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

BARCELONA . SPAIN
24 POSTGRADUATE COURSE SYLLABUS ALCOHOLIC LIVER DISEASE 25
APRIL 18 - 19/2012 THE INTERNATIONAL LIVER CONGRESS TM 2012
Dr Nick Sheron is the Royal College of Physicians representative at the EU Alcohol Forum and parts of this
article are reproduced with kind permission of the RCP Journal Clinical Medicine(5).
REFERENCES
World Health Organisation. Global status report on alcohol and health 2011.
Anderson P, Baumberg B. Alcohol in Europe: A public health perspective. EU Health and
Consumer Protection Directorate General; 2007.
House of Commons Health Committee. Alcohol: First Report of Session 2009–10. London:
Stationary Office; 2010 Jan 8.
Babor TF, Caetano R, Casswell S, Edwards G, Giesbrecht N, Graham K, et al. Alcohol: No
Ordinary Commodity—Research and Public Policy Oxford and London: Oxford University Press,
2003.
Jewell J, Sheron N. Trends in European liver death rates: implications for alcohol policy.
Clin Med 2010 Jun;10(3):259-263.
PATTERNS OF ALCOHOL INTAKE AND ALD: EFFECTS OF BINGE
DRINKING ON THE LIVER
Sam Zakhari
Bethesda, Maryland, USA
E-mail: zakhari@willco.niaaa.nih.gov
KEY POINTS
• Binge drinking (too much too fast ) is a pattern corresponds to consuming 5 or more drinks
(male), or 4 or more drinks (female), in about 2 hours.
• Binge drinking while fasting may result in hypoglycemia and severe lactic acidosis.
• Binge drinking may precipitate acute severe alcoholic hepatitis (AH) against a background of
chronic liver disease. Thirty day mortality in patients with severe AH may exceed 40%.
• If you drink, drink moderately with food.
PATTERN OF DRINKING
In the United States, the pattern of drinking is divided into three categories: moderate, low-risk, and high risk.
• Moderate drinking, according to the U.S. dietary guidelines, is up to 2 drinks per day for men and up to
1 drink per day for women. Obviously, the definition of moderate drinking varies in different countries.
• Low-risk drinking is not just another term for "moderate" drinking, even though the weekly amounts may
be the same, but the daily ones are different; the recommendations serve different purposes for different
types of drinkers. Low-risk drinking for healthy men under age 65 is no more than 4 drinks on any day and
14 per week, and for healthy women (and men over 65) is no more than 3 drinks on any day and 7 per week.
• High-risk drinking comprises: 1) binge drinking (too much too fast - A “binge” is a pattern of drinking
alcohol that brings blood alcohol concentration (BAC) to 0.08 gram percent or above. For the typical adult,
this pattern corresponds to consuming 5 or more drinks (male), or 4 or more drinks (female), in about 2
hours; and 2) chronic heavy drinking (drinking too much too often).
BINGE DRINKING AND THE LIVER
While drinking too much and too often over a long period of time results in alcoholic liver disease (ALD),
which encompasses fatty liver, steatohepatitis, liver fibrosis and cirrhosis, and may proceed to hepatocellular
carcinoma, binge drinking can lead to glycogen depletion, which would be aggravated in the presence of
liver disease, and may lead to acidosis and hypoglycemia. In addition, people who drink heavily tend to
have hyperuricemia and hypertriglyceridemia, which may exacerbate diabetic hypertriglyceridemia.
Correlation of Quantity and Frequency of Drinking and Liver Damage:
The effects of drinking too much too fast, or too much too often on the liver have been sparingly studied.
Past studies focused on the incidence of cirrhosis among alcoholics (Lelbach et al., 1975), or sought the
clinical manifestations of alcoholism among cirrhotic patients (Caroli et al.,). In these two approaches,
the quantity of alcohol consumed and the drinking pattern were undetermined. A third indirect approach
attempted to correlate average quantities of alcohol consumption (based on demographic and economic
statistics) with cirrhosis mortality. This approach, however, did not measure the quantity and frequency of
alcohol consumption, and did not provide information on individual consumption and risk.
In a prospective study, Kamper-Jørgensen and colleagues (2004) interviewed a cohort of 6152 alcoholabusing
men and women about their drinking pattern, frequency of alcohol intake, duration of alcohol
misuse, and beverage type. The rate of alcoholic cirrhosis mortality in men and women was, respectively,
27- and 35-fold the rate of the Danish general population. They also reported that “alcohol has a threshold
effect rather than a dose-response effect on mortality from alcoholic cirrhosis.”