What is the daily alcohol intake that can lead to alcoholic liver cirrhosis?

From the Guidelines

Daily alcohol intake of more than 20-25 grams can lead to alcoholic liver cirrhosis.

Key Findings

• The risk of cirrhosis increases proportionally with the quantity of alcohol consumed, with a relative risk of 2.9-4.9 for daily consumption of approximately 25 grams of pure alcohol 1.
• For subjects consuming between 24 and 60 grams of alcohol per day, the relative risk for cirrhosis increases significantly to 12.5 (95% CI 8.8–17.7) 1.
• A daily consumption of more than 30 grams of alcohol per day, or a weekly consumption above seven units in women and 14 units in men, increases the risk of developing alcohol-related liver disease (ALD) 1.
• Some studies suggest that even lower levels of alcohol consumption, such as more than two standard drinks per day, can be harmful for patients with cirrhosis, with a significantly increased risk of mortality 1.

Important Considerations

• The type and pattern of drinking can also influence the development of ALD, with a lower risk of alcoholic cirrhosis reported in red wine drinkers compared to individuals consuming other types of alcoholic beverages 1.
• Other factors, such as smoking, coffee drinking, and genetic predisposition, can also modify the risk of ALD and its progression to cirrhosis 1.
• Complete and permanent abstinence from alcohol is likely recommended for patients with cirrhosis and/or hepatocellular carcinoma (HCC) to limit the risk of excess mortality 1.

From the Research

Daily Alcohol Intake and Alcoholic Liver Cirrhosis

The daily alcohol intake that can lead to alcoholic liver cirrhosis varies among individuals and depends on several risk factors.

• A study published in 2019 2 found that drinking ≥5 drinks per day was associated with a substantially increased risk of liver cirrhosis in both women and men.
• Another study from 2017 3 suggested that the current recommended "safe" limit for alcohol consumption might be set too high, with evidence indicating that even low to moderate consumption could lead to an increased risk of liver cirrhosis.
• A 2011 study 4 reported that about 90% of heavy drinkers (more than 60 g/day of alcohol) show evidence of fatty livers, while only 10-35% develop alcoholic hepatitis and 5-15% develop cirrhosis.

Risk Factors and Thresholds

Several studies have investigated the correlation between average alcohol consumption and the risk of liver disease, aiming to determine the threshold for clinically significant alcohol consumption.

• A 2023 study 5 found that drinking more than 11.5 ± 3.3 standard units/week (92 ± 26.4 g/week) significantly increases the risk of developing liver-related diseases.
• A 2015 prospective cohort study 6 observed that daily drinking was associated with an increased risk of alcoholic cirrhosis, and recent alcohol consumption rather than earlier in life was associated with the risk of alcoholic cirrhosis.
• The same study 6 also found that compared to beer and liquor, wine might be associated with a lower risk of alcoholic cirrhosis.

Sex-Specific Risks

Some studies have reported sex-specific differences in the risk of liver cirrhosis associated with alcohol consumption.

• The 2019 study 2 found that the risk for women was consistently higher compared to men, even with low levels of alcohol consumption.
• The 2017 study 3 also suggested that women may be at higher risk of liver cirrhosis compared to men, even with moderate alcohol consumption.