Other Infections

EASL 2015: Heavy Drinkers Contribute Most to Liver Cirrhosis Burden; Heavy Alcohol Use Rising in U.S.

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The number of people who regularly consume more than a moderate amount of alcohol is a better indicator of alcoholic cirrhosis prevalence than per capita annual consumption, or the total amount consumed per year divided by the entire population, according to a presentation at the European Association for the Study of the Liver (EASL) 50th International Liver Congress last month in Vienna. A related study found that heavy drinking and binge drinking have risen over the past decade in the U.S., largely due to increases among women.

Over years or decades ongoing injury to the liver can lead to cirrhosis (scarring), liver cancer, and end-stage liver failure. Such injury is often caused by chronic viral hepatitis -- and hepatitis B and C are major causes of advanced liver disease in the U.S. and worldwide -- but the World Health Organization (WHO) estimates half of liver cirrhosis cases are related to alcohol consumption.

Drinking and Cirrhosis

Eva Stein from the University of North Carolina at Chapel Hill and colleagues looked at the relationship between daily alcohol consumption and alcoholic cirrhosis across countries. They analyzed data from the WHO Global Status Report on Alcohol and Health, which includes parameters on alcohol consumption and drinking patterns from nearly 200 countries.

Most studies assessing excessive alcohol use as a risk factor for cirrhosis focus on total annual per capita consumption, they noted as background. But clinical studies indicate that high daily consumption is the strongest predictor of alcoholic cirrhosis. Therefore, they hypothesized that areas with the highest daily alcohol use would have a greater burden of cirrhosis.

The researchers categorized countries by heavy or moderate drinking, based on average daily consumption among drinkers using the U.S. Dietary Guidelines threshold. The guidelines define "moderate" alcohol consumption as up to 1 drink per day for women and up to 2 drinks per day for men. "Heavy" or "high-risk" drinking is consumption of more than 3 drinks per day or more than 7 per week for women and more than 4 drinks per day or more than 14 per week for men. "Binge drinking" is consumption of 4 or more drinks for women and 5 or more drinks for men within 2 hours.

They also analyzed other liver disease risk factors, including hepatitis B and C rates using data from published seroprevalence estimates and obesity data from the WHO Data Repository.

After adjusting for cirrhosis cofactors, the classification of countries by moderate or heavy daily drinking had the strongest influence on the contribution of alcohol to the burden of cirrhosis. The cirrhosis burden due to alcohol increased by 11% as countries transitioned from the moderate to heavy classification. Total yearly per capita consumption had a significantly smaller impact on cirrhosis burden. However, drinking patterns -- such as heavy episodic or binge drinking and the type of alcoholic beverages consumed (wine, beer, or spirits) -- were not independently associated with the alcohol-attributable fraction of cirrhosis.

"The presence of heavy daily drinkers in a population most significantly and independently influences the weight of alcohol in a country’s cirrhosis burden," the researchers concluded. "Reducing heavy drinking should therefore be considered as an important target for public health monitoring and policies."

A related French study presented at the conference found that people with hepatitis C had a much greater risk of liver-related hospitalization or death if they had a diagnosis of problematic drinking, and people in the general population also had worse prognosis if they had an alcohol use disorder. 

Drinking Patterns in the U.S.

In another recent alcohol study, Laura Dwyer-Lindgren and colleagues with the Institute for Health Metrics and Evaluation at the University of Washington in Seattle estimated the prevalence of any drinking and binge drinking during 2002-2012, and of heavy drinking during 2005-2012, in every county in the U.S. using Behavioral Risk Factor Surveillance System data.

As described in the April 23 online edition of the American Journal of Public Health and presented at the Association of Health Care Journalists conference, the researchers found large differences between counties in all measures of alcohol consumption. In 2012, the proportion of people who drank any amount of alcohol ranged from 11% to 79%, the proportion of heavy drinkers ranged from 2% to 22%, and the proportion of binge drinkers ranged from 6% to 36%. There was also wide variation in the proportion of all drinkers who engaged in heavy or binge drinking.

While the proportion of people who drank alcohol overall remained stable (56% in both 2005 and 2012), the prevalence of heavy drinking increased by 17% and binge drinking by 9% between 2005 and 2012 -- large attributable to a steep rise among women. In 2012, about 8% of all Americans were considered heavy drinkers and 18% were binge drinkers.

While some regional differences in alcohol consumption were apparent -- notably lower prevalence of drinking in southern states and Utah -- the largest disparities were seen between different counties within the same state, highlighting the need for locally focused alcohol policies and programs.

"There are large differences within the United States in levels and recent trends in alcohol use," the study authors concluded. "These estimates should be used as an aid in designing and implementing targeted interventions and to monitor progress toward reducing the burden of excessive alcohol use."

5/12/15

References

R Bataller, E Stein, JT Altamirano, et al. A Worldwide Study Reveals that the Amount of Daily Alcohol Intake is a Better Predictor of the Weight of Alcohol in the Cirrhosis Burden than the Total
Per Capita Consumption. 2015 International Liver Congress: 50th Annual Meeting of the European Association for the Study of the Liver (EASL). Vienna, April 22-26, 2015. Abstract O127.

M Schwarzinger, S Thiébaut, V Mallet, and J Rehm. The confounding role of severe comorbidities and alcohol use disorders on prognosis in chronic hepatitis C virus infection: an analysis of the 2008-2012 French national hospital discharge database. 2015 International Liver Congress: 50th Annual Meeting of the European Association for the Study of the Liver (EASL). Vienna, April 22-26, 2015. Abstract G16.

L Dwyer-Lindgren, AD Flaxman, M Ng, et al. Drinking Patterns in US Counties From 2002 to 2012. American Journal of Public Health. April 23, 2015 (Epub ahead of print).

Other Sources

EASL. Drinking just one or two alcoholic drinks a day linked to liver disease. Press release. April 25, 2015.

Institute for Health Metrics and Evaluation. Heavy drinking and binge drinking rise sharply in US counties.Press release. April 23, 2015.

 

Institute for Health Metrics and Evaluation. Heavy drinking and binge drinking rise sharply in US counties. Press release. April 23, 2015.