Recent research has shown a significant increase in liver disease cases in recent years, raising concerns about public health. Concurrently, mounting evidence highlights the adverse health effects of alcohol, even at levels previously deemed "moderate." These alarming trends underscore the necessity of approaching alcohol consumption from a public health standpoint.
The liver is a critical organ essential for human survival. It plays a key role in metabolism, food storage, and the production of proteins necessary for blood clotting. Moreover, the liver is vital for maintaining a robust immune system. At the cellular level, alcohol is recognized as a toxic substance that is primarily metabolized in the liver. Excessive alcohol intake can lead to inflammation and damage of liver cells, a condition medically referred to as hepatitis. Over time, these damaged cells can be replaced by fibrous scar tissue, culminating in cirrhosis, a severe condition characterized by liver dysfunction and scarring, which can be fatal and may also lead to liver cancer.
Alcohol-related liver disease (ALD), formerly known as alcoholic liver disease, is a significant health concern. While heavy drinkers and individuals with alcohol use disorder (AUD) are at the greatest risk of developing cirrhosis and liver failure, recent studies reveal that chronic alcohol consumption at lower levels can also adversely affect liver function. This is particularly true for individuals with pre-existing risk factors for liver disease.
Patterns of alcohol consumption play a critical role in liver health. Binge drinking, defined as men consuming five or more drinks and women four or more drinks in a single occasion, poses a severe risk to liver health due to the resultant high blood alcohol concentrations. Even those who do not drink heavily on average can suffer liver damage due to binge drinking episodes.
Deaths from liver disease have surged dramatically across Canada and the United States over the past two decades. While increased alcohol consumption has been a key factor, trends indicate a slight decline in alcohol intake over the last few years. Between 2016 and 2022, Canada experienced a 22% increase in deaths due to alcohol-related liver disease. However, alcohol is not the sole contributor to this rise. Another significant factor is the emergence of metabolic dysfunction-associated steatotic liver disease (MASLD), a liver condition linked to metabolic disturbances associated with obesity and sedentary lifestyles. This condition can be likened to the liver equivalent of diabetes.
Additionally, hepatitis C, a viral infection often spread through injection drug use and needle sharing, remains a crucial contributor to liver disease and cirrhosis. Despite historical distinctions in medical terminology between alcohol-related and non-alcohol-related liver diseases, it is becoming increasingly evident that alcohol use exacerbates the progression of non-alcoholic liver diseases, including MASLD and hepatitis C.
In a study involving patients with MASLD conducted by my colleagues and me as part of the U.S.-based Framingham Heart Study, we discovered a dose-dependent relationship between alcohol consumption and the severity of liver inflammation and fibrosis, even among non-heavy drinkers. Research indicates that low levels of alcohol can accelerate the development of liver cirrhosis in patients with hepatitis C. For instance, each additional drink per day can increase the risk of cirrhosis by 11% in hepatitis C patients.
To mitigate the impact of alcohol on liver health, it is essential to implement preventive measures within the healthcare system. This includes routine screening for alcohol use in primary care settings, counseling for individuals exhibiting risky drinking behaviors, and providing treatment for those struggling with alcohol use disorders. However, addressing individual cases alone is insufficient; a broader public health approach is necessary to reduce alcohol consumption across the population.
Effective strategies to lower alcohol consumption include implementing alcohol control policies that aim to make alcohol more expensive—such as through taxes and minimum pricing—restricting availability through sales hour limitations, and decreasing the social desirability of alcohol through advertising restrictions. Previous research has shown that states with stronger alcohol policies have lower ALD mortality rates. Even a modest increase in policy restrictiveness can lead to a subsequent decline in alcohol-related liver disease cases.
Alcohol-induced liver harm is a pressing public health issue that requires collective action. By prioritizing measures to reduce alcohol consumption at the population level, we can better safeguard our liver health and reduce the burden of liver disease, its associated disabilities, and the risks of hospitalization and death.
