Table 1.
Selection of studies and trials in chronological order concerning the influence of ethanol intake on obesity, MASLD, and cardiovascular risk
| Author, year | Study design | Hypothesis/aim | Main variables | Outcomes/major findings |
|---|---|---|---|---|
| John B. Dixon et al. 2002 [51] | Cross-sectional study with 486 severely obese subjects | To examine the association between the clinical and biochemical features of the metabolic syndrome and quantity and type of alcohol intake in the severely obese | Adipose tissue (BMI) | Light-to-moderate alcohol consumption is associated with a lower prevalence of type 2 diabetes, reduced insulin resistance, and a more favorable vascular risk profile in the severely obese |
| Rosalind A. Breslow et al. 2005 [52] |
Cross-sectional study 45,896 adults, never smokers who were current alcohol drinkers |
Examined the relation between drinking patterns and BMI | Adipose tissue (BMI) | Participants consuming the smallest quantity the most frequently were leanest, and those who consumed the greatest quantity the least frequently were heaviest. Alcohol may contribute to excess body weight among certain drinkers |
| Mattias Ekstedt et al. 2009 [53] |
Longitudinal study 71 patients with chronically elevated liver enzymes and diagnosed with biopsy-proven MASLD |
To investigate whether low alcohol intake, consistent with the diagnosis of MASLD, is associated with fibrosis progression in established MASLD | Liver disease (MASLD) | Moderate alcohol consumption, consistent with the diagnosis of MASLD to be set, is associated with fibrosis progression in MASLD |
| Carole L. Hart et al. 2010 [54] |
RCT longitudinal Midspan prospective cohort studies (n = 9559 men) |
To investigate whether alcohol consumption and raised BMI act together to increase the risk of liver disease | Adipose tissue (BMI) and liver disease (liver diseases and liver cancer) | Raised BMI and alcohol consumption are both related to liver disease, with evidence of a supra-additive interaction between the two |
| Rohit Loomba et al. 2010 [55] |
RCT longitudinal 2260 Taiwanese men from the Risk Evaluation of Viral Load Elevation and Associated Liver Disease/Cancer-Hepatitis B Virus Study Cohort |
To determine if body mass index and alcohol use have synergistic effects on HCC risk | Adipose tissue (BMI) and liver disease (HCC) markers | The risk of incident HCC increased in overweight (HR, 2.4; 95% CI, 1.3–4.4); obese (HR, 2.0; 95% CI, 1.1–3.7); and extremely obese (HR, 2.9; 95% CI, 1.0–8.0) users of alcohol (P for trend = 0.046) in hepatitis B surface antigen-positive men |
| Simona Costanzo et al. 2010 [56] |
Meta-analysis 16,351 patients with cardiovascular disease |
To quantify the relation between alcohol consumption and cardiovascular and total mortality in patients with a history of cardiovascular events | Cardiovascular disease markers | In patients with cardiovascular disease, light-to-moderate alcohol consumption (5 to 25 g/day) was significantly associated with a lower incidence of cardiovascular and all-cause mortality |
| Carmen Sayon–Orea et al. 2011 [57] |
Longitudinal study 9318 adults without previous chronic disease |
To evaluate the association between the type of alcoholic beverage intake and weight change in a Mediterranean cohort | Adipose tissue (BMI) | The type of alcoholic beverage can modulate the effect of alcohol intake on the risk of developing overweight/obesity |
| Kayoung Lee et al. 2012 [58] |
Cross-sectional study 3793 (963 men and 1830 women) current drinkers |
To examine gender-specific relationships between alcohol drinking patterns (frequency, typical drinking quantity, and frequency of binge drinking) and the prevalence of metabolic syndrome and its components | Cardiovascular markers | Binge drinking frequency was dose-dependently associated with high TAG, high glucose, high blood pressure, and abdominal obesity in men, and with high glucose and high blood pressure in women. Average drinking frequency was not associated with the prevalence of MetS in either sex |
| Cosmin S. Voican et al. 2015 [59] |
Longitudinal study 47 patients with ALD were prospectively included |
To study the consequences of alcohol withdrawal in macrophage markers and polarization in the SAT of alcoholic patients and adipokine expression according to liver inflammation | Adipose tissue (inflammatory biomarkers) | One week of alcohol withdrawal alleviates macrophage infiltration in subcutaneous adipose tissue and orients adipose tissue macrophages towards a M2 anti-inflammatory phenotype; this implicates alcohol in adipose tissue inflammation |
| Michael Roerecke et al. 2019 [60] |
Systematic Review and Meta-Analysis 2,629,272 participants with 5505 cases of liver cirrhosis |
To systematically summarize the risk relationship between different levels of alcohol consumption and incidence of liver cirrhosis | Liver disease (cirrhosis) | There was no increased risk for occasional drinkers. Consumption of one drink per day in comparison to long-term abstainers showed an increased risk for liver cirrhosis in women, but not in men |
| Elif Inan–Eroglu et al. 2022 [61] |
RCT longitudinal 465,437 participants from the UK Biobank |
To examine the associations of adiposity and alcohol consumption on ALD, MASLD, and liver disease incidence and mortality | Adipose tissue (BMI and WC) and liver disease (MASLD and ALD) | Overweight/obese participants with alcohol consumption above the guidelines had a greater HR for liver disease incidence and mortality (HR 1.52 and HR 2.20, respectively) than normal weight individuals (HR 0.95 and HR 1.24, respectively) |
| Briansó Llort L. et al. 2022 [62] |
RCT and cross-over 29 healthy male and female (45–75 years) |
To analyze if resveratrol content in red wine increases SHBG levels | Cardiovascular disease | Red wine rich in resveratrol reduces total cholesterol in men and women and increases SHBG only in women |
| Laurens A. van Kleef et al. 2023 [63] |
Longitudinal study 12,656 participants NANHES cohort |
To study the mortality risk of MASLD in relation to excessive alcohol consumption and its potential interactions | Liver disease (MASLD) | Participants with both MASLD and excessive alcohol consumption expressed the highest mortality risk (aHR, 1.47; 95% CI, 1.28–1.71) |
ALD alcoholic fatty liver disease, BMI body mass index, HCC hepatocellular carcinoma, TAG triacylglycerol, MASLD metabolic dysfunction-associated steatotic liver disease, SAT subcutaneous adipose tissue, WC waist circumference