Youth, Women and Non-Alcoholic Fatty Liver Disease

"Traditionally, cirrhosis has been thought to be a disease of older men, but our data show that the face of cirrhosis is changing."
"More young people are being diagnosed with cirrhosis at an earlier age than they had previously. If these sorts of trends continue, they are going to result in a significant burden on the health-care system."
"I see lots of people who consume amounts of alcohol that would not classify them as having an alcohol use disorder, but because of other factors it predisposes them to getting cirrhosis."
"This is a public health issue as many of the causes of cirrhosis, including viral hepatitis and alcohol consumption are treatable and cirrhosis can ultimately be prevented."
"We have certainly seen many young people requiring liver transplantation. The youngest person this year that I saw was 25."
Strategies to increase awareness of this silent epidemic in young adults and women are needed."
Dr. Jennifer Flemming, gastroenterologist, Kingston General Hospital, Kingston, Ontario

Young adults and women are a high-growth population for the potentially deadly liver disease. The risk of cirrhosis is 116 per cent higher for millennials who were born in 1990 than Baby Boomers born in 1951. For women, the risk is even higher. A woman born in 1990 was 160 per cent more likely to be diagnosed with cirrhosis than a woman born in 1951.

"I see 20 or more new patients with advanced inflammatory fatty liver disease every week. Two nurse practitioners see five to ten less severe new patients a week."
"It’s estimated that 25 per cent of adults around the globe have fatty liver disease. In Nova Scotia, an estimated 35 to 40 per cent of the adult population is affected."
"There are so many factors involved, from insulin resistance, to bile acid regulation, to the gut microbiome… a cocktail of agents may be required."
"Every patient is different… ultimately we’re looking at personalized medicine."
"Liver biopsy is the current gold standard, because blood tests of liver enzymes give high rates of false positives and false negatives. We have a fibroscan that uses ultrasound and other vibration waves to measure liver elasticity, but we’re collaborating with radiology to develop far more precise measures."
Dr. Magnus McLeod, internist, head, Division of Digestive Care & Endoscopy, Nova Scotia Health Authority

Cirrhosis of the liver is characterized when normal liver tissue is replaced by scar tissue. And although many people with fatty liver disease experience no symptoms, some of whom may recognize fatigue feelings and a general state of malaise, symptoms include jaundice, swelling of the ankles and abdomen, itching, fatigue and loss of appetite. It has been known for some time that young adults and women are recognized in the medical community as a steadily growing population hosting the potentially deadly liver disease.

For those born in the 1990s, the risk of cirrhosis onset is 116 percent higher than for baby boomers born in 1951. For women alone the risk soars higher; there is a 160 percent likelier diagnosis for a woman born in 1990 for cirrhosis in contrast to a women born in 1951. Alcohol use and hepatitis C are the well-known factors historically as causes of cirrhosis of the liver. However, since effective treatment is available for hepatitis C, the medical community increasingly searches for the cause of non-alcoholic fatty liver disease.

Some 20 to 30 percent of the population is affected by non-alcoholic fatty liver disease, among whom twenty percent are considered more severe, at risk of cirrhosis. A new study out of (Kingston) Ontario published in the journal The Lancet Gastroenterology and Hepatology headed by Dr. Flemming, adjunct scientist at ICES Queen's University and an assistant professor at Queen's  points out details such as that among those with diabetes, rates of NAFLD (non-alcoholic fatty liver disease) are 80 percent. The disease's potential to become severe can result in liver transplants.

Between 1997 when 5,318 people were diagnosed and 2016 when 12,047 people were diagnosed, new cases of cirrhosis of the liver close to doubled. To the point where close to one percent of the Ontario population now has cirrhosis, figures reached through a retrospective population-based study from the Institute for Clinical Evaluative Sciences.

Stock art of a doctor with a patient. Tyler Olson Simplefoto 

There is a recognized link with obesity, but NAFLD is not just characteristic of people who are obese, for genetics also play a part to place some people at higher risk. It is a condition, however, that can be reversed, following a healthy lifestyle, inclusive of a balanced diet and exercise, according to the Canadian Liver Foundation. It is being increasingly viewed that high rates of NAFLD, particularly among millennials represent some of the reason behind increasing cases of cirrhosis among young adults and women, points out the study report.

The study's conclusions are meant to place a spotlight on drinking trends among young adults in recognition that alcohol consumption remains a key cause of cirrhosis, once seen as the precinct of older male alcoholics. Young women in North America now imbibe alcohol at similar rates to young men, according to some studies. Since women are more susceptible to developing alcohol-related liver disease it is seen as an imperative that full information be available to the public.

Dr. Flemming stresses the need for public health strategies to inform awareness among young adults and women about cirrhosis, particularly since these represent groups not normally associated with high risk of acquiring the disease. Frequently when patients are diagnosed they are astonished, having had no idea beforehand that acquiring the disease was even possible. 

Liver disease by the numbers

• 7 million Canadians have non-alcoholic fatty liver disease

• 20 per cent of people with non-alcoholic steatohepatitis (NASH), the most severe form of non-alcoholic fatty liver disease, can develop cirrhosis

• 11 per cent of NASH patients may die from the disease

• In 2016: 500 liver transplants took place in Canada                                                                   400 people were waiting for a liver transplant                                                                                 90 children and adults died while waiting

• Since 1970, liver cancer has doubled in women

Source: The Canadian Liver Foundation