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Liver disease is less prevalent  than cancer and cardiovascular diseases as cause of death in heavy drinkers

A study was undertaken by Professor Nick Sheron et al in response to the Chief Medical officers assumption in 2001, that as underlying patterns of alcohol consumption were not increasing, it must be pattern of consumption - or an increase in binge drinking that was affecting levels of alcohol related liver disease in the UK. The study therefore sought to detect an increase of episodic drinkers with alcohol-related cirrhosis, but with one exception all the patients with severe alcohol-related liver problems were daily or very frequent drinkers, with a median weekly alcohol intake of 84 units— only one-quarter were drinking 40 units or fewer at the time of the study.The study looked at the drinking patterns of those admitted to Southampton Hospital with liver disease over a six-month period and found that heavy daily drinkers, who may not be obviously dependent, not episodic binge drinkers, are more likely to present to the hospital with Alcohol liver disease (ALD). The average amongst all the 234 subjects (133 males and 101 females, with a median age of 51 and 55 years), was over 30 units of 8g a week - higher than government guidelines. The average consumption for women in the UK is just 7.7 units a week and 18 units for men. Just 6% of women are estimated to drink more than 26 units a week and 13% of men over 35 units (source: Office of National statistics report for the NHS: Drinking: adults’ behaviour and knowledge in 2008).
Approximately half - 106 subjects of the 234 subjects (76 men and 30 women) had alcohol as a major contributory factor to their liver disease ((ALD patients)—these individuals were either drinking more than 30 units/week or had a strong history of heavy alcohol consumption); of these subjects, 28 had at least one specific additional risk factor for liver disease—20 had positive viral serology, three autoimmune serology, two metabolic disease and three others. Of the remaining 128 subjects (non-ALD patients), 36 had non-alcohol-related fatty liver disease, 23 viral hepatitis, 23 autoimmune or metabolic liver disease, 16 cancers, seven cryptogenic cirrhosis and 23 others. Of the ALD subjects, 58 were in-patients (55%) and 80 (75%) had evidence of cirrhosis or progressive fibrosis. Of the non- ALD subjects, 29 (23%) were in-patients and 54 (42%) had cirrhosis or progressive fibrosis.
The authors state ‘Although the exact mechanisms of alcohol-related liver damage are not delineated fully, we know that alcohol is not acutely toxic to the liver. In general, the previous studies examining human drinking patterns and the development of liver disease have similar findings. In Australia, daily drinking subjects with alcohol dependency were shown to have an eightfold increase in cirrhosis compared with subjects who drink periodically. Danish studies found a twofold increase in cirrhosis morbidity in daily drinkers compared with intermittent drinkers’.
The study concludes that ‘data on levels of alcohol dependency essentially confirms the findings of a previous study from our unit and those of an earlier study from the King’s Liver Unit that only a minority of patients with cirrhosis or progressive cirrhosis have evidence of severe alcohol dependency —they are controlled heavy drinkers. By the time a patient presents to hospital with liver disease it is often too late. The mortality of alcohol-related cirrhosis is around one-quarter in the first few months, and these people never gain the chance to modify their drinking. The link between heavy daily or near-daily drinking and the development of liver disease is important’.
Lead author of the study Dr Nick Sheron, consultant hepatologist and senior lecturer at the University of Southampton, commented “The transition from a late teenage and early 20’s binge drinking pattern to a more frequent pattern of increased intake may prove to be a useful point of intervention in the future, and the importance of alcohol-free days each week should receive more prominence.”
It should be emphasised that patients suffering from alcoholic liver disease were not daily, moderate drinkers, but heavy daily drinkers, those with alcoholic liver disease averaged 80 units a week.

Source: Hatton J, Burton A, Nash H, Munn E, Burgoyne L, Sheron N. Drinking patterns, dependency and life-time drinking history in alcohol-related liver disease. Addiction, 2009; 104 (4): 587 DOI: 10.1111/j.1360-0443.2008.02493.x

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