Abstract
Objective: To evaluate the association between different levels of alcohol intake and all-cause mortality in metabolic dysfunction-associated steatotic liver disease（MASLD）and alcohol-related/associated liver disease（MetALD）. Method: This study included participants aged 20 to 74 who were diagnosed with hepatic steatosis by ultrasound. The data were derived from the Third National Health and Nutrition Examination Survey（NHANES Ⅲ）conducted in the United States from 1988 to 1994. Multivariable-adjusted hazard ratios（aHR）and their 95% confidence intervals（CI）were calculated by Cox proportional risk regression modelling to assess the effect of alcohol consumption levels on all-cause mortality. Participants were categorized into three groups based on daily alcohol intake：low，moderate，and high consumption groups. Results: A total of 2 322 participants were included，with 50.2% males（1 166/2 322），and median age 42.0（31.3-57.0）years. During a median follow up of 316.0（270.0-337.0）months，the overall mortality rate was 1.48% per person-year. The all-cause mortality were 1.38%，1.67% and 2.10% per person-year for those participants in three alcohol intake groups. After adjusting for covariates，daily moderate alcohol intake group（adjusted hazard ratio［aHR］=1.37，95% CI 1.12-1.67，P=0.002），and daily high alcohol intake group（aHR=1.45，95% CI 1.17-1.80，P=0.001），were independently associated with increased all-cause mortality. In subgroup analysis by diabetes status and age，there were significant differences in all-cause mortality across various levels of alcohol intake among non-type 2 diabetes mellitus（T2DM）participants under 60 years old，but not among non-T2DM participants over 60 years old，and T2DM participants of all ages. Conclusion: Alcohol intake has a dose-dependent negative impact on MASLD and MetALD patients. The risk of all-cause mortality significantly increases with higher alcohol intake. To evaluate the association between different levels of alcohol intake and all-cause mortality in metabolic dysfunction-associated steatotic liver disease（MASLD）and alcohol-related/associated liver disease（MetALD）.