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Increase in cases of liver disease among young people worries specialists
There is an alarming rise in cases of alcoholic liver disease among young people, a new study warns.
Posted yesterday at 10:19 am
Jean-Benoit Legault
The Canadian Press
Alcoholic liver disease is a serious and potentially fatal liver disease that has long been associated with men who consume excessive amounts of alcohol over many years.
But for reasons that remain largely mysterious, a large portion of new diagnoses today affect young women.
"If you look at the numbers, at least in our study, the rates were relatively stable until 2011 or 2012," said study author Dr. Jennifer Flemming of Queen's University. "But after that, it starts to climb and it was consistent with what we were seeing on the ground."
Unlike viral hepatitis, which is caused by infections such as hepatitis B and C, alcoholic liver disease occurs when the liver becomes inflamed in connection with prolonged and excessive alcohol consumption. In both cases, the problem can progress to a more serious disease, such as cirrhosis or liver failure.
Dr. Flemming and her team studied the records of some 3,300 young people aged 13 to 39 who were diagnosed with alcoholic liver disease between 2001 and 2022 after being admitted to hospital or emergency rooms in Ontario.
The researchers measured an 8% increase in the number of cases per year in men and 11% in women.
Six months after diagnosis, 71% of patients were alive and free of cirrhosis. However, over the next four years, 22% experienced disease progression, including cirrhosis or worsening liver function. Women were disproportionately affected, with 37% of survivors developing serious complications, compared with 29% of men.
Over a 10-year follow-up, 11% of women died of liver complications, compared with just under 7% of men. Women were also about 50% more likely than men to develop cirrhosis.
"And it's not just in Canada," Flemming said. "We see the same thing in the United States and the United Kingdom, for example."
Several factors could potentially explain this worrying trend.
The researchers first mention the stress, isolation and disruption caused by COVID-19, which could have increased alcohol consumption.
They also point to biological differences between men and women, since it is well established that the two sexes metabolize alcohol differently. Thus, the risk of problems is higher for women than for men, for the same amount of alcohol consumed.
"It's multifactorial," Flemming said. "You have body size and body mass and body water content. Also, basically, women have about 30 percent less of an enzyme that breaks down alcohol. And we know the liver responds to estrogen, so maybe there's something there as well."
Fifty years ago, Dr. Flemming recalled, men consumed far more alcohol than women. The gap has since narrowed, and women now consume as much as men, she added.
"And studies have shown that alcohol marketing is more specific to women," Dr. Flemming said.
Finally, researchers point to the growing popularity of very sweet alcoholic drinks such as cider, which can be harmful to the liver, and the fact that alcohol is available in an increasing number of stores.
It is noteworthy that more than 50% of the cohort had previously consulted for mental health problems; that approximately one-third of them had presented a substance abuse problem in the two years preceding the onset of alcoholic liver disease; and that more than two-thirds of them had had alcohol-related medical consultations that were not related to alcoholic liver disease in the two years preceding the onset of alcoholic liver disease, the researchers point out in their study.
"This suggests that there are likely missed opportunities to identify people with alcohol use disorders and harmful alcohol use before they progress to alcoholism," they add in the pages of the prestigious Journal of the American Medical Association .
Ultimately, Flemming said, we have to recognize that this is a problem that needs to be identified and treated.
"If I told you that 25% of young people aged 13 to 39 die within five years of being diagnosed with cancer, people would be outraged and would demand that we fix the problem," she concluded. "But because we're talking about alcohol consumption, we're saying it's the patient's fault, even though the damage caused by alcohol can be reversed if we identify and treat the problem. But people don't want to talk about it and they blame the individual."
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