Alcohol Consumption and Risk of Liver Cirrhosis: A Systematic Review and Meta-Analysis

Single and multi-omic characterization of a porcine model of ethanol-induced hepatic fibrosis

Cirrhosis is a form of end-stage liver disease characterized by extensive hepatic fibrosis and loss of liver parenchyma. It is most commonly the result of long-term alcohol abuse in the United States. Large animal models of cirrhosis, as well as of one of its common long-term sequelae, HCC, are needed to study novel and emerging therapeutic interventions. In the present study, liver fibrosis was induced in the Oncopig cancer model, a large animal HCC model, via intrahepatic, intra-arterial ethanol infusion. Liver sections from five fibrosis induced and five age-matched controls were harvested for RNA-seq (mRNA and lncRNA), small RNA-seq (miRNA), and reduced representation bisulfite sequencing (RRBS; DNA methylation). Single- and multi-omic analysis was performed to investigate the transcriptomic and epigenomic mechanisms associated with fibrosis deposition in this model. A total of 3,439 genes, 70 miRNAs, 452 lncRNAs, and 7,715 methylation regions were found to be differentially regulated through individual single-omic analysis. Pathway analysis indicated differentially expressed genes were associated with collagen synthesis and turnover, hepatic metabolic functions such as ethanol and lipid metabolism, and proliferative and anti-proliferative pathways including PI3K and BAX/BCL signaling pathways. Multi-omic latent variable analysis demonstrated significant concordance with the single-omic analysis. lncRNA's associated with UHRF1BP1L and S1PR1 genes were found to reliably discriminate the two arms of the study. These genes were previously implicated in human cancer development and vasculogenesis, respectively. These findings support the validity and translatability of this model as a useful preclinical tool in the study of alcoholic liver disease and its treatment.

Association between change in alcohol use reported during routine healthcare screening and change in subsequent hospitalization: A retrospective cohort study

BACKGROUND AND AIMS

Primary care systems often screen for unhealthy alcohol use with brief self-report tools such as the 3-item Alcohol Use Disorders Identification Test for consumption (AUDIT-C). There is little research examining whether change in alcohol use measured on the AUDIT-C captures meaningful change in outcomes affected by alcohol use. This study aimed to measure the association between change in AUDIT-C and change in all-cause hospitalization risk, measured in the year after each AUDIT-C.

DESIGN

Retrospective cohort study.

SETTING

Health system in the state of Washington, USA, that conducts annual screening with the AUDIT-C in outpatient care.

PARTICIPANTS

Adults (n = 165 101) who had completed at least two AUDIT-Cs 11-24 months apart (2016-2020).

MEASUREMENTS

AUDIT-C scores were grouped into five risk categories reflecting no drinking (0), drinking without unhealthy alcohol use [1-2 (female)/1-3 (male)] and unhealthy alcohol use with moderate risk [3-6 (female)/4-6 (male)], high risk (7-8), and very high risk (9-12). Changes in AUDIT-C were based on the number of category levels that changed (0-4). Hospitalizations were binary, reflecting one or more hospitalizations in the 365 days after each AUDIT-C, identified from insurance claims.

FINDINGS

Of 165 101 eligible patients, 5.7% and 6.1% were hospitalized the year after the first and second AUDIT-C, respectively. Decreases in AUDIT-C risk category of 1 or ≥2 levels were associated with statistically significant decreases in risk of hospitalization, compared with the change in hospitalization risk for those with no change in AUDIT-C [1-level decrease: ratio of adjusted risk ratios (aRR) = 0.92, 95% confidence interval (CI) = 0.86-0.99; ≥2-level decrease: ratio of aRR = 0.68, 95% CI = 0.58-0.81]. Increases in AUDIT-C risk category of 1 or ≥2 levels were not associated with statistically significant differences in risk of hospitalization, compared with those with no change in AUDIT-C.

CONCLUSIONS

A decrease in AUDIT-C score risk category is associated with a decreased risk of both all-cause hospitalizations and hospitalizations with conditions directly or potentially attributable to alcohol. An increase in AUDIT-C score does not appear to be associated with a change in risk of hospitalization in the following year.

