{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T00:58:52Z","timestamp":1783385932915,"version":"3.54.6"},"reference-count":55,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2023,9,7]],"date-time":"2023-09-07T00:00:00Z","timestamp":1694044800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Metabolic dysfunction-associated steatotic liver disease (MASLD) is distinguished by the buildup of excessive liver fat unrelated to alcohol consumption. However, the role of alcohol consumption on disease progression is debatable. Recently, alcohol flushing syndrome in Asian populations has gained interest, and its role in the risk of developing MASLD is unknown. Therefore, in this cross-sectional study, we investigated the association between alcohol consumption and MASLD in Korean men, considering their alcohol flushing response and utilizing the lipid accumulation product (LAP) score. Data from the Korean National Health and Nutrition Examination Survey (2019\u20132021) were analyzed. Participants were categorized into non-or-infrequent drinkers and light-to-heavy drinkers and further sub-classified based on alcohol flushing response as non-flushers and flushers. Multivariate logistic regression analysis showed a significant association between alcohol consumption and MASLD risk in both non-flushers (aHR 1.90, 95% CI 1.51\u20132.40, p &lt; 0.001) and flushers (aHR 2.35, 95% CI 1.94\u20132.84, p &lt; 0.001) after adjusting for potential confounding factors such as age, exercise, smoking, body mass index, systolic blood pressure, total cholesterol, and fasting plasma glucose. There was a significant interaction between alcohol consumption and alcohol flushing response for MASLD risk (p for interaction &lt; 0.001). These findings emphasize the importance of alcohol flushing as a potential indicator of MASLD risk in Korean men and highlight the need for further research to understand the underlying mechanisms and develop targeted preventive strategies.<\/jats:p>","DOI":"10.3390\/nu15183901","type":"journal-article","created":{"date-parts":[[2023,9,7]],"date-time":"2023-09-07T10:09:50Z","timestamp":1694081390000},"page":"3901","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Association between Alcohol Consumption and Metabolic Dysfunction-Associated Steatotic Liver Disease Based on Alcohol Flushing Response in Men: The Korea National Health and Nutrition Examination Survey 2019\u20132021"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-3017-208X","authenticated-orcid":false,"given":"Dae Eon","family":"Kang","sequence":"first","affiliation":[{"name":"Department of Family Medicine, Severance Hospital, Seoul 03722, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2452-6069","authenticated-orcid":false,"given":"Si Nae","family":"Oh","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, National Health Insurance Service Ilsan Hospital, Goyang 10444, Republic of Korea"},{"name":"Department of Medicine, Yonsei University Graduate School, Seoul 03722, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,9,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1080\/03602532.2017.1293683","article-title":"Metabolic dysfunction-associated steatotic liver disease (MASLD)\u2014Pathogenesis, classification, and effect on drug metabolizing enzymes and transporters","volume":"49","author":"Cobbina","year":"2017","journal-title":"Drug Metab. Rev."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Malnick, S.D.H., Alin, P., Somin, M., and Neuman, M.G. (2022). Fatty liver disease-alcoholic and Metabolic associated: Similar but different. Int. J. Mol. Sci., 23.","DOI":"10.3390\/ijms232416226"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Kim, H.K., Lim Si En, R., and Wong Kang Min, D. (2019). Psychosocial Motivators for Moderate Drinking among Young Asian Flushers in Singapore. Int. J. Environ. Res. Public Health, 16.","DOI":"10.3390\/ijerph16111897"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"24","DOI":"10.4082\/kjfm.19.0141","article-title":"Association between Alcohol Consumption and Metabolic Syndrome Determined by Facial Flushing in Korean Women","volume":"42","author":"Seo","year":"2021","journal-title":"Korean J. Fam. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"211","DOI":"10.4082\/kjfm.2012.33.4.211","article-title":"Relationship between Alcohol Consumption and Metabolic Syndrome according to Facial Flushing in Korean Males","volume":"33","author":"Kim","year":"2012","journal-title":"Korean J. Fam. