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Original Article
- Normal liver enzymes do not indicate safety from alcohol-related liver disease: evidence from a Korean nationwide cohort
- Yeon Woo Oh, Jun Young Park, Eun-Cheol Park
- Epidemiol Health. 2026;48:e2026004. Published online January 22, 2026
- DOI: https://doi.org/10.4178/epih.e2026004
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AbstractOBJECTIVES
This study examined whether individuals with consistently normal liver enzyme levels are protected from alcohol-related liver disease and investigated whether heavy drinking increases liver disease risk independent of normal biomarker status.METHODSWe conducted a nationwide cohort study using Korean National Health Insurance Service data (2002–2019), including 19,035 participants aged ≥40 years who maintained normal liver enzyme levels (aspartate aminotransferase ≤40 μ/L, alanine aminotransferase ≤40 μ/L, gamma-glutamyl transferase ≤63 μ/L for men and ≤35 μ/L for women) across multiple examinations conducted between 2002 and 2008. Participants were categorized as abstainers (≤1 time/mo), moderate drinkers (≤2 times/wk), and heavy drinkers (≥3 times/wk). Primary outcomes included incident liver disease identified using diagnostic codes. Cox proportional hazards models were used to estimate hazard ratios (HRs), with age-stratified analyses performed.RESULTSHeavy drinkers demonstrated a significantly higher risk of liver disease than abstainers (HR, 1.73; 95% confidence interval [CI], 1.40 to 2.14), whereas moderate drinkers showed no significant association (HR, 1.06; 95% CI, 0.94 to 1.19). Consistent patterns emerged for middle-aged adults (40–69 years), with attenuated effects among participants aged ≥70 years. When alcoholic liver disease was analyzed specifically, both moderate (HR, 1.29; 95% CI, 1.05 to 1.58) and heavy drinkers (HR, 2.86; 95% CI, 2.09 to 3.91) exhibited significantly increased hazards.CONCLUSIONSDespite normal liver enzyme levels, heavy alcohol consumption was associated with a significantly increased risk of liver disease. These findings challenge current reactive screening paradigms relying solely on biomarker abnormalities and support proactive alcohol counseling regardless of enzyme results. More sensitive strategies are needed for early detection of alcohol-related liver injury. -
SummaryKorean summary
간 효소 수치가 지속적으로 정상 범위를 유지한 사람들에게서도 과음은 간 질환 발생 위험을 유의하게 높이는 것으로 나타났다. 이는 정상 간 효소 수치가 간 건강을 보장하지 않음을 의미하며, 간 효소 수치와 무관하게 과음자 모두를 대상으로 한 적극적인 음주 상담과 예방적 개입이 필요하다.Key Message
Even among individuals who consistently maintain normal liver enzyme levels, heavy alcohol consumption significantly increases the risk of liver disease. These findings challenge the conventional assumption that normal biomarker results reflect hepatic safety. Proactive alcohol counseling should be provided to all heavy drinkers regardless of their liver enzyme status.
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