The Association Between Alcohol Intake and Incident Major Adverse Liver Outcomes Remains Stable Despite Rising Metabolic Risk.

Background

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Aims

Alcohol consumption is a leading cause of liver-related morbidity and mortality, with dose-dependent effects on liver outcomes. However, a weakening association between alcohol consumption and liver-related mortality has been suggested. As metabolic burden increases and may act synergistically with alcohol, we assessed whether the association between alcohol intake and major adverse liver outcomes (MALOs) has changed over time.

Methods

We analysed 34 756 participants from five population-based FINRISK health examination surveys (1992-2012) linked to nationwide registry data. Associations between self-reported alcohol intake and MALOs and all-cause mortality were evaluated across survey waves using Cox proportional hazards regression, with or without metabolic adjustment.

Results

From 1992 to 2012, metabolic risk factors increased markedly, with high waist-hip ratio rising from 11.0% to 34.7% and diabetes from 3.7% to 10.8%. Alcohol consumption patterns showed only modest changes over time. The association between alcohol intake and MALOs remained stable across survey waves with HR 1.28 (95% CI 1.19-1.38) in 1992 and 1.33 (95% CI 1.17-1.52) in 2012 (p for interaction = 0.94), and was not attenuated after metabolic adjustment. For all-cause mortality, HRs decreased from 1.17 (95% CI 1.12-1.22) in 1992 to 0.99 (95% CI 0.89-1.10) in 2012 (p for interaction = 0.027), with similar findings after metabolic adjustment.

Conclusion

The association between alcohol intake and MALOs remained stable over time despite increasing metabolic burden. These findings suggest that increasing metabolic burden has not modified the association between alcohol intake and liver outcomes at the population level.