Liver disease is on the rise. Here's what you need to know

Times

28-04-2025

New data from the British Liver Trust has highlighted a fourfold rise in mortality rates for liver disease over the past 50 years, making it one of the leading causes of death in adults under 65. And because the organ has such huge reserves, many of those affected remain blissfully unaware that they are heading for trouble. Might you be one of them?
The liver is the organ equivalent of Monty Python's Black Knight, who battles on despite losing his arm (and eventually all his limbs) in a sword fight with King Arthur, declaring: 'Tis but a scratch.' Put simply, by the time many people develop symptoms of liver damage, the organ is often approaching irreversible end-stage failure.
There are lots of reasons people develop liver disease, but the main drivers behind the increase over the past 50 years have been viral infection (particularly hepatitis C in the UK), our expanding waistlines, alcohol, and a combination of all three.
• Gulp! I took a £300 liver test after drinking Christmas dry
Hepatitis C warrants a whole article in itself, not least because advances in antiviral therapy have transformed the outlook for people with the infection. Thankfully it is now much less common than it used to be.
As for alcohol, the latest Health Survey for England revealed that 32 per cent of men and 15 per cent of women questioned admitted drinking more than the recommended maximum of 14 units a week, with the heaviest drinkers being in the 45-65 age group. The weekly limit errs on the low side as it is hard to predict how alcohol affects individuals, but I often encounter problems (not all liver related — see below) in people drinking 20-30 units a week, and in those consuming 50 or more it's not so much if they will run into trouble as when.
However, the link between diet and lifestyle and non-alcohol related fatty liver disease — or, to use its latest medical title, metabolic dysfunction-associated steatotic liver disease (MASLD) — isn't so well appreciated, despite it being very common. The British Liver Trust estimates that at least one in five adults in the UK now have some degree of MASLD, most of whom will probably never know and go on to fall ill and die from something different. However, a significant minority will develop worrying liver disease unless mitigating steps are taken.
Most (but not all) people with MASLD are overweight or obese, with apple-shaped men and women who store fat around their midriff being at particular risk. It is also linked to poor diet, a sedentary lifestyle, high cholesterol levels, raised blood pressure, type 2 diabetes and, in women, polycystic ovarian syndrome.
If you have ever eaten foie gras you will know what a fatty liver looks like: pale and yellow rather than a healthy pink. We may not be cruelly force-fed ducks or geese, but overindulgence has a similar effect in humans, and the resulting fatty infiltration can be the start of a scarring process that leads to stiffening of the liver and, eventually, cirrhosis and failure. Indeed, similar fatty changes are typically the first sign of trouble in heavy drinkers too, and the pathway to irreversible liver failure much the same from a pathological point of view. You can both drink and eat yourself to a liver disease-related death.
Routine blood tests can pick up signs that the liver is struggling (higher than normal levels of liver enzymes in the blood) but, because of the liver's initial resilience, getting the all clear from these doesn't mean yours is healthy. Ultrasound scans are better at detecting early signs of trouble, particularly a FibroScan, which evaluates the stiffness of the organ (a measure of scarring). Both are available on the NHS but generally only where there is a clinical indication, such as deranged blood results.
Private screening scans are available to anyone willing to pay — typically £160 to £500 a time depending on the test and the clinic — but in many cases are only likely to confirm what you already suspect: that you are drinking too much, or your diet, lifestyle and/or weight need addressing.
• Read more from Dr Mark Porter on The Times
Treatment for MASLD is all about modifying risk factors. What is good for your heart is good for your liver, so lose excess weight, eat healthily, don't drink excessively and exercise. And, if you have underlying health issues such as type 2 diabetes, high blood pressure or very high cholesterol levels, ensure these are well controlled.
And if a liver function test does come back as slightly abnormal, don't dismiss it (something we doctors are just as guilty of doing as our patients). At the very least regard it as a warning shot, and a prompt to take a closer look at your diet, lifestyle and weight. It won't just be your liver that thanks you.
Totting up weekly units of alcohol is only half the story if you are worried about your drinking — or someone else's. Just as important is how drinking affects your social life, work, relationships and health.
You don't need to drink heavily every day to have alcohol use disorder (AUD). The Audit questionnaire is a screening tool developed by the World Health Organisation. It's not foolproof, but should identify nine out of ten people at risk from their drinking.
You can screen yourself at auditscreen.org/check-your-drinking