Who gets alcoholic liver disease : nature o r nurture ? (extended abstract)

Alcoholic Liver Disease (ALD) represents a conside- rable burden to the practising Clinician. Between 1988 and 2000, ALD was the commonest indication for ortho- topic liver transplantation in Europe and remains the commonest reason for admitting patients with liver dis- ease to hospital. Despite this burden, surprisingly little consensus exists in the field. In particular there is no consensus on disease pathogenesis and, as a result, on the factors that determine susceptibility. Most heavy drinkers will develop some degree of steatosis (fatty liver) but only about a third go on to develop alcoholic hepatitis and only between 1 in 4 and 1 in 12 progress to cirrhosis. The most obvious explanation for susceptibili- ty to ALD is the dose and pattern of alcohol consumed. Epidemiological studies have certainly demonstrated that there is a linear correlation between the number of alcohol units consumed per day and the risk of liver dis- ease and cirrhosis. However, in these studies, less than 6% of those taking the highest number of drinks per day had cirrhosis. Several other studies have shown that the pattern of intake is important, with disease risk incre- ased by drinking alcohol away from meal times, drin- king several rather than a single type of alcoholic bever- age and drinking daily rather than weekend drinking. There has also been recent evidence that wine drinkers may have a lower risk of ALD than consumers of other alcoholic beverages but this may be due to confounding factors.