What should we recommend to our patients with NAFLD regarding alcohol use?

It is generally recommended that patients with nonalcoholic fatty liver disease (NAFLD) not consume alcohol. However, because these patients are at increased cardiovascular risk, and light to moderate alcohol consumption may have hepatic benefits in people with or at risk for NAFLD, this recommendation may be ill-advised. We reviewed the literature on alcohol consumption and NAFLD and conclude that (i) heavy consumption has many harmful effects, including those on the liver, and should be discouraged whether a person has NAFLD or not; (ii) it is unknown whether cardiovascular and metabolic benefits of light to moderate consumption observed in the general population extend to those with NAFLD; (iii) epidemiological and cohort studies suggesting that light to moderate drinking may have hepatic benefits are largely cross-sectional and used surrogate end points; and (iv) until further data from rigorous prospective studies become available, people with NAFLD should avoid alcohol of any type or amount.