Liver disease: unravelling the interacting risk factors

Obesity is increasing across Europe and, together with alcohol consumption, is contributing to rising rates of chronic liver diseases, and related conditions [1,2,3]; alcoholic liver disease will shortly overtake ischaemic heart disease in the number of years of working life lost (3). Quantifying the epidemiological and economic burden of obesity and alcohol-related conditions is essential in order to  provide the quantitative evidence to ensure effective interventions and policies are implemented. 

However, unravelling the individual and combined effects of obesity and alcohol consumption on the prevalence of liver disease is a huge challenge.  In a research program sponsored by EASL, The European Association for the Study of the Liver  (https://easl.eu/) HealthLumen have taken up the challenge, by applying multi-risk methods within the microsimulation to account for body mass index (BMI) and alcohol as interacting joint risk factors to quantify the burden of liver diseases, stroke, and coronary heart disease.

Modelling interacting risk factors is complex. Risk factors are rarely independent, so a common modelling technique of multiplying separate risk factors can lead to double counting in the results. To address this issue, HealthLumen have developed our well-established microsimulation model to include joint distributions of the risk factors alcohol and body mass index (BMI).

Our recently published research confirms that, if current trends continue unchecked over the next decade, the rising tide of non-communicable diseases (NCDs) may inundate healthcare systems across Europe. By following current demographic trends in different countries across Europe, the prevalence of obesity is predicted to increase the burden of NCDs, and the associated economic burden to healthcare systems. For example, between 2020 and 2030, the number of people with obesity is set to rise by 29% in France, and by 26% in The Netherlands. These increases are predicted to lead to the emergence of over 91,000 cases of coronary heart disease in France and 81,000 in the Netherlands. 

Although the most well-known cause of liver disease is excessive alcohol consumption, there is less awareness of obesity as another major cause of chronic liver disease. While obesity is defined by the accumulation of excess body fat, and the liver is particularly prone to this accumulation. This leads to chronic liver disease, which unchecked can progress to liver cancer.[4] Currently, this is largely happening under the surface, but potentially poses a huge healthcare burden. Our recently published projected increase in obesity in France alone has been predicted to lead to 12,000 cases of chronic liver disease and 12,000 cases of liver cancer by 2030.

What does a healthcare system have to do to turn this tide? Microsimulation can also be used to predict the potential benefits of theoretical or aspirational reductions in BMI and alcohol consumption, and multi-risk factor interventions. The recently published results suggest that policies designed to impact on both obesity and alcohol consumption may be of benefit to national populations across Europe from France to Romania, and that even small changes in these risk factors can lead to significant outcomes. 

The modelling shows that reduction of BMI by as little as 1% and alcohol consumption by 5% could have a major positive impact on healthcare outcomes. Using France as an example, policies that could achieve these goals could “avoid” 17,000 cases of heart disease, 4,000 cases of chronic liver disease and 2,000 cases of liver cancer by 2030. This reduced disease burden is projected to avoid over 8,000 premature deaths over the next decade and reduce direct healthcare expenditure by €1.5bn for liver cancer and of €1.4bn for coronary heart disease. 

This research is clear that policies designed to tackle the growing obesity rates and reducing alcohol consumption can have a major effect on the burden of liver disease (and indeed all NCDs) in Europe over the next decade. Implementing these policies may be the first step that healthcare systems need to take to eventually succeed in stemming the rising tide of NCDs.

These results were recently presented at virtual congresses held by the European Congress on Obesity (ECO 2021) and the International Liver Congress (ILC 2021). Details of the publications are shown below:

ECO, European Congress on Obesity; ILC, International Liver Congress

To access the original abstracts please refer to the congress abstracts for ECO 2021 or ILC 2021. 

References:

[1] Webber L, Divajeva D, Marsh T, McPherson K, Brown M, Galea G, Breda. The future burden of obesity-related diseases in the 53 WHO European-Region countries and the impact of effective interventions: a modelling study.  BMJ Open. 2014 Jul 25;4(7):e004787. doi: 10.1136/bmjopen-2014-004787.

[2] Stanaway JD, Flaxman AD, Naghavi M, Fitzmaurice C, Vos T, Abubakar I, et al. The global burden of viral hepatitis from 1990 to 2013: findings from the Global Burden of Disease Study 2013. Lancet. 2016 Sep;388(10049):1081–8.

[3] Pimpin L, Cortez-Pinto H, Negro F, Corbould E, Lazarus J V., Webber L, et al. Burden of liver disease in Europe: Epidemiology and analysis of risk factors to identify prevention policies. Vol. 69, Journal of Hepatology. Elsevier B.V.; 2018. p. 718–35.

[4] NHS. https://www.nhs.uk/conditions/non-alcoholic-fatty-liver-disease/

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