LAUSR

BACKGROUND AND AIMS MAFLD often co-occurs with excessive alcohol consumption, while its prognostic value in this group remains unclear. We aimed to study the mortality risk of MAFLD in relation to excessive alcohol consumption and its potential interactions. METHODS We analyzed individuals aged 25-74 enrolled in the NHANES III cohort with available steatosis and alcohol data. Individuals with viral hepatitis, BMI <18.5 and missing data on age or follow-up were excluded, leaving 12.656 participants for analysis with a median follow-up of 22.9[20.9-24.8] years. MAFLD was defined as steatosis on ultrasound in the presence of metabolic dysfunction. Daily alcohol intake of ≥10 grams in female and ≥20 grams in male was considered excessive alcohol consumption. We quantified mortality risk with multivariate Cox regression for MAFLD and excessive alcohol consumption. Models were adjusted for age, age squared, sex, race, marital status, education and smoking. RESULTS MAFLD was present in 31% and excessive alcohol consumption in 13% and were both independently and simultaneously associated with increased mortality risk in fully adjusted models (aHR:1.21, 95%CI:1.13-1.30 and aHR:1.14, 95%CI:1.04-1.26, respectively). Similarly, MAFLD was associated with increased mortality risk in individuals with and without excessive alcohol consumption. Participants with both MAFLD and excessive alcohol consumption (4.0%) expressed the highest mortality risk (aHR:1.47, 95%CI:1.28-1.71). Results were consistent using the initial ten years of follow-up, a stringent definition of excessive alcohol, and propensity score weighting. CONCLUSIONS MAFLD increases mortality risk independent of excessive alcohol consumption. This underscores the importance of MAFLD, even in patients with excessive alcohol consumption.