Non-heavy alcohol use associates with liver fibrosis and ‘nonalcoholic’ steatohepatitis in the Framingham Heart Study

Background and Aims

While heavy alcohol use consistently associates with liver disease, the effects of non-heavy alcohol consumption are less understood. We aimed to investigate the relationship between non-heavy alcohol use and chronic liver disease.


This cross-sectional study included 2629 current drinkers in the Framingham Heart Study who completed alcohol use questionnaires and transient elastography. We defined fibrosis as liver stiffness measurement (LSM) ≥8.2 kPa. We defined at-risk non-alcoholic steatohepatitis (NASH) as Fibroscan-Aspartate Aminotransferase (FAST) score >0.35 (90% sensitivity) or ≥0.67 (90% specificity). We performed logistic regression to investigate associations of alcohol use measures with fibrosis and NASH, adjusting for sociodemographic and metabolic factors. Subgroup analysis excluded heavy drinkers (>14 drinks per week for women or >21 for men).


In this sample (mean age 54.4 ± 8.9 yrs, 53.3% women), mean LSM was 5.6 ± 3.4 kPa, 8.2% had fibrosis, 1.9% had NASH by FAST ≥0.67, and 12.4% had NASH by FAST >0.35. Participants drank 6.2 ± 7.4 drinks/week. Total drinks/week and frequency of drinking associated with increased odds of fibrosis (aOR 1.18, 95% CI 1.04-1.33 and aOR 1.08, 95% CI 1.01-1.16). Risky weekly drinking, present in 17.4%, also associated with fibrosis (aOR 1.49, 95% CI 1.03-2.14). After excluding 158 heavy drinkers, total drinks/week remained associated with fibrosis (aOR 1.16, 95% CI 1.001-1.35). Multiple alcohol use measures positively associated with FAST >0.35.


In this community cohort, we demonstrate that non-heavy alcohol use associates with fibrosis and NASH, after adjustment for metabolic factors. Longitudinal studies are needed to determine the benefits of moderating alcohol use to reduce liver-related morbidity and mortality.