Rising Liver Disease Among Heavy Drinkers

A new study from Keck Medicine of USC indicates that serious liver disease is becoming more prevalent among Americans who engage in heavy drinking.

This isn’t about an increase in the number of people partying or drinking more than before. Rather, it seems that those who already drink regularly are becoming ill at higher rates.

Looking back over the last twenty years, the percentage of heavy drinkers with advanced liver scarring rose significantly—from 1.8% to 4.3%. For women, consuming more than 1.5 drinks per night is categorized as heavy drinking, while for men, it’s 2 drinks.

“The fact that the risk not only increased but that it more than doubled — almost tripled — is really astonishing,” noted Dr. Brian P. Lee, a liver transplant specialist and the study’s main author.

The study, which appeared in the journal Clinical Gastroenterology and Hepatology, could potentially inspire patients to rethink their drinking habits if they knew these findings.

The rise in liver illnesses is particularly concerning for women, older adults, and individuals suffering from obesity or diabetes.

Three researchers at USC examined health data from over 44,000 adults surveyed between 1999 and 2020 as part of a renowned national health study known as NHANES. Among these, 2,474 individuals met the criteria for heavy drinking defined by the National Institute on Alcohol Abuse and Alcoholism—which is about 20 grams of alcohol per day for women and 30 grams for men (roughly equivalent to 1.5 and 2 drinks).

They discovered that significant liver fibrosis—a condition where healthy liver tissue is replaced with stiff, fibrous tissue—has more than doubled over the two decades. If not managed, this condition can lead to liver failure or cancer.

In contrast, non-heavy drinkers saw a modest increase from 0.8% to 1.4% during that same time frame.

This uptick in liver damage is alarming, particularly since many individuals remain unaware of their condition until it has progressed to a serious stage. “Liver disease is silent,” Lee explained. “Most people won’t, even if they have [advanced liver scarring], show any symptoms.”

Interestingly, the drinking patterns don’t seem to have changed notably over the study period. However, the health profiles of heavy drinkers have shifted. Rates of metabolic syndrome—which includes obesity, diabetes, and high blood pressure—rose from 26% to nearly 38%. The demographics also evolved: heavy drinkers are increasingly more likely to be women, individuals over 45, or those living in poverty.

“This study shows that the profile of the American drinker is changing dramatically,” said Lee. “We see more women and ethnic minorities drinking heavily, groups that are particularly vulnerable to alcohol-induced liver damage.”

As Dr. Sammy Saab, a liver specialist at UCLA, pointed out—who did not participate in the study—other influences may also be relevant. People might be selecting different types of drinks or consuming alcohol in different contexts. “Are we shifting from beer and wine to hard cocktails? Are we drinking without food, which can lead to quicker alcohol absorption?” Saab questioned.

There are also cultural shifts at play. “In the past, if you drank, you’d have to drive home. Now with services like Uber and Lyft, those deterrents are less significant,” he noted.

Lee expressed concerns that the current U.S. definition of heavy drinking may be too lenient. For comparison, Canada now suggests limiting intake to two drinks per week to reduce health risks.

“Currently in the U.S., heavy drinking is considered as eight drinks or more per week for women and 15 or more for men, which feels quite high,” he said. “Previous studies have shown that liver disease can occur at amounts lower than these thresholds.”

The findings from this study underscore the need to reevaluate long-standing views on alcohol-related liver disease, with hopes of fostering more effective early detection methods.

According to Saab, the paper opens many important questions, serving as a prompt for researchers and clinicians to understand this rise in alcohol-related liver disease better and seek ways to address it.