The role of alcohol use in the aetiology and progression of liver disease: A narrative review and a quantification

Abstract

Issues Alcohol use has been shown to impact on various forms of liver disease, not restricted to alcoholic liver disease. Approach We developed a conceptual framework based on a narrative review of the literature to identify causal associations between alcohol use and various forms of liver disease including the complex interactions of alcohol with other major risk factors. Based on this framework, we estimate the identified relations for 2017 for the USA. Key Findings The following pathways were identified and modelled for the USA for the year 2017. Alcohol use caused 35 200 (95% uncertainty interval 32 800–37 800) incident cases of alcoholic liver cirrhosis. There were 1700 (uncertainty interval 1100–2500) acute hepatitis B and C virus (HBV and HCV) infections attributable to heavy‐drinking occasions, and 14 000 (uncertainty interval 5900–19 500) chronic HBV and 1700 (uncertainty interval 700–2400) chronic HCV infections due to heavy alcohol use interfering with spontaneous clearance. Alcohol use and its interactions with other risk factors (HBV, HCV, obesity) led to 54 500 (uncertainty interval 50 900–58 400) new cases of liver cirrhosis. In addition, alcohol use caused 6600 (uncertainty interval 4200–9300) liver cancer deaths and 40 700 (uncertainty interval 36 600–44 600) liver cirrhosis deaths. Implications Alcohol use causes a substantial number of incident cases and deaths from chronic liver disease, often in interaction with other risk factors. Conclusion This additional disease burden is not reflected in the current alcoholic liver disease categories. Clinical work and prevention policies need to take this into consideration.

The Global Impact of Alcohol Consumption on Premature Mortality and Health in 2016

“…The burden of disease due to liver cirrhosis was high in all HDI categories and in most GBD regions. The burden of alcoholic liver cirrhosis is affected by multiple risk factors which interact with alcohol, including hepatitis B and C infections, obesity, and socio-economic status [24]. The burden of alcoholrelated injuries is problematic as investment in preventing mortality from injury has fallen behind other causes of death, such as HIV/AIDS and reproductive health [21].…”

“…Per capita consumption of alcohol is utilized to estimate the volume of alcohol use among drinkers to avoid bias; however, no correction exists for the prevalence of HED. This study did not fully account for the interaction between alcohol use and other risk factors, such as smoking (increased risk of cancer [28]), hepatitis B and C (increased risk of liver cirrhosis [29]), and obesity (increased risk of liver cirrhosis [24,30]). Furthermore, the study did not account for the differential alcohol RRs by socio-economic status.…”

The space between research and action: Commentary on ‘The role of alcohol use in the aetiology and progression of liver disease: A narrative review and a quantification’

“…This publication, however, raises some theoretical problems. One concerns the authors' claim that 'the causal impact of alcohol use is not disputed' [5], a claim that questions the relationship between causal link and probability. Epistemological advances in the last decades have moved us beyond exclusive focus on the relation between cause and effect to consider the importance of causal series-that more causes contribute to an effect-of causality as a connection, and of the probability of causation [6].…”

“…The assumption that the consumption of alcoholic beverages in 'non-significant' or 'non-excessive' amounts (<20-30 g day À1 ) has no pathogenic effects on the liver is replaced by the authors' claim that any quantity of 'alcohol use plays a role in all types of liver disease… even in so-called non-alcoholic liver disease' [5]. On this basis, it can be argued that the clinical category 'non-alcoholic liver disease' is ambiguous, and hepatologists should no longer diagnose non-alcoholic fatty liver disease among people who consume any level of alcoholic beverages, since any drinking can cause any kind of liver damage.…”

“…Here we focus on both the risk of harm related to alcohol consumption, the main focus of this paper, and on alcohol policy implemented to prevent harm. Among alcohol policy measures the authors mention 'brief interventions' and 'alcohol therapy', while 'overall population health effects in reducing alcoholattributable liver disease could best be achieved by alcohol-control policies using the so-called "best buys" of the World Health Organization: increases in alcohol taxation, limitations on the availability of alcohol and a ban on its marketing and advertisement' [5].…”