Alcohol and already existing health problems increase the risk of advanced liver disease

Why do some people who consume a few glasses of alcohol per day, do not develop advanced liver disease, while others who drink the same amount do not develop?

The answer can be in three common underlying medical conditions, according to a new study published in Clinical gastroenterology and hepatology van Keck Medicine or USC. The research showed that heavy drinkers with diabetes, high blood pressure or a high waist circumference are up to 2.4 times more likely to develop advanced liver disease.

The results identify a very risky segment of the population that is sensitive to liver disease and suggest that existing health problems can have a major influence on how alcohol influences the liver. “

Brian P. Lee, MD, MAS, Hepatologist and specialist in liver transplantation at Keck Medicine and Chief Researcher of the study

Diabetes, high blood pressure and a high waist circumference (35 inch for women; 40 inches for men), associated with obesity, belong to a cluster of five health problems that affect the risk of an individual on heart attack and stroke, known as cardiometabolical factors .

Cardiometabolic risk factors are linked to the structure of fat in the liver (also known as metabolic dysfunction-associated steatotic liver disease), which can lead to fibrosis or scars of the liver. These risk factors influence more than one in three Americans, and cardiometabolic health has been worsened among the population, especially among those younger than 35, according to Lee.

Alcohol also causes fat accumulation in the liver and alcohol consumption has increased since the COVID-19 Pandemie, Lee said. Due to the prevalence of both cardiometabolic risk factors and drinks in the United States, Lee and his fellow researchers have conducted the study to investigate which cardiometabolic risk factors were susceptible to damage caused by alcohol.

They analyzed data from the National Health and Nutrition Examination Survey, a large national study, including more than 40,000 participants, looking at the intersection of heavy drinking, individual cardiometabolic risk factors and the incidents of significant liver fibrosis. Significant liver fibrosis refers to liver heets that can lead to liver failure.

Before the study, heavy drinking was characterized as 1.5 drinks per day for women (20 grams) and two drinks per day for men (30 grams).

Researchers discovered that heavy drinkers with diabetes or a high waist circumference were 2.4 times more likely to develop advanced liver disease and that with high blood pressure 1.8 times more chance. They discovered that the other two cardiometabolic risk factors – high triglycerides (raised levels of a type of fat in the blood) and low HDL (lipoprotein with high density or “good” cholesterol) had less significant correlations for liver disease.

Although the study did not analyze why these three cardiometabolic risk factors are more dangerous for the liver, Lee speculates that these disorders share a common route to fat accumulation in the liver that can become substantial damage in combination with extra fat deposits in the liver due to excessive alcohol.

Lee emphasizes that the study does not imply that it is safe for people without these three cardiometabolic risks to consume large amounts of alcohol. “We know that alcohol is toxic to the liver and all heavy drinkers run the risk of advanced liver disease,” he said.

Lee hopes that the research results will encourage people to consider their individual health and risk profile when making decisions about alcohol consumption. He would also like to see practitioners offer more personalized health investigations and interventions for those who drink with cardiometabolic risk factors, so that liver damage can be caught and treated early in this risk group.

Norah Terrault, MD, a Keck Medicine gastroenterologist and division chief of gastroenterology and liver diseases at the Keck School of Medicine, was also a study author.