The Interplay Between Alcohol Consumption and Cardiometabolic Risk Factors in Individuals With MASLD and MetALD

ABSTRACT Aims The synergistic impact of alcohol consumption and cardiometabolic risk factors (CMRFs) on liver health remains unclear. Herein, we aimed to investigate the interplay between varying levels of alcohol consumption and the number of CMRFs on all‐cause mortality in individuals with metabolic dysfunction‐associated steatotic liver disease (MASLD) and metabolic and alcohol‐associated liver disease (MetALD). Methods Adult participants with ultrasound‐proven hepatic steatosis were identified using the Third National Health and Nutrition Examination Survey (NHANES III) database. Multivariate Cox regression was applied to investigate the association between incremental alcohol consumption and the number of CMRFs, with all‐cause mortality as the outcome. The E‐value was calculated to assess the robustness of the associations, and additive interaction models were used to explore the synergistic effects of alcohol consumption and CMRFs on mortality. Results A total of 2161 individuals (1957 with MASLD and 204 with MetALD) between the Years 1988 and 1994 were included in the analysis. During a follow‐up period of 51,719 person‐years, the overall mortality rate was 1.46% per person‐year. Stratification by age showed an increased mortality risk associated with CMRFs and alcohol consumption in individuals aged < 65 years, especially among those with 3–5 CMRFs (hazard ratio: 3.15–5.71, all p < 0.05). Additive interaction models also supported a synergistic effect in this subgroup, while no such trend was observed in those aged ≥ 65 years. Conclusion Among individuals with MASLD/MetALD and MASLD alone, a significant synergistic effect between alcohol consumption and CMRFs on mortality risk was found in those aged < 65 years. This suggests an age‐stratified approach for managing modifiable risk factors in individuals with MASLD or MetALD.