SynthesisBMJ open2022
Does moderate alcohol consumption accelerate the progression of liver disease in NAFLD? A systematic review and narrative synthesis.
Synthesis in BMJ open, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 32 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
32 citing papers in PubMed, 1 synthesis or guideline pooled it, 59 citations in OpenAlex.
- EASL-EASD-EASO Clinical Practice Guidelines on the Management of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD).Obesity facts · 2024Guideline
- Alcohol use trajectories and liver enzyme changes in adolescents with MASLD: A longitudinal multicenter cohort.Hepatology communications · 2026Article
- Metabolic Dysfunction-Associated Steatotic Liver Disease: Current Treatment Strategies and Novel Therapies.Gut and liver · 2026Review
- Risk assessment in metabolic dysfunction-associated steatotic liver disease and metabolic dysfunction and alcohol-related liver disease: current approaches and future directions.Clinical and molecular hepatology · 2026Review
- Therapeutic landscape evolution for steatotic liver disease: from lifestyle interventions to precision pharmacotherapy.Clinical and molecular hepatology · 2026Review
- Special Population: A Global Perspective on Metabolic Dysfunction-Associated Alcohol-Related Liver Disease.Clinics in liver disease · 2026Review
- Alcohol Intake, Cardiometabolic Risk, Fibrosis, and Gut Microbiota in Steatotic Liver Disease: A Population-Based Health Checkup Study.Journal of clinical medicine · 2026Article
- Associations of cardiometabolic burden with cardiovascular disease-death transitions in metabolic dysfunction-associated steatotic liver disease: a prospective cohort study using multistate analysis.Frontiers in nutrition · 2026Article
- Prophylactic effects of nutrition, dietary strategies, exercise, lifestyle and environment on nonalcoholic fatty liver disease.Annals of medicine · 2025Review
- Diet and Lifestyle Interventions in Metabolic Dysfunction-Associated Fatty Liver Disease: A Comprehensive Review.International journal of molecular sciences · 2025Review
- Association between oxidative stress and metabolic-associated fatty liver disease in the US population.Scientific reports · 2025Article
- Clinical Utility of Non-Invasive Tests for Liver Fibrosis in People Living With Alpha-1 Antitrypsin Deficiency.Liver international : official journal of the International Association for the Study of the Liver · 2025Review
- Pathogenesis and Clinical Management of Metabolic Dysfunction-Associated Steatotic Liver Disease.International journal of molecular sciences · 2025Review
- Addressing the essentials of the recent guidelines for managing patients with metabolic dysfunction-associated steatotic liver disease.Hormones (Athens, Greece) · 2025Review
- MetALD: New Perspectives on an Old Overlooked Disease.Liver international : official journal of the International Association for the Study of the Liver · 2025Review
- The importance of patient engagement in the multimodal treatment of MASLD.Communications medicine · 2025Review
- Μetabolic dysfunction-associated steatotic liver disease: a condition of heterogeneous metabolic risk factors, mechanisms and comorbidities requiring holistic treatment.Nature reviews. Gastroenterology & hepatology · 2025Review
- The steatotic liver disease burden paradox: unravelling the key role of alcohol.Nature reviews. Gastroenterology & hepatology · 2025Review
- [Exploring the relationship between alcohol intake and all-cause mortality in participants with MASLD and MetALD: a study based on NHANES III data].Zhonghua gan zang bing za zhi = Zhonghua ganzangbing zazhi = Chinese journal of hepatology · 2025Article
- Metabolic associated steatotic liver disease misses fewer high-risk patients than metabolic associated fatty liver disease.Clinical and experimental hepatology · 2024Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesLiver disease is a leading cause of premature death, partly driven by the increasing incidence of non-alcohol-related fatty liver disease (NAFLD). Many people with a diagnosis of NAFLD drink moderate amounts of alcohol. There is limited guidance for clinicians looking to advise these patients on the effect this will have on their liver disease progression. This review synthesises the evidence on moderate alcohol consumption and its potential to predict liver disease progression in people with diagnosed NAFLD.
methodsA systematic review of longitudinal observational cohort studies was conducted. Databases (Medline, Embase, The Cochrane Library and ClinicalTrials.gov) were searched up to September 2020. Studies were included that reported progression of liver disease in adults with NAFLD, looking at moderate levels of alcohol consumption as the exposure of interest. Risk of bias was assessed using the Quality in Prognostic factor Studies tool.
resultsOf 4578 unique citations, 6 met the inclusion criteria. Pooling of data was not possible due to heterogeneity and studies were analysed using narrative synthesis. Evidence suggested that any level of alcohol consumption is associated with worsening of liver outcomes in NAFLD, even for drinking within recommended limits. Well conducted population based studies estimated up to a doubling of incident liver disease outcomes in patients with NAFLD drinking at moderate levels.
conclusionsThis review found that any level of alcohol intake in NAFLD may be harmful to liver health.Study heterogeneity in definitions of alcohol exposure as well as in outcomes limited quantitative pooling of results. Use of standardised definitions for exposure and outcomes would support future meta-analysis.Based on this synthesis of the most up to date longitudinal evidence, clinicians seeing patients with NAFLD should currently advise abstinence from alcohol. PROSPERO REGISTRATION NUMBER: The protocol was registered with PROSPERO (#CRD42020168022).
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.