Investigating the Impact of Long-Term Alcohol Consumption on Serum Chemical Changes: Fourier Transform Infrared Spectroscopy for Human Blood Serum

Chronic alcohol consumption significantly impacts physiological and neurological functions. This study aimed to investigate the biochemical alterations in serum associated with long-term alcohol use using Fourier Transform Infrared (FTIR) spectroscopy. Serum samples from control and alcohol use disorder (AUD) were analyzed, and their spectra were compared. Multivariate analysis techniques, including Principal Component Analysis (PCA) and Hierarchical Cluster Analysis (HCA), were employed to differentiate the groups. A machine learning model, Grid Search-Support Vector Machine Discriminant Analysis (GS-SVMDA), was developed to classify samples with high accuracy. Significant differences in the absorbance values of specific functional groups, particularly those associated with phospholipids, amides, and fatty acids revealed. The AUD exhibited lower levels of these biomolecules. The models achieved perfect classification, demonstrating the potential ofFTIR spectroscopy as a non-invasive tool for diagnosing AUD. Findings contribute to a better understanding of the biochemical mechanisms underlying alcohol addiction and may aid in the development of novel diagnostic and therapeutic strategies.

Association among occupational class, alcohol consumption, and the risk of hospitalisations due to alcoholic liver diseases: a matched case-control study

BACKGROUND

This study aimed to identify the occupational class and specific occupations associated with hospitalisations due to alcohol-related liver disease and alcoholic liver cirrhosis, based on the distribution of alcohol consumption.

METHODS

This matched case-control study used a nationwide, multicentre, inpatient dataset from the Inpatient Clinico-Occupational Database of the Rosai Hospital Group in Japan. A total of 5,490 cases with alcohol-related liver disease and 10,961 controls were included in this study. Participants were categorised according to occupational class (blue-collar, service, professional, and manager) and industrial sector (blue-collar, service, and white-collar). Professionals in white-collar industries were set as the reference group. We calculated the odds ratios (ORs) and confidence intervals (CIs) of alcohol-related liver disease and alcoholic liver cirrhosis using conditional logistic regression models.

RESULTS

Blue-collar workers and service workers in both the service and blue-collar industries had a higher risk of hospitalisations due to alcohol-related liver disease: The ORs (95% CIs) for alcohol-related liver disease were 1.33 (1.15-1.55) for blue-collar workers in the blue-collar industry, 1.21 (1.03-1.42) for service workers in the blue-collar industry, 1.23 (1.01-1.51) for blue-collar workers in the service industry, and 1.47 (1.25-1.72) for service workers in the service industry. Among service workers, food and drink preparatory workers and customer service workers had a higher risk of hospitalisations due to alcohol-related liver disease and alcoholic liver cirrhosis compared to professionals (reference group), with ORs of 2.28 (1.81-2.89) and 2.18 (1.64-2.89), respectively, for alcohol-related liver disease. Among blue-collar workers, skeleton construction workers had a higher risk of hospitalisations due to alcohol-related liver disease, with an OR of 2.31 (1.63-3.3). Workers in occupations with a high risk of hospitalisations due to alcohol-related liver disease had higher percentages of alcohol consumption compared to professionals.

CONCLUSIONS

Occupational class and specific jobs were associated with the risk of hospitalisations due to alcohol-related liver disease and alcoholic liver cirrhosis, with alcohol consumption patterns contributing to this increased risk.

Latest Insights in Alcohol-Related Liver Disease and Alcoholic Hepatitis

Alcohol-related liver disease (ALD) is still to this date one of the leading causes of chronic liver disease globally. ALD comprises a wide disease spectrum, from the benign liver steatosis, to the life-threatening inflammatory acute phenotype of alcoholic hepatitis (AH) and ultimately, advanced liver fibrosis and cirrhosis. AH represents an acute inflammatory liver condition caused by prolonged high quantities of alcohol intake. Disease outcome varies from mild to severe, with systemic implication and high mortality. Although the pathogenesis has been extensively studied over the years, little progress has been made regarding therapeutic options. In over 50 years, steroid treatment is still the cornerstone therapeutic option, albeit having multiple limitations and a low success rate. On the other hand, important progress has been made regarding disease management and severity stratification with the implementation of different prognostic score. Although highly prevalent, AH still has many unmet needs, with a growing necessity for novel non-invasive diagnosis, prognosis biomarkers and impactful treatment options.

