Introduction

Chronic liver disease (CLD) causes 1.8% of all deaths in Europe. Without policies to mitigate harmful alcohol consumption and obesity, that proportion will continue to increase. This study aims to estimate the impact of policy interventions targeting alcohol and obesity on the incidence of CLD and primary liver cancer in France, the Netherlands, and Romania.

Aims & Methods

A validated and peer-reviewed microsimulation model was employed using data from online databases and published literature. Static and dynamic trends in alcohol consumption and body mass index (BMI) respectively were projected from 2022 to 2030. We modeled the incidence of CLD and liver cancer under three policy scenarios versus an inaction scenario. The policies were 1€ minimum unit pricing (MUP) on alcohol; a combination of 0.7€ MUP and a sugar sweetened beverage (SSB) tax; and a combination of 0.7€ MUP, SSB tax, and a volumetric tax on alcohol.

Results

All policies had an important impact ranging from a 2% to 7% reduction in annual incidence of chronic liver disease and liver cancer by 2030. The 1€ MUP policy had the largest predicted impact: In the three countries combined, that policy would result in 11,550 fewer cases of CLD and 7,921 fewer cases of liver cancer by 2030. Policy interventions combining a €0.7 MUP, an SSB tax, and a volumetric tax on alcohol would prevent nearly as many cases: 7,317 cases of CLD and 5,390 cases of liver cancer by 2030 compared with the inaction scenario.

Conclusion

In conclusion, we can reduce the number of Europeans who develop chronic liver disease or liver cancer by up to 7% before 2030 if we introduce a €1 MUP on alcohol, or we introduce complementary public health policies targeting alcohol consumption and obesity.

Disclosure

Financial support statement: This research was carried out as part of the HEPAHEALTH II project, commissioned by the European Association for the Study of the Liver (EASL), a non-profit medical association and has been supported by grants from Gilead Sciences Europe Ltd and Bristol-Myers Squibb. Nine EASL members co-authored this study.

Introduction

Although chronic alcohol consumption has progressively decreased in recent years, a third of people over 15 years declare at least one episode of excessive use every month, which ranks Romania on second position, with a rate of 35%, far above the average registered in the EU (20%). Therefore, Romania has one of the highest incidence rates of alcohol-related liver cirrhosis, which has become a major public health problem. This study aimed to investigate the prevalence of liver fibrosis in the asymptomatic alcohol-consuming population.

Aims & Methods

The study aimed to evaluate the relationship between advanced liver fibrosis measured by transient elastography, laboratory parameters, and the amount of alcohol consumed depending on non-modifiable risk factors such as age and gender. Between January 2022 and December 2022, we examined patients with day hospitalization in the Institute of Gastroenterology and Hepatology in Iasi, without liver history, who admitted a moderate or high consumption (women <7 versus >7 drinks/week; men <14 versus >14 drinks/week) for at least one year. The classification of the fibrosis stage by transient elastography was adjusted according to transaminase values. The results were analyzed by univariate analysis and logistic regression to establish models of prediction.

Results

The study included 689 patients with an average age of 49.32±14.31 years, a proportion of 63.7% represented by men. Advanced fibrosis (³ F3) was detected in 19.30% of the examined patients, predominantly in men (14.1%) and patients over 55 years old (12.5%). Excessive alcohol consumption is associated 2 times more with advanced fibrosis in women (OR=5.08; CI 95%: 3.45-9.50, p<0,001) and the group under 40 years old (OR=6.29; CI 95%: 1.67-9.43, p<0,001) compared to men (OR=2.27; CI 95%: 1.76-3.81, p=0,012) respectively patients over 55 years old (OR=3.21; CI 95% : 2.28-4.45 p<0,001). Using logistic regression, it was demonstrated that there was a strong correlation between advanced fibrosis, excessive alcohol consumption, low serum albumin level and the reduction of triglycerides in men (R² Nagelkerke = 0.854; p<0.001) supplemented with the reduction of cholesterol in the age group 40-55 years (R² Nagelkerke = 0.785; p<0.001), respectively of ferritin in those over 55 years old (R² Nagelkerke = 0.804; p<0.001). The association of excessive alcohol consumption, age, low levels of albumin, LDL-cholesterol and C-reactive protein generated a significant predictive model (R² Nagelkerke = 0.784; p<0.001) for female patients.

Conclusion

Screening using transient elastography represents an approach that could provide early diagnosis of advanced liver fibrosis in an asymptomatic population, with the possibility to prevent the evolution of ALD and the development of complications of cirrhosis.