Drinking habits as cofactors of risk for alcohol induced liver damage

Abstract

Background-The Dionysos Study is a cohort study of the prevalence of chronic liver disease in the general population of two northern Italian communities. It included 6917 subjects, aged 12-65 (69% of the total population). Aims-The aim of this part of the study was to examine the relationship of daily alcohol intake, type of alcoholic beverage consumed, and drinking patterns to the presence of alcohol induced liver damage in an open population. Patients and methods-6534 subjects, free of virus related chronic liver disease and participating in the first cross-sectional part of the study, were fully examined. Each subject underwent: (a) medical history and physical examination, (b) evaluation of alcohol intake using an illustrated dietary questionnaire, and (c) routine blood tests. More invasive diagnostic procedures were performed when indicated. Results-Multivariate analysis showed that the risk threshold for developing either cirrhosis or non-cirrhotic liver damage (NCLD) was ingestion of more than 30 g alcohol per day in both sexes. Using this definition, 1349 individuals (21% of the population studied) were at risk. Of these, only 74 (5.5% of the individuals at risk) showed signs of liver damage. The prevalence of "pure" alcoholic cirrhosis was 0.43% (30 of 6917), representing 2.2% of the individuals at risk, with a ratio of men to women of 9:1, while 44 (3.3% of the individuals at risk) showed persistent signs of NCLD. After 50 years of age, the cumulative risk of developing both NCLD and cirrhosis was significantly higher (p<0.0001) for those individuals who regularly drank alcohol both with and without food than for those who drank only at mealtimes. Conclusions-Our data show that in an open population the risk threshold for developing cirrhosis and NCLD is 30 g ethanol/day, and this risk increases with increasing daily intake. Drinking alcohol outside mealtimes and drinking multiple diVerent alcoholic beverages both increase the risk of developing alcohol induced liver damage. (Gut 1997; 41: 845-850)

Southern Europe as an example of interaction between various environmental factors: a systematic review of the epidemiologic evidence

“…A recent cohort study among patients with alcoholic fatty liver in the UK found that those who drank >40 g/day of alcohol were at risk of developing cirrhosis (Teli et al, 1995). A cross-sectional population-based study in Italy found no increased risk of alcoholic liver disease below 30 g/day (Bellentani et al, 1997).…”

Prevalence of and risk factors for nonalcoholic fatty liver disease: The Dionysos nutrition and liver study

“…8 The first phase of the Dionysos Study provided important and novel information on the prevalence of CLD in a representative sample of apparently healthy subjects from the general population and allowed determination of the threshold of alcohol intake for liver damage. [8][9][10][11] Ten years later (2001)(2002), all of the residents of the same towns were invited by letter to participate in the second phase of the Dionysos study, aimed to define the incidence and natural history of CLD.…”

Mitochondrial dysfunction and oxidative stress in the pathogenesis of alcohol- and obesity-induced fatty liver diseases

“…In the case of alcohol induced liver injury there is a longstanding belief that the severity of disease is dependent on the cumulative dose and duration of alcohol consumption, with decades of heavy drinking needed to induce pathology. However, studies show that only about 25% of heavy drinkers develop steatohepatitis with less than 10% developing alcoholic cirrhosis [2,3]. Based on this, it has been suggested that exposure to environmental toxicants like cigarette smoke or the presence of pre-existing conditions like type 2 diabetes, obesity, hypercholesterolemia, and/or hyperglycemia; conditions linked to the cardiometabolic syndrome, could worsen liver disease in the chronic alcohol consumer.…”