The study indicates that heavy drinkers who have diabetes, high blood pressure, or a large waist circumference are up to 2.4 times more susceptible to developing serious liver disease.
Why do some individuals who drink a few alcoholic beverages daily end up with serious liver disease while others, who consume the same amount, do not?
A recent study published in Clinical Gastroenterology and Hepatology by Keck Medicine of USC suggests the answer may be linked to three prevalent medical conditions. The research shows that heavy drinkers diagnosed with diabetes, high blood pressure, or a waist circumference above a certain threshold are significantly more likely to experience advanced liver disease.
“These findings highlight a particularly vulnerable group at risk for liver problems, indicating that pre-existing medical conditions may significantly influence the impact of alcohol on liver health,” explained Brian P. Lee, MD, MAS, a specialist in hepatology and liver transplants at Keck Medicine, who led the research.
Diabetes, high blood pressure, and an enlarged waist circumference (35 inches for women and 40 inches for men) are components of a cluster of five health conditions known as cardiometabolic risk factors. These factors notably increase a person’s likelihood of heart attacks and strokes.
These cardiometabolic risk factors contribute to fat accumulation in the liver—referred to as metabolic dysfunction-associated steatotic liver disease—which may result in fibrosis, or liver scarring. According to Lee, more than one-third of Americans are affected by these risk factors, which have worsened, particularly in those under 35.
Moreover, alcohol consumption also leads to fat buildup in the liver, and incidence of drinking has increased since the COVID-19 pandemic began, Lee noted. Given the widespread nature of both cardiometabolic issues and alcohol consumption in the U.S., Lee and his colleagues set out to explore which specific cardiometabolic conditions heightened the liver’s vulnerability to alcohol-related damage.
The researchers examined data from the National Health and Nutrition Examination Survey, which includes over 40,000 participants, to analyze the relationship between heavy drinking, specific cardiometabolic risk factors, and the occurrence of significant liver fibrosis. Significant liver fibrosis can indicate potential liver failure.
In this study, heavy drinking was defined as drinking 1.5 alcoholic beverages per day for women (equivalent to 20 grams) and two drinks per day for men (about 30 grams).
The findings revealed that heavy drinkers with diabetes or a large waist circumference were 2.4 times more likely to develop severe liver disease. Those with high blood pressure had a 1.8 times increased risk. The other two cardiometabolic factors—high triglycerides (heightened levels of a specific type of fat in the bloodstream) and low HDL (high-density lipoprotein, known as “good” cholesterol)—showed weaker connections to liver disease.
While the research did not investigate the reasons why these three cardiometabolic conditions pose a greater risk to liver health, Lee theorizes that they may share similar pathways leading to the accumulation of liver fat, and combined with excess fat from alcohol consumption, result in considerable liver harm.
Lee stresses the study does not suggest it is safe for individuals without these three cardiometabolic conditions to drink excessive alcohol. “We understand that alcohol is harmful to the liver, and all heavy drinkers face the risk of developing advanced liver disease,” he said.
Lee hopes that these study results will prompt individuals to assess their health profiles and risks when deciding about alcohol intake. He also advocates for healthcare providers to offer more tailored health screenings and interventions for those who drink and possess cardiometabolic risk factors to enable early detection and treatment of potential liver damage among this vulnerable population.
Norah Terrault, MD, a gastroenterologist at Keck Medicine and the division chief of gastroenterology and liver diseases at the Keck School of Medicine, contributed to the study.