Associations of alcohol with the human gut microbiome and prospective health outcomes in the FINRISK 2002 cohort

BACKGROUND AND AIMS

Alcohol remains a global risk factor for non-communicable diseases with the gut microbiome emerging as a novel elucidator. We investigated how gut microbiome associates with alcohol on population level, if there is mediation reflected in health outcomes, and how functional potential is related.

METHODS

Our sample consisted of 4575 shallow-shotgun sequenced fecal samples from the FINRISK 2002 cohort (25-74yrs., 52.5% women). Alcohol (g 100% alcohol/week) use was self-reported. Diversity and differential species abundances were analyzed using multiple linear regression. Compositional differences were analyzed using PERMANOVA, and prospective associations with Cox-regression. Connections between alcohol, microbiome, inflammatory markers, and outcomes were assessed using serial mediation. Functional associations were assessed using KEGG-orthologies and multiple linear regression.

RESULTS

High-risk alcohol consumers had significantly lower bacterial diversity when compared to low-risk consumers (mean±SD:4.04±0.41 vs. 4.11±0.43, p = 9.56 × 10- 4). Alcohol also associated with significant shifts in overall composition (PERMANOVA; p ≤ 1.00 × 10- 4) and differential abundances of 344 species (ANCOM-BC2; q ≤ 0.05). These shifts were characterized by an increase in relative abundances of Gram-negative bacteria, the top genera of which were Bacteroides and Prevotella, and a decrease in putatively beneficial species in genera such as Lactobacillus, Bifidobacterium, and Akkermansia. Prospective associations with all-cause mortality (HR:1.12 [1.02-1.23]), and liver disease (HR:1.53 [1.22-1.92]) were observed. The association between alcohol and liver disease had a mediating link via a proinflammatory beta-diversity principal coordinate (OR:1.04 [1.001-1.10]). Functional associations were observed with 1643 KO-groups (q < 0.05, npositive=431, nnegative=1212). Antioxidative and gut integrity maintaining functions were diminished and lipopolysaccharide synthesis enriched.

CONCLUSIONS

Alcohol use is associated with community-level shifts in composition towards enriched Gram-negative bacteria, and diminished levels of putatively beneficial bacteria. Alcohol use associates with a proinflammatory gut microbiome profile that mediates alcohol's effect on incident liver disease risk, possibly via increased proliferation of endotoxins through the gut epithelial lining.

Comprehensive insights of etiological drivers of hepatocellular carcinoma: Fostering targeted nano delivery to anti-cancer regimes

Hepatocellular carcinoma (HCC) stands as one of the most prevalent and deadliest malignancies on a global scale. Its complex pathogenesis arises from multifactorial etiologies, including viral infections, metabolic syndromes, and environmental carcinogens, all of which drive genetic and molecular aberrations in hepatocytes. This intricate condition is associated with multiple causative factors, resulting in the abnormal activation of various cellular and molecular pathways. Given that HCC frequently manifests within the context of a compromised or cirrhotic liver, coupled with the tendency of late-stage diagnoses, the overall prognosis tends to be unfavorable. Systemic therapy, especially conventional cytotoxic drugs, generally proves ineffective. Despite advancements in therapeutic interventions, conventional treatments such as chemotherapy often exhibit limited efficacy and substantial systemic toxicity. In this context, nanomedicine, particularly lipid-based nanoparticles (LNPs), has emerged as a promising strategy for enhancing drug delivery specificity and reducing adverse effects. This review provides a comprehensive overview of the molecular and metabolic underpinnings of HCC. Furthermore, we explored the role of lipid-based nano-formulations including liposomes, solid lipid nanoparticles, and nanostructured lipid carriers in targeted drug delivery for HCC. We have highlighted recent advances in LNP-based delivery approaches, FDA-approved drugs, and surface modification strategies to improve liver-specific delivery and therapeutic efficacy. It will provide a comprehensive summary of various treatment strategies, recent clinical advances, receptor-targeting strategies and the role of lipid composition in cellular uptake. The review concludes with a critical assessment of existing challenges and future prospects in nanomedicines-driven HCC therapy.

