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Rethinking Cirrhosis Risk: Drinking Patterns Trump Volume in Liver Health

Recent research indicates that drinking patterns, genetic factors, and type-2 diabetes play a crucial role in the risk of developing alcohol-related cirrhosis. The study emphasizes the significance of how and when alcohol is consumed, rather than the total amount, in determining liver disease risk. Credit:

Those who binge drink and have a certain genetic makeup are six times more likely to develop alcohol-related cirrhosis, according to new research from UCL, the Royal Free Hospital, the University of OxfordThe University of Oxford is a collegiate research university in Oxford, England that is made up of 39 constituent colleges, and a range of academic departments, which are organized into four divisions. It was established circa 1096, making it the oldest university in the English-speaking world and the world's second-oldest university in continuous operation after the University of Bologna.” data-gt-translate-attributes=”[{“attribute”:”data-cmtooltip”, “format”:”html”}]” tabindex=”0″ role=”link”>University of Oxford and the University of Cambridge.

The study, published on December 14 in the journal Nature Communications<em>Nature Communications</em> is a peer-reviewed, open-access, multidisciplinary, scientific journal published by Nature Portfolio. It covers the natural sciences, including physics, biology, chemistry, medicine, and earth sciences. It began publishing in 2010 and has editorial offices in London, Berlin, New York City, and Shanghai. ” data-gt-translate-attributes=”[{“attribute”:”data-cmtooltip”, “format”:”html”}]” tabindex=”0″ role=”link”>Nature Communications, is the first to assess how an individual’s pattern of drinking, their genetic profile (via a polygenic risk score), and whether or not they have type-2 diabetes affects their risk of developing alcohol-related cirrhosis (ARC).

The observation that pattern of drinking is more important than volume, coupled with the increased risk when genetic makeup and type-2 diabetes are also present, provides more accurate information with which to identify those most vulnerable to liver disease.

Global Impact of Liver Disease

Liver disease is one of the major causes of premature death globally, with 2-3% of the world’s population having cirrhosis (scarring of the liver) or liver disease. Since the COVID-19First identified in 2019 in Wuhan, China, COVID-19, or Coronavirus disease 2019, (which was originally called "2019 novel coronavirus" or 2019-nCoV) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It has spread globally, resulting in the 2019–22 coronavirus pandemic.” data-gt-translate-attributes=”[{“attribute”:”data-cmtooltip”, “format”:”html”}]” tabindex=”0″ role=”link”>COVID-19 pandemic began, alcohol-related deaths have risen by 20%.

Study Details and Findings

In this study, researchers analyzed data from 312,599 actively drinking adults in the UK Biobank cohort, to assess the impact of pattern of drinking, genetic predisposition, and type-2 diabetes on the likelihood of developing ARC.

A baseline hazard ratio (HR) of one was set using data from participants who reported drinking within daily limits, had low genetic predisposition to ARC, and were free of diabetes.

Those who engaged in heavy binge drinking, which is categorized as having 12 units in a day at some point during a week, were three times as likely to develop ARC. The risk for those with a high genetic predisposition was four times higher and the risk for type-2 diabetics was two times higher.

Dr. Linda Ng Fat, a first author of the study from UCL Epidemiology & Public Health, said: “Many studies that look into the relationship between liver disease and alcohol focus on the volume of alcohol consumed. We took a different approach by focusing on the pattern of drinking and found that this was a better indicator of liver disease risk than volume alone. The other key finding was that the more risk factors involved, the higher the ‘excess risk’ due to the interaction of these factors.”

When heavy binge drinking and high genetic predisposition were at play, the risk of developing ARC was six times higher than the baseline risk. The addition of type-2 diabetes as well resulted in an even greater risk.

Dr. Gautam Mehta, a senior author of the study from UCL Division of Medicine and the Royal Free Hospital, said: “Only one in three people who drink at high levels go on to develop serious liver disease. While genetics plays a part, this research highlights that pattern of drinking is also a key factor. Our results suggest, for example, that it would be more damaging to drink 21 units over a couple of sessions rather than spread evenly over a week. Adding genetic information, which may be widely used in healthcare over the coming years, allows an even more accurate prediction of risk.”

Though polygenic risk scores are not in widespread clinical use at the moment, they are likely to become more commonly used as a method of defining personalized disease risk.

Concluding Remarks and Implications

Dr. Steven Bell, a senior author of the study from the University of Cambridge, said: “As liver disease, particularly alcohol-related fatalities, has seen a significant surge since the onset of the COVID-19 pandemic, it is imperative that we adopt innovative strategies to address this escalating crisis. This study equips us with novel tools that are essential in pinpointing individuals at highest risk, thereby enabling us to direct interventions more effectively towards those who stand to benefit the most.”

Pamela Healy, Chief Executive of the British Liver Trust said, “This research is important because it reveals that it’s not just how much you drink overall but the way that you drink matters. Drinking a lot, quickly, or drinking to get drunk can have serious consequences for your liver health. Over the last twenty years, as alcohol has become more accessible and affordable, there has been a disconcerting shift in the UK’s drinking culture. The UK needs to tackle increased alcohol consumption through a joined up ‘alcohol strategy’ that includes taxation, stronger controls on alcohol advertising and marketing, and improved awareness of the dangers of binge drinking.”

Reference: “Binge-pattern alcohol consumption and genetic risk as determinants of alcohol-related liver disease” by Chengyi Ding, Linda Ng Fat, Annie Britton, Pek Kei Im, Kuang Lin, Anya Topiwala, Liming Li, Zhengming Chen, Iona Y. Millwood, Steven Bell and Gautam Mehta, 14 December 2023, Nature Communications.
DOI: 10.1038/s41467-023-43064-x

Source: SciTechDaily