Recent trends in the epidemiology of alcoholic liver disease

Abstract

Alcohol has been the most frequently abused drug for centuries, but it was not until the 1960s that it was recognized as a direct hepatotoxin. 1 Chronic excessive use of alcohol can lead to fatty liver, alcoholic hepatitis, alcoholic cirrhosis, and liver cancer. Whereas fatty liver is a reversible process upon cessation of drinking alcohol, other pathologies are usually progressive despite abstinence. In the United States, approximately 60% of people in the general population report some drinking of alcohol with approximately 8% to 10% reporting heavy drinking (two or more drinks per day) where one drink is equivalent to 12 ounces of beer (4%-5% wt/vol), 6 ounces of wine (8%-10% wt/vol), and 2 ounces of hard liquor or whiskey (45% wt/vol). 2 Alcohol remains the second most common cause of liver cirrhosis after hepatitis C virus (HCV) infection in the United States, contributing to approximately 20% to 25% cases of liver cirrhosis and about half of all admissions among patients with cirrhosis. Of the various factors responsible for liver disease, duration and amount of drinking alcohol is the most important factor. Pooled data from many epidemiological studies show a minimum intake of 30 g/day of alcohol in women and 50 g/day in men consumed over at least 5 years to cause liver cirrhosis. 3 Prevalence and mortality rates from cirrhosis parallel alcohol consumption prevalence rates in the population globally. Within Europe, which has the highest rate of consumption per capita in the implementation of policies on alcohol sale has resulted in changing epidemiology in different parts of Europe. Alcohol consumption rates have decreased in southern Europe, whereas they have increased in eastern Europe and some areas of northern Europe (including Ireland and the United Kingdom). 4 Because only 10% to 15% of people engaged in heavy drinking develop liver cirrhosis, other factors such as host factors and comorbidities are clearly important (Fig. 1). Women are more prone to the hepatotoxic effect of alcohol compared with men and are prone to develop liver cirrhosis at a lower amount of alcohol consumption. Type of alcohol consumed, binge drinking (five or more drinks at one time), drinking on an empty stomach, and participation in alcohol rehabilitation programs such as Alcoholic Anonymous are some of the other factors. Alcohol use and concomitant HCV infection act synergistically to cause more frequent and faster progression of fibrosis. 5 With the epidemic of obesity in the United States, prevalence rates of metabolic syndrome and visceral adiposity are increasing among alcoholics contributing to more prevalent and severe liver disease. 6 Alcohol remains the third most common preventable cause of death after smoking and hypertension. Alcohol-related mortality affects young and middle-aged population with loss of productive life years. Liver-related mortality from alcohol contributes to 4% of mortality and 5% of disability adjusted life years (DALY) globally, with highest impact in Europe, where these same figures are 7% ...

Diagnosis and Treatment of Alcoholic Hepatitis: A Systematic Review

“…(Keshavarzian et al, 2009, Mutlu et al, 2012, McClain and Cohen, 1989) Patatin-like phospholipase protein (PNPLA3) polymorphisms, Caucasian race, and female gender may increase susceptibility to AH. (Singal, 2013, Salameh et al, 2015) Individual susceptibility to alcohol induced damage may also be driven by differences in the composition and metabolites of intestinal microbiota. (Llopis et al, 2015) The cytokine load consists of pro-inflammatory cytokines of the interleukin-1 family mediating inflammasome formation and anti-inflammatory cytokines of interluekin-10 family.…”

“…(Altamirano et al, 2014, Michelena et al, 2015) Genetic polymorphisms, female gender, ethnicity, obesity, concomitant hepatitis C infection and binge drinking modify the AH risk among individuals with heavy alcohol use. (Singal, 2013, Singal et al, 2012b, Salameh et al, 2015) As of 2010, there were 326, 403 annual admissions in the US with a discharge diagnosis of AH. This contributes to 0.83% of all hospitalizations within the US and is associated with high mortality, morbidity, economic burden, and use of hospital resources.…”

How to prevent alcoholic liver disease

“…About 50% of all admissions among patients with cirrhosis have ALD (Singal and Anand, 2013). Now that HCV treatment is at least 99% successful (4) (Manns et al, 2013), alcohol abuse will become the most common cause of cirrhosis.…”

“…Liver-related disease from alcohol abuse adds 4% death and 5% disability adjusted life years globally (Singal and Anand, 2013). It has been estimated that in 2010 alone, alcohol-related cirrhosis accounted for 47.9% of all cirrhosis deaths and 46.9% of all cirrhosis disability adjusted life years (Wang et al, 2014).…”

Immunity and inflammatory signaling in alcoholic liver disease

“…Alcohol is the most commonly abused drug and the second most common cause of liver disease to HCV infection, contributing to 20–25 % of the total cases in the US [1]. Alcoholic liver disease (ALD) is characterized by a spectrum of pathological conditions such as fatty liver disease or steatosis and steatohepatitis, which can progress to fibrosis, cirrhosis and hepatocellular carcinoma.…”