The steatotic liver disease burden paradox: unravelling the key role of alcohol

The classification of steatotic liver disease (SLD) has evolved, incorporating all conditions characterized by hepatic lipid accumulation. SLD represents a continuum of disorders that are shaped by the dynamic factors of alcohol intake and cardiometabolic risk factors. This updated classification has profound implications for both the management and research of SLD, especially with the new distinct category of patients with both metabolic and alcohol-related liver disease. In this Perspective, we highlight the pivotal role of alcohol within the SLD framework. We introduce the 'SLD burden paradox': a concept illustrating the disparity in which metabolic dysfunction-associated steatotic liver disease is more prevalent, yet individuals with SLD and excessive alcohol intake (such as in metabolic and alcohol-related liver disease and in alcohol-related liver disease) account for greater global liver-related morbidity and mortality. We explore strategies to mitigate the effect of SLD on morbidity and mortality, emphasizing the importance of early detection and reducing stigma associated with alcohol intake. Our discussion extends to methods for assessing and monitoring alcohol intake together with the critical role of managing cardiometabolic risk factors in patients across the SLD spectrum. Conclusively, we advocate for a coordinated care framework that adopts a person-centric approach when managing SLD, aiming to improve outcomes and patient care.

Long-Term Risk of Inflammatory Bowel Disease With MASLD: A Large-Scale Prospective Cohort Study in UK Biobank

BACKGROUND

Similar worsening epidemics globally have been showed in newly coined metabolic dysfunction-associated steatotic liver disease (MASLD) and inflammatory bowel disease (IBD). We aimed to investigate the prospective association of MASLD, MASLD types, and cardiometabolic risk factors (CMRFs) with long-term risk of incident IBD in a large-scale population cohort.

METHODS

Participants free of IBD at enrollment from UK Biobank were included. Baseline MASLD was measured by fatty liver index together with at least one CMRF, based on the latest AASLD/EASL criteria. MASLD type was classified as pure MASLD and MetALD (MASLD with increased alcohol intake). Primary outcome was incident IBD, including ulcerative colitis (UC) and Crohn's disease (CD). Multivariable Cox regression was conducted to examine the related associations.

RESULTS

Overall, 403 520 participants (aged 56.2 ± 8.1 years, 45.6% males) were included. Of whom, 151 578 (37.6%) were considered as MASLD at baseline. During a median of 13.0 years' follow-up, 2398 IBD cases were identified. Compared with normal population, individuals with MASLD showed significant higher associations of incident IBD (HR = 1.39, 95% CI: 1.21-1.60), UC (HR = 1.34, 95% CI: 1.13-1.58), and CD (HR = 1.51, 95% CI: 1.20-1.89). Meanwhile, results were consistent when assessing pure MASLD (HR = 1.43, 95% CI: 1.23-1.66) and MetALD (HR = 1.46, 95% CI: 1.15-1.86). The excess risk of incident IBD was more evident with the increase of CMRFs numbers (ptrend < 0.001).

CONCLUSION

MASLD, either pure MASLD or MetALD, and a combination of different CMRFs are all associated with increased risk of IBD, including both UC and CD. Additionally, there is greater risk of incident IBD as the number of CMRFs increase.

Purchasing Under the Influence of Alcohol: The Impact of Hazardous and Harmful Patterns of Alcohol Consumption, Impulsivity, and Compulsive Buying

The current research examined how hazardous and harmful patterns of alcohol consumption, problematic online shopping when drinking alcohol, impulsivity, and compulsive buying were associated with and predicted the frequency of making purchases while under the influence of alcohol. A sample of American adults between the ages of 25 and 64 who reported having at least one drink per week over the past 6 months were surveyed. Regression-based path modeling revealed for those who made online purchases while moderately intoxicated, hazardous and harmful patterns of drinking alcohol and, problematic online shopping when drinking alcohol, predicted the frequency of making purchases while intoxicated. For those who made online purchases while heavily intoxicated, hazardous and harmful patterns of drinking alcohol, impulsivity, problematic online shopping when drinking alcohol, and compulsive buying predicted the frequency of making purchases while intoxicated. We explain our findings by suggesting individuals engage in frequent drunk purchases because they are motivated to alleviate their negative mood states.

