Drinking patterns and the risk of serious liver disease

Binge drinking and the risk of liver events: A population-based cohort study

BACKGROUND & AIMS

Binge drinking or heavy episodic drinking is increasingly prevalent, but the health effects are incompletely understood. We investigated whether binge drinking increases the risk for liver disease above and beyond the risk due to average alcohol consumption.

METHODS

6366 subjects without baseline liver disease who participated in the Finnish population-based Health 2000 Study (2000-2001), a nationally representative cohort. Follow-up data from national registers until 2013 were analysed for liver-related admissions, mortality and liver cancer. Binge drinking (≥5 drinks per occasion, standard drink 12 g ethanol) was categorised as weekly, monthly, or as less often or none. Multiple confounders were considered.

RESULTS

Eighty-four subjects developed decompensated liver disease. Binge drinking frequency showed a direct association with liver-disease risk after adjustment for average daily alcohol intake and age. After adjustment, the hazard ratios (HRs) for weekly and monthly binge drinking were 3.45 (P=.001) and 2.26 (P=.007) and were higher after excluding regular heavy drinkers. The HR for weekly binging was 6.82 (P=.02) in women; 2.34 (P=.03) in men; and 4.29 (P=.001) in subjects with the metabolic syndrome. Weekly binge drinking and the metabolic syndrome produced supra-additive increases in the risk of decompensated liver disease. Weekly, and to a lesser extent monthly, binging retained significance in sequential multivariate models that additionally adjusted for beverage preference and lifestyle, metabolic, and socioeconomic factors.

CONCLUSIONS

Binge drinking is associated with an increased risk for liver disease independently of average alcohol intake and confounders. The rising prevalence of binge drinking and the metabolic syndrome is particularly concerning.

'IF You Drink Alcohol, THEN You Will Get Cancer': Investigating How Reasoning Accuracy Is Affected by Pictorially Presented Graphic Alcohol Warnings

AIMS

To investigate the cognitive processing of emotive pictorial warnings intended to curb alcohol misuse, using novel methodologies adapted from the reasoning literature to assess whether emotive pictorial warnings alter reasoning.

METHOD

In Study 1, individuals completed a version of the Wason selection task-evaluating warnings in which content type (Alcohol and Non-Alcohol) and emotional valence (Positive and Negative) were manipulated through imagery. In Study 2, people evaluated the certainty of outcomes described by alcohol-related and non-alcohol-related warnings in the form of If-Then statements.

RESULTS

Study 1 found that in alcohol-related warnings, there was no difference in reasoning accuracy between positive and negative content. However, fewer correct responses followed exposure to negative general-health messages. Study 2 suggested that when a warning involves the potential consequences of drinking alcohol, accuracy is improved when the content is negative. However, when considering the consequences of abstinence, accuracy was greatest when the content was positive. This was supported by an inference by content interaction.

CONCLUSION

In conclusion, negative imagery should be used with caution in health warnings, and goals carefully considered. In some cases imagery of negative outcomes may improve reasoning, however, its use in alcohol-related messages does not appear to be consistently beneficial.

The effect of beverage type on alcoholic psychoses rate in Russia

AIMS

To test the hypothesis of beverage-specific effect in Russia on the incidence rate of alcoholic psychoses (a known indicator of a population's alcohol-related problems).

METHODS

Time series analytical modeling techniques (ARIMA) were used to examine the relation between the sales of different alcoholic beverages (vodka, wine, beer) and alcoholic psychoses incidence rate between 1970 and 2013.

RESULTS

The analysis suggests that of the three beverages vodka alone was associated with alcoholic psychoses incidence rate. The estimated effect of vodka sales on the alcohol psychoses rate is statistically significant: a 1 l per person per year increase in vodka sales would result in a 23.4% increase in the alcoholic psychoses incidence rate.

CONCLUSION

The incidence of alcoholic psychoses is more responsive to changes in vodka sales per capita than wine or beer sales.

Impact of minimum price per unit of alcohol on patients with liver disease in the UK

The slow epidemic of liver disease in the UK over the past 30 years is a result of increased consumption of strong cheap alcohol. When we examined alcohol consumption in 404 subjects with a range of liver disease, we confirmed that patients with alcohol-related cirrhosis drank huge amounts of cheap alcohol, with a mean weekly consumption of 146 units in men and 142 in women at a median price of 33p/unit compared with £1.10 for low-risk drinkers. For the patients in our study, the impact of a minimum unit price of 50p/unit on spending on alcohol would be 200 times higher for patients with liver disease who were drinking at harmful levels than for low-risk drinkers. As a health policy, a minimum unit price for alcohol is exquisitely targeted at the heaviest drinkers, for whom the impact of alcohol-related illness is most devastating.

