A new study has found that drinking alcohol more than doubles the risk of severe liver damage for individuals with a large belly or diabetes, while those with high blood pressure who consume alcohol nearly double their risk.
A Dangerous Combination
The study highlights the serious impact of alcohol consumption when combined with certain cardiometabolic risk factors. According to Dr. Andrew Freeman, director of cardiovascular prevention and wellness at National Jewish Health in Denver, alcohol consumption—particularly alongside unhealthy foods—can accelerate liver damage.
“People are going to do exactly what they shouldn’t do and poison themselves,” Freeman said. “Particularly during big [sports events], people will eat things like hot dogs, sausage, bacon, pepperoni, and ham—processed meats that are in the same category as cigarettes for cancer risk.”
The combination of highly processed, high-fat, and high-sugar foods with alcohol consumption can lead to insulin resistance, excess blood sugar, and fatty liver disease, Freeman explained. “Then if you’re drinking on top of it, it just amplifies the risk.”
The Link Between Obesity, Diabetes, and Liver Disease
A waist size of 35 inches or more for women and 40 inches or more for men—often associated with obesity—is a key indicator of cardiometabolic risk. Other factors include high blood sugar and elevated blood pressure, which are increasingly common health concerns in the U.S.
According to the Centers for Disease Control and Prevention (CDC):
- Nearly half of all Americans have high blood pressure.
- More than 1 in 3 have prediabetes.
- About 40% of the population is considered obese.
These conditions contribute to fat accumulation in the liver, which can lead to fibrosis (scarring). “Most people don’t realize this, but before one develops diabetes, they typically first develop fatty liver,” Freeman said. “It has to do with sugar dysregulation—when you have high blood sugars, your liver is storing fat to get rid of some of that sugar, and it’s that excess fat that impairs liver function.”
Alcohol’s Role in Liver Damage
While excessive alcohol consumption is already known to damage liver cells, the study found that preexisting health issues make the liver even more vulnerable.
Dr. Brian Lee, lead author of the study and an associate professor at the University of Southern California’s Keck School of Medicine, explained that alcohol consumption increases liver fat buildup, leading to inflammation and scarring. Over time, this can progress to cirrhosis, increasing the risk of liver failure and liver cancer.
“The results identify a very high-risk segment of the population prone to liver disease and suggest that preexisting health issues may have a large impact on how alcohol affects the liver,” Lee said.
Health Risks for All Drinkers
While the study emphasizes the heightened risk for individuals with obesity, diabetes, or high blood pressure, Lee cautioned that even those without these conditions are not immune to liver damage from heavy drinking.
“We know that alcohol is toxic to the liver, and all heavy drinkers are at risk for advanced liver disease,” Lee said.
Given the increasing prevalence of obesity and metabolic disorders, experts warn that alcohol consumption could further exacerbate the public health crisis of liver disease. Reducing alcohol intake, maintaining a balanced diet, and managing weight and blood sugar levels are key steps to protecting liver health