Effect of long-term moderate red wine consumption in CD1 female mice

In the early 80s, the so-called "French paradox" was proposed, that is, a correlation between wine consumption, a diet rich in fats, and low mortality from coronary disease. Conversely, it is well established that excessive alcohol consumption increases the risk of cirrhosis and cancer, but few studies have investigated the effects of moderate alcohol consumption. However, all these conclusions were derived from epidemiological population studies that may be subject to distortions due to multiple factors. Here, the effect of moderate consumption of red wine on health throughout life was examined in a murine model. Different variables were evaluated in groups of female animals that were fed a standard or a fat diet throughout their adult life and given water, or wine or alcohol diluted in water in proportions similar to what is considered moderate consumption in humans. Our results showed few differences in most of the analyzed variables (body weight, liver profile and survival rate) between the different female mouse groups. The most remarkable findings were observed in the fat-diet groups that showed more frequent and severe liver lesions and a lower average ovarian weight. Moreover, moderate and prolonged ethanol consumption significantly affected telomere length only when the diet was high in fat, whereas wine consumption showed no difference compared to water, pointing to a possible predominant role of the compounds, particularly polyphenols present in wine. On the other hand, wine-drinking mice fed a fat diet had more oocytes than those in the ethanol-drinking group. Overall, our data suggest that long-term moderate red wine consumption does not substantially influence the health of female mice.

Dose-dependent Relationship between Alcohol Consumption and the Risks of Hepatitis B Virus-associated Cirrhosis and Hepatocellular Carcinoma: A Meta-analysis and Systematic Review

BACKGROUND AND AIMS

The quantitative effects of alcohol consumption on cirrhosis and hepatocellular carcinoma (HCC) in hepatitis B virus (HBV) infection are unknown. This study aimed to establish a dose-dependent model of alcohol consumption on the risks of cirrhosis and HCC.

METHODS

PubMed, Embase, the Cochrane Library, Web of Science, and four Chinese databases were searched for studies published from their inception to 15 May 2024. A random-effects model was used to pool the data on the incidence of cirrhosis and HCC, and a dose-dependent model of alcohol's effect on cirrhosis and HCC was established.

RESULTS

A total of 33,272 HBV patients from 45 studies were included. Compared with non-drinkers, the overall pooled odds ratio (OR) for cirrhosis was 2.61 (95% confidence interval [CI]: 1.46-4.66; I2 = 94%, p < 0.001), and the OR for HCC was 2.27 (95% CI: 1.50-3.43; I2 = 90%, p < 0.001) among drinkers. Compared with low-level drinkers, the estimated pooled OR for cirrhosis was 2.34 (95% CI: 1.59-3.44; I2 = 87%, p < 0.001), and the OR for HCC was 2.42 (95% CI: 1.90-3.09; I2 = 80%, p < 0.001) among high-level drinkers. Furthermore, a linear dose-dependent analysis showed that each daily consumption of 12 g of alcohol increased the risk of cirrhosis by 6.2% and the risk of HCC by 11.5%.

CONCLUSIONS

Alcohol dose-dependently increases the risks of cirrhosis and HCC in patients with HBV infection, and patients with daily alcohol consumption of more than 12 g should be strictly monitored.

Improving radiomics-based models for esophagogastric variceal bleeding risk prediction in cirrhotic patients

A recent study by Peng et al developed a predictive model for first-instance secondary esophageal variceal bleeding in cirrhotic patients by integrating clinical and multi-organ radiomic features. The combined radiomic-clinical model demonstrated strong predictive capabilities, achieving an area under the curve of 0.951 in the training cohort and 0.930 in the validation cohort. The results highlight the potential of noninvasive prediction models in assessing esophageal variceal bleeding risk, aiding in timely clinical decision-making. Additionally, manual delineation of regions of interest raises the risk of observer bias despite efforts to minimize it. The study adjusted for clinical covariates, while some potential confounders, such as socioeconomic status, alcohol use, and liver function scores, were not included. Additionally, an imbalance in cohort sizes between the training and validation groups may reduce the statistical power of validation. Expanding the validation cohort and incorporating multi-center external validation would improve generalizability. Future studies should focus on incorporating long-term patient outcomes, exploring additional imaging modalities, and integrating automated segmentation techniques to refine the predictive model.

