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

BARCELONA . SPAIN
16 POSTGRADUATE COURSE SYLLABUS ALCOHOLIC LIVER DISEASE 17
APRIL 18 - 19/2012 THE INTERNATIONAL LIVER CONGRESS TM 2012
Figure 3
Mortality from liver cirrhosis among men in three groups of European countries (n=27), 2000-2005. Data
from WHO report 2010
Eur-A: 27 countries with very low child and adult mortality: Andorra, Austria, Belgium, Croatia, Cyprus, the
Czech Republic, Denmark, Finland, France, Germany, Greece, Iceland, Ireland, Israel, Italy, Luxembourg,
Malta, Monaco, the Netherlands, Norway, Portugal, San Marino, Slovenia, Spain, Sweden, Switzerland and
the United Kingdom.
ALCOHOLIC LIVER DISEASE IN EUROPE
Nick Sheron
Southampton, UK
E-mail: nick.sheron@soton.ac.uk
Eur-B: 17 countries with low child and adult mortality: Albania, Armenia, Azerbaijan, Bosnia and
Herzegovina, Bulgaria, Georgia,Kyrgyzstan, Montenegro, Poland, Romania, Serbia, Slovakia, Tajikistan,
the former Yugoslav Republic of Macedonia, Turkey, Turkmenistan andUzbekistan.
Eur-C: 9 countries with low child but high adult mortality: Belarus, Estonia, Hungary, Kazakhstan, Latvia,
Lithuania, Republic of Moldova, the Russian Federation and Ukrain
KEY POINTS
• Mortality from liver disease is directly proportional to population level alcohol consumption
within each country in the EU.
• There is a strong evidence base for effective policies which can reduce liver deaths by reducing
population level alcohol consumption.
• These effective and cost effective policies are based on the 4p’s of the marketing mix: price,
product, place of sale and promotion.
• The drinks industry are reliant on hazardous and harmful drinkers for around 75% of their
turnover in the UK, and by inference many other EU member states.
• As with tobacco, the EU liver community will need to be pro-active in countering the sophisticated
lobbying of the drinks industry if effective alcohol strategies are to be achieved.
INTRODUCTION
The European region is the heaviest drinking region in the world and the evidence detailing the burden of
ill health and the economic costs attributable to excessive consumption of alcohol is extensive. The World
Health Organisation recognises alcohol as the third leading risk factor for poor health in Europe(1), resulting
in 200,000 deaths each year with a cost to society of around €125 billion, or 1.3% of gross domestic
product(2).
Figure 4
Liver transplantion in Europe. Indications in cirrhosis. Data from European Liver Transplantation Registry
(ELTR) 2010
Different varieties of harm result from different patterns of drinking alcohol; acute intoxication causes people
to put themselves and others at risk and is implicated in sexual and other violence, suicide, accidental
death and trauma. Regular heavy drinking can lead to alcohol dependency and chronic ill health. Alcohol
is metabolised by the liver, and regular heavy intake causes progressive fibrosis, cirrhosis, liver failure
and death. Alcohol-related disease is the most common cause of cirrhosis, liver death rates are a reliable
indicator of the harm caused by regular heavy drinking and there is a strong relationship between liver
death rates (liver SDR) and overall alcohol consumption which becomes stronger as overall consumption
increases (Figure 1).
Over the last 30 years liver death rates in the EU have gradually declined in response to changing patterns
of alcohol intake. In 1970 the EU liver death rate was 13.25 and in 2007 it had declined to 8.01 (for pre 2004
EU member states) - a reduction of 60%. But this overall decline conceals very large differences between
Member States. France and Italy, the countries with the largest decline in liver deaths, have seen three to
four-fold reductions in liver mortality. Whereas UK and Finland have seen liver deaths rise by more than five
fold over the same period of time (figure 2). These are very dramatic changes in liver mortality and in this
paper we examine possible reasons for these changes, and the lessons they may hold for liver clinicians.
Drinking cultures
Across the EU there are many different cultural behaviours related to alcohol consumption and the
nature of the resulting harm differs in terms of its impact on the individual, society and the economy. A
traditional distinction has been drawn between northern European countries and their southern European
counterparts in terms of alcohol consumption and drinking patterns, and it is tempting to place the origin for
these differences back in antiquity. In the epic Babylonian poem Gilgamesh (2700BC) - the fall of the hero
Enkidu was precipitated by seduction into drunkenness: “Enkidu drank the beer - seven jugs and became