Liver disease, alcohol and obesity
In the next #CO90sDiscoveries episode, Dr Kushala Abeysekera discusses the prevalence of liver disease and how Children of the 90s can help understand this trend.
Researchers using Children of the 90s data have discovered that 1 in 5 young people shows signs of fatty liver. 1 in 40 young people has liver scarring. As healthy young people are rarely studied, doctors now understand how common this condition is and can seek to prevent it developing into severe liver disease.
Early detection among the young
Deaths from liver disease are increasing to such a degree that the condition is now the leading cause of death among 35-49-year-olds. Fatty liver disease is usually caused by obesity and can lead to irreversible liver scarring if left untreated. However, it is difficult to spot because symptoms only begin to show once patients develop complications.
“Early detection is key, before people develop advanced liver scarring and to help reverse any damage,” says Dr Kushala Abeysekera, from the Bristol Doctoral College at the University of Bristol. He was responsible for the study which analysed liver scans from the Children of the 90s Focus @24+ clinic, when the participants were aged 24.
“We think of liver disease as developing in people in their 40-60s. Young adults represent something of a blind spot for doctors – we just didn’t know how much liver disease there is in this age group. Children of the 90s has been vital in discovering how common liver damage is within this younger age group.”
A total of 4,021 study participants were recruited to attend the Focus @24+ clinic in Bristol. As well as undergoing a series of clinical tests including blood and insulin measurements, participants’ BMI scores were taken and they were asked about their alcohol consumption.
Researchers first looked at people who did not report harmful alcohol consumption and found that one in five had non-alcoholic fatty liver. Then they looked at all participants, and again found that more than 20% displayed evidence of fatty liver. One in 40 people were found to have already developed fibrosis or liver scarring. Participants who had fatty liver and reported harmful alcohol use had the greatest risk of liver scarring.
“Without the support of Children of the 90s, we’d be unaware of the scale of this problem in young people in the UK,” says Dr Abeysekera.
Tackling obesity & harmful drinking
The concerning findings was reported by the national media and presented at the influential International Liver Congress in April 2019. Our research has helped doctors to identify people who present with symptoms at an earlier stage, and to understand why they might be affected. Gastroenterologists and hepatologists across the country have been seeing patients present to hospital earlier with the complications of alcohol-related liver disease.
“We know that the main causes of advanced liver disease in the UK are alcohol and obesity. These findings should lead to further public health measures such as minimum unit pricing on alcohol and reduced targeted advertising from fast food chains, for example. Ultimately, by supporting public health initiatives like these, this kind of knowledge can help us to save lives,” says Dr Abeysekera.
The liver scans have been repeated with the now 30-year-old participants to measure trends in a different age group. Bristol’s Children of the 90s is one of a few studies in the world investigating liver disease in a younger population and is important in helping to identify and treat those most at risk.
What we discovered
- At 17 years old, 2.5% of participants had moderate to severe levels of fatty liver, which increased to 13% by the age of 24 years
- 1 in 5 people had fatty liver disease by the age of 24 and 1 in 40 people had developed fibrosis (scarring of the liver) by the same age
- Men were more likely to have liver disease than women
- Our research has helped doctors to identify people who present with symptoms at an earlier stage, and to understand why they might be affected.