Alcohol and Obesity: Elevated Risk of Cancer and Liver Damage

Research indicates that the combined effect of alcohol consumption with overweight and obesity can increase the risk of cancer and liver damage.

Globally 4% of all new cancer cases in 2020 were linked with alcohol use. In the United States, alcohol and obesity are linked with a higher risk of 13 types of cancer that account for over 40% of all these cancers diagnosed in the country. Many of these cancers are preventable if necessary action is taken by governments and policymakers to reduce the risk factors. And alcohol is the third leading risk factor for cancer after tobacco and obesity.

With around 650 million adults living with obesity worldwide, this is a hugely important issue,” said Dr. Elif Inan-Eroglu from the University of Sydney, Australia, as per EurekAlert.
When it comes to the lifestyle factors and habits that people can change to reduce their risk of cancer, obesity and alcohol are top of the list.”
Dr. Elif Inan-Eroglu, University of Sydney, Australia

Alcohol and obesity increase risk of liver disease and death from liver disease

In 2021, Dr. Inan-Eroglu and her team from the University of Sydney published research in the European Journal of Clinical Nutrition which found that people who are obese or overweight and use alcohol are at a greater risk of suffering from liver disease and death from liver disease as a result of their alcohol use, than their healthy weight counterparts who used alcohol at the same level.

The study examined 465,437 people aged 40 to 69 years from the UK biobank study, following them over a period of 10.5 years. The researchers reviewed data on participants classified as overweight/obese based on their body mass index (BMI) and waist circumference, self-reported alcohol consumption according to UK alcohol guidelines, and liver disease incidence and liver disease as the cause of death.

The level of risk for developing liver disease was given a number called a ‘hazard ratio’. The higher the number than 1, the higher the risk.

Comparing people who consume alcohol above UK guidelines to people who consume alcohol within the guidelines, the researchers found that alcohol users who consumed above UK alcohol guidelines had:

A 5.83 hazard ratio of being diagnosed with alcoholic fatty liver disease.
A 6.94 hazard ratio of death caused by alcoholic fatty liver disease.

The study found that people with overweight or obesity who consumed within or above low-risk alcohol guidelines had over 50% greater risk of developing liver disease compared to normal-weight participants who consumed alcohol at the same level.

50%

Greater risk of liver disease from alcohol consumption for people with overwheight and obesity

These results while using a UK sample can be applied in the Australian context as well. The researchers called for improving National Health and Medical Research Council (NHMRC) low-risk alcohol use guidelines to reflect these new findings. Current Australian guidelines state healthy adults should consume no more than 10 units of alcohol in a week and no more than 4 units in one occasion. However these guidlines do not take the risks of overwheight and obesity into account. It is important to update the guidelines given that over one-third of Australians are affected by obesity.

Liver-Damaging Effects of Alcohol Worsens From Overweight or Obesity

The combined effect of alcohol and obesity increases risk of cancer

Recently, new first-of-its-kind research by Dr. Inan-Eroglu and her colleagues was presented at the European Congress on Obesity held from May 4 to 7, 2022. The new research shows the combined effect of alcohol and obesity on increased cancer risk.

In this study, the researchers analyzed data from 399,575 participants (aged 40-69 years; 55% female) from the UK Biobank prospective cohort, who were cancer-free when the study began and followed for an average of 12 years. Cancers were identified from hospital admissions and cancer registry data.

The participants were divided into three groups according to their body fat percentage, waist circumference, and BMI, and classified according to their self-reported alcohol consumption based on UK guidelines (never, previous, within guidelines [14 units or less of alcohol/week] and above guideline alcohol users [more than 14 units/week]).

Researchers then examined the joint association of alcohol consumption and obesity with the risk of 21 different types of cancer, 13 obesity-related and eight alcohol-related cancers. The eight alcohol-related cancers studied in this research were oral, throat, larynx, esophagus, liver, bowel, stomach, and female breast cancers.

The study was adjusted for other factors which could affect results such as age, sex, diet, education level, physical activity, smoking status, sleep duration, socioeconomic status, and existing cardiovascular disease or type 2 diabetes.

The following key findings are reported in the new study:

Over an average follow-up of 12 years, 17,617 participants were diagnosed with alcohol-related cancer, and 20,214 developed obesity-related cancer.
Across all obesity markers, people with higher body fat percentage levels who consumed more alcohol than the low-risk guidelines were at greater risk of cancer.
- For example, compared to people with the lowest body fat percentage who never consumed alcohol,
  - people in the highest body fat percentage tertile who consumed within the low-risk alcohol guidelines were 53% more likely to develop alcohol-related cancers, while those who consumed above the low-risk alcohol guidelines were at 61% greater risk.
Regardless of alcohol intake, the analysis identified a dose-response relationship between larger waist circumference and risk of developing obesity-related cancer.
- For example, compared to people with a healthy waistline who never consumed alcohol,
  - people with bigger waistlines who consumed more than the low-risk alcohol guidelines had a 17% greater risk of developing obesity-related cancer, while people with the largest waistlines who consumed above alcohol guidelines had a 28% higher risk.

The researchers again point out that the current low-risk alcohol use guidelines do not reflect the degree of cancer risk from the combined effects of alcohol and obesity. They call for increased public awareness of these risks.

Alcohol [use] guidelines need to acknowledge that two-thirds of the UK adult population are overweight or obese and consider specific recommendations to increase public awareness of the link between alcohol and cancer risk in this group,” said Dr. Inan-Eroglu, as per EurekAlert.
From a cancer-prevention standpoint, the safest level of alcohol consumption is total avoidance.”
Dr. Elif Inan-Eroglu, University of Sydney, Australia

This study was presented at the European Congress on Obesity (ECO). All accepted abstracts have been extensively peer-reviewed by the congress selection committee.

But the full paper is not yet available at this stage. The research has been submitted to a medical journal for publication.

Better alcohol policies needed to protect UK citizens

Civil society organizations such as the Alcohol Health Alliance UK and the Institute of Alcohol Studies have been calling on the UK government for years to take action to better protect people from the harm caused by the products and practices of the alcohol industry. Proposed solutions include:

Implementing a minimum unit price on alcohol products, such as in Scotland and Wales.
Comprehensive regulations on alcohol marketing.
Reducing the availability of alcohol products.
Improved government-mandated labeling on alcohol products which displays the UK low-risk alcohol use guidelines, caloric, and other information.

Alcohol is responsible for 46 new cancer cases every day in the UK,” said Professor Sir Ian Gilmore, chairman of the Alcohol Health Alliance UK, as per the Daily Mail.
This latest research is yet another reminder of the damage that alcohol can do to our health, and particularly underlines the combined cancer risk of obesity and calorie-rich alcohol.
It also highlights the urgent need for the government to ensure policies that reduce alcohol consumption are part of the wider Obesity Strategy.
We owe it to our nation’s health to introduce a minimum unit price for alcohol and comprehensive restrictions on alcohol marketing and availability.”
Professor Sir Ian Gilmore, chairman, Alcohol Health Alliance UK