Doctors have seen an increase in alcohol-related liver disease in...

Doctors have seen an increase in alcohol-related liver disease in recent years, accelerated by a surge in drinking during the pandemic. Credit: AFP via Getty Images/Daniel Leal

An increase in alcohol consumption, exacerbated by the COVID-19 pandemic, is fueling a surge in liver disease that could lead to a greater need for organ transplants, according to several Long Island-based health care experts.

That trend is particularly pronounced among women and younger adults, who are increasingly being diagnosed with acute liver disease.

Hospital admissions for alcohol-associated liver disease remain at the heightened levels that hit during the pandemic, said Dr. David Bernstein, director of the gastrointestinal and liver ambulatory network for Long Island at NYU Langone Health.

“As the majority of these patients are relatively young, there remains significant concerns about the need for liver transplantation in the near future,” he said.

Historically, the majority of liver transplants were needed by people who had hepatitis C, said Dr. Nabil Dagher, director of Northwell Health's Transplant Institute. Improved treatment options have led to a decrease in those numbers, while growing rates of obesity have led to a corresponding increase in fatty liver disease, he said.

But in recent years, liver disease due to alcohol use has “gone up astronomically.”

And the patients are younger, he said, adding: “We are seeing people in their 30s in acute liver failure from alcohol.”

Since 2016, alcohol-related liver disease has been the top reason people are on waiting lists for a liver, besides “other/unknown,” according to federal data. Dagher estimated about 70% of the transplants performed currently are on people with alcohol-related liver disease.

A study in the journal Hepatology warned in 2021 that the growing number of young adults having more severe liver disease and waiting for transplants is an "ominous sign" and that the “impact of unhealthy alcohol use may be felt for several years to come.” 

A 2022 study estimated that an increase in alcohol consumption at the start of the pandemic could result in 8,000 additional deaths from alcohol-related liver disease, 18,700 cases of liver failure and 1,000 cases of liver cancer by 2040 if no interventions are made to help these patients. 

People with existing health conditions such as high blood pressure, high cholesterol and obesity already have a greater chance of developing liver disease, said Dr. Michael Clores, director of hepatology and the liver disease program at Stony Brook Medicine.

“You add alcohol into the mix and it's a recipe for someone to have a really high risk of scarring and fibrosis [of the liver],” he said.

The upward trend in cases is happening all over the country, said Dr. Allison Kwong, a hepatologist and researcher at Stanford University who has focused on alcohol-related liver disease.

“It’s not just only the people we are seeing in the hospital now needing transplants,” she said. “Long term, 20 years down the line, we are still going to see a higher burden of cirrhosis, of liver cancer, and that’s all from increased alcohol use now.”

A “perfect storm” of factors led to an increase in drinking during the early days of the COVID-19 pandemic, according to Jeffrey Reynolds, president and CEO of the Family and Children’s Association, which has programs to treat addiction throughout Long Island.

Liquor stores remained open and restaurants allowed takeout alcoholic drinks even while most other places were closed to the public. Social media feeds were full of cheeky nods to day drinking and “quarantini” recipes, he said.

“You had people who were at home no longer needed to fit into a 9-to-5 schedule,” Reynolds said. “So when you take increased access to alcohol and you mix it up with anxiety, depression, and no set schedule, which means you could begin drinking earlier in the day.”

The problems caused by these habits didn’t go away when workers were called back into their offices, he said.

“Going back to work was tough for everybody, but going back to work for people who were used to drinking at 2 p.m. in the afternoon became a real challenge,” Reynolds said.

Dr. Jarid Pachter, a Southhold-based physician who specializes in family medicine and addiction medicine, said the United States has had “a huge problem related to alcohol for many years.”

He pointed out that about 140,000 people die every year in the United States due to excessive alcohol use.

One of the most troubling trends has been the rise in drinking among women. Earlier this year, researchers at Hofstra University published a study showing the alcohol mortality rate among women between 2018 and 2020 had risen by 14.7%, while it increased 12.5% for men.

Since women absorb alcohol at a much faster rate than men — due to several physiological differences such as body mass and stomach enzymes — it takes less alcohol for them to develop a significant liver problem, Bernstein said.

