What is the cause of the increasing incidence of liver cirrhosis?

From the Guidelines

Liver cirrhosis is indeed on the rise globally, and the most recent evidence suggests that the main drivers of this increase are rising rates of obesity leading to non-alcoholic fatty liver disease (NAFLD), increased alcohol consumption, and chronic viral hepatitis infections, particularly hepatitis B and C 1. The obesity epidemic has made NAFLD the fastest-growing cause of cirrhosis in developed countries. Additionally, heavy alcohol use continues to be a significant contributor, with alcoholic liver disease affecting millions worldwide. Prevention strategies include:

• Maintaining a healthy weight through balanced diet and regular exercise
• Limiting alcohol consumption (no more than 1 drink daily for women and 2 for men)
• Getting vaccinated against hepatitis B
• Avoiding behaviors that can spread hepatitis C
• Regular medical check-ups for those with risk factors Early detection is crucial as cirrhosis is often asymptomatic until advanced stages, when complications like jaundice, fluid accumulation in the abdomen, and bleeding varices may occur. While early-stage liver damage can sometimes be reversed with lifestyle changes, advanced cirrhosis typically requires specialized medical management and possibly liver transplantation. According to the most recent study, approximately 90% of HCCs are associated with a known underlying aetiology, most frequently chronic viral hepatitis (B and C), alcohol intake, and aflatoxin exposure 1. The study also found that cirrhosis is an important risk factor for HCC, and may be caused by chronic viral hepatitis, chronic alcohol abuse, acquired and inherited metabolic diseases, such as NAFLD, as well as genetic haemochromatosis, or in some cases alpha-1-antitrypsin deficiency. Overall, one-third of cirrhotic patients will develop HCC during their lifetime, and long-term follow-up studies have found that approximately 1–8% of patients with cirrhosis develop HCC per year 1. Therefore, it is essential to prioritize prevention and early detection strategies to reduce the morbidity, mortality, and improve the quality of life for patients with liver cirrhosis.

From the Research

Liver Cirrhosis on the Rise

• Liver cirrhosis is a significant cause of morbidity and mortality worldwide, with increasing prevalence in more developed countries 2.
• The annual age-adjusted mortality of cirrhosis has increased from 14.9 per 100 000 to 21.9 per 100 000 people in the US from 2010 to 2021 3.
• The most common causes of cirrhosis include viral hepatitis, alcoholic liver disease, and nonalcoholic steatohepatitis 4, with alcohol use disorder, nonalcoholic fatty liver disease, and hepatitis C being the leading causes in the US 3.

Diagnosis and Management

• Cirrhosis can be diagnosed noninvasively using elastography, a noninvasive assessment of liver stiffness measured in kilopascals, which can typically confirm cirrhosis at levels of 15 kPa or greater 3.
• Liver biopsy remains the reference standard for diagnosis and should be used when results of noninvasive evaluation are indeterminate, when the etiology of liver disease remains unknown, or when the result may alter management 5.
• Management of liver cirrhosis is centered on the treatment of the causes and complications, and liver transplantation can be required in some cases 6.
• Treatment goals include preventing cirrhosis, decompensation, and death, with therapies such as carvedilol or propranolol to prevent variceal bleeding, lactulose for hepatic encephalopathy, and combination aldosterone antagonists and loop diuretics for ascites 3.

Complications and Prognosis

• Patients with cirrhosis experience symptoms including muscle cramps, pruritus, poor-quality sleep, and sexual dysfunction, which are common and treatable 3.
• The median survival time following onset of hepatic encephalopathy and ascites is 0.92 and 1.1 years, respectively, with a high risk of spontaneous bacterial peritonitis and hepatorenal syndrome 3.
• Approximately 1% to 4% of patients with cirrhosis develop hepatocellular carcinoma each year, which is associated with a 5-year survival of approximately 20% 3.