Heavy drinking and obesity have been on the rise for decades, research suggests, and with it, preventable cases of liver disease have skyrocketed.
Alcohol use has long been known to inflict damage on the liver until it can no longer filter toxins from the blood, a serious deterioration which can be life-threatening.
Obesity can also put significant strain on the liver, with a build-up of fat causing inflammation and eventually scarring that can result in sepsis.
But whether caused by alcohol or obesity, metabolic dysfunction-associated steatotic liver disease (MASLD) often develops silently, meaning many people have no idea they have it until the organ has been irreversibly damaged.
Now new data, representative of over 257 million US adults, suggests that nearly one in ten are both obese and drink heavily, which significantly increases their risk of the condition, which was formerly known as non-alcoholic fatty liver disease.
Writing in the journal JAMA Internal Medicine, Dr Bryant Shuey, an expert in internal medicine at the University of Pittsburgh said the need for intervention is clear.
‘Public health and clinical interventions to mitigate risk factors for this high-risk population are needed to curb rising rates of alcohol-associated liver disease deaths.’
He added preventative efforts should be tailored to younger and middle-aged adults, who have a better chance at recovery if the disease is caught early.
One in ten adults are now obese and drink heavily, significantly increasing their risk of liver disease
The study analysed the drinking habits of 45,133 US adults using the 2023 National Survey on Drug Use and Health.
Past-month heavy drinking was defined as 15 or more drinks a week for men – or five or more a day – and exceeding eight drinks a week for women.
Participants who had a body mass index (BMI) of 30 or over were considered obese, in line with national guidelines.
They were then split into five sub groups: obese, heavy drinkers, those with alcohol use disorder, overlapping heavy drinking and obesity, and those who were obese and had an alcohol problem.
Overall, results showed that young to middle-aged adults were most likely to be obese and drink heavily with around 12 per cent of women aged 26 to 34-years-old falling into this category.
Prevalence of overlapping alcohol-use disorder and obesity was also highest among this age group.
The curve seemed to fall off with age, with just 6 per cent of men aged 65 and older being both obese and drinking more than 15 drinks a week.
The researchers concluded: ‘Whilst evidence is limited on concurrent treatment of risky alcohol use and obesity, clinicians should offer interventions that are effective for both conditions, including motivational interviews, cognitive behavioural therapy and pharmacotherapy.’
They added that weight-loss medications – collectively known as GLP-1 agonists – such as Mounjaro and Wegovy could help in the fight against liver disease.
‘Expanding access for patients with co-occurring risky alcohol use and obesity may reduce liver disease burden,’ Dr Shuey said.
‘Early trials also suggested GLP-1 receptor antagonists may reduce alcohol use among patients with alcohol use disorder.
‘If this finding is confirmed in larger studies, GLP-1s could become a dual therapeutic for risky alcohol use and obesity.’
The team also warned there could be many more adults at-risk of the life-threatening disease, with may underreporting their alcohol use.
Latest figures from the Global Burden of Disease study estimates 1.3billion people were living with MASLD in 2023.
Worldwide, alcohol-associated end-stage liver disease where the organ is severely damaged has been estimated at more than 23.6million.
That figure is expected to rise to around 1.8 billion in the next 25 years, making it one of the fastest-growing health problems worldwide.
While more cases are now being diagnosed, the overall health impact has remained relatively stable – something researchers believe may reflect earlier detection and improved management slowing progression to more severe disease.
However, experts warn the long-term risks remain serious.
If left undetected and unmanaged, liver disease in any form can progress to cirrhosis, liver failure and liver cancer.