Who gets cirrhosis of the liver? You might be surprised.
A new study in Ontario found cirrhosis of cirrhosis the fastest growing rates among young adults. An epidemic of fatty liver disease is being pointed to as one possible cause of a spike.
After being considered a disease of older men, liver cirrhosis appears to change, according to the authors of the study published in the Lancet Gastroenterology and Hepatology on Thursday.
New cases of cirrhosis were almost doubled in Ontario between 1997, when 6,318 people were diagnosed, and 2016, with 12,047 people diagnosed. Nearly 1% of the population currently suffers from cirrhosis, according to a population-based retrospective study from the Institute for Clinical Assessment Sciences.
Young men and women are a high growth population for fatal liver disease. The risk of liver cirrhosis is 116% higher among the 1000-year-olds born in 1990 than in 1991. Baby Boomers were born in 1951. The risk to women is even higher. A woman born in 1990 was 160 percent more diagnosed with cirrhosis than a woman born in 1951.
"Cirrhosis of the liver is considered to be a disease of older men, but our data show that cirrhosis is changing," said Dr. Jennifer Fleming, author of the study, and Fleming is an associate scientist at ICES Queen and a professor at Queens University .
Cirrhosis of the liver is characterized by replacement of normal liver tissue with scar tissue. Symptoms of cirrhosis include jaundice, swelling of the ankles and stomach, itching, fatigue and loss of appetite. In general, people with fatty liver disease have no symptoms, although some may report feelings of fatigue and a general feeling of being ill.
"More young people are diagnosed with cirrhosis at an earlier age than before," Fleming said. "If these trends continue, they will have a significant burden on the healthcare system."
The next step, Fleming said, is to pinpoint the exact causes of increased cirrhosis among young people and women. Non-alcoholic fatty liver disease, the main cause of liver disease, is a reasonable link.
Historically, alcohol consumption and hepatitis C were the most common causes of cirrhosis of the liver. But with effective Hepatitis C treatment, attention is turned to alcohol and non-alcoholic liver disease.
It is found in 20-30 percent of the population. 20% of these cases are more severe at risk of liver cirrhosis, according to the study. Among people with diabetes, NAFLD rates, as it is known, are 80 percent. In its most severe form, the disease can cause patients who need liver transplants.
Although associated with obesity, it is not just a disease of obese people, Fleming said. Genetics has raised some people at higher risk. This can be reversed if a patient follows a healthy lifestyle, including a balanced diet and exercise, according to the Canadian Liver Foundation.
High rates of NAFLD, especially among thousands of years, may be part of the cause of increased cirrhosis among young men and women, the report said.
Alcohol also remains a key factor in liver cirrhosis, Fleming said. The findings should shed light on the drinking trends among young people. Some studies have found that young women in North America are drinking at similar rates to younger men, and women are more likely to develop liver-related liver diseases.
Like non-alcoholic liver disease, some people are at risk of developing cirrhosis more than others, says Fleming, who works as a gastroenterologist at Kingston General Hospital.
"I see a lot of people consuming alcohol that will not be classified as having an alcohol disorder, but because of other factors it causes them to get cirrhosis of the liver," she said.
Public health strategies are needed to raise awareness of liver cirrhosis among young people and women, groups that are not traditionally associated with a high risk of disease.
"This is a public health problem as many of the causes of cirrhosis including viral hepatitis and alcohol consumption are treatable and can prevent cirrhosis of the liver," she said.
Fleming said that it is not unusual to see young people with cirrhosis in their liver. "We have certainly seen many young people who require liver transplantation.The youngest man of the year I saw was 25."
And patients often have no idea before they are diagnosed.
Fleming said she wanted to raise awareness of the issue and see some of the stigma removed.
"There is a need for strategies to increase awareness of this silent epidemic among young people and women."
Liver disease by numbers
7 million Canadians have non-alcoholic fatty liver disease
20% of patients with non-alcoholic staphatitis (NASH), the most severe form of non-alcoholic fatty liver disease, may develop liver cirrhosis
11% of NASH patients may die from the disease
500 liver transplants were conducted 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: Canadian Liver Foundation
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