The United States is hardly the only country where heavy and binge drinking is a problem. But Americans face a unique crisis: This country’s obesity and diabetes epidemics, combined with heavy alcohol use, are causing more people to get sick from a liver disease that, until recently, didn’t even have a name.
Metabolic dysfunction and alcohol-associated liver disease, or MetALD, is now a leading concern among doctors in the U.S. as more young people and women face serious illness and die from the condition. Doctors worry that many more Americans might be silently developing MetALD, at least in part because many people do not realize they are drinking too much.
MetALD occurs in people who have liver fat, metabolic risk factors — obesity, prediabetes or diabetes, high blood pressure, or high cholesterol — and who have more than 10 alcoholic drinks per week for women, or more than 15 for men.
The share of Americans who meet those criteria has more than doubled since 1990, some studies suggest. Nearly 1 in 10 U.S. adults report overlapping heavy drinking and obesity, according to a recent JAMA Internal Medicine study.
MetALD is now nearly twice as common as alcohol-associated liver disease, and the risk factors are hitting younger adults: People 26 to 34 years old have the most overlapping alcohol use disorder and obesity of any age group, national survey data reveal.
“If you drink alcohol, you are going to accumulate fat in the liver,” liver researcher and transplant hepatologist Juan Pablo Arab said. “But what happens if you already have obesity and insulin resistance, and you already have fat in your liver?”
It’s a bad combination, physicians like Arab told STAT. Over one-third of Americans are thought to have troubling levels of fat accumulation in their livers, what’s known broadly as steatotic liver disease. A third of adults also meet the criteria for MASLD, or metabolic dysfunction-associated steatotic liver disease — formerly known as non-alcoholic fatty liver disease.
