Severe alcohol-related liver disease is on the rise, a new study suggests. Experts say the increase may be due to heavy binge drinking, especially in young adults.
Researchers found that while there has been little change in the rate of people developing alcoholic fatty liver disease, there appears to be an increase in those who are at greater risk of cirrhosis, liver cancer and death, according to the study published in JAMA.
“I think what triggered me to do this study was seeing a lot of patients with advanced alcoholic fatty liver disease,” said the study’s lead author, Dr. Robert Wong, an assistant clinical professor of medicine and director of research and education at the Alameda Health System-Highland Hospital.
“The most concerning finding was that the number of patients with more advanced disease, which increases the risk of dying, increased significantly over the time period we studied,” Wong said.
The new report adds to the mounting evidence that more and more Americans are developing severe liver disease. A study published last summer found that increasing numbers of young people were dying from alcohol related liver failure. That study, published in the BMJ, linked heavy alcohol consumption in young people to a pronounced increase in deaths.
Alcoholic liver disease is one of the leading causes of death in the United States, Wong noted, adding that nearly 250,000 deaths were attributed to the disease in 2010.
In fact, he said, “a 2016 study showed that it’s become the number one reason for liver transplants in the U.S.”
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To determine whether rates of the disease were rising, Wong and his colleagues turned to data from 2001 to 2016 from the National Health and Nutrition Examination Survey (NHANES). The database includes information on people’s self-reported drinking habits as well as liver enzyme measurements from periodic blood tests.
The amount of alcohol that was considered to be enough to lead to liver damage in this study was two or more drinks per day for women and three or more drinks per day for men.
The researchers excluded people from their analysis who had medical conditions that could also lead to fatty liver disease, such as obesity, metabolic syndrome and hepatitis C and B. And that, Wong said, means that the final numbers in the study might actually be an underestimate.
Those exclusions left 34,423 NHANES participants for the analysis, which identified 4.3 percent as having alcoholic fatty liver disease. The average age of those with the disease was 40.
Wong hopes that his research will help raise awareness of the issue and spark more conversations about alcohol consumption between doctors and patients. And that “might help get patients plugged into resources that could help prevent them from becoming one of those patients with advanced fatty liver disease,” he said.
While the study has limitations, “it’s clear that there are many more sick livers out there due to alcohol,” said Dr. Elliot Tapper, a liver disease specialist and assistant professor at the University of Michigan. Tapper was lead author of a prior study that found increasing numbers of young people dying because of alcohol-related liver disease.
“If you were to come with me on my rounds in the hospital you’d see that in every other room there is a 28-year-old or a 30-year-old with severe liver disease,” Tapper said.
The reason for the increase in young people may be the rising rates of binge drinking.
“There have been studies in the last few years that suggest that amongst millennials about 40 percent will report binge drinking in the past month,” Tapper said. “That means it’s basically become a part of the culture for the American millennial. There’s no historical precedent for that.”
Tapper believes that consuming seven to 14 drinks in a binge is far worse for the liver than drinking one to two drinks per day.
What about women?
One issue the new study didn’t raise was the increasing rates of liver disease in women, said Dr. Sammy Saab, a professor of medicine and surgery and head of outcomes research in hepatology at the David Geffen School of Medicine at the University of California, Los Angeles.
“What we are seeing now is an explosion of young women with liver disease,” Saab said. “Young women are dying in their 30s and 40s.”
Nevertheless, Saab said, the new study “does bring more attention to a very serious problem that’s been ignored for many years.”
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