Role of Alcohol in Steatotic Liver Disease: Impact on Patients with Cardiometabolic Risk Factors

The new definition of steatotic liver disease (SLD), as a broader concept, was a step forward in the increasing recognition of the substantial overlap between alcohol and cardiometabolic risk factors (CMRFs), in a continuum way. The spectrum of pathophysiological aspects, ranging from liver steatosis to fibrosis, has similarities in MASLD and ALD. Also, there is now considerable evidence that the association of metabolic dysfunction with increased alcohol consumption impacts on the risk of severe liver disease and prognosis. The new MetALD class, as recently proposed, shows clear differences in prognosis when comparing with MASLD and ALD groups. However, there is room for improvement, such as considering the role of previous alcohol intake, fluctuations of consumption over time, including binge drinking, refinement of alcohol assessment, and better understanding of the role of biomarkers. In summary, SLD is no doubt a significant improvement, but the new classification needs to be dynamic and adapting to patients needing frequent reassessment. Furthermore, it brings opportunities for research on the interaction between alcohol consumption and CMRFs.

Safety and Effectiveness of Naltrexone in the Management of Alcohol Use Disorder in Patients With Alcohol-associated Cirrhosis: First Clinical Observation From Indian Cohort

Background and aims

Naltrexone is a promising drug to treat alcohol use disorder with limited evidence of safety in liver diseases. An observational study was performed to study the safety, effectiveness, and tolerability of Naltrexone in the management of alcohol use disorder in patients with alcohol-associated cirrhosis.

Methods

Naltrexone was started in patients with alcohol-related liver disease for the management of alcohol use disorder in 86 patients who were followed up for 4 weeks. Baseline liver parameters were compared with those at 4 weeks to establish safety of the drug. Effectiveness was determined by observing reduction in AUDIT scores, craving, number and days of drinking. Self-report of side effects was noted.

Results

After 4 weeks of starting Naltrexone there was a decrease in AST-89.86 vs 57.61, ALT-50.19 vs 27.08, SAP-121.81 vs 98.19, GGT-166.93 vs 109 and MELD 16.32 vs 12.13 (none statistically significant). There was a statistically significant reduction in Serum Bilirubin- (4.31 vs 1.98), INR (1.49 vs 1.32), self-reported craving (3.71 Vs 1.97; P = 0.01), AUDIT scores (24.13 Vs 16.91; P <0.01) and number of drinking days in last one month (10.22 Vs 4.19; P = 0.03).

Conclusion

The reduction in all liver parameters and AUDIT scores and craving after treatment with Naltrexone supports its safety and utility in the management of alcohol use disorder in alcohol-related liver cirrhosis.

Disparities in Alcohol-Associated Liver Disease Hospital Encounters Amongst a Texas-Based Cohort of Patients

INTRODUCTION

Alcohol-associated liver disease (ALD) disproportionately impacts men, racial and ethnic minorities, and individuals of low socioeconomic status; however, it's unclear how recent increases in ALD burden have impacted these disparities. We aimed to describe trends in racial, ethnic and socioeconomic disparities in alcohol-associated hospital encounters.

METHODS

We conducted a retrospective cohort study of adult hospital encounters with alcohol-associated diagnoses from three health systems between January 2016 and December 2021. The cohort was divided into three eras: a 'Historical Era,' (Oct 2016-June 2018, used only for trends); 'Era 1' (July 2018-March 2020); and 'Era 2' (April 2020-December 2021). Kaplan Meier and Cox regression analyses were performed to identify factors associated with overall survival.

RESULTS

We identified 19,295 individuals with alcohol-associated encounters (44.7% White, 29.8% Hispanic, and 21.8% non-Hispanic Black (NHB) individuals), with a greater increase observed between eras 1 and 2 than the historical era and Era 1 (8.7% vs. 5.0%, p < 0.01). By age and sex, the greatest increases in encounters were observed in the youngest and oldest females but only the oldest males. By race and ethnicity, Hispanic individuals had greater increases in encounters compared to Black and White individuals (14.8% vs. 7.5% and 6.3%, p < 0.01). Older age (aSHR: 1.03, 95% CI: 1.03-1.0), higher MELD (aSHR: 1.08, 95% CI: 1.0-1.09), hepatic encephalopathy (aSHR: 1.42, 95% CI: 1.06-1.90), and hepatocellular carcinoma (HCC) (aSHR: 3.20, 95% CI: 2.29-4.49) were associated with increased mortality.

