Saving drinks for a heavier night out may carry more risk than spreading them out over time, according to a new study of U.S. adults. Researchers found that among people with metabolic dysfunction–associated steatotic liver disease, those who engaged in occasional heavy drinking had significantly higher odds of advanced liver damage, even when their total weekly alcohol intake was similar to others.
The study, published in Clinical Gastroenterology and Hepatology, analyzed data from more than 8,000 adults and found that episodic heavy drinking was associated with nearly three times higher odds of advanced liver fibrosis, a form of scarring that can impair liver function. Episodic heavy drinking was defined as four or more drinks in a day for women or five or more for men, at least once per month.
“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 Brian P. Lee, a hepatologist and liver transplant specialist at University of Southern California and the study’s lead author. “Our research suggests that the public needs to be much more aware of the danger of occasional heavy drinking and should avoid it even if they drink moderately the rest of the time.”
The researchers used data from the National Health and Nutrition Examination Survey, a nationally representative dataset, to compare adults with similar weekly alcohol consumption but different drinking patterns. Their analysis focused on people with metabolic dysfunction–associated steatotic liver disease, or MASLD, a common condition linked to excess weight and metabolic risk factors such as type 2 diabetes and high blood pressure.
Among participants with MASLD, more than half reported episodic heavy drinking, and those individuals had substantially higher odds of advanced liver fibrosis compared with those who did not drink heavily on single occasions. The findings suggest that how alcohol is consumed may play an important role in liver health, particularly for people already at higher metabolic risk.
The researchers noted that consuming a large amount of alcohol in a short period may overwhelm the liver and increase inflammation, which over time can contribute to scarring. People with underlying metabolic conditions may be especially vulnerable to this type of damage.
The study was observational, meaning it cannot prove that episodic heavy drinking directly causes liver damage. Alcohol intake was also self-reported, which can introduce some uncertainty. In addition, the findings were focused on people with MASLD, so they may not apply in the same way to the general population.
This study was supported by the National Institute on Alcohol Abuse and Alcoholism.