barcelona . spain - European Association for the Study of the Liver

BARCELONA . SPAIN
APRIL 18 - 19/2012 THE INTERNATIONAL LIVER CONGRESS TM 2012
11
INCREASING BURDEN OF ALCOHOLIC LIVER DISEASE IN EUROPE
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Helena Cortez-Pinto
Lisbon, Portugal
E-mail: hlcortezpinto@netcabo.pt
KEY POINTS
• Alcohol is the main cause of liver disease in Europe. The prevalence of alcoholic disease is
increasing mostly in Eastern countries but also in some Western countries such as United
Kingdom, Ireland and Finland.
• Alcoholic liver disease is partially preventable through policies that reduce alcohol consumption,
since a good correlation between alcohol consumption and cirrhosis mortality has been
demonstrated. Policies that reduce the availability of alcohol either though pricing increase or
reducing hours of sale, have shown to be the more effective.
• Binge drinking is increasing and more data is needed on its impact on liver disease.
INTRODUCTION
Alcoholic liver disease (ALD) is the main cause of liver-related mortality in Europe. However, viral- and
other liver diseases have attracted much more attention in what concerns investigation in the past decades.
This is very well illustrated by the Death-To-Trials ratio score (ETOh), that is the ratio of estimated deaths
attributed to a disease to the number of trials focused on that disease. Alcoholic liver disease has a very
high score when compared for example with hepatitis C virus, 358 vs 4.8, thus demonstrating that there
is a lack of studies performed on ALD. Among the causes for the relative low interest for ALD, may be
the fact that other liver diseases have more potential to be treated, or that alcoholic liver disease affects
individuals that are poorer or less influential in Society. However, recent years have witnessed advances
in the pathogenesis and treatment of ALD. Furthermore, a remarkable increase in the frequency of alcohol
consumption, and consequently of ALD has been demonstrated mostly in Europe, and particularly in
Eastern European countries. On the other hand, it is likely that in short-term, viral-related diseases are
going to become much less important. Consequently, it is foreseeable that metabolic and alcoholic liver
disease will become the main focus of research in liver disease.
EFFECT OF ALCOHOL CONSUMPTION ON MORBIDITY AND MORTALITY
Alcohol consumption accounts for 3.8% of global mortality and 4.6% of DALYs, that are the sum of life years
lost due to premature death or years lived in disability, according to the World Health Organization (WHO).
If Europe alone is considered, these numbers are higher, with 6.5% of all deaths and 11.6% of DALY’s
(Figure 1 and 2). It is of note that males are predominantly affected, with 17.3% of male and 4.4% of female
DALY’s in Europe, after accounting for health benefits. Also young people share a disproportionate amount
of the burden of disease, with alcohol being responsible for over 10% and 25% of female and male youth
mortality, respectively. Altogether, alcohol consumption ranks third as a cause of premature death and
disability in the European Union (EU), just after tobacco smoking and high blood pressure (1).
Indeed, liver disease represents 9.5% of alcohol-related DALY’s worldwide, although these rates may vary
according to different countries and areas of the world (2). For instance in Portugal, liver-related DALY’s
accounted for 31.5% of all alcohol-related DALY´s.
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