Healthy Diet, Physical Activity Improve Alcohol-Related Liver Health

New research is shedding light on the benefits of adhering to a healthy diet and being physically active in the context of alcohol-attributable liver-related mortality risk, highlighting notable attenuations in this risk across all drinking patterns, including heavy and binge drinking.¹

In the study, National Health and Nutrition Examination Survey (NHANES) data were analyzed and linked to the National Death Index. Findings showed daily alcohol intake and binge drinking are independently associated with greater risks of liver-related mortality, but that this risk can be reduced with healthy dietary patterns and increased physical activity. Of note, women were found to achieve greater liver survival benefits than men.¹

“A significant knowledge gap exists regarding the interplay of dietary patterns and physical activity with alcohol-attributable liver-specific mortality. It is not well understood whether healthy diets or increased physical activity levels explain differences in liver-specific mortality risks between lifetime abstainers and light-to-moderate alcohol consumers,” lead investigator Naga Chalasani, MD, of the division of gastroenterology and hepatology at Indiana University School of Medicine, explained in a statement.² “More importantly, it remains unclear whether a healthy diet and physical activity can lower liver-specific mortality in individuals engaging in high-risk alcohol consumption, such as heavy or binge drinking.”

To address this gap in research, he and colleagues assessed data from NHANES for the 1984-2018 cycles for 60,334 participants representing 151,920,199 persons of the US population.¹

Investigators gathered mortality follow-up information for participants from the date of the interview through December 31, 2019. Their death status was determined by linking survey data with death certificate records from the National Death Index. Liver-specific mortality was the primary outcome of interest and was ascertained using ICD-10 codes.¹

Self-reported alcohol use, diet quality based on the healthy eating index (HEI), and physical activity levels were obtained. Participants were categorized into 3 groups based on self-reported alcohol consumption:

• Never drinkers, defined as individuals who answered “no” to ever having consumed at least one alcoholic drink in their lifetime
• Former drinkers, defined as individuals who reported having consumed alcohol at some point in their lifetime but had not consumed any in the past 12 months
• Current drinkers, defined as those who had consumed alcohol in the past 12 months.

Former and never drinkers were combined into a single group and considered as non-drinkers for the primary analysis. Physically active participants reported ≥ 150 min of moderate-intensity physical activity, 75 min of vigorous-intensity physical activity, or a combination per week.¹

During a mean follow-up period of 12.2 years (11.8 years for men and 12.6 years for women), 12,881 (21.3%) deaths were observed, including 252 (0.4%) due to liver disease. Increased risk of liver-related death was associated with older age (adjusted SHR [aSHR], 1.05), current smoking (aSHR, 1.66), diabetes (aSHR, 1.62), higher BMI (aSHR, 1.04), waist circumference (aSHR, 1.02), FIB-4 >3.25 (aSHR, 34.9), average daily alcohol intake (aSHR, 1.04), and binge drinking (aSHR, 2.06). Conversely, economically advantaged participants (aSHR, 0.42) and those who reported being physically active (aSHR, 0.65) or adhering to healthier diet quality (aSHR, 0.35) were linked to lower risk of liver-related death.¹

In both sexes and compared to abstainers, a non-linear, dose-dependent association was observed between average alcohol intake per day and liver-related death. Average alcohol drinks/day remained independently linked to liver-related death in men (aSHR, 1.04; 95% CI, 1.01-1.06) and women (aSHR, 1.08; 95% CI, 1.04-1.12). Similarly, binge drinking was associated with a greater risk of liver mortality among women (aSHR, 2.52; 95% CI, 1.44-4.41; PAF, 35%) than men (aSHR, 1.52; 95% CI, 1.04-2.29; PAF, 21%). Compared with no consumption, even light intake (aSHR, 1.08; 95% CI, 1.01-1.28; PAF, 2%) was associated with an increased risk.¹

Investigators noted adopting a healthier eating pattern (aSHR for top quartile HEI, 0.43; 95% CI, 0.18-0.97 in men and aSHR, 0.19; 95% CI, 0.08-0.47 in women) and being physically active (aSHR, 0.72; 95% CI, 0.37-0.95 in men and aSHR, 0.38; 95% CI, 0.18-0.76 in women) were independently associated with a lower liver-related death risk. Of note, women showed greater liver-specific survival benefits from diet quality and physical activity than men.¹

Further analysis revealed healthier dietary intake reduced liver mortality risk among non-heavy (aSHR, 0.35; 95% CI, 0.13-0.90), heavy (aSHR, 0.14; 95% CI, 0.04-0.82), and binge (aSHR, 0.16; 95% CI, 0.06-0.46) drinkers compared to unhealthier diets. Similarly, physically active participants had lower liver mortality risk among non-heavy (aSHR, 0.52; 95% CI, 0.28-0.94), heavy (aSHR, 0.64; 95% CI, 0.35-0.99), and binge (aSHR, 0.31; 95% CI, 0.10-0.88) drinkers.¹

“We found that adherence to high levels of physical activity and/or diet quality was associated with a lower risk of liver-related death across all drinking patterns, including 36% and 69% liver mortality risk reduction from physical activity and 86% and 84% liver mortality risk reduction from healthier eating among heavy and binge drinkers, respectively,” Chalasani said.² “The uniqueness of our study lies in its ability to simultaneously assess the moderating effects of two important lifestyle behaviors on liver mortality risk across different levels and patterns of alcohol consumption in a representative US population, offering a more nuanced and complete view of the risks of drinking.”

References

1. Vilar-Gomez E, Nephew L, Gawrieh S, et al. Healthy eating and physical activity significantly lower sex-specific alcohol-attributable liver mortality in the United States. Journal of Hepatology. doi:10.1016/j.jhep.2025.06.033

2. Elsevier. Study reveals beneficial effects of diet and exercise on alcohol-related adverse liver health. EurekAlert! August 27, 2025. Accessed August 28, 2025. https://www.eurekalert.org/news-releases/1095378