How Queen’s researchers are fighting against increasing rates of liver disease

Feature Stories | 02 Mar 2021

The liver is one of the hardest working and most complex organs in the human body. It performs countless functions vital to survival, including the cleansing and clotting of blood, the creation of proteins, and the regulation of hormones, cholesterol and vitamins. Due to the liver’s resilience, and a lack of symptoms in individuals with liver disease, many Canadians with underlying liver health issues are often unaware until they have cirrhosis at which point the liver can start to fail. It is estimated that 1 in 4 Canadians are affected by some form of underlying chronic liver disease, and it is currently ranked as the fifth leading cause of death in those aged 35-64 years of age in the country. Despite this, general knowledge about liver disease in the public and access to specialists remains limited.

There are a variety of different chronic liver diseases, the most common being non-alcoholic fatty liver disease (NAFLD), alcohol-related disease and viral hepatitis B and C which are caused by external lifestyle related factors. For instance, NAFLD, the most common form of liver disease, is more common in patients who are obese, have been diagnosed with diabetes, have lower involvement in exercise and have poor dietary habits.

Over the last two decades, rates of chronic liver disease and cirrhosis, particularly among young people, have continued to increase, a trend that has been shown to be exacerbated by the COVID-19 pandemic due to increases in alcohol use. In order to combat this phenomenon, health care providers and members of the public need to be made more aware of the true burden of liver disease and how to address it.

Dr. Jennifer Flemming is a hepatologist and clinician scientist in the Department of Medicine and is cross appointed to the Department of Public Health Sciences. Dr. Flemming conducts epidemiologic research related to primary liver cancers and cirrhosis, a condition which can result from untreated chronic liver disease. She uses large population level databases from Ontario to study trends of the occurrence of cirrhosis in the province over time and compares the rates between different patient populations. For the last five years, much of her research has been focused on how cirrhosis disease burden is influenced by changes in external lifestyle factors such as increases in obesity and alcohol consumption. Dr. Flemming’s goal is to be able to accurately identify high risk populations for liver disease, and to determine how to best target them with public health interventions.

“Many people think that cirrhosis of the liver is only caused by alcohol consumption and only occurs in middle-aged or older individuals,” says Dr. Flemming. “Misconceptions like these are why it is important to educate the public about the burden of liver disease, what causes it, and the fact that it sometimes doesn't have symptoms until it's too late.”

Through her research, Dr. Flemming uses data to look at the different types of chronic liver diseases that led to cirrhosis. Then she looks at how the diseases can inform educational campaigns. “For instance, if we're seeing a lot of younger adults coming into the clinic or hospital with alcohol-related cirrhosis and liver failure, and we know that ongoing alcohol use usually takes at least 10 years to develop, then maybe we need to increase efforts at the level of secondary education,” says Dr. Flemming. “Now let’s say that you have younger individuals who are consuming a lot of alcohol, are obese and have diabetes. That combination of factors makes them a particularly high-risk group to develop liver disease, and it is important to find ways to target them specifically.”

One of the upsides to liver disease, is that if it is treated at early stages, liver damage can be reversed. For this reason, Dr. Flemming’s research also looks at external lifestyle factors and how behaviour modification can be a part of both prevention and healing.

“Ultimately what I aim to do is highlight the burden of liver disease on a population level and try to make people aware that it's a significant problem,” says Dr. Flemming. “There are ways to identify liver disease early and as long as we begin treating underlying chronic liver disease before the development of cirrhosis, we generally have very good outcomes. Over the past five years I have noticed an increase in questions regarding chronic liver disease from my primary care colleagues, particularly when it comes to identification and staging. Moving forward, we need to continue to advocate to spend more attention and resources on the primary prevention of liver disease and not just managing it once it's become advanced.”

How Queen’s researchers are fighting against increasing rates of liver disease

Related topics

Explore Our Stories