We all know that overeating is bad for your health, and that’s a safe assumption. But a new study shows that binging one night a week is more harmful than drinking the same amount spread out over the same period. A new study is the first to assess how individuals' drinking patterns and factors such as genetics and type 2 diabetes determine their increased risk of alcohol-related cirrhosis (ARC).

Liver disease is one of the leading causes of premature death, with 2%-3% of people worldwide suffering from cirrhosis or liver disease. It’s no surprise that alcohol consumption is a major contributor to alcohol-related liver disease (ARLD), but less than one-third of heavy drinkers will develop ARLD.

Of course, alcohol consumption has also been linked to cancer, injury and dementia for a long time. Senior author Gautam Mehta, from UCL Medicine and the Royal Free Hospital, said: "Only one in three alcoholics will develop severe liver disease. This study highlights that drinking patterns are also a key factor. For example, our results show that drinking 21 units of alcohol spread over several times is more harmful than spreading it evenly over the week. Genetic information is likely to be widely used in healthcare in the coming years, and adding genetic information can more accurately predict risk."

Researchers from University College London (UCL), the Royal Free Hospital, the Universities of Oxford and Cambridge analyzed data from 312,599 adult drinkers recorded in the UK Biobank to examine whether there was evidence of an increased risk of liver disease based on lifestyle and added genetic and diabetes factors.

By calculating the average daily alcohol consumption, the population was divided into four groups: drinking within the limit (under 24 grams for women and under 32 grams for men), drinking above the limit but less than binge drinking (under 24 to 48 grams for females, 32 to 64 grams for males), binge drinking (under 48 to 72 grams for females, 64 to 96 grams for males), and severe binge drinking (above 72 grams for females and above 96 grams for males).

People who drink within the limit account for 20% of the population, people who drink above the limit account for 42% of the population, and binge drinkers (23%) and heavy binge drinkers (15%) account for 15% of the population.

In the UK, a standard unit contains about 8 grams of alcohol; in the US, it's about 14 grams, or about a 12-ounce glass of regular 5% beer.

They found that healthy adults who drank more than their daily limit but not to binge levels had a slightly increased risk of acute alcoholic hepatitis (hazard ratio, 1.33), while binge drinkers had more than twice the risk (2.37) and heavy binge drinkers had nearly four times the risk (3.85).

However, when the researchers separated these groups based on details of self-reported drinking patterns to distinguish between consistent drinkers and those who were more likely to down an entire unit in one or two times, the results were eye-opening. The risk for moderate drinkers rose from 1.33 to 2.39, while for binge drinkers the risk rose to more than five times (5.16) and for heavy binge drinkers to more than nine times (9.38).

Breaking down the data into ALC and links to genetic factors, it shows that heavy drinkers who exhibit these binge drinking patterns have between three and 13 times the risk of developing the disease than the general population, depending on the degree of genetic predisposition.

Likewise, when diabetes was taken into account, the data reflected a similar pattern, with those who consumed more alcohol every week having a significantly higher risk of developing diabetes.

The researchers also found that heavy drinkers were more likely to be male, that heavy drinkers and binge drinkers drank less frequently (one to three times a week), and that both groups were also more likely to go to bars without a meal.

"Many studies examining the relationship between liver disease and alcohol have focused on alcohol consumption," said first author Linda NgFat of the University of London, Los Angeles School of Epidemiology and Public Health. "We took a different approach and looked at patterns of alcohol consumption and found that this was a better reflection of liver disease risk than the amount of alcohol consumed alone. Another key finding was that the more risk factors involved, the higher the 'excess risk' due to the interaction of these factors."

The study underscores earlier research into why people with "all-or-nothing" drinking patterns are at such high risk for alcohol-related diseases. Experimental data had earlier hypothesized that these binge-drinking behaviors trigger elevated circulating levels of bacterial proteins (lipopolysaccharides) and pro-inflammatory cytokines, both of which are key contributors to acute alcoholic liver disease.

Pamela Healy, chief executive of the British Liver Trust, said: "This research is important because it reveals that it's not just how much you drink overall, but how you drink it. Drinking large amounts, drinking quickly or drinking to get drunk can have serious consequences for liver health."

The researchers hope these findings will add important insights into the risk of alcohol abuse in an area of ​​research that has been lacking data to date. Taking genetic risk into account may also prove to be a useful clinical tool to assess a patient's risk based on the amount and duration of their alcohol consumption.

Senior author Steven Bell, from the University of Cambridge, said: "Deaths from liver disease, particularly alcohol-related deaths, have surged since the COVID-19 pandemic, so we must adopt innovative strategies to tackle this escalating crisis. This study gives us novel tools that are crucial for identifying individuals who are most at risk, allowing us to target interventions more effectively to those who will benefit most."

The research was published in the journal Nature Communications.