Colder Weather and Fewer Sunlight Hours Increase Alcohol Consumption and Alcoholic Cirrhosis Worldwide

Abstract

Risk of alcoholic cirrhosis is determined by genetic and environmental factors. We aimed to investigate if climate has a causal effect on alcohol consumption and its weight on alcoholic cirrhosis. We collected extensive data from 193 sovereign countries as well as 50 states and 3,144 counties in the United States. Data sources included World Health Organization, World Meteorological Organization, and the Institute on Health Metrics and Evaluation. Climate parameters comprised Koppen-Geiger classification, average annual sunshine hours, and average annual temperature. Alcohol consumption data, pattern of drinking, health indicators, and alcohol-attributable fraction (AAF) of cirrhosis were obtained. The global cohort revealed an inverse correlation between mean average temperature and average annual sunshine hours with liters of annual alcohol consumption per capita (Spearman's rho −0.5 and −0.57, respectively). Moreover, the percentage of heavy episodic drinking and total drinkers among population inversely correlated with temperature −0.45 and −0.49 (P < 0.001) and sunshine hours −0.39 and −0. 57 (P < 0.001). Importantly, AAF was inversely correlated with temperature −0.45 (P < 0.001) and sunshine hours −0.6 (P < 0.001). At a global level, all included parameters in the univariable and multivariable analysis showed an association with liters of alcohol consumption and drinkers among population once adjusted by potential confounders. In the multivariate analysis, liters of alcohol consumption associated with AAF. In the United States, colder climates showed a positive correlation with the age-standardized prevalence of heavy and binge drinkers. Conclusion: These results suggest that colder climates may play a causal role on AAF mediated by alcohol consumption. (Hepatology

Letter to the Editor: mTOR‐Inhibitor‐Based Immunosuppression Following Liver Transplantation for Hereditary Hemorrhagic Telangiectasia

“…I read with interest regarding the influence of colder weather and fewer sunlight hours on the increase in alcohol consumption and alcoholic cirrhosis. (1) The study of a global cohort including 193 countries showed that colder climates may play a causal role on alcohol-attributable fraction (AAF) of cirrhosis mediated by alcohol consumption. Although it may hold true in many countries, the situation in Taiwan appears to be opposite to this conclusion.…”

“…We have read with interest the article by Dumortier et al reporting that patients with hereditary hemorrhagic telangiectasia (HHT) have a high radiological recurrence rate after liver transplantation (LT) with an estimated cumulative risk of 47.9% at 15 years, although clinical consequences in terms of symptomatic liver disease are unknown. (1) The immunosuppressant regimen used in these patients was based in calcineurin inhibitors (tacrolimus and ciclosporin) in addition to mycophenolate mofetil when necessary. The authors suggest the possible role of antiangiogenic medications, such as bevacizumab, as adjuvant therapy to LT when radiological recurrent disease appears.…”

“…However, this drug is expensive, is for intravenous use, has potential severe secondary effects, and has not been tested in patients with LT, and, as the authors comment, HHT vascular growth can recur after bevacizumab withdrawal. (1,2) In a recent study, using heterozygous activin receptorlike kinase 1 (ALK1) mouse retines and cultured endothelial cells, loss of ALK1 led to increased stalk cell proliferation as a result of overactivation of the phosphatidylinositol 3-kinase (PI3K) signaling pathway. In the same study, these results were also found using cutaneous telangiectasia biopsies from a small cohort of patients with HHT, in which an increase in endothelial cell proliferation linked to an increase on the PI3K pathway was detected.…”

“…The recently published article by Anstee et al (1) provides key insights into the complex etiopathogenesis of nonalcoholic steatohepatitis (NASH)-mediated advanced fibrosis. (2) STELLAR trials' baseline data strongly emphasized the predictive-value(s)/reliability of noninvasive tests (NITs) for bias-free, accurate…”

Don't Blame It on the Sunshine, Don't Blame It on the Moonlight, Don't Blame It on Good Times: Blame It on the Sociocultural Factors

“…In this issue of Hepatology , Ventura‐Cots et al present their study arguing that colder weather and fewer sunlight hours increase alcohol consumption and thus cause alcoholic cirrhosis . “Causality” is a key concept for this study.…”