Alcohol-Related Liver Disease Increases Sharply

Significant liver fibrosis associated with heavy alcohol use rose more than twofold over roughly the past two decades in the US despite alcohol use rates holding steady, which might be explained by risk factors for alcohol-related liver injury in the population, researchers said.

Those most likely to be heavy drinkers are women, adults aged 45 years or older, those living in poverty, and those with metabolic syndrome, the data showed.

“Alcohol-related liver disease is the main cause of liver-related death, and these results are a major wake-up call to the dangers of drinking,” lead investigator Brian Lee, MD, MAS, hepatologist and liver transplant specialist with Keck Medicine of University of Southern California, Los Angeles, said in a statement.

The study was published online on July 23 in Clinical Gastroenterology and Hepatology.

Call for Increased Awareness

To gauge trends in advanced alcohol-related liver disease among heavy drinkers, Lee and colleagues mined data from the National Health and Nutrition Examination Survey (NHANES) spanning 1999-2020.

The primary outcome was a high Fibrosis-4 (FIB-4) score (FIB-4 > 2.67 for those aged 65 years or younger and > 3.25 for those older than 65 years), which has previously been linked to a 25-fold higher risk for liver-related death. People with hepatitis B or C were excluded.

Among 44,628 adults, 2474 were heavy drinkers — defined as at least 20 g/d for women and 30 g/d for men in the prior year.

Among heavy drinkers, the prevalence of high FIB-4 — a marker of advanced liver scarring — increased more than twofold over time, from 1.8% in 1999-2004 to 4.3% in 2013-2020, vs an increase of 0.8%-1.4% among non-heavy drinkers.

Notably, average alcohol intake stayed the same during the study period, the researchers said.

Among heavy drinkers, the prevalence of metabolic syndrome rose from 26.4% in 1999-2004 to 37.6% in 2013-2020, the mean age increased, and a greater proportion was women or living in poverty — factors that can amplify susceptibility to alcohol’s liver effects.

Supplementary analyses restricting the cohort to adults aged 35-65 years or to pre-pandemic years (1999-2018) confirmed the same upward trends, with significant liver scarring tripling over 20 years.

Limitations cited by the authors include the cross-sectional design of NHANES and reliance on self-reported alcohol intake, which can’t capture fluctuations over time, and the use of FIB-4 as a surrogate for liver disease.

Collectively, the data suggest that increasing morbidity and mortality due to alcohol-related liver disease “may be related to a population more sensitized to the alcohol-related effects in the liver due to increased baseline risk factors,” the researchers wrote.

The findings provide impetus for “urgent awareness” of the contemporaneous risk for alcohol-related liver disease with heavy drinking and interventions to screen and treat risk factors, they added.

The study had no commercial funding. The authors had no relevant disclosures.