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1016\/j.annepidem.2012.04.014","article-title":"Relationships among Alcohol Consumption, Facial Flushing Response, and Metabolic Syndrome in Healthy Men","volume":"22","author":"Jung","year":"2012","journal-title":"Ann. Epidemiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"101919","DOI":"10.1016\/j.redox.2021.101919","article-title":"Acetaldehyde Dehydrogenase 2 regulates HMG-CoA reductase stability and cholesterol synthesis in the liver","volume":"41","author":"Zhong","year":"2021","journal-title":"Redox Biol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1152\/physrev.00017.2013","article-title":"Targeting Aldehyde Dehydrogenase 2: New Therapeutic Opportunities","volume":"94","author":"Chen","year":"2014","journal-title":"Physiol. Rev."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1111\/j.1469-1809.2009.00517.x","article-title":"Re-fined geographic distribution of the oriental ALDH2*504Lys (nee 487Lys) variant","volume":"73","author":"Li","year":"2009","journal-title":"Ann. Hum. Genet."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Han, B., Lee, G.B., Yim, S.Y., Cho, K.H., Shin, K.E., Kim, J.H., Park, Y.G., Han, K.D., and Kim, Y.H. (2022). Non-Alcoholic Fatty Liver Disease Defined by Fatty Liver Index and Incidence of Heart Failure in the Korean Population: A Nationwide Cohort Study. Diagnostics, 12.","DOI":"10.3390\/diagnostics12030663"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1111\/j.1440-1746.2011.06895.x","article-title":"Transitional features of histologic type of Metabolic dysfunction-associated steatotic liver disease in Korean young men","volume":"27","author":"Kim","year":"2012","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Kang, S.Y., Kim, Y.J., and Park, H.S. (2020). Trends in the prevalence of Metabolic dysfunction-associated steatotic liver disease and its future predictions in Korean men, 1998\u20132035. J. Clin. Med., 9.","DOI":"10.3390\/jcm9082626"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1186\/s12944-023-01802-6","article-title":"Lipid accumulation product (LAP) index for the diagnosis of nonalcoholic fatty liver disease (NAFLD): A systematic review and meta-analysis","volume":"22","author":"Ebrahimi","year":"2023","journal-title":"Lipids Health Dis."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"410","DOI":"10.3346\/jkms.2016.31.3.410","article-title":"The Risk of Abdominal Obesity according to the Degree of Metabolic dysfunction-associated steatotic liver disease in Korean Men","volume":"31","author":"Park","year":"2016","journal-title":"J. Korean Med. Sci."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Song, D.S., Chang, U.I., Choi, S., Jung, Y.D., Han, K., Ko, S.-H., Ahn, Y.-B., and Yang, J.M. (2016). Heavy Alcohol Consumption with Alcoholic Liver Disease Accelerates Sarcopenia in Elderly Korean Males: The Korean National Health and Nutrition Examination Survey 2008-2010. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0163222"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"977625","DOI":"10.3389\/fendo.2022.977625","article-title":"The lipid accumulation product is a powerful tool to diagnose metabolic dysfunction-associated fatty liver disease in the United States adults","volume":"13","author":"Li","year":"2022","journal-title":"Front. Endocrinol."},{"key":"ref_17","first-page":"1393","article-title":"Role of re-productive factors in hepatocellular carcinoma: Impact on hepatitis B- and C-related risk","volume":"38","author":"Yu","year":"2003","journal-title":"Hepatology"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1503\/cmaj.1040752","article-title":"Liver enzyme alteration: A guide for clinicians","volume":"172","author":"Giannini","year":"2005","journal-title":"Can. Med. Assoc. J."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"204","DOI":"10.2174\/1574887109666141216101939","article-title":"Insulin resistance, Metabolic dysfunction-associated steatotic liver disease and hepatitis C virus infection","volume":"9","author":"Goossens","year":"2014","journal-title":"Rev. Recent Clin. Trials"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e24746","DOI":"10.1097\/MD.0000000000024746","article-title":"The relationship between alcohol consumption and knee osteoarthritis in Korean population over 50 years-old: Results from Korea National Health and Nutrition Examination Survey","volume":"100","author":"Kim","year":"2021","journal-title":"Medicine"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"111","DOI":"10.4046\/trd.2022.0107","article-title":"Impact of Alcohol Consumption on Quality of Life, Depressive Mood and Metabolic Syndrome in Obstructive Lung Disease Patients: Analysis of Data from Korean National Health and Nutrition Examination Survey from 2014 and 2016","volume":"86","author":"Heo","year":"2023","journal-title":"Tuberc. Respir. Dis."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Hong, J.W., Noh, J.H., and Kim, D.-J. (2017). The prevalence of and factors associated with high-risk alcohol consumption in Korean adults: The 2009\u20132011 Korea National Health and Nutrition Examination Survey. