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Home > Education Resources > Liver Lowdown > Liver Lowdown Oct 2013 > Liver Disease - The Big Picture

Liver Lowdown


Q&A


Liver Disease: The Big Picture


Check out the infographic above and learn some amazing facts about liver disease by clicking here.

To coincide with Liver Awareness Month, here’s a Q&A “big picture” guide that highlights key issues about liver disease. Check out the infographic. Plus, watch the video that reveals how people like you or someone you love can, without warning, be affected by liver disease.

Q: We hear about diseases that are under control or no longer the severe threat they once were. Are any liver diseases on the rise?

A: Unfortunately, we’re seeing an ever-increasing number of people with liver diseases such as hepatitis C, non-alcoholic fatty liver disease (NAFLD), and liver cancer.

Q: How many people in the United States have liver disease?

A: At least 30 million people—or one in 10 Americans—have some form of liver disease. At the same time, keep in mind that there are more than 100 types of liver disease.

Q: Can we break down some of these numbers?

A: Three examples:

  • More than one million Americans are infected with hepatitis B and four million Americans have hepatitis C. Unlike hepatitis A and hepatitis B, there’s no vaccine to prevent hepatitis C.
  • A hot news topic is the 20 percent of Americans who have fatty livers, which is the basis of non-alcoholic fatty liver disease or NAFLD.
  • Each year, about 21,000 Americans are diagnosed with primary liver cancer—one of the few cancers on the rise in the U.S.

Q: If someone has liver disease, are they immediately aware of it?

A: Very often they aren’t.

  • Hepatitis C is called “the silent epidemic.” Three-quarters of people infected with hepatitis C don’t know they have it because they can have no symptoms for years. The disease often lies undetected for 20 to 30 years and is a leading cause of cirrhosis and liver failure. (Think about the baby boomers who simply don’t know).
  • There are usually no symptoms of cirrhosis in its early stage. Over time, cirrhosis may cause symptoms, complications and even lead to liver failure.

Q: Does liver disease strike people of any age?

A: Yes. Take children, for example:

  • The incidence of biliary atresia is one in 10,000 live births in the U.S. and there are approximately 300 new cases each year.
  • The prevalence of all causes of neonatal liver disease may be as high as one in 2,500 live births.
  • An alarming statistic is that six million children—up to 10 percent of all children in the nation—have NAFLD, the non-alcoholic fatty liver disease we referred to earlier. NAFLD is the leading cause of chronic liver disease in children and adults in the United States.

Q: Talking about adults, what about older Americans and liver disease?

A: Let’s limit our answer to another story making headlines.A high profile study unveiled by the Centers for Disease Control and Prevention (CDC) finds that more than 75 percent of adults with hepatitis C are baby boomers, those born between1945 and 1965. It’s estimated that one in every 33 baby boomers has viral hepatitis. They are five times more likely to have hepatitis C. The CDC recommends that all baby boomers get tested for the virus, as should all at-risk groups.

Q: Why are baby boomers so susceptible to hepatitis C?

A: The CDC states that reason isn’t completely understood. Most boomers are believed to have become infected in the 1970s and 1980s when rates of hepatitis C were the highest. Specifically:

  • Many baby boomers could have gotten infected from contaminated blood and blood products before widespread screening of the blood supply began in 1992 and universal precautions were adopted.
  • Others may have become infected from injecting drugs, even if only once in the past.
  • Still, many baby boomers don’t know how or when they were infected.

Are you a baby boomer? Get more information here.

Q: Does liver disease affect men and women differently?

A: In some instances. For example:

  • Primary liver cancer is about twice as common in men than in women.
  • About 70 percent of people with autoimmune hepatitis are women, usually between the ages of 15 and 40. Many people with this disease also have other autoimmune diseases. The disease is chronic, meaning it lasts many years. Less common forms of autoimmune hepatitis generally affects girls between the ages of 2 and 14.

Q: And what about different ethnic groups and liver disease?

