The factors determining why fewer than 10% of heavy drinkers develop advanced alcoholic liver disease remain largely unknown. There is a weak relationship between disease risk and the dose and pattern of alcohol consumed. The risk of all stages of alcoholic liver disease is increased by obesity, probably reflecting the role of steatosis in the pathogenesis of more advanced disease.Compared with men, women develop disease at a lower intake due in part to their lower volume of distribution for alcohol, but also potentially to increased gut permeability to entotoxin. Recent studies suggest a non-gender-linked genetic component to disease susceptibility and recent case-control studies have suggested that polymorphisms of genes encoding cytokines and other immuno-regulatory molecules may exert a significant effect. The pattern of polymorphins associated with risk suggests that antibody-mediated mechanisms play a role in disease pathogenesis. This has implications for treatment and for identifying high risk individuals at an early age.

Source.Day CP. Who gets alcoholic liver disease:nature or nurture? Ctr Liver Res, FI 4 William Leech Bldg, The Med Sch, Framlington PL, Newcastle upon Tyne NE2 4HH, UK. J R Coll Physicians Lond 2000: 34:557-62