Many adults who consider themselves moderate drinkers may be unknowingly harming their livers by bingeing just once a month, according to new research from the University of Southern California's Keck School of Medicine that challenges long-held assumptions about "safe" occasional heavy drinking.

The study, published April 2, 2026, in the journal Clinical Gastroenterology and Hepatology, found that people with metabolic dysfunction–associated steatotic liver disease (MASLD) who consume four or more drinks in a single day for women or five or more for men at least once a month face nearly three times the odds of developing advanced liver fibrosis compared with those who spread out the same total weekly alcohol intake more evenly.

MASLD, formerly known as nonalcoholic fatty liver disease, affects about one in three U.S. adults and is closely linked to obesity, type 2 diabetes and metabolic syndrome. The condition causes fat to build up in the liver, making the organ more vulnerable to inflammation and scarring when exposed to alcohol spikes.

Researchers analyzed data from more than 8,000 U.S. adults participating in the National Health and Nutrition Examination Survey (NHANES) between 2017 and 2023. Among nearly 4,000 participants with MASLD who had liver stiffness measurements via vibration-controlled transient elastography, 15.9% reported episodic heavy drinking — defined as the binge threshold at least once a month.

After adjusting for age, sex and average weekly alcohol consumption, those with episodic heavy drinking had 69% higher odds of significant liver fibrosis and nearly three times higher odds (adjusted odds ratio 2.76) of advanced fibrosis. The weighted........

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