A: To highlight a few facts:

  • Though African-Americans represent 13 percent of the U.S population, they make up about 22 percent of chronic hepatitis C cases. In addition, numbers published by the National Medical Association from the CDC show that four of every 100 infants born to African-American mothers with hepatitis C become infected with the virus. Chronic liver disease, often hepatitis C-related is the leading cause of death among African-Americans ages 45 to 64.
  • Also, according to the CDC, an estimated one in 12 Asian-Americans and Pacific Islanders have hepatitis B, yet as many as two in three are unaware they’re infected.
  • The American Cancer Society (ACS) estimated that in 2012, approximately 4,300 Hispanics would be diagnosed with liver cancer, and about 2,700 would die from the disease. Among men, liver cancer was expected to account for about 10 percent of the total.
  • The ACS stated that liver cancer incidence rates in the U.S. were about twice as high in Hispanics as in non-Hispanic whites and about three times higher in men than in women.
  • Liver cancer is one of the most fatal types of cancer; the 5-year survival rate among Hispanics is about 19 percent for both men and women, according to the ACS.

Q: If there’s no vaccine to prevent hepatitis C, what efforts are being made to find more effective treatments?

A:For the sake of brevity, let’s respond by saying that, as one would expect, there’s ongoing research to find efficacious medications to combat hepatitis C. For patients with chronic hepatitis C, medications are often used in combination, including interferon, ribavirin, and the more recently FDA-approved boceprevir and telaprevir.

Q: What about other cutting edge developments in diagnosis and treatment of liver disease in general?

A: Two examples:

  • Renal Risk Index: With their results published in the Journal of the American Society of Nephrologists (Sept. 12, 2013), researchers have created and validated a score that predicts the risk of end-stage renal disease after a liver transplant. Investigators at the University of Michigan and Arbor Research Collaborative for Health created the Renal Risk Index using national data of 43,514 liver transplant recipients. It’s calculated by evaluating recipient characteristics like age, race/ethnicity, history of hepatitis C and body mass index.

  • Magnetic Resonance Elastography (MRE): This is a new, noninvasive imaging test that accurately detects fibrosis in children, including those who are severely obese, with non-alcoholic fatty liver disease and other forms of chronic liver disease. A case series was published online in the Journal of Pediatrics (Sept. 23, 2013). Lead author Stavra Xanthakos, MD, a gastroenterologist at Cincinnati Children's Hospital Medical Center in Ohio, said in a news release: “MRE is likely to be superior to ultrasound-based elastography in this population, as ultrasound-based methods are less reliable in severely obese patients.”

Q: To what extent do liver transplants offer a solution to those with liver failure?

A: Think of this topic in three different ways:

  • Waiting: Currently, about 16,000 adults and children are on the national waiting list for liver transplants. The list grows every year and the shortage of organ donors—deceased and living—is a major obstacle.
  • Transplants: From January 1, 1988 through July 31, 2013, there were 123,392 liver transplants in the U.S., according to data from UNOS/OPTN. Of those, 4,931 were living donors.
  • Deaths: But, on the other hand, UNOS/OPTN data reveals that from January 1, 1995 through July 31, 2013 (a shorter period, by comparison), a total of 29,424 listed patients died while still waiting for liver transplants.

Q: Why, as mentioned earlier, are the cases of non-alcoholic fatty liver disease increasing? Why is it getting so much media attention?

A: Having type-2 diabetes or high cholesterol increases the risk of non-alcoholic fatty liver disease. But by far the biggest problem is obesity. More than one-third of Americans and approximately 12.5 million (17%) of children and adolescents are obese. As it becomes an emerging epidemic, non-alcoholic fatty liver disease is the third most common reason for liver transplants in the U.S.

Q: Can we hope that one day liver disease can be combated?

A: Many liver diseases are preventable with vaccines or reversible, and nearly all are less expensive to treat if detected early. This is why education and awareness provided by the American Liver Foundation, as well as the Foundation’s research projects, are so important. Getting tested can help people learn if they are infected and shifting them into life-saving care and treatment.

If you wish to fully grasp the “big picture about different liver diseases, then trends and statistics only tell part of the story. To understand how different people are affected by various forms of liver disease, we invite you to view The Faces of ALF (American Liver Foundation). You’ll also find out why the American Liver Foundation means so much to them.

Faces of ALF was compiled in an effort to honor those individuals currently living with liver disease and to remember those individuals who have lost their battles. As the name implies, the video showcases the various 'faces' of liver disease to show that the over 100 types of liver disease can affect a variety of people in a variety of ways. The video also provides a brief education on liver disease and its effects.

The video premiered at the American Liver Foundation’s New England Division's Flavors of Boston event on Tuesday, September 13, 2011. It was conceived, filmed and produced by the American Liver Foundation New England Division and Nabil Aidoud of fiVi.com.

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Page updated: October 18th, 2013