effects of moderate alcohol intake (up to 30 g/day for men and 20 g/day for women) on the development and progression of Steatotic Liver Disease (SLD), including outcomes such as histopathological progression, hepatocellular carcinoma (HCC), cardiovascular disease, and mortality.

METHODS: The review followed PRISMA guidelines and included longitudinal cohort studies identified through PubMed, Scopus, Web of Science, Embase, and LILACS. Nine studies were selected for qualitative analysis, and seven were included in the meta-analysis. Effect measures, Hazard Ratios (HR) and Odds Ratios (OR), were pooled using CochraneCochrane is a global independent network of health practitioners researchers patient advocates and o... RevMan, and study quality was assessed with the Newcastle-Ottawa Scale. PROSPERO: CRD420261277466.

RESULTS: The meta-analysis showed no statistically significant association between moderate alcohol consumption and fibrosis progression (HR: 1.63 [95% CI: 0.96-2.77]; OR: 1.44 [95% CI: 0.56-3.72]). However, a statistically significant protective association was observed for all-cause mortality (HR: 0.73 [95% CI: 0.62-0.86]). High heterogeneity was noted across studies (I(2) = 56.9-86.2%). Excessive alcohol consumption remained a strong risk factor for adverse outcomes, and the incidence of HCC significantly increased among patients with advanced fibrosis, even with light alcohol intake.

CONCLUSIONS: Even moderate alcohol consumption may contribute to the progression of severe hepatic outcomes in SLD. These findings support clinical recommendations for total abstinence, particularly in patients with established fibrosis, to prevent progression to cirrhosis and hepatocellular carcinoma.