Exercise and diet: Protections against mortality from alcohol-related liver damage

Healthy eating and increased levels of physical activity “significantly lower” the risk of mortality from an alcohol-damaged liver, according to new research based on a large multi-ethnic US cohort.

The study authors stress the importance of considering different lifestyle behaviors when assessing the mortality risk from the preventable disease at a population level.

However, they caution against interpreting their findings too broadly. They warn that residual confounding and unmeasured lifestyle behaviors can significantly differ between nondrinkers and light-to-moderate drinkers, which may influence health risks.

Lead investigator Naga Chalasani, MD, from the Department of Medicine at Indiana University School of Medicine’s Department of Medicine, US, says there is still a critical knowledge gap regarding how dietary patterns and exercise protect against mortality from alcohol-impacted liver health.

“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,” he stresses.

“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.”

Any amount of daily alcohol intake is associated with an increased risk of liver mortality, note the researchers.

Women better protected with healthy diet

One important finding of the study is that women face a “significantly higher” risk of alcohol-related liver death compared to men. However, they also gain greater liver protection from physical activity and a healthy diet, even if they drink.

The researchers strongly associate diets rich in vegetables, fruits, grains, seafood, plant-based proteins, and healthy fats with a lower risk of liver-related death. They also encourage reducing the intake of “empty calories” from solid fats, alcohol, and added sugars.

They warn that economically disadvantaged populations have increased liver mortality because they are more likely to be exposed to high-risk alcohol use, unhealthy diet, and physical inactivity.

Women face a “significantly higher” risk of alcohol-related liver death compared to men. However, they are better protected than men from a healthy diet.“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,” says Chalasani. 

“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.”

An endemic issue

The research team underscores that more than half (53%) of US adults over 18 regularly consume alcohol, while an estimated 178,000 people die from excessive alcohol use each year.

Risks from this lifestyle habit are well documented, they note, stressing that there is strong evidence linking heavy and binge drinking to higher all-cause and cause-specific mortality — including cancer, liver disease, and cardiovascular disease.

Their research processed data from 60,334 adults in the US National Health and Nutrition Examination Survey and cross-examined this information against the National Death Index and the Healthy Eating Index.

They also looked at self-reported alcohol use, which they categorized as “light,” “moderate,” or “heavy” drinkers based on National Institute on Alcohol Abuse and Alcoholism guidelines, and their physical activity levels.

The findings build on previous epidemiological studies suggesting that “low-level drinking” — one to two drinks per day — may be associated with lower risks of cardiovascular disease-, cancer-, and liver-related illness.

Earlier this year, US alcohol industry’s stocks fell shortly after US Surgeon General Dr. Vivek Murthy called for mandatory cancer warning labels on all alcoholic F&B products in a report. He argued that the 100,000 annual cancer cases caused by drinking warrants tobacco-style packaging requirements.

Product innovation is keeping pace with growing consumer awareness around alcohol. For instance, Quantum BioPharma is touting the hangover-alleviating properties of its clinically backed dietary supplement Unbuzzd. A double-blind, randomized, placebo-controlled crossover design study investigated its role in preventing alcohol intoxication and boosting alcohol metabolism.