Is even the occasional night out bad for your liver?

By Stephen Beech

Even occasional binge drinking may triple the risk of liver damage, warns new research.

Just the odd session of drinking can cause harm for moderate drinkers, according to the study.

Scientists described their findings as a "huge wake-up call" for those who enjoy a night out only every now and again.

They say many people assume that if they drink lightly during the week or month, heavy drinking on the occasional Friday or Saturday may not cause their liver harm.

But the new study, published in the journal Clinical Gastroenterology and Hepatology, suggests otherwise.

American researchers discovered that people with metabolic dysfunction–associated steatotic liver disease (MASLD) — the most common liver condition — face a "significantly" higher risk of liver fibrosis, or harmful scarring of the liver, if they engage in episodic heavy drinking.

Episodic heavy drinking is defined as four or more drinks in one day for women and five or more drinks in one day for men, at least once a month.

Those who consume large amounts of alcohol in a single day at least once per month are three times more likely to develop advanced liver fibrosis than people who spread out the same total alcohol intake over time, according to the findings.

Younger adults and men were more likely to report episodic heavy drinking, and the more drinks downed in one session, the more liver fibrosis people tended to have.

Principal investigator Dr. Brian Lee said: “This study is a huge wake-up call because traditionally, physicians have tended to look at the total amount of alcohol consumed, not how it is consumed, when determining the risk to the liver.

“Our research suggests that the public needs to be much more aware of the danger of occasional heavy drinking and should avoid it even if they drink moderately the rest of the time.”

Dr. Lee, a hepatologist and liver transplant specialist with Keck Medicine of the University of Southern California (USC), and his colleagues used data from the National Health and Nutrition Examination Survey, a long-running health survey of the U.S. population.

The researchers included data from more than 8,000 adults, collected between 2017 and 2023.

More from this section

Are ADHD medications overprescribed in kids?

For adults with ADHD – or even those with just some symptoms – using smart strategies to start and complete tasks can make all the difference

Taxpayer dollars flood pregnancy centers. Oversight hasn't followed.

They looked, in particular, at the link between episodic heavy drinking and advanced liver fibrosis to understand how drinking patterns — not just total drinks — may cause harm even to moderate drinkers, which is considered seven drinks a week for women and 14 or less for men.

The research team focused on MASLD because of its prevalence.

It affects people who are overweight or have other metabolic conditions, including diabetes, high blood pressure, or high cholesterol, and is on the rise.

While MASLD is not defined as alcohol-related, Dr. Lee and his colleagues wanted to explore if alcohol consumption did in fact play some role in the condition.

More than half of the adults included in the study reported episodic heavy drinking and almost 16% of patients with MASLD were episodic heavy drinkers.

The research team compared people with MASLD with the same age, sex, and average weekly alcohol consumption, dividing some as episodic heavy drinkers and others as non-episodic heavy drinkers.

They reached the conclusion that episodic heavy drinkers with MASLD had nearly three times higher odds of experiencing advanced liver fibrosis.

Dr. Lee speculates that episodic heavy drinking can harm the liver both directly and indirectly.

He said drinking large amounts of alcohol at once can overwhelm the liver and increase inflammation, which leads to scarring and damage.

People with MASLD may be particularly at risk, as Dr. Lee’s previous research has shown that obesity, high blood pressure, and other conditions associated with MASLD can more than double liver disease risk.

Dr. Lee said cases of alcohol-related liver disease have more than doubled in the last two decades.

He believes the trend is driven by surges in drinking during the COVID-19 pandemic and an increase in people with risk factors for MASLD, such as obesity and diabetes.

Dr. Lee added: “Although this study focused on patients with MASLD, these findings may also be pertinent to a broader patient population.

“With more than half of adults reporting some episodic heavy drinking, this issue deserves further attention from both physicians and researchers to help better understand, prevent and treat liver disease.”