England is facing a rising tide of fatal liver disease, the Chief Medical Officer has warned, fuelled by obesity, alcohol and preventable infections.
In her first report on the state of the nation’s health, Professor Dame Sally Davies said comprehensive action was needed to tackle the entirely avoidable problem.
Deaths from liver disease have increased by a fifth between 2000 and 2009, while they have dropped by around the same amount in most comparable European countries, she said.
Liver disease and cirrhosis now kills 16 people in every 100,000.
Dame Sally said: “My report is a stark reminder of the preventable damage that eating too much and drinking too much alcohol can do.
“Liver disease is one of the few major causes of premature death that is on the increase and urgent action is needed to halt this trend.
“The NHS Commisioning Board forthcoming liver strategy should help address this. ”
Experts said couples sharing a bottle of wine a night were in denial about the health consequences and GPs needed to do more to educate them.
Andrew Langford, chief executive of the British Liver Trust, said: “GPs have to work harder to explain to people that liver disease is a hidden disease. It has always been called alcoholic liver disease, making people assume it only strikes very heavy drinkers when in fact it is the housewife who puts the children to bed and drinks a bottle of wine a night, even if she shares one with her husband.
“You need to drink in moderation but in order to protect your liver your really need two or three consecutive days off a week.”
He added that poor diet and lack of physical activity were contributing to a rise in fatty liver disease and that was as much a problem as cirrhosis caused by alcohol.
The report showed that in the World Health Organisation list of factors that contribute to an early death in the UK, alcohol is second only to smoking, with obesity at fifth, following high blood pressure and cholesterol which can be related to weight.
A quarter of men and more than a fifth of women aged 16 to 24 admitted binge drinking in the last week while those in older age groups are more likely to drink on five or more days a week, the report said.
It added: “While there is evidence that alcohol consumption levels are falling, there is a lagged effect in terms of the harms cause by higher risk drinking. Alcohol related death rates have risen steadily over the last two decades, and while there is some evidence that the rate is now falling, hospital admission rates for alcohol conditions continue to rise.”
Obesity levels are rising and are linked to deprivation, the report said, with higher levels in the North West, Midlands, and parts of the South East.
The report said: “Common to both sexes and all age groups has been a progressive increase in levels of obesity, although there is evidence among children and younger adults of a levelling off of obesity rates in recent years.”
Undetected hepatitis is also a major problem, the report said, and can cause symptomless liver disease and lead to liver cancer.
Mr Langford added that Dame Sally could have gone further in her report and called for universal vaccination against hepatitis B and better screening for hepatitis C which would ‘considerable reduce’ the amount of liver disease in England.
The report warned that liver problems cause few symptoms until a late stage when the disease is relatively advanced.
Dame Sally recommended public health measures are needed to tackle alcohol use and obesity while awareness needed to be raised of the dangers of liver disease amongst the public.
Doctors need to improve early detection of the disease by questioning patients about their health more closely and using new diagnostic tests.
Dame Sally added that seven in ten people in England have two or more unhealthy habits that can raise the risk of an early death. Only one in 14 people have no poor health indicators, the report said.
These include smoking, binge drinking, lack of fruit and vegetables in the diet, and obesity which is linked to a lack of exercise.
The report said: “High levels of energy intake without sufficient physical activity can lead to obesity and increase the risk of diabetes, cardiovascular disease, high blood pressure, some cancers and osteoarthritis.
“Excessive sugar intake is a particular concern, but is often only one source of unhealthy energy intake.
“High levels of salt consumption are associated with an increase in blood pressure which is a risk factor for heart disease and stroke. Diets high in saturated fat also increase cholesterol levels, another heart disease risk factor.”
Only one in ten children aged between 11 and 18 eat the recommended five portions of fruit and vegetables a week, the report said, rising to almost four in ten of the over 65s.
Sir Richard Thompson, president of the Royal College of Physicians, welcomed the Chief Medical Officer ’s focus on the damage that alcohol misuse is causing.
He said: ” ‘We echo the CMO ’s concerns, which could not come at a better time as we await the imminent publication of the Government ’s alcohol strategy.
“These figures underline the urgent need for a 50p minimum unit price for alcohol, which would hit younger drinkers and heavy drinkers, while not greatly affecting moderate drinkers.”
Dr Vivienne Nathanson, the British Medical Association’s (BMA) director of professional activities, said: “It is extremely worrying that so many people are dying in England from preventable liver disease, especially given this illness is falling in many other European countries.
“One of the major causes of liver disease is harmful drinking. The BMA has been campaigning for many years for action to tackle alcohol misuse, including the introduction of a minimum price per unit of alcohol, an end to two-for-one deals that can promote irresponsible drinking and more regulation on the marketing of alcohol.
“If we are to turn the tide on rising liver disease, we must tackle harmful drinking as well as focusing on other public health issues such as obesity.”
