Liver‐related mortality in countries of the developed world: an ecological study approach to explain the variability

Abstract

Hepatitis B infection, alcohol consumption and GDP, but not hepatitis C or other factors, explain most of the variance of liver-related mortality.

Editorial: the burden of chronic liver disease – an ecological method sees the wood for the trees

“…2 Von Wulffen and colleagues present a 'big picture' of the burden in Western countries by correlating population statistics on liver deaths with prevalence of common risk factors of chronic liver disease, including hepatitis B and C, alcohol intake per capita, metabolic syndrome and other comorbidities and environmental factors. 3 Overall, liver deaths were associated with alcohol intake and hepatitis B but not with hepatitis C, human immunodeficiency virus (HIV), and the metabolic syndrome. Although some information on the competing risk of dying before liver disease progression is missing, the study underlines how liver disease progression models, including hepatitis C, may be complex and interlaced.…”

“…Indeed, several cohort studies in hepatitis C infected individuals demonstrated that in the absence of risk factors (such as alcohol consumption), progression to severe liver disease may take decades or may not occur at all in the vast majority of patients. 3,4 One problem for a substantial group of patients with chronic hepatitis C is impaired quality of life (QoL). 5 Patients with advanced fibrosis have impairment in quality of life.…”

Editorial: the burden of chronic liver disease – an ecological method sees the wood for the trees. Authors’ reply

“…2 Several nutraceuticals have been investigated in NASH; well known among these is the association between coffee consumption and fibrosis reduction in NASH. 3 Poly-unsaturated fatty acids, and polyphenols such as silymarin, curcumin and resveratrol have been studied in pre-clinical models and small-scale trials demonstrating reduction in markers of liver injury, inflammation, apoptosis and oxidation.…”

“…8 Therefore, inhibition of ROS signalling presents an attractive therapeutic opportunity. 2 In this single blind, cross-over trial, 19 NASH subjects and 19 age, gender and body mass index matched controls were randomised to 20 g dark chocolate or milk chocolate twice a day for 2 weeks, with a 1 week washout period in between. By self-monitoring, caloric intake was identical among subjects, and adjusted for chocolate-derived energy.…”

“…1 While our study revealed a strong association between hepatitis B and alcohol intake with mortality from chronic liver disease, it is remarkable that no association between hepatitis C and liver-related mortality occurred. 2 Our study was not designed to address aspects of hepatitis C treatment. Nevertheless, Dr Madden and Dr Mallet point out that cost-effectiveness in treatment of hepatitis C is largely dependent on co-morbidities and patient selection.…”