“Advertising in the alcohol industry has really [been] geared toward women … fruity drinks and low calorie drinks geared to the female population. They even call it ‘Mommy Juice,’ ” Pachter said. “In the 1970s and 1980s, it was really geared toward men.”

While the stigma surrounding behavioral health issues such as depression and anxiety has started to lift in recent years, it remains steadily in place for alcohol and other substance use, said Christian Racine, senior director of clinics at the Huntington-based Family Service League.

He said there has been a general increase in alcohol consumption and the impact of alcohol among the people they work with, even if they are not seeking treatment immediately.

Clores said current federal dietary guidelines say men should not have more than two alcoholic drinks a day and women not more than one drink a day.

“There are a lot of variations in what the threshold is that leads to liver damage,” he said. “But generally that’s the safe amount to drink, and when you get to more than that on average, that's when there is going to be an increased probability in developing” liver problems, particularly those with underlying risk factors such as obesity and diabetes.

Kwong said there is no definitive measure of safe daily drinking or binge drinking, and researchers don’t know how much alcohol consumption causes liver disease. Some people are less impacted by alcohol than others, and genetics also plays a role, she said. 

“It’s different for everybody,” she said. “From what I can tell, it’s daily drinking more than binge drinking, but both can lead to it.”

An increase in alcohol consumption, exacerbated by the COVID-19 pandemic, is fueling a surge in liver disease that could lead to a greater need for organ transplants, according to several Long Island-based health care experts.

That trend is particularly pronounced among women and younger adults, who are increasingly being diagnosed with acute liver disease.

Hospital admissions for alcohol-associated liver disease remain at the heightened levels that hit during the pandemic, said Dr. David Bernstein, director of the gastrointestinal and liver ambulatory network for Long Island at NYU Langone Health.

“As the majority of these patients are relatively young, there remains significant concerns about the need for liver transplantation in the near future,” he said.

WHAT TO KNOW

  • More people on Long Island and across the United States are being diagnosed with alcohol-related liver disease, which could lead to a need for more liver transplants, experts said.
  • Doctors said a rise in drinking, especially during the COVID-19 pandemic, could be one of the causes.
  • There also has been a pronounced rise in the number of young adults in their 20s and 30s, as well as women, being diagnosed with alcohol-related liver disease in recent years, experts said.

Historically, the majority of liver transplants were needed by people who had hepatitis C, said Dr. Nabil Dagher, director of Northwell Health's Transplant Institute. Improved treatment options have led to a decrease in those numbers, while growing rates of obesity have led to a corresponding increase in fatty liver disease, he said.

But in recent years, liver disease due to alcohol use has “gone up astronomically.”

Liver disease due to alcohol use has “gone up astronomically,"...

Liver disease due to alcohol use has “gone up astronomically," said Dr. Nabil Dagher, director of Northwell Health's Transplant Institute. Credit: Credit Northwell Health /Lee S. Weissman

And the patients are younger, he said, adding: “We are seeing people in their 30s in acute liver failure from alcohol.”

Alcohol top reason for liver transplants

Since 2016, alcohol-related liver disease has been the top reason people are on waiting lists for a liver, besides “other/unknown,” according to federal data. Dagher estimated about 70% of the transplants performed currently are on people with alcohol-related liver disease.

A study in the journal Hepatology warned in 2021 that the growing number of young adults having more severe liver disease and waiting for transplants is an "ominous sign" and that the “impact of unhealthy alcohol use may be felt for several years to come.” 

A 2022 study estimated that an increase in alcohol consumption at the start of the pandemic could result in 8,000 additional deaths from alcohol-related liver disease, 18,700 cases of liver failure and 1,000 cases of liver cancer by 2040 if no interventions are made to help these patients. 

People with existing health conditions such as high blood pressure, high cholesterol and obesity already have a greater chance of developing liver disease, said Dr. Michael Clores, director of hepatology and the liver disease program at Stony Brook Medicine.

“You add alcohol into the mix and it's a recipe for someone to have a really high risk of scarring and fibrosis [of the liver],” he said.

