Binge drinking is not captured by current classification schemes for steatotic liver disease (SLD), which are anchored to alcohol intake measured in grams per week.¹ Patients with metabolic and alcohol-associated liver disease (MetALD) or alcohol-associated liver disease (ALD) may appear to drink moderately by weekly gram thresholds while concentrating hepatotoxic exposure into a single episode.¹ Frances Lee, MD, assistant professor of medicine at the Icahn School of Medicine at Mount Sinai, set out to test whether binge frequency, independent of total weekly intake, predicts fibrosis severity.

Using National Health and Nutrition Examination Survey data from 2017 to 2023, Lee and colleagues identified 5,093 participants with SLD among 27,493 surveyed, presenting the findings at Digestive Disease Week (DDW) 2026.¹ Compared with metabolic dysfunction-associated steatotic liver disease (MASLD), MetALD carried 2.58-fold higher odds of advanced fibrosis (95% CI, 1.19 to 5.61), and ALD carried 4.55-fold higher odds (95% CI, 1.35 to 15.26).¹ Binge drinking 4 to 7 times weekly trended toward greater fibrosis risk than binge drinking once monthly or less (OR, 3.77; 95% CI, 0.93 to 15.40), though the association did not reach statistical significance.¹

"Your liver is processing a larger amount of toxic metabolites and alcohol in a short amount of period, which can lead to further damage to the liver," Lee said. She directs Mount Sinai's Alcohol-Associated Liver Disease Program and treats patients whose drinking patterns place them at the intersection of metabolic risk and alcohol-related injury.

Nationally, ALD mortality has risen fastest among women and adults 25 to 44 years old, even as the mechanisms behind the shift remain debated.² In the following interview, Lee discusses how binge patterns should factor into risk assessment and whether the demographic shift reflects a true rise in disease or better detection of previously underreported drinking.

Q&A: binge drinking and fibrosis risk in ALD, MetALD

HCPLive: How should binge drinking patterns factor into risk assessment for patients with ALD or MetALD, based on your DDW 2026 findings?

Frances Lee, MD: Current definitions of MetALD and ALD account for chronic, consistent alcohol intake, but binge alcohol intake has also been associated with worsened liver outcomes. Our study shows many patients categorized as MASLD or MetALD were participating in binge alcohol intake between twice a week and twice a month. Binge alcohol intake may increase the risk of fibrosis progression in MASH patients. Physicians may also not be asking about binge alcohol intake, further reducing awareness of the harms of binge drinking.

HCPLive: How much of the rise in ALD among younger adults and women reflects a true increase in disease versus better detection?

Frances Lee, MD: I believe both can be true. The rise in ALD is likely multifactorial: increased alcohol use in our society, increasing metabolic dysfunction and metabolic syndrome features in younger patients, and improved detection of ALD.

Editor's Note: This transcript has been edited for grammar and clarity using artificial intelligence tools. Lee does not report any relevant disclosures.

References:

1. Liang L, Dhandibhotla S, Lee F. The Association Between MetALD, ALD, Binge Alcohol Intake and Hepatic Fibrosis. Presented at: Digestive Disease Week; 2026.

2. Pan CW, Abboud Y, Chitnis A, Zhang W, Singal AK, Wong RJ. Alcohol-associated liver disease mortality. JAMA Netw Open. 2025;8(6):e2514857. doi:10.1001/jamanetworkopen.2025.14857