Binge drinking as rarely as once a month can triple the risk of severe liver scarring for the roughly one in three American adults living with metabolic dysfunction–associated steatotic liver disease (MASLD). A study published today in the journal Clinical Gastroenterology and Hepatology challenges the long-held assumption that moderate weekly intake mitigates the harm caused by occasional heavy drinking.
Researchers at Keck Medicine of USC defined episodic heavy drinking as consuming four or more drinks in a single day for women, or five or more for men. The findings indicate that the pattern of consumption is just as critical as the total volume of alcohol.
Rethinking Liver Health
"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," said Dr. Brian P. Lee, a hepatologist and the study's lead investigator. "Our research suggests that the public needs to be much more aware of the danger of occasional heavy drinking."
The study analyzed data from more than 8,000 adults collected between 2017 and 2023 through the National Health and Nutrition Examination Survey. Investigators compared individuals with MASLD who had similar weekly alcohol consumption levels but different drinking patterns. They discovered that those who engaged in episodic binge drinking were three times more likely to develop advanced liver fibrosis than those who spread their alcohol intake evenly over the week.
MASLD is currently the most common liver condition in the United States, frequently affecting individuals with obesity, Type 2 diabetes, high blood pressure, or high cholesterol. While the condition is not inherently caused by alcohol, the researchers sought to understand how episodic drinking exacerbates existing metabolic damage.
Lee explains that binge drinking may overwhelm the liver, triggering intense inflammation that accelerates the scarring process. This mechanism is particularly dangerous for patients whose livers are already stressed by metabolic dysfunction.
Nearly 16% of patients with MASLD identified as episodic heavy drinkers. The study also noted that younger adults and men were the most likely to engage in these drinking patterns, with a clear correlation between the number of drinks consumed in a single session and the severity of liver fibrosis.
Alcohol-related liver disease has more than doubled in the last two decades, a trend Lee attributes partly to the rise in MASLD and shifts in drinking habits since the pandemic. The findings suggest that patients with metabolic health concerns should avoid binge drinking entirely, regardless of their average weekly alcohol intake.
