Persistent Binge Drinking History Associated With Advanced Liver Fibrosis and All‐Cause Mortality in MetALD

BACKGROUND: Metabolic dysfunction and alcohol-related liver disease (MetALD) is characterised by the coexistence of metabolic dysfunction and moderate alcohol intake. In this population, the impact of specific drinking patterns and history, particularly persistent binge drinking (PBD) history, on disease severity and prognosis remains unclear. AIM: To evaluate the association between a history of PBD and the risks of advanced fibrosis and all-cause mortality in individuals with MetALD. METHODS: We analysed data from NHANES 1999-2016, including adults with MetALD. PBD is defined as having had a history of drinking ≥ 4 (women) or 5 (men) alcoholic beverages almost every day, based on ALQ150/151 questionnaires. Advanced fibrosis was defined as FIB-4 > 2.67, and mortality outcomes were obtained from the National Death Index. Multivariable logistic and Cox regression models were used to examine the associations between PBD and both liver fibrosis and all-cause mortality, adjusting for alcohol intake and other confounders. RESULTS: Among 865 individuals with MetALD, 326 (37.7%) reported a history of PBD. Compared to those without PBD, participants with PBD had a higher risk of advanced fibrosis (adjusted OR = 2.23, 95% CI: 1.12-4.45, p = 0.023). PBD was also associated with increased all-cause mortality (adjusted HR = 1.48, 95% CI: 1.03-2.13, p = 0.035). A higher risk of overnight hospitalisation in PBD supports these findings (adjusted OR = 1.88, 95% CI: 1.15-3.06, p = 0.012). CONCLUSION: PBD history is associated with increased risks of advanced fibrosis and mortality in MetALD. Clinical assessment should include an evaluation of drinking patterns and history, particularly persistent binge drinking.