Conflicting data exist on the impact of alcohol use on risk of liver disease progression in patients with steatotic liver disease. We aimed to evaluate the effect of longitudinal alcohol use on risk of cirrhosis among veterans with steatotic liver disease. US veterans with steatotic liver disease were identified from January 2010 through December 2022. Alcohol use was assessed using documented Alcohol Use Disorders Identification Test-Concise (AUDIT-C) scores and categorized as no alcohol (AUDIT-C = 0), low-risk alcohol use (AUDIT-C 1–2 for women and 1–3 for men), and high-risk alcohol (AUDIT-C ≥ 3 for women and ≥ 4 for men). Incidence of cirrhosis was evaluated with competing risks Nelson-Aalen methods. Adjusted multivariable regression models evaluated risks of cirrhosis associated with baseline alcohol use and changes in alcohol use during follow-up. There were 1,156,189 veterans with steatotic liver disease identified (54.2% no alcohol, 34.6% low-risk alcohol, and 11.2% high-risk alcohol). Veterans with steatotic liver disease and high-risk alcohol have a 43% higher incidence of cirrhosis compared with patients reporting no alcohol use. Compared with patients with baseline high-risk alcohol who reported no change in alcohol use, those who decreased their alcohol use during follow-up experienced a 39% reduction in long-term risk of cirrhosis (hazard ratio, 0.61; 95% CI, 0.45–0.83; < .01). One in 9 veterans with steatotic liver disease report concurrent high-risk alcohol use, which is associated with 43% greater risk of cirrhosis compared with no alcohol use. However, reducing alcohol use lowers risk of cirrhosis, emphasizing the importance of timely alcohol use assessment and early interventions to address high-risk alcohol use in steatotic liver disease.

中文翻译：

---

纵向饮酒模式对患有脂肪肝病的美国退伍军人患肝硬化的长期风险的影响

关于饮酒对脂肪肝患者肝病进展风险的影响，存在相互矛盾的数据。我们的目的是评估长期饮酒对患有脂肪肝病的退伍军人肝硬化风险的影响。 2010 年 1 月至 2022 年 12 月期间，美国退伍军人被诊断患有脂肪肝。使用记录的酒精使用障碍识别测试简明测试 (AUDIT-C) 分数评估饮酒情况，并将其归类为不饮酒 (AUDIT-C = 0)、低风险饮酒（女性 AUDIT-C 1-2，男性 1-3），以及高风险饮酒（女性 AUDIT-C ≥ 3，男性 ≥ 4）。肝硬化的发病率采用竞争风险 Nelson-Aalen 方法进行评估。调整后的多变量回归模型评估了与基线饮酒和随访期间饮酒变化相关的肝硬化风险。已确定 1,156,189 名退伍军人患有脂肪肝病（54.2% 不饮酒，34.6% 低风险饮酒，11.2% 高风险饮酒）。与报告不饮酒的患者相比，患有脂肪肝病和高风险饮酒的退伍军人的肝硬化发病率高出 43%。与基线高风险饮酒但饮酒量没有变化的患者相比，那些在随访期间减少饮酒的患者的长期肝硬化风险降低了 39%（风险比，0.61；95% CI，0.45） –0.83；< .01)。患有脂肪肝病的退伍军人中，有九分之一报告同时存在高风险饮酒，与不饮酒相比，发生肝硬化的风险增加了 43%。然而，减少饮酒可以降低肝硬化的风险，这强调了及时饮酒评估和早期干预措施的重要性，以解决脂肪肝病中高风险饮酒的问题。