Systematic review and meta-analysis: prevalence of alcohol use among young people in eastern Africa

Objective

Systematic review and meta-analysis of published studies of alcohol use among young people (age 15–24 years) in eastern Africa to estimate prevalence of alcohol use and determine the extent of use of standardised screening questionnaires in alcohol studies.

Methods

Five databases (MEDLINE, EMBASE, Global Health, Africa-wide, and PsycINFO) were searched for publications until 30th June 2013. Results were summarised using the guidelines on preferred reporting items for systematic reviews and meta-analyses (PRISMA) and on quality assessment using the modified quality assessment tool for systematic reviews of observational studies (QATSO). Heterogeneity was assessed using the I² statistic (DerSimonian-Laird).

Results

We identified 2785 potentially relevant studies, of which 56 were eligible for inclusion. Only two studies (4%) used the standardised Alcohol Use Disorder Identification Test (AUDIT) questionnaire, and six studies (13%) used the Cut down, Annoyed, Guilt, Eye opener (CAGE) questionnaire. The reported median prevalence of alcohol use was ever-use 52% [interquartile range (IQR): 20–58%], use in the last month 28% (IQR: 17–37%), use in the last year 26% (IQR: 22–32%), and problem drinking as defined by CAGE or AUDIT 15% (IQR: 3–36%). We observed high heterogeneity between studies, with the highest prevalence of ever use of alcohol among university students (82%; 95%CI: 79–85%) and female sex workers (66%; 95%CI: 58–74%). Current use was most prevalent among male sex workers (69%; 95%CI: 63–75%).

Conclusions

Reported alcohol use and problem drinking were common among diverse groups of young people in eastern Africa, indicating the urgent need for alcohol-focused interventions in this population. Few studies have used standardised alcohol screening questionnaires. Epidemiological research to investigate alcohol-focused interventions in young people should aim to apply such questionnaires that should be validated for use in this population.

Activation of carbohydrate response element-binding protein by ethanol

OBJECTIVE

Carbohydrate response element-binding protein (ChREBP) is a transcription factor involved in hepatic lipogenesis. Its function is in part under the control of AMP-activated protein kinase (AMPK) and protein phosphatase 2A (PP2A). Given known effects of ethanol on AMPK and PP2A, it is plausible that ethanol might enhance fatty acid synthesis by increasing the activity of ChREBP. We hypothesized that another potential pathway of ethanol-induced hepatic steatosis is mediated by activation of ChREBP.

METHODS

The effects of ethanol on ChREBP were assessed in hepatoma cells and in C57BL/6J mice fed with the Lieber-DeCarli diet.

RESULTS

When the cells were exposed to ethanol (50 mM) for 24 hours, the activity of a liver pyruvate kinase (LPK) promoter-luciferase reporter was increased by ∼4-fold. Ethanol feeding of mice resulted in the translocation of ChREBP from cytosol to the nucleus. Protein phosphatase 2A activity was increased in the liver of ethanol-fed mice by 22%. We found no difference in the levels of hepatic Xu-5-P between ethanol-fed mice and controls. Transfection of a constitutively active AMPK expression plasmid suppressed the basal activity of the LPK luciferase reporter and abolished the effect of ethanol on the reporter activity. However, transfection of rat hepatoma cells with a dominant-negative AMPK expression plasmid induced basal LPK luciferase activity by only ∼20%. The effect of ethanol on ChREBP was attenuated in the presence of okadaic acid, an inhibitor of PP2A.

CONCLUSIONS

The effects of ethanol on AMPK and PP2A may result in activation of ChREBP, providing another potential mechanism for ethanol-induced hepatic steatosis. However, additional okadaic acid-insensitive effects appear to be important as well.

Rodent models of alcoholic liver disease: of mice and men

Alcoholic liver disease (ALD) is a major cause of acute and chronic liver disease worldwide. The progressive nature of ALD is well described; however, the complex interactions under which these pathologies evolve remain to be fully elucidated. Clinically there are no clear biomarkers or universally accepted, effective treatment strategies for ALD. Experimental models of ALD are an important component in identifying underlying mechanisms of alcohol-induced injury to develop better diagnostic markers, predictors of disease progression, and therapeutic targets to manage, halt, or reverse disease progression. Rodents remain the most accessible model for studying ALD pathology. Effective rodent models must mimic the natural history of ALD while allowing examination of complex interactions between multiple hepatic, and non-hepatic, cell types in the setting of altered metabolic or oxidative/nitrosative stress, inflammatory responses, and sensitivity to cytotoxic stress. Additionally, mode and duration of alcohol delivery influence hepatic response and present unique challenges in understanding disease pathology. This review provides an overview of rodent models of ALD, their strengths and weaknesses relative to human disease states, and provides insight of the potential to develop novel rodent models to simulate the course of human ALD.