hepatic and biliary disorders
Alcohol Related Liver Disease
Risk Factors for Alcohol Related Liver Disease
The main risk factors for alcohol-related liver disease are Quantity and duration of alcohol use Sex Genetic and metabolic traits Obesity A standard alcoholic drink contains 14 grams of alcohol, the amount found in a 12-ounce (355-mL) bottle of 5% beer, a 5-ounce (148-mL) glass of wine, or 1.5 ounces (44-mL) of a beverage of 80-proof distilled spirits containing 40% alcohol by volume. (SeeNational Institute on Alcohol Abuse and Alcoholism (NIAAA): Drinking Patterns and Their Definitions). There appears to be a threshold effect above which the amount and duration of alcohol use increases the risk of the development of liver disease. That threshold is not known and varies by individual risk factors ( Risk factors references ). ). However, the World Health Organization stated that there is no safe level of alcohol consumption that does not affect health ( Risk factors references ). The NIAAA defines "at-risk" (heavy) drinking in males as more than 14 standard drinks per week, or more than 4 drinks per day, and in females as more than 7 standard drinks per week, or more than 3 drinks per day (seeNIAAA: Drinking Levels Defined). Binge drinking may also increase alcohol-related liver disease. The NIAAA defines binge drinking as a pattern of drinking that brings blood alcohol concentration levels to 0.08 g/dL, which typically occurs after 4 drinks for women and 5 drinks for men, in about 2 hours (seeNIAAA: Drinking Levels Defined). Patients with alcohol-related liver disease or other liver diseases, in particular Metabolic Dysfunction–Associated Liver Disease (MASLD) , recommends that patients receiving care in primary care and gastroenterology/hepatology outpatient clinics, emergency departments, and in hospitals (as inpatients) be screened routinely for alcohol use with validated questionnaires. Brief intervention, pharmacotherapy, and referral to treatment should be offered to patients engaged in hazardous drinking (ie, heavy or binge drinking) ( Risk factors references , Alcohol biomarkers, such as urine or hair ethyl glucuronide, urine ethyl sulfate, and phosphatidylethanol (PEth), can be used to support patient history and aid in recovery. Women are more susceptible to alcohol-related liver disease, even after adjustment for body size. Women require only 20 to 40 g of alcohol/day to be at risk—half of that for men. Risk in women may be increased because they have less alcohol dehydrogenase in their gastric mucosa; thus, more intact alcohol reaches the liver. Alcohol-related liver disease often runs in families, suggesting genetic factors (eg, deficiency of cytoplasmic enzymes that eliminate alcohol). A diet high in unsaturated fat increases susceptibility, as does obesity. Other risk factors include Overview of Iron Overload (not necessarily related to iron intake) and concomitant 1.Rehm J, Taylor B, Mohapatra S, et al: Alcohol as a risk factor for liver cirrhosis: a systematic review and meta-analysis.Drug Alcohol Rev29(4):437-445, 2010. doi:10.1111/j.1465-3362.2009.00153.x 2.Anderson BO, Berdzuli N, Ilbawi A, et al: Health and cancer risks associated with low levels of alcohol consumption.Lancet Public Health8(1):e6-e7, 2023. doi: 10.1016/S2468-2667(22)00317-6 3.Crabb DW, Im GY, Szabo G, et al: Diagnosis and Treatment of Alcohol-Associated Liver Diseases: 2019 Practice Guidance From the American Association for the Study of Liver Diseases.Hepatology71(1):306-333, 2020. doi:10.1002/hep.30866 4.Saunders JB, Aasland OG, Babor TF, et al: Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption--II.Addiction88(6):791-804, 1993. doi:10.1111/j.1360-0443.1993.tb02093.x 