The upward trend in cases is happening all over the country, said Dr. Allison Kwong, a hepatologist and researcher at Stanford University who has focused on alcohol-related liver disease.

The trend is happening across the country, said Dr. Allison...

The trend is happening across the country, said Dr. Allison Kwong, a researcher at Stanford University. Credit: Stanford Medicine

“It’s not just only the people we are seeing in the hospital now needing transplants,” she said. “Long term, 20 years down the line, we are still going to see a higher burden of cirrhosis, of liver cancer, and that’s all from increased alcohol use now.”

Pandemic 'perfect storm' for alcohol

A “perfect storm” of factors led to an increase in drinking during the early days of the COVID-19 pandemic, according to Jeffrey Reynolds, president and CEO of the Family and Children’s Association, which has programs to treat addiction throughout Long Island.

Liquor stores remained open and restaurants allowed takeout alcoholic drinks even while most other places were closed to the public. Social media feeds were full of cheeky nods to day drinking and “quarantini” recipes, he said.

“You had people who were at home no longer needed to fit into a 9-to-5 schedule,” Reynolds said. “So when you take increased access to alcohol and you mix it up with anxiety, depression, and no set schedule, which means you could begin drinking earlier in the day.”

The problems caused by these habits didn’t go away when workers were called back into their offices, he said.

“Going back to work was tough for everybody, but going back to work for people who were used to drinking at 2 p.m. in the afternoon became a real challenge,” Reynolds said.

Dr. Jarid Pachter, a Southhold-based physician who specializes in family medicine and addiction medicine, said the United States has had “a huge problem related to alcohol for many years.”

He pointed out that about 140,000 people die every year in the United States due to excessive alcohol use.

One of the most troubling trends has been the rise in drinking among women. Earlier this year, researchers at Hofstra University published a study showing the alcohol mortality rate among women between 2018 and 2020 had risen by 14.7%, while it increased 12.5% for men.

Since women absorb alcohol at a much faster rate than men — due to several physiological differences such as body mass and stomach enzymes — it takes less alcohol for them to develop a significant liver problem, Bernstein said.

“Advertising in the alcohol industry has really [been] geared toward women … fruity drinks and low calorie drinks geared to the female population. They even call it ‘Mommy Juice,’ ” Pachter said. “In the 1970s and 1980s, it was really geared toward men.”

While the stigma surrounding behavioral health issues such as depression and anxiety has started to lift in recent years, it remains steadily in place for alcohol and other substance use, said Christian Racine, senior director of clinics at the Huntington-based Family Service League.

He said there has been a general increase in alcohol consumption and the impact of alcohol among the people they work with, even if they are not seeking treatment immediately.

How much alcohol is too much?

Clores said current federal dietary guidelines say men should not have more than two alcoholic drinks a day and women not more than one drink a day.

“There are a lot of variations in what the threshold is that leads to liver damage,” he said. “But generally that’s the safe amount to drink, and when you get to more than that on average, that's when there is going to be an increased probability in developing” liver problems, particularly those with underlying risk factors such as obesity and diabetes.

Kwong said there is no definitive measure of safe daily drinking or binge drinking, and researchers don’t know how much alcohol consumption causes liver disease. Some people are less impacted by alcohol than others, and genetics also plays a role, she said. 

“It’s different for everybody,” she said. “From what I can tell, it’s daily drinking more than binge drinking, but both can lead to it.”

Alcohol-related liver damage

  • The liver, which weighs between 3 and 5 pounds, is a vital organ that filters blood, stores nutrients and processes chemicals in food, alcohol and medications.
  • Excessive drinking can lead to the buildup of fat in the liver, triggering inflammation, causing cells to die.
  • Every time a liver regenerates, scar tissue forms, making it tougher for blood to flow through it.
  • When scar tissue builds up in the liver, it turns from a soft sponge into a “firm piece of bark,” according to Dr. Nabil Dagher, director of Northwell Health's Transplant Institute, making it harder for the liver to do its job.
  • There are more than 10,000 people in the United States waiting for liver transplants, including more than 560 in New York.
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