Rates of cirrhosis are increasing, particularly among young adults and women, and an epidemic of non-alcoholic fatty liver disease (NAFLD) is one possible reason, say researchers from Canada.

Traditionally, cirrhosis has been considered a disease of older men, but the face of cirrhosis is changing, Dr. Jennifer Flemming from Queen’s University, in Kingston, Canada, told Reuters Health by phone.

“This is likely either related to alcohol or non-alcohol-related fatty liver disease,” she explained. Non-alcoholic fatty liver disease has been on the rise over the past two decades.

“Alcohol use patterns in young individuals and women have also changed over the past several decades such that women are drinking pretty much the same amount as men and women are predisposed to alcohol-related liver disease at much lower levels of alcohol than are men. My thought is that women are kind of catching up to the same risk factors that men have had, in addition to now having this epidemic of non-alcohol-related fatty liver disease,” said Dr. Flemming.

She and her colleagues did a retrospective population-based study looking at cirrhosis incidence by age group. They identified nearly 166,000 people in Ontario with cirrhosis from 1997 to 2016.

New cases of cirrhosis nearly doubled in the province during the study period, from 6,318 new cases diagnosed in 1997 (3,979 males/2,339 females) to 12,047 in 2016 (7,061 males/4,986 females).

The risk of cirrhosis is 116% higher for millennials who were born in 1990 than for baby boomers born in 1951, the researchers report in The Lancet Gastroenterology & Hepatology, online December 17. For women, the risk is even higher. A woman born in 1990 was 160% more likely to be diagnosed with cirrhosis than a woman born in 1951.

Strategies to increase awareness of this “silent epidemic in young adults and women are needed,” the researchers note in their paper.

“Future studies able to define the cause and natural history of cirrhosis in these groups are essential to develop strategies that could reverse these trends for future generations,” they conclude.

Funding for the study was provided by the Southeastern Ontario Academic Medical Association and the American Association for the Study of Liver Disease (AASLD). Dr. Flemming has received grants from both organizations.