Comparing the Effect of Changes in Alcohol Intake on Liver Fibrosis Risk Scores Among Patients With Two Distinct Types of Steatotic Liver Disease

ABSTRACT Background and Aim Fibrosis determines the prognosis of metabolic dysfunction–associated steatotic liver disease (MASLD) and metabolic dysfunction and alcohol‐associated liver disease (MetALD). However, how changes in alcohol consumption affect fibrosis progression in MASLD and MetALD remains unclear. We aimed to evaluate the longitudinal association between changes in alcohol intake and fibrosis risk scores (FRS) in patients with MASLD and MetALD. Methods In this retrospective observational cohort study, 2198 patients with MASLD and 644 with MetALD underwent three health check‐ups, each conducted at least 1 year apart. Associations between changes in alcohol intake and the worsening FRS were assessed using Cox proportional hazards models. Results FRS were higher in patients with MetALD than in those with MASLD. Among men with MASLD, changes in alcohol intake were not associated with worsening FRS; however, women with MASLD who increased alcohol consumption experienced worsening FRS. In patients with MetALD, including men with MetALD consuming 280–419.9 g/week of alcohol, reducing alcohol intake was associated with a lower risk of worsening FRS than that in individuals who maintained the same consumption level. Conclusions The influence of changes in alcohol intake on FRS varied by sex and disease type. Although fibrosis risk scores were more advanced in patients with MetALD than in those with MASLD, reducing alcohol consumption was associated with a lower risk of further worsening FRS in patients with MetALD. These findings highlight the importance of considering both sex and changes in alcohol consumption when evaluating fibrosis risk in patients with MASLD or MetALD.