Alcohol intake and markers of liver health in patients with type 2 diabetes and metabolic dysfunction–associated steatotic liver disease

Objective: The study evaluated the impact of low-level alcohol intake on liver health in patients with type 2 diabetes (T2DM) and metabolic dysfunction–associated steatotic liver disease (MASLD).

Methods: In this prospective study T2DM patients with MASLD (alcohol intake <20 g/day (women) and <30 g/day (men)) underwent a comprehensive clinical and laboratory evaluation at baseline (v1) and after 12 months (v2). Alcohol consumption was assessed using the AUDIT-C questionnaire and a detailed clinical interview. Markers of liver health were measured, and liver steatosis and fibrosis were evaluated with non-invasive indexes, including the Liver Risk Score (LRS), an indicator of the risk of liver fibrosis and liver-related events.

Results: The average alcohol intake was 0.47 [2.77] g/day. Patients with an average intake >10 g alcohol/day showed significantly higher levels of aspartate aminotransferase, gamma glutamyl transpeptidase (GGT), direct bilirubin, ferritin, and higher LRS (7.86±1.64 vs. 6.86 [1.46] vs. 6.49 [1.71]; p=0.0039) at v1 compared to those who consumed <10 g/day or were abstinent. At v2, the aminotransferases and LRS were higher in patients with an alcohol intake >10 g/day compared with the other groups. In the multivariable analyses, GGT (β=0.168;p=0.008) and male sex (β=0.417;p<0.001) were independently correlated with the average alcohol intake. Drinking more than one type of alcoholic beverage significantly increased the LRS (v1: 7.02 [1.38] vs. 6.69 [1.43], p=0.0387; v2: 6.88 [1.25] vs. 6.42 [1.24], p=0.0010).

Conclusions: In patients with T2DM and MASLD, even minimal alcohol consumption is associated with markers of liver injury and higher risk of liver-related outcomes.