Liver Disease

Causes and Risk Factors

Causes for liver disease include the following:

• Alcoholism
• Autoimmune diseases (e.g., autoimmune hepatitis)
• Bile duct disorders (e.g., primary biliary cirrhosis, primary sclerosing cholangitis)
• Exposure to toxins through ingestion, inhalation, or skin absorption (e.g., toxic hepatitis)
• Hereditary conditions (e.g., Wilson's disease, hemochromatosis, galactosemia, Alagille syndrome, alpha-1 antitrypsin (AAT) deficiency, type 1 glycogen storage disease)
• Obesity (may cause non-alcoholic fatty liver disease [NAFLD] and non-alcoholic steatohepatitis [NASH])
• Severe reactions to certain prescription or over-the-counter (OTC) medications
• Viruses (primarily hepatitis A [HAV], hepatitis B [HBV], or hepatitis C [HCV])

Obesity/overweight increases the risk for liver disease. Obesity often results in the accumulation of fat cells in the liver. Acids that are secreted by these fat cells (called fatty acids) can cause a reaction in the body that destroys healthy liver cells and results in scarring (sclerosis) and liver damage.

The risk for developing liver disease varies, depending on the underlying cause and the particular condition. General risk factors for liver disease include alcoholism, exposure to industrial toxins, heredity (genetics), and long-term use of certain medications.

Age and gender also are risk factors for liver disease. These factors vary, depending on the particular type of disease. For example, women between the ages of 35 and 60 have the highest risk for primary biliary cirrhosis and men aged 30-40 are at higher risk for primary sclerosing cholangitis.

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The following factors increase the risk for viral hepatitis:
Hepatitis A (HAV)

• Working or traveling to places with high rates of hepatitis A infection:
• Africa
• South America
• Central America (including Mexico)
• Southeast Asia
• Caribbean
• Eastern Europe
• Middle East
• Using illegal drugs
• Receiving blood products (e.g., to treat hemophilia)
• Engaging in high risk sexual behavior (e.g., resulting in contact with fecal matter)

Hepatitis B (HBV)

• Working or traveling to places with high rates of hepatitis B infection:
• Africa (sub-Saharan)
• Southeast Asia
• South America (Amazon Basin)
• Pacific Islands
• Middle East
• Having unprotected sex with more than one partner or with an infected partner
• Having a sexually transmitted disease (STD)
• Using IV (injected) drugs
• Living with an infected person
• Having end-stage kidney disease and receiving hemodialysis treatments
• Living in a correctional facility in the United States (mainly young adults and adolescents)
• Being exposed to human blood at work (e.g., health care workers)
• Having received blood products before 1972

Hepatitis C (HCV)

• Using IV (injected) or intranasal (snorted) drugs
• Receiving a blood transfusion or organ transplant before 1992, or clotting factor before 1987
• Working in a setting where you are exposed to human blood
• Having end-stage kidney disease and receiving hemodialysis treatments
• Being born to an HCV infected mother

The following factors can increase the risk for non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH):

• Being overweight or obese
• Having high cholesterol and high triglyceride levels in the blood
• Having diabetes
• Undergoing abdominal surgery that results in rapid weight loss (e.g., small bowel resection, gastric bypass, jejunal bypass)
• Long-term use of certain medications (e.g., corticosteroids [prednisone, hydrocortisone], synthetic estrogens for symptoms of menopause [Premarin®, Ortho-Est], amiodarone for heart arrhythmias [Cordarone®, Pacerone®], antiestrogen medication for breast cancer [Tamoxifen], immune suppressants for rheumatoid arthritis [Rheumatrex®, Trexall®])

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