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Background and aim <p>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&#xa0;g/day for men and 20&#xa0;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.</p> Methods <p>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 Cochrane RevMan, and study quality was assessed with the Newcastle–Ottawa Scale. PROSPERO: CRD420261277466.</p> Results <p>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<sup>2</sup> = 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.</p> Conclusions <p>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.</p>

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

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月30日

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  • Neilson Silveira de Souza,
  • Helma Pinchemel Cotrim,
  • Antônio Ricardo Cardia Ferraz de Andrade

摘要

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 Cochrane 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 (I2 = 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.