As the prevalence of obesity, alcohol use, and liver disease increases, physicians should take note of patients’ lifestyle habits.

According to new research presented at The Liver Meeting, held by the American Association for the Study of Liver Diseases, beer drinkers tend to have lower-quality diets, engage in less physical activity, and are more likely to smoke cigarettes compared to those who consume wine, liquor, or a combination of alcoholic beverages.

“Alcohol overuse is the leading cause of cirrhosis in the U.S., and metabolic dysfunction-associated steatotic liver disease (MASLD) is rapidly increasing,” said Madeline Novack, chief resident at Tulane School of Medicine’s internal medicine residency program and lead author of the study. “Both types of liver disease often coexist, and lifestyle changes are key to managing and preventing these conditions, starting with understanding the link between alcohol use and poor nutrition.”

Alcohol Type and Diet Quality

Using a survey of a nationally representative sample of more than 1,900 U.S. adults who reported current alcohol use, researchers compared the diet quality among people who consume beer only (38.9%), wine only (21.8%), liquor only (18.2%), or a combination of alcohol types (21%), measuring self-reported eating habits against the Healthy Eating Index, a validated standardized tool based on dietary guidelines.

None of the alcohol-using groups came close to achieving the 80-point score that is considered an adequate diet on the 100-point Healthy Eating Index, Novack said, but the beer drinkers scored lowest at 49. Wine drinkers scored 55, and both liquor-only drinkers and combination drinkers scored nearly 53.

Beer-only drinkers, who were more likely to be male, younger, smokers, and low income, also reported the highest total daily caloric intake, adjusting for body weight, and the lowest level of physical activity. Previous studies have found that dietary quality declines with increasing alcohol consumption of any type, but little has been reported on the influence of specific alcoholic beverage type.

Contextual Factors Affecting Alcohol and Diet Choices

Novack said the differences in diet quality among drinkers could be attributed to the context in which food and alcohol are consumed together. In the U.S., beer is often chosen in settings where the available foods tend to be low in fiber and high in carbohydrates and processed meats. On the other hand, wine — particularly red wine — is often paired with meals complete with meat, vegetables, and dairy.

Another possibility is the inverse, where dietary choices influence the choice of alcohol consumed, Novack said. For example, fried or salty foods create thirst that may also lead to beer-only consumption.

For prevention of liver disease and other health issues, physicians should ask about the type of alcohol consumed to guide discussion of healthy behaviors, Novack said. For example, the findings of this study can be applied to patients who identify as beer-only drinkers and physicians could suggest increasing fruit and vegetable intake, as well as physical activity.

Reference: “Convergence of Alcohol Consumption and Dietary Quality in US Adults Who Currently Drink Alcohol: An Analysis of Two Core Risk Factors of Liver Disease” by Peng-Sheng Ting, Wei-Ting Lin, Suthat Liangpunsakul, Madeline Novack, Chiung-Kuei Huang, Hui-Yi Lin, Tung-Sung Tseng and Po-Hung Chen, 12 November 2024, Nutrients.
DOI: 10.3390/nu16223866