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GENETIC AND ENVIRONMENTAL DETERMINANTS OF SUSCEPTIBILITY TO ALCOHOL‐INDUCED LIVER DISEASE
Author(s) -
Saunders J.B.
Publication year - 1983
Publication title -
australian alcohol/drug review
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.018
H-Index - 74
eISSN - 1465-3362
pISSN - 0726-4550
DOI - 10.1080/09595238380000211
Subject(s) - genetic predisposition , alcohol , cirrhosis , alcoholic liver disease , liver disease , medicine , alcohol intake , disease , hepatitis , liver injury , physiology , liver damage , alcohol and health , alcoholic hepatitis , alcohol consumption , biology , biochemistry
Although there is an overall relationship between cumulative alcohol intake and the severity of alcohol‐related liver damage, there is considerable variation in individual susceptibility to the hepatotoxic effects of alcohol. In this review I shall discuss what factors appear to influence susceptibility. Women develop liver disease after a shorter period of excessive drinking and at a lower alcohol intake than men. This is partly related to differences in body size and composition between the sexes which result in women having preportionately higher blood alcohol levels than men after a standard drink; this probably explains why women are more susceptible to a variety of alcohol‐related problems. Other genetic determinants of susceptibility have until recently proved elusive, but certain HLA types, such as HLA‐B8, have been shown to increase the risk of chronic liver damage by up to 50%. No genetic variations in the enzymes responsible for alcohol metabolism have been definitely associated with predisposition to liver damage. The more severe lesions — alcoholic hepatitis and cirrhosis — are more common in regular daily drinkers compared with intermittent or ‘qbinge’ drinkers and in moderately dependent patients compared with those who have severe alcohol‐withdrawal symptoms. No exogenous agents such as hepatitis viruses of chemicals have yet been shown to contribute to the development of any of the morphological abnormalities of alcoholic liver disease. At the present time there is insufficient information for us to be able to tailor our advice about drinking to the individual patient. We recommend that men should on no account drink more than 80 g alcohol per day and that women should keep below half this amount. People whose intakes approach these amounts should have two alcohol‐free days every week. In the future it may be possible to screen specifically for markers of susceptibility to liver damage in populations known to be at risk of alcohol problems.