New studies prove lethal link between alcohol, weight

Research announced today at the International Liver Congress 2013 has revealed the deadly impact that alcohol and body weight have on liver disease.

Women should forgo the wine and doughnuts after a new study found the harmful combination of high intake and high (BMI) causes an increased risk of . The study analysed a cohort of over 107,000 women to investigate how a female's weight and alcohol consumption affected their chances of suffering and dying from chronic liver disease.

EASL's Member Dr. Daniele Prati said this research involved a large study to investigate the combined influence of a person's alcoholic intake and BMI on the liver.

Dr. Prati said: "It's well known that alcohol and a person's weight are major causes of chronic liver disease however there has been a need for a large population study to compare these factors' influences on each other. Interestingly, the research found the combination of a woman's drinking habits and weight has an important effect on liver health and life expectancy."

More than 107,000 women across the United Kingdom who took part in the study were classed with a low or high BMI (<25 or ≥ 25) and a low or high alcohol intake (between 0-15 or over 15 units per week). BMI is a measure for human body shape based on an individual's weight and height, with people scoring ≥ 25 classified as overweight. The study found risk was significantly increased in the group of women with a high BMI and high , with these participants more likely to suffer from chronic liver disease.

Dr. Prati explained: "These findings will have a significant impact on how we can help millions of people across the world at risk of developing liver disease. are at particular risk as they are twice as sensitive as men to alcohol related and developing a more severe form of the disease at lower doses with shorter durations of alcohol consumption. Based on this research we know that a person with low BMI and high alcoholic intake have a greater risk of developing chronic liver disease compared to a woman with a high BMI who doesn't drink very much. More research is required to determine the exact thresholds for each risk factor that independently and in combination increase the risk of chronic liver disease but this is an important first step in the right direction."

Other new research released at the congress showcased a strong link between the development of hepatocellular carcinoma (HCC) in alcoholic cirrhosis patients and metabolic fatty liver disease. The study found that patients with alcoholic cirrhosis who also have fatty liver disease and are overweight, obese or type 2 diabetic are more likely to develop HCC.

The research examined 100 patients who received transplants for alcoholic end stage liver disease to analyse the impact of both fatty liver and metabolic risk factors such as obesity and type 2 diabetes on the development of HCC in patients.

The results showed more patients with HCC had been frequently overweight (54% compared to 14% of non-HCC patients) or diabetic (43% compared to 22% of non-HCC patients). Half (50%) of patients who had fatty liver disease and were overweight, obese or had type 2 diabetes were found to have HCC compared to just 6% of patients with HCC without these other conditions.

Dr. Prati commented: "Fatty liver and alcohol have long been known as for HCC but this study tested their combined effect in patients with alcoholic cirrhosis. These findings show patients suffering from alcoholic cirrhosis who also have a history of fatty , obesity or type 2 diabetes have a higher risk of developing liver cancer. The results will be useful to improve the management of patients with cirrhosis, and to identify cancer at early stages."

Worldwide, HCC accounts for approximately 5.4% of all cancers and causes 695,000 deaths per year, including 47,000 deaths in Europe per annum.

Europe has the highest rate of in the world with one in seven adults consuming more than the recommended average daily amount.

More information: References:

1 Trembling PM, INFLUENCE OF BMI AND ALCOHOL ON LIVER-RELATED MORBIDITY AND MORTALITY IN A COHORT OF 108,000 WOMEN FROM THE GENERAL POPULATION FROM UKCTOCS. Presented at the International Liver CongressTM 2013

2 Sato N, Lindros KO, Baraona E, Ikejima K, Mezey E, Jarvelainen HA, et al. Sex difference in alcohol-related organ injury. Alcohol Clin Exp Res. 2001;25:40S– 45S.

3 Pais, R. METABOLIC FATTY-LIVER DISEASE INCREASES THE RISK OF HEPATOCELLULAR CARCINOMA IN PATIENTS WITH ALCOHOLIC CIRRHOSIS LISTED FOR LIVER TRANSPLANTATION. Presented at the International Liver CongressTM 2013

4 Kumar Vinay, Nelso Fausto and Abul Abbas. Robbins & Cotran Pathologic Basis of Disease, 7th ed. Saunders; 2004.

5 Cancer fact sheet. World Health Organisation. February 2006. www.who.int/mediacentre/factsheets/fs297/en/ Accessed 04.04.12

6 EU Burden of Liver Disease: A review of available epidemiological data. European Association for the Study of the Liver Disease. 2013.

7 EU Burden of Liver Disease: A review of available epidemiological data. European Association for the Study of the Liver. 2013 www.easl.eu/assets/application… 845caec619f_file.pdf. Accessed 26.02.13

Provided by European Association for the Study of the Liver

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