Alcohol Related Liver Disease – What is new (Part 1)

Alcohol is known to be associated with liver disease to everyone. There are lot many misconceptions about liver disease and alcohol. Let us break these misconceptions about alcohol disease. Also, I have tried to include the recent changes in terminology and have included some aspects of management.

How big is Alcohol a problem?

About 30% males and 5% Indian Females take alcohol. Alcohol consumption is the seventh leading risk factor for both death and the burden of disease and injury. Except for tobacco, alcohol accounts for a higher burden of disease than any other drug.Alcohol use accounts for 6.8% of age-standardized deaths in men and 2.2% in women, with a disproportionate effect on young people. In a multi-center study from India, published 4 years back, off 13014 patients of liver cirrhosis, 2253 had alcohol as their chief risk factor. Almost all patients were male.

Does everyone who take alcohol develop liver disease?

Neither everyone who drinks alcohol develops liver disease nor all those who develop liver disease have history of alcohol. The following diagram simplifies this understanding.

If not all, then who develops liver disease because of alcohol?

Nearly 5-20% individuals who take significant alcohol develop liver disease. There are many factors which decide who will develop liver disease. Those who drink daily, have binge drinks (more than 5 drinks for males), do not take adequate nutrition, have additional liver disease (fatty liver, hepatitis B,hepatitis C) and females have higher risk for developing liver disease. Genetics also play a role and Indians as compared to Caucasians seem to have lower threshold for developing liver disease. Individuals who have sudden large intake of alcohol in spite ofalcohol-free weeks and months have high likelihood of developing liver fibrosis as per recent research.

Is beer safe?

All alcohol is similar. One drink means 10 grams of alcohol. The following table explains why beer is as dangerous as any other liquor.So, beer is safe is the biggest misconception

330 ml beer (1 can) 10–15-gram alcohol
125 ml wine (one glass wine) 10–15-gram alcohol
45 ml whiskey 10–15-gram alcohol

What do you mean by drinking?

Whenever alcohol is used, based on the amount of alcohol consumed and the way it is consumed, different terminologies are used. The following terms harmful drinking, binge drinking and heavy drinking.

Standard Drink 10 grams of alcohol
Harmful Drinking Alcohol causes physical or mental damage
Heavy drinking More than 60-gram alcohol on single occasion
Binge Drinking Consumption within about 2 hours of four or more drinks for women and five or more drinks for men

 

What is alcohol use disorder?

The term “Alcoholic” is no longer used. Instead, the term used is alcohol use disorder.The term ‘alcoholic’ is stigmatizing. It undermines patient dignity and self-esteem. Following are new terminology

How do you identify individuals with alcohol use disorder?

There are many scoring systems which can be used to individuals with AUD. The simplest and effective tool is AUDIT-C scoring system. We just need to ask the following three questions. A score of 8 or more should be considered as fulfilling to be labelled as Alcohol Use Disorder.

What are the clinical signs of alcohol related liver disease? 

If you know someone who is suffering from alcohol-related liver disease, kindly contact your local hepatologist. The second part will discuss the management of these individuals.

Dr Pathik Parikh
Liver Specialist / hepatologist in Ahmedabad
Contact no.: +91 86521 19730

 

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