Belly fat more than doubles the risk for liver damage from alcohol, study finds

A recent U.S. study indicates that drinking alcohol more than doubles the risk of severe liver damage for individuals with abdominal obesity or diabetes. Furthermore, those with hypertension who consume alcohol also face a near doubling of their liver damage risk. These findings carry significant implications for public health, particularly during social events like the "Super Bowl," where overindulgence in food and drink is common.

Dr. Andrew Freeman, Director of Cardiovascular Prevention and Wellness at National Jewish Health in Denver, Colorado (who was not involved in the study), stated, "People might do things they shouldn't do and hurt themselves during the 'Super Bowl.'" He specifically pointed out that people tend to consume processed meats like hot dogs, sausages, bacon, pepperoni, and ham while watching big football games, and these processed meats carry the same cancer risks as cigarettes. Dr. Freeman added that consuming large quantities of highly processed, high-fat, and high-sugar foods can lead to excessive insulin secretion, resulting in insulin resistance, high blood sugar, and fatty liver, and drinking alcohol on top of that further amplifies the risk of liver damage.

The study points out that excessive waist circumference (over 89 cm for women and 102 cm for men) is often associated with obesity and is one of several cardiometabolic risk factors, including high blood sugar and high blood pressure. Data from the U.S. Centers for Disease Control and Prevention shows that nearly half of Americans have high blood pressure, more than a third have prediabetes, and approximately 40% of the population is considered obese. Experts say these health issues can lead to fat accumulation in the liver, which can then lead to fibrosis or liver scarring.

Dr. Freeman emphasized, "Most people don't realize that fatty liver usually occurs before developing diabetes. It's related to disordered sugar metabolism—when blood sugar is too high, the liver stores fat to clear some of the sugar, and it's this excess fat that damages liver function." In addition, alcohol consumption damages liver cells that are trying to metabolize the alcohol and can lead to additional fat buildup. Inflammation and scarring caused by excess fat can eventually lead to cirrhosis, which increases the risk of liver failure and liver cancer.

Dr. Brian Lee, Associate Professor of Clinical Medicine at the Keck School of Medicine of USC and lead author of the study, stated that the double whammy of fat deposition may be the reason the study found a significant increase in liver scarring in people with moderate to heavy alcohol consumption and chronic diseases. Dr. Lee said in a statement, "The findings identify a high-risk population that is very susceptible to liver disease and suggest that pre-existing health problems can have a significant impact on how alcohol affects the liver." Dr. Lee also cautioned that even if a person does not have a large belly, high blood pressure, or diabetes, it does not mean they can drink heavily. "We know that alcohol is toxic to the liver, and all heavy drinkers are at risk of developing advanced liver disease."

The study, recently published in the journal *Clinical Gastroenterology and Hepatology*, analyzed data from the National Health and Nutrition Examination Survey (a U.S. national government survey of nearly 41,000 people). Of those, more than 2,200 were classified as "heavy" drinkers. The study defined heavy drinkers as women who consumed more than 20 grams of alcohol per day or men who consumed more than 30 grams of alcohol per day. However, according to the U.S. Centers for Disease Control and Prevention, this amount of alcohol is generally considered "moderate" drinking. In the United States, a standard drink is defined as containing 14 grams of pure alcohol. This is equivalent to 141 ml of wine with 12% alcohol content, 340 ml of beer with 5% alcohol content, or one shot of spirits (80 proof).

Experts say most people don't realize they're pouring far more than these standards. "If you look at what people have with dinner or as a cocktail, they're filling their glasses with three to four ounces (88 to 118 ml) of liquor," Dr. Freeman said. "If a restaurant pours you five ounces (145 ml) of wine, you'll complain that they didn't fill your glass. People are probably drinking a lot more than they realize."

A growing number of new studies are finding that any amount of alcohol is harmful to health. In January, then-U.S. Surgeon General Dr. Vivek Murthy issued a strongly worded advisory report pointing to the link between alcohol and cancer. Murthy said, "Alcohol is a definite, preventable cause of cancer, accounting for approximately 100,000 cancer cases and 20,000 cancer deaths each year in the United States—higher than the 13,500 alcohol-related traffic fatalities in the United States each year—but most Americans are not aware of this risk." However, the new advisory report noted that a 2019 survey by the American Institute for Cancer Research showed that only 45% of Americans believe that drinking alcohol can cause cancer.

One simple way to reduce alcohol intake is to substitute alcoholic beverages with non-alcoholic cocktails, especially in social situations where you want to be part of the party. Experts say some non-alcoholic cocktails rely on artificial non-alcoholic spirits, botanicals, and bitters, but others are simple mixtures of juices, sodas, and syrups. If you find that non-alcoholic cocktails don't satisfy your craving for alcohol, experts recommend using the SMART method to set achievable goals. This acronym stands for:

1. **Specific:** Set an achievable goal, such as reducing alcohol consumption for three days a week. You can increase the number of days until you reach your ultimate goal.

2. **Measurable:** How many drinks will you cut back on—are you paying attention to the size of your drinks?

3. **Achievable:** Reduce social activities that may offer alcohol as you progress toward your goal of not drinking.

4. **Relevant:** Ask yourself how not drinking will help you improve your life and health.

5. **Time based:** Set a reasonable time frame to reduce alcohol consumption.

Dr. Sanam Hafeez, a neuropsychologist in New York City, said in a previous CNN interview, "If you set the bar too high, you may fail, so it's best to set smaller goals to achieve it." Hafeez pointed out that, first, it's best to understand what you're already doing: "Nothing can begin unless you have an honest conversation with yourself."