Binge Drinking Triples Risk of Advanced Liver Scarring in People With Common Liver Disease

New research from Keck Medicine at the University of Southern California shows that occasional binge drinking can significantly increase the risk of liver scarring, even among people who otherwise drink moderately. The study, published in Clinical Gastroenterology and Hepatology, focused on individuals with metabolic dysfunction-associated steatotic liver disease (MASLD), the most common liver condition in the United States. MASLD affects about one in three adults nationwide.

Researchers found that people with MASLD who engaged in binge drinking—defined as four or more alcoholic drinks in a day for women and five or more for men, at least once a month—were nearly three times more likely to develop advanced liver fibrosis compared to those who spread out their alcohol consumption over time. The study analyzed data from more than 8,000 adults collected between 2017 and 2023 through the National Health and Nutrition Examination Survey, a long-running health survey representing the U.S. population.

The findings challenge the common belief that moderate drinking during the week or month can offset the risks of occasional heavy drinking on weekends. According to Brian P. Lee, a hepatologist and liver transplant specialist at Keck Medicine and lead investigator of the study, doctors have traditionally focused on total alcohol intake when assessing liver risk. However, this research suggests that how alcohol is consumed—specifically, whether it is concentrated in single episodes—can be just as important as how much is consumed overall.

The study found that young adults and men were more likely to report binge drinking episodes. The risk of advanced fibrosis increased with the number of drinks consumed during these episodes. Among participants with MASLD, nearly 16% reported binge drinking behavior. When comparing individuals of similar age, sex, and average weekly alcohol intake, those who binged were almost three times as likely to have advanced liver scarring as those who did not.

MASLD is especially prevalent among people with overweight, obesity, or other metabolic conditions such as type 2 diabetes, high blood pressure, or high cholesterol. While MASLD is not classified as an alcohol-related disease, Lee and his colleagues wanted to understand whether alcohol consumption patterns could influence its progression. Their findings indicate that even moderate drinkers with MASLD are at higher risk if they engage in episodic heavy drinking.

Lee explained that consuming large amounts of alcohol in a short period can overwhelm the liver and trigger inflammation, leading to scarring and long-term damage. People with MASLD may be particularly vulnerable because conditions like obesity and hypertension can already double the risk of liver disease.

Alcohol-related liver disease has more than doubled in the past two decades in the United States. Lee attributes this trend to increased alcohol consumption during the pandemic and rising rates of obesity and diabetes—both risk factors for liver disease.

While this study focused on patients with MASLD, Lee believes the findings could apply to a broader population. With more than half of U.S. adults reporting at least occasional binge drinking episodes, he says there is a need for greater awareness among both healthcare providers and the public about the dangers of episodic heavy drinking—even for those who otherwise drink within recommended limits.