Alcohol-related liver disease may be twice as common as previously thought
New study shows underreported drinking hides the true scale of liver disease and increases risk of early death.
April 13, 2026
Researchers involved in the study found that underreported binge drinking was linked to long-term health risks. (Getty Images)
By A.J. Hostetler
Alcohol-related liver disease is likely much more widespread in the United States than people think, according to a new study involving a VCU Health clinician-researcher.
The research shows that when people’s alcohol use is measured more accurately, the number of adults with alcohol-related liver disease nearly doubles. This includes both metabolic dysfunction-associated alcohol-related liver disease (MetALD) and standard alcohol-related liver disease (ALD).
“This study shows that alcohol-related liver disease is more common than we thought,” said study co-author Juan Pablo Arab, M.D., director of alcohol sciences at VCU’s Stravitz-Sanyal Institute for Liver Disease and Metabolic Health and VCU Health hepatologist. “Better ways to track alcohol use could help doctors identify at-risk patients and act sooner.”
Historically, ALD has been reported in about 1% of adults, even though it is a leading cause of cirrhosis, liver transplants and liver-related deaths. Many people underreport how much they drink, which hides the real scale of the problem. After adjusting for this, the study found a large increase in adults affected by alcohol-related liver disease.
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Juan Pablo Arab, M.D., a liver specialist with VCU Health and director of alcohol sciences for the VCU Stravitz-Sanyal Institute for Liver Disease and Metabolic Health. (Enterprise Marketing and Communications)
Arab is one of the more than two dozen researchers from around the world contributed to the study, which was published by the medical journal The Lancet Gastroenterology and Hepatology.
Underreported binge drinking linked to long-term health risks, including early death
The research team analyzed liver health-related data collected from the National Health and Nutrition Examination Survey on adults 20 and older. The data included self-reported alcohol use, which was then adjusted for underreporting.
Researchers also tracked deaths over time to see how alcohol use and liver disease affected early mortality, paying special attention to binge drinking, defined as having five or more drinks at one time at least once in the past year.
Among the findings, the researchers discovered that liver disease has become more common over time. Between 2021 to 23, unadjusted estimates suggested ALD affected 1.65% of adults and MetALD 2.14%. After adjusting for underreporting, those numbers rose to 4.59% and 4.10%.
The analysis revealed that people with alcohol-related liver disease had the highest risk of dying early, and binge drinking was the strongest risk factor for both liver disease and early death. The study estimates that about 21% of early deaths among people with MetALD and nearly 93% of deaths among those with ALD were linked to binge drinking.
“These results show that it’s not just how much people drink on average, but how they drink that matters,” Arab said.
Diabetes also plays a major role. For people with metabolic-related liver disease, type 2 diabetes alone accounted for nearly 45% of early deaths. People who binge drink and also have diabetes or high blood pressure face the highest risk of dying early. The study shows that alcohol and metabolic disease together make liver damage progress faster.
“Our findings suggest that alcohol-related liver disease is much more widespread than current estimates show, largely because people often underreport drinking,” Arab said. “This has real consequences: delayed diagnosis, limited prevention, and preventable illness and death.”
Implications for clinical care and patient screening
The study highlights the importance of assessing alcohol consumption carefully in clinical settings, with particular attention to binge drinking patterns. It also reinforces the need for comprehensive management of cardiometabolic conditions, such as type 2 diabetes and hypertension.
“Addressing both alcohol use and metabolic health is critical,” Arab said. “When these factors occur together, they accelerate liver damage and significantly increase the risk of early death. Better screening and intervention strategies could prevent serious outcomes and save lives.”
The authors also note that public health efforts should focus on reducing alcohol use and managing metabolic conditions, particularly in younger people since alcohol consumption and obesity rates are on the rise.
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