Drinking light all week and then “let loose” on a Friday evening seems, for many, an acceptable compromise. An American study published in the journal Clinical Gastroenterology and Hepatology in more than 8,000 adults calls this pattern into question, especially in those whose liver is already weakened.
Letting go only for the weekend is not trivial…
Researchers were interested in the link between metabolic fatty liver disease (MASLD), liver damage linked to metabolic disorders, and “binge drinking” (the
excessive and occasional alcohol consumption
defined as at least four drinks in a day for women and five for men), once a month or more.
They show that this type of “cooking” could almost triple the risk of advanced liver fibrosis compared to the same amount of alcohol spread over time. A pattern which is not insignificant for the liver.
When the weekend binge meets an already fatty liver
MASLD, formerly called non-alcoholic fatty liver disease, affects people who are overweight, obese or have type 2 diabetes, hypertension or high cholesterol. This condition has become the most common liver disease in the United States, affecting approximately one in three adults, often without the slightest symptom at first. Patients are at significantly higher risk of hepatic fibrosis (harmful scarring of the liver).
Using data from the National Health and Nutrition Examination Survey (NHANES), the scientists sought to understand how drinking habits—and not just the total number of drinks—can be harmful even for moderate drinkers, that is, seven drinks per week for women and fourteen or fewer for men. Among the 8,000 people, 4,571 had fatty liver disease, including 3,969 with MASLD. Among them, 15.9% reported monthly episodes of excessive consumption. Men and younger adults reported this behavior more often, while total weekly consumption sometimes remained within thresholds considered “moderate.”
Occasional excessive consumption triples the risk of advanced fibrosis
By measuring liver stiffness using elastography, the authors observed that, in MASLD patients, occasional excessive consumption was associated with a risk of advanced liver fibrosis almost three times higher than among those who spread their drinks over the week, at the same age, gender and average quantity. “This study is a huge wake-up call, as doctors have traditionally tended to look at the total amount of alcohol consumed, not how it is consumed, to determine liver risk.” said Brian P. Lee, hepatologist and liver transplant specialist, at Keck Medicine of USC.
To explain this increased risk, Brian P. Lee suggests that large quantities of alcohol in one go can overwhelm the liver, cause acute inflammation and then lasting scars, especially when obesity, hypertension or diabetes are added, which alone can more than double the risk of liver disease. He also recalls that alcohol-related liver diseases have more than doubled in 20 years, in a context of increased consumption during the pandemic and the progression of metabolic disorders.
“Although this study focused on patients with MASLD, these results may also be relevant to a broader patient population.”Lee said. “With more than half of adults reporting occasional excessive alcohol consumption, this issue deserves increased attention from doctors and researchers in order to better understand, prevent and treat liver diseases.
A signal considered serious, even with limits
For Brian P. Lee, “our research suggests that the public needs to be much more aware of the dangers of occasional heavy drinking, and should avoid even moderate drinking the rest of the time“.
Ultimately, moderation is not calculated by the week, but by the glass. For those whose liver is already silently weakened by excess weight or diabetes, a single evening of excess can weigh much more than expected: a stark reminder that liver health does not tolerate any festive “catch-up”.