Healthy eating and physical activity significantly lower sex-specific alcohol-attributable liver mortality in the United States

The influence of diet quality (DQ) and physical activity (PA) on alcohol-related liver mortality remains insufficiently studied. In the Journal of Hapatology,researchers examine how DQ and PA affect alcohol-attributable liver mortality in the US.
Data from 60,334 adults in the National Health and Nutrition Examination Surveys (1984-2018) were analysed and linked to the National Death Index through 31 December 2019. Self-reported alcohol use, DQ (healthy eating index [HEI]), and physical activity levels were obtained. Participants were classified as light, moderate, or heavy drinkers based on NIAAA guidelines. Physically active participants reported at least 150 minutes of moderate-intensity physical activity, 75 minutes of vigorous-intensity physical activity, or a combination of both per week. A healthier diet was defined as being in the top quartile of HEI. The outcome was liver-related mortality.
During a 12.2-year follow-up, 252 liver-specific deaths were recorded. The average daily alcohol intake increased the risk of liver-specific mortality (adjusted sub-distribution hazard ratio [aSHR]-men: 1.04, 95% CI 1.01-1.06; women: 1.08, 95% CI 1.04-1.12) compared to abstainers. Binge drinking also elevated the risk of liver mortality (aSHR-men: 1.52, 95% CI 1.04-2.29; women: 2.52, 95% CI 1.44-4.41) compared to non-binge drinkers. Healthier dietary intake (top quartile of HEI) lowered liver mortality risk among non-heavy (aSHR: 0.35, 95% CI 0.13-0.90), heavy (aSHR: 0.14, 95% CI 0.04-0.82), and binge (aSHR: 0.16, 95% CI 0.06-0.46) drinkers compared to those with unhealthier diets (lower quartile of HEI). Physically active participants had reduced liver mortality risk among non-heavy (aSHR: 0.52, 95% CI 0.28-0.94), heavy (aSHR: 0.64, 95% CI 0.35-0.99), and binge (aSHR: 0.31, 95% CI 0.10-0.88) drinkers. Diets high in vegetables, fruits, whole grains, seafood, plant-based proteins, and unsaturated fats – and low in solid fats, alcohol, and added sugars – proved protective. The survival benefits of DQ and PA were notably greater in women than in men. Healthy eating and increased levels of PA significantly reduce the risk of alcohol-attributable liver-related mortality.This study found that any amount of alcohol consumption and binge drinking are linked to a higher risk of liver-related mortality. Following healthy dietary patterns and engaging in increased physical activity reduce the risk of liver mortality across all drinking habits, including heavy and binge drinking.
Source: Vilar-Gomez E, Nephew Let al.. (2025) Healthy eating and physical activity significantly lower sex-specific alcohol-attributable liver mortality in the United States. Journal of Hepatology, S0168-8278(25)02334-7.