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