How dangerous is fatty liver when alcohol is added? A 10-year follow-up of 44,000 people finds... [Health Check]

[Financial News] If you continue drinking despite being told during a health checkup that you have “fatty liver,” your liver isn’t the only thing to worry about. A large follow-up study has found that alcohol consumption alongside fatty liver raises the risk of esophageal and stomach cancer as well as liver cancer.
A team led by Professor Park Ha-na of the Department of Gastroenterology at Konkuk University Hospital and Professor Shim Ju-hyeon of the Department of Gastroenterology at Asan Medical Center followed 43,994 adults who underwent health screenings in 2010–2011 for a median of about 10.5 years, comparing cancer risks by type of fatty liver. The findings were published in the international journal Gut and Liver.
The research team divided cases of fatty liver diagnosed by abdominal ultrasound into three types, according to an international classification introduced in 2023: metabolic dysfunction-associated steatotic liver disease (MASLD), involving low alcohol consumption but metabolic problems such as obesity or diabetes; MetALD, in which alcohol consumption is added to these metabolic issues; and alcoholic liver disease (ALD), which occurs in people who drink heavily.

Compared with people without fatty liver, the risk of liver cancer was about twice as high for those with metabolic dysfunction-associated steatotic liver disease, about 7.9 times as high for those with MetALD, and about 12 times as high for those with alcoholic liver disease. The risk rose sharply as alcohol consumption was added.
A similar pattern emerged for other digestive cancers. The alcoholic liver disease group had about six times the risk of esophageal cancer and about 2.4 times the risk of stomach cancer. The MetALD group also had about 1.6 times the risk of stomach cancer. For cancer overall, the risk was about 1.4 times higher only in the alcoholic liver disease group.
Even among people who drank, risks differed depending on whether they had fatty liver. Compared with people who drank heavily but did not have fatty liver, those with alcoholic liver disease had about 5.2 times the risk of liver cancer and about twice the risk of upper gastrointestinal cancers, including esophageal and stomach cancer. The research team said that whether a person has fatty liver, along with their drinking habits, is an important indicator of cancer risk.

Women faced higher cancer risks even with metabolic dysfunction-associated steatotic liver disease alone. In this group, the risk of cancer overall was about 1.2 times as high, and the risk of gynecologic cancers about 1.5 times as high. However, very few women had MetALD or alcoholic liver disease, limiting the analysis.
Liver fibrosis scores calculated from blood tests (FIB-4 and SAFE) were also associated with cancer risk. Higher scores tended to correspond to greater cancer risk. The association weakened after adjusting for age, but remained independent in the highest score range. The SAFE score, in particular, provided additional risk-prediction information beyond age. The research team said these scores could serve as supplementary tools for identifying people at high risk of cancer.
The research team said the findings could provide a basis for assessing alcohol consumption when diagnosing fatty liver, classifying the condition by type, and recommending abstinence and cancer screening suited to each type.
Professor Park Ha-na said, “If you have fatty liver, your drinking habits must also be assessed. Fatty liver accompanied by alcohol consumption in particular raises the risk of esophageal and stomach cancer as well as liver cancer, so abstaining from alcohol and having regular liver ultrasounds and endoscopic examinations are important.”
This large cohort study followed about 44,000 adults for more than 10 years, and its significance lies in identifying differences in cancer risk by type of fatty liver. By broadening the analysis to include fatty liver accompanied by alcohol consumption, it also highlighted the importance of assessing risk while considering both metabolic dysfunction and drinking habits. Professor Park was the paper’s first author and co-corresponding author.


[email protected] Jung Myung-jin, medical correspondent Reporter