Does Your Past Drinking Still Matter for Your Liver Health?
Citation
Fakhoury B et al.
Prognostic significance of prior alcohol use disorder in patients with presumed metabolic dysfunction-associated steatotic liver disease: A large multi-center cohort study.
Addiction. 2026.
DOI: 10.1111/add.70567
Each month, Professor Charles Knowles examines a recently published scientific paper that adds to our understanding of alcohol, its effects on our health, and why we drink.
This month's research raises an important question: Can a history of problematic drinking continue to influence liver health, even when someone is no longer drinking heavily?
Why This Paper Matters
In my book, Why We Drink Too Much – The Science of Alcohol, I describe how people like me, who turned 18 in the 1980s, have become part of what I call the 'liver transplant generation' in our 50s and 60s.
Many people developing liver disease today have several overlapping risk factors, including obesity, high cholesterol, diabetes and high blood pressure.
They may be diagnosed with metabolic dysfunction-associated steatotic liver disease (MASLD), previously often called non-alcoholic fatty liver disease.
But there is a complication.
Some of these people also have a history of years of heavy drinking, perhaps drinking they regarded as perfectly normal or social at the time.
When assessing liver disease, doctors often focus on how much someone currently drinks. Yet drinking habits change, and people may underestimate or under-report their consumption.
This raises the question: Could a previous history of alcohol use disorder still affect someone's long-term liver health, even if their current drinking is low?
Study at a Glance
Who took part?
Researchers examined anonymised healthcare records from 73 American healthcare organisations, covering 2010 to 2024.
They identified 41,236 adults newly diagnosed with metabolic fatty liver disease (MASLD) who had a previous recorded diagnosis of alcohol use disorder (AUD). Each was matched with someone with MASLD but no recorded history of AUD, creating two groups of 41,236 people.
Study design
A large observational study using existing healthcare records. Participants were matched for factors including age, sex, ethnicity, weight, diabetes, blood pressure, cholesterol and liver blood tests.
They were followed for up to five years, with an average follow-up of approximately three years.
What did the researchers measure?
Researchers looked at the development of cirrhosis (severe liver scarring), serious complications of cirrhosis, liver cancer, and liver transplantation or death.
What was the main question?
Whether a previous history of alcohol use disorder was associated with worse liver-related outcomes in people diagnosed with metabolic fatty liver disease.
What Did the Researchers Find?
1. A greater risk of cirrhosis
People with a previous diagnosis of alcohol use disorder were approximately 40% more likely to develop cirrhosis (severe scarring of the liver) than those without a recorded history of AUD.
2. More complications of liver disease
Those with previous AUD were approximately 12% more likely to develop serious complications of cirrhosis, including fluid accumulation in the abdomen, bleeding or confusion.
3. Increased risk of liver transplantation or death
People with previous AUD were approximately 40% more likely to undergo liver transplantation or die from any cause.
This equated to around 24 events per 1,000 people each year, compared with 17 per 1,000 in those without recorded AUD.
4. What about liver cancer?
Liver cancer was slightly more common in people with previous AUD. However, the number of cases was small, and the difference could have been due to chance.
5. Did the increased risk persist over time?
Yes. The increased risks remained even when researchers excluded events occurring during the first year of follow-up.
This suggests the findings were not simply explained by people who already had advanced liver disease at the beginning of the study.
What Does This Study Not Tell Us?
1. Did past drinking directly cause the poorer outcomes?
Not necessarily. This was an observational study using existing healthcare records. It identified an association between previous alcohol use disorder and worse liver outcomes, but it cannot prove that one caused the other.
2. Was the damage caused by previous drinking or continued alcohol consumption?
The researchers could not establish whether some participants had lasting liver damage from previous heavy drinking or were still consuming more alcohol than they reported.
Both factors may have contributed to the findings.
3. Could some liver disease have been incorrectly classified?
Yes. The increased risk was smaller among people with three or more metabolic risk factors, such as obesity, diabetes and high blood pressure.
The authors suggest that some people diagnosed with metabolic fatty liver disease may actually have liver disease in which alcohol has played a greater role than recognised.
Heavy drinking can itself contribute to metabolic problems, making the distinction difficult.
4. Was everyone's drinking history accurately recorded?
Not necessarily. Alcohol use disorder is often under-recorded in medical records.
Some people classified as having no previous AUD may actually have experienced problematic drinking, meaning the true number affected could be higher than the records suggest.
Why This Matters
The key message is that someone's drinking history may be just as important as their current consumption when assessing liver health.
A person who has reduced or stopped drinking may still have risk factors worth discussing with their doctor, particularly if they have been diagnosed with fatty liver disease.
This is not a reason to assume that past drinking has caused irreversible harm. The study cannot establish that.
Rather, it highlights the importance of taking a full alcohol history and recognising that alcohol-related and metabolic liver risks frequently overlap.
The researchers recommend that healthcare professionals ask about alcohol consumption routinely, use appropriate screening tools and blood tests when indicated, and offer support to people experiencing alcohol-related difficulties.
Charles's View
We tend to think of alcohol exposure in terms of what we drink today or this week.
But liver disease often develops over many years, and this study suggests that looking only at someone's current drinking may miss an important part of the picture.
Understanding someone's drinking history, alongside their metabolic health, may help doctors identify those who need closer monitoring and support.
The past cannot be changed, but recognizing its potential influence can help us make better decisions about future health.
Key Takeaways
1. Past drinking history matters. People diagnosed with metabolic fatty liver disease who had a previous recorded alcohol use disorder experienced worse liver outcomes than those without a recorded history.
2. Current drinking doesn't tell the whole story. Looking only at how much someone drinks today may overlook important information about their long-term liver health.
3. Alcohol and metabolic risks often overlap. Obesity, diabetes, high blood pressure and previous heavy drinking can all contribute to liver disease, making its underlying causes difficult to distinguish.
4. Better assessment can lead to better care. Taking a full alcohol history, alongside appropriate screening and medical monitoring, may help identify people who need additional support.
Reference
Fakhoury B et al. Prognostic significance of prior alcohol use disorder in patients with presumed metabolic dysfunction-associated steatotic liver disease: A large multi-center cohort study.
Addiction. 2026.
DOI: 10.1111/add.70567