Notes traded over AUD screening after ALD review

In the Journal of the American Medical Association ( JAMA ) on August 4, Aleksander Krag, M.D., and colleagues in Denmark published a review of alcohol‐related liver disease (ALD), calling for screening to include consumption amounts and frequency. However, in a comment published in on November 2, M. Eugenia Socias, M.D., and Evan Wood, M.D., of the University of British Columbia, Vancouver, Canada, wrote that the screening tool AUDIT‐C is not sensitive enough to be used as a gatekeeping measure for full screening. They noted that, as the Krag review acknowledged, consumption is not part of AUD diagnosis, and further, that the AUDIT‐C is unproven for ALD screening. Canada's Guidance on Alcohol and Health (CGAH) identified that drinking more than two standard drinks per week was associated with health harms, with only three standard drinks per week increasing cirrhosis risk by 19% in men and 124% in women, they wrote, adding that at the thresholds of use proposed by Krag and colleagues, CGAH estimates would increase cirrhosis risk for 135% for men and 330% for women. Krag's response included thanks for highlighting the importance of recognizing harmful alcohol use and AUD in people with steatotic liver disease (SLD). “This is a clinically important issue, particularly because alcohol use is not systematically assessed in many individuals with SLD,” leading to misclassification of heavy alcohol use as metabolic dysfunction–associated SLD, Krag stated. ALD is asymptomatic in 90% of patients, and at that point it can be treated by alcohol cessation. The issue is fraught in the United States, which eliminated dietary limits for alcohol consumption in January for the first time since they were imposed in 1980 (see “Alcohol limits removed in dietary guidelines,” ADAW , Jan. 2026; https://onlinelibrary.wiley.com/doi/10.1002/adaw.34783 ). Whether one drink a day for women (two for men) is too much to use as a threshold, it was the threshold amount the United States used to have. But as the National Institute on Alcohol Abuse and Alcoholism has repeatedly told us, the less alcohol use, the better.