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0175299"},{"key":"ref_23","first-page":"308","article-title":"Relationship between bone mineral density and alcohol consumption in Korean men: The Fourth Korea National Health and Nutrition Examination Survey (KNHANES), 2008\u20132009","volume":"25","author":"Hyeon","year":"2016","journal-title":"Asia Pac. J. Clin. Nutr."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1082","DOI":"10.1111\/j.1360-0443.2008.02197.x","article-title":"Alcohol measurement methodology in epidemiology: Recent advances and opportunities","volume":"103","author":"Greenfield","year":"2008","journal-title":"Addiction"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1038\/s41574-021-00584-0","article-title":"Non-invasive methods for imaging hepatic steatosis and their clinical importance in MASLD","volume":"18","author":"Tamaki","year":"2021","journal-title":"Nat. Rev. Endocrinol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"101167","DOI":"10.1016\/j.molmet.2021.101167","article-title":"Imaging biomarkers of MASLD, NASH, and fibrosis","volume":"50","author":"Ajmera","year":"2021","journal-title":"Mol. Metab."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1016\/j.sleep.2019.02.012","article-title":"The impact of the sleep duration on MASLD score in Korean middle-aged adults: A community-based cohort study","volume":"57","author":"Kim","year":"2019","journal-title":"Sleep Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"117","DOI":"10.5009\/gnl19301","article-title":"Hepatic Steatosis Index in the Detection of Fatty Liver in Patients with Chronic Hepatitis B Receiving Antiviral Therapy","volume":"15","author":"Chang","year":"2021","journal-title":"Gut Liver"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1007\/s12072-018-9892-8","article-title":"Serum ferritin level is associated with liver steatosis and fibrosis in Korean general population","volume":"13","author":"Jung","year":"2018","journal-title":"Hepatol. Int."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1111","DOI":"10.1007\/s10787-021-00842-7","article-title":"Association between metabolic associated fatty liver disease and osteoarthritis using data from the Korean national health and nutrition examination survey (KNHANES)","volume":"29","author":"Han","year":"2021","journal-title":"Inflammopharmacology"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1232","DOI":"10.3803\/EnM.2021.1087","article-title":"The leg fat to total fat ratio is associated with lower risks of Metabolic dysfunction-associated steatotic liver disease and less severe hepatic fibrosis: Results from nationwide surveys (KNHANES 2008\u20132011)","volume":"36","author":"Kim","year":"2021","journal-title":"Endocrinol. Metab."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Kang, Y., Park, S., Kim, S., and Koh, H. (2018). Normal serum alanine aminotransferase and non-alcoholic fatty liver disease among Korean adolescents: A cross-sectional study using data from KNHANES 2010\u20132015. BMC Pediatr., 18.","DOI":"10.1186\/s12887-018-1202-z"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"776","DOI":"10.1002\/hep.28376","article-title":"Sarcopenia is associated with significant liver fibrosis independently of obesity and insulin resistance in nonalcoholic fatty liver disease: Nationwide surveys (KNHANES 2008\u20132011)","volume":"63","author":"Lee","year":"2016","journal-title":"Hepatology"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"2104","DOI":"10.12659\/MSM.901309","article-title":"Association between alcohol consumption and metabolic syndrome in a com-munity-based cohort of Korean adults","volume":"23","author":"Kim","year":"2017","journal-title":"Med. Sci. Monit."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"70","DOI":"10.21037\/tgh.2019.09.02","article-title":"Effect of alcohol consumption on nonalcoholic fatty liver disease","volume":"4","author":"Weng","year":"2019","journal-title":"Transl. Gastroenterol. Hepatol."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Rinella, M.E., Lazarus, J.V., Ratziu, V., Francque, S.M., Sanyal, A.J., Kanwal, F., Romero, D., Abdelmalek, M.F., Anstee, Q.M., and Arab, J.P. (2023). A multi-society Delphi consensus statement on new fatty liver disease nomenclature. J. Hepatol., 101133.","DOI":"10.1016\/j.aohep.2023.101133"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"5760","DOI":"10.3748\/wjg.v13.i43.5760","article-title":"Genetic polymorphisms of ADH2 and ALDH2 association with esophageal cancer risk in southwest China","volume":"13","author":"Yang","year":"2007","journal-title":"World J. Gastroenterol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"921","DOI":"10.7150\/ijbs.42300","article-title":"Aldehyde Dehydrogenase, Liver Disease and Cancer","volume":"16","author":"Wang","year":"2020","journal-title":"Int. J. Biol. Sci."