CONCLUSION

The highest increases of alcohol-associated encounters were observed amongst young Hispanic and NHB women, highlighting variation in trends by age, sex, race and ethnicity. These disparities merit further investigation to elucidate underlying mechanisms and develop tailored interventions to improve ALD burden and outcomes.

A Comparison of the Effects of Alcohol Abstinence and Drinking Habit on the Survival of Patients with Alcohol-related Cirrhosis: A Retrospective Observational Study

Objective Abstaining from alcohol improves the outcome of alcohol-related cirrhosis. This study evaluated the effect of alcohol abstinence on the outcomes of patients with alcohol-related cirrhosis recruited from a core hospital in Boso Peninsula, Japan. Methods This single-center retrospective study recruited 116 patients with alcohol-related cirrhosis who were admitted to our department between April 2014 and October 2022. Taking the day of discharge as day 0, the patients were divided into two groups based on their subsequent behavior (abstinence/non-abstinence from alcohol). The study analysis included 98 patients after excluding 13 who died during hospitalization and 5 for whom follow-up at our hospital ended after discharge. We evaluated differences in the patient survival between the abstaining and drinking groups. Results The abstaining and drinking groups comprised 57 and 41 patients, respectively. We excluded from the analysis 10 and 6 patients with viable hepatocellular carcinoma in the abstaining and drinking groups, respectively. The findings revealed that the survival rate plateaued in the abstaining group from the third year onward, whereas the survival rate in the drinking group gradually decreased with time. Conclusion Our findings suggest that at least two years of alcohol abstinence is required to sustain the survival of patients with alcohol-related cirrhosis. The data collected by our hospital retrospectively demonstrated the importance of abstinence on a timescale of years of sustained abstinence.

Reward Neurocircuitry Predicts Longitudinal Changes in Alcohol Use Following Trauma Exposure

BACKGROUND

Trauma is a risk factor for developing maladaptive alcohol use. Preclinical research has shown that stress alters the processing of midbrain and striatal reward and incentive signals. However, little research has been conducted on alterations in reward-related neurocircuitry posttrauma in humans. Neuroimaging markers may be particularly useful because they can provide insight into the mechanisms that may make an individual vulnerable to developing trauma-related psychopathologies. In this study, we aimed to identify reward-related neural correlates associated with changes in alcohol use after trauma exposure.

METHODS

Participants were recruited from U.S. emergency departments for the AURORA study (n = 286; 178 female). Trauma-related change in alcohol use at 8 weeks posttrauma relative to pretrauma was quantified as a change in 30-day total drinking per the PhenX Toolkit Alcohol 30-Day Quantity and Frequency measure. Reward-related neurocircuitry activation and functional connectivity were assessed 2 weeks posttrauma using functional magnetic resonance imaging during a monetary reward task using region of interest and whole-brain voxelwise analyses.

RESULTS

Greater increase in alcohol use from pretrauma to 8 weeks posttrauma was predicted by 1) greater ventral tegmental area, 2) greater cerebellum activation during gain > loss trials measured 2 weeks posttrauma, and 3) greater seed-based functional connectivity between the ventral tegmental area and lateral occipital cortex and precuneus.

CONCLUSIONS

Altered ventral tegmental area activation and functional connectivity early posttrauma may be associated with reward seeking and processing, thereby contributing to greater alcohol use posttrauma. These data provide novel evidence of neural correlates that underlie increased alcohol use early posttrauma that may be targeted via early interventions to prevent the development of maladaptive alcohol use.

Liver transplantation for alcohol-associated liver disease: The changing landscape

Alcoholic liver disease(ALD) is considered as a growing public health issue with universally increasing disease burden. Various genetic and environmental factors play role in its etiology. ALD recently has become the major indication for Liver Transplantation (LT). Most LT programs select their candidates by adhering to six months of alcohol abstinence policy. Nevertheless, early liver transplantation (ELT) has become a subject of research, both in Europe and the United States, as an effective and lifesaving option among highly selected severe alcohol-associated hepatitis (SAH) patients. ELT is a promising way in the management of ALD, perhaps changing clinical practice for carefully selected patient groups.

Real-time impaired control over drinking: The role of contextual influences during naