Three health factors identified as risks for liver disease in heavy drinkers

LOS ANGELES — Three common medical conditions may explain why some heavy drinkers develop advanced liver disease while others do not, according to new research from Keck Medicine of University of Southern California.

The study, published in Clinical Gastroenterology and Hepatology, found that heavy drinkers with diabetes, high blood pressure, or high waist circumference face up to 2.4 times greater risk of developing advanced liver disease compared to those without these conditions.

"The results identify a very high-risk segment of the population prone to liver disease and suggest that preexisting health issues may have a large impact on how alcohol affects the liver," said Brian P. Lee, hepatologist and liver transplant specialist with Keck Medicine and principal investigator of the study.

Researchers analyzed data from the National Health and Nutrition Examination Survey, which included more than 40,000 participants. They examined relationships between heavy drinking, cardiometabolic risk factors, and significant liver fibrosis — scarring that can lead to liver failure.

For the study, heavy drinking was defined as 1.5 drinks daily for women (20 grams) and two drinks daily for men (30 grams).

The findings revealed that heavy drinkers with diabetes or high waist circumference (35 inches for women; 40 inches for men) were 2.4 times more likely to develop advanced liver disease. Those with high blood pressure faced 1.8 times greater risk.

Two other cardiometabolic risk factors—high triglycerides and low HDL cholesterol—showed less significant correlations with liver disease.

These three higher-risk conditions belong to a cluster of five health issues known as cardiometabolic risk factors, which affect more than one in three Americans. According to Lee, cardiometabolic health has been worsening among the U.S. population, especially among those under 35.

While the study did not analyze why these specific risk factors create greater liver vulnerability, Lee speculates they share a common pathway to fat buildup in the liver. When combined with alcohol-induced fat deposits, this combination may cause significant damage.

"We know that alcohol is toxic to the liver, and all heavy drinkers are at risk for advanced liver disease," Lee said.

Both cardiometabolic risk factors and alcohol consumption have been linked to fat accumulation in the liver. Alcohol consumption has increased since the COVID-19 pandemic began, Lee noted.