Letter: Optimising public health policies to combat alcohol-associated liver disease in youth—Addressing key methodological and regional challenges

Abstract

We read with great interest the article by Danpanichkul et al. titled ‘Global Epidemiology of Alcohol-Associated Liver Disease in Adolescents and Young Adults’.¹ The study offers valuable insights into the global burden of alcohol-associated liver disease (ALD) among young populations. However, several limitations deserve further discussion.

First, the study relies heavily on the global burden of disease (GBD) data set. While comprehensive, the GBD data set may not fully capture regional differences in alcohol consumption patterns and liver disease prevalence, especially in low- and middle-income countries.² Cultural and religious factors often lead to underreporting of alcohol consumption in these areas, potentially resulting in an underestimation of ALD prevalence.³ Future research could enhance data accuracy by integrating local epidemiological data or conducting targeted surveys that consider these contextual factors.

Second, although the Joinpoint regression analysis provides valuable insights into temporal trends, it does not account for potential confounders such as access to healthcare, socioeconomic changes and regional differences in alcohol policy enforcement.⁴ These factors could significantly influence ALD prevalence and mortality rates. Future studies should incorporate multivariate regression models to adjust for these confounders, enabling a more accurate identification of the key drivers behind ALD trends.

Moreover, with the global rise in obesity and metabolic syndrome, particularly among young people, it is crucial to investigate how metabolic dysfunction-associated steatotic liver disease might exacerbate ALD.⁵ The increasing prevalence of obesity-related metabolic disorders could further complicate ALD progression.⁶ Thus, future research should stratify data by metabolic risk factors to better understand their role in ALD development.

Lastly, while the authors emphasise the importance of public health policies aimed at reducing alcohol consumption, they do not thoroughly analyse the effectiveness of these policies across different regions. Given the variability in alcohol consumption patterns and healthcare infrastructure, policy outcomes can vary significantly.⁷ Region-specific interventions should be developed to address these differences.

In regions such as Europe and the Americas, where alcohol consumption is high, existing policies should be strengthened by increasing taxes on alcohol, restricting sales channels and promoting public education to reduce alcohol dependence.⁸ Additionally, policymakers should consider cultural attitudes towards alcohol and work to foster a healthier drinking culture. Innovative interventions are necessary in Africa and the Eastern Mediterranean, where traditional taxation and legislation often struggle to regulate alcohol consumption in the informal economy.⁹ Collaborating with local communities and religious leaders to raise awareness of alcohol-related harms, along with strengthening local healthcare services, particularly in early diagnosis and treatment, is essential. In regions with weaker infrastructure, such as Southeast Asia, policies should prioritise the development of community-based alcohol cessation support programmes and leverage mobile health technologies to provide remote medical services, addressing gaps in healthcare resources.⁷

In conclusion, the study by Danpanichkul et al. highlights the significant increase in ALD burden among adolescents and young adults, presenting a major public health challenge that requires urgent attention. We strongly urge policymakers and health organisations to take immediate action by implementing targeted interventions to mitigate the long-term health impacts of alcohol consumption on younger generations.

Rui Zhang: Methodology; formal analysis; writing – original draft. Hua Wei: Methodology; writing – original draft. Ming Liu: Conceptualization; methodology; supervision; writing – review and editing.

No fundings were received for this research.

The authors declare no conflicts of interest that pertain to this work.

This article is linked to Danpanichkul et al papers. To view these articles, visit https://doi.org/10.1111/apt.18101 and https://doi.org/10.1111/apt.18250