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1093\/toxsci\/kfy106","article-title":"Alcohol Metabolism in the Progression of Human Metabolic associated Steatohepatitis","volume":"164","author":"Li","year":"2018","journal-title":"Toxicol. Sci."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1002\/path.4650","article-title":"Systematic transcriptome analysis reveals elevated expression of alcohol-metabolizing genes in MASLD livers","volume":"238","author":"Zhu","year":"2016","journal-title":"J. Pathol."},{"key":"ref_41","first-page":"16","article-title":"Alcoholic liver disease","volume":"4","author":"Seitz","year":"2018","journal-title":"Nat. Rev. Dis. Primers 2018, 4, 18; Erratum in Nat. Rev. Dis. Primers"},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Rumgay, H., Murphy, N., Ferrari, P., and Soerjomataram, I. (2021). Alcohol and Cancer: Epidemiology and Biological Mechanisms. Nutrients, 13.","DOI":"10.3390\/nu13093173"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"53","DOI":"10.7150\/ijms.50174","article-title":"Mulberry leaves extract ameliorates alcohol-induced liver damages through reduction of acetaldehyde toxicity and inhibition of apoptosis caused by oxidative stress signals","volume":"18","author":"Liang","year":"2021","journal-title":"Int. J. Med Sci."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"17756","DOI":"10.3748\/wjg.v20.i47.17756","article-title":"Pathogenesis of alcoholic liver disease: Role of oxidative metabolism","volume":"20","author":"Ceni","year":"2014","journal-title":"World J. Gastroenterol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1016\/j.alcohol.2004.01.005","article-title":"Ethanol and acetaldehyde in alcoholic cardiomyopathy: From bad to ugly en route to oxidative stress","volume":"32","author":"Zhang","year":"2004","journal-title":"Alcohol"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1097\/TP.0000000000002480","article-title":"Nonalcoholic Fatty Liver Disease: Basic Pathogenetic Mechanisms in the Progression From NAFLD to NASH","volume":"103","author":"Pierantonelli","year":"2019","journal-title":"Transplantation"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"908","DOI":"10.1038\/s41591-018-0104-9","article-title":"Mechanisms of MASLD development and therapeutic strategies","volume":"24","author":"Friedman","year":"2018","journal-title":"Nat. Med."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"2212","DOI":"10.1016\/S0140-6736(20)32511-3","article-title":"Non-alcoholic fatty liver disease","volume":"397","author":"Powell","year":"2021","journal-title":"Lancet"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"S47","DOI":"10.1016\/j.jhep.2014.12.012","article-title":"MASLD: A multisystem disease","volume":"62","author":"Byrne","year":"2015","journal-title":"J. Hepatol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1002\/ncp.10449","article-title":"Evolution of MASLD and Its Management","volume":"35","author":"Mundi","year":"2019","journal-title":"Nutr. Clin. Pract."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"e168","DOI":"10.1161\/ATV.0000000000000153","article-title":"Nonalcoholic Fatty Liver Disease and Cardiovascular Risk: A Scientific Statement From the American Heart Association","volume":"42","author":"Duell","year":"2022","journal-title":"Arter. Thromb. Vasc. Biol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"3920196","DOI":"10.1155\/2020\/3920196","article-title":"The Intricate Relationship between Type 2 Diabetes Mellitus (T2DM), Insulin Resistance (IR), and Nonalcoholic Fatty Liver Disease (NAFLD)","volume":"2020","author":"Tanase","year":"2020","journal-title":"J. Diabetes Res."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1406","DOI":"10.1111\/j.1541-0420.2011.01619.x","article-title":"A New Criterion for Confounder Selection","volume":"67","author":"VanderWeele","year":"2011","journal-title":"Biometrics"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1001\/jamapediatrics.2014.2702","article-title":"Nonalcoholic Fatty Liver Disease: A Challenge for Pediatricians","volume":"169","author":"Nobili","year":"2015","journal-title":"JAMA Pediatr."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"1547","DOI":"10.1002\/hep.27368","article-title":"Fibrosis stage is the strongest predictor for disease-specific mortality in MASLD after up to 33 years of follow-up","volume":"61","author":"Ekstedt","year":"2015","journal-title":"Hepatology"}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/15\/18\/3901\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:46:51Z","timestamp":1760129211000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/15\/18\/3901"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9,7]]},"references-count":55,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2023,9]]}},"alternative-id":["nu15183901"],"URL":"https:\/\/doi.org\/10.3390\/nu15183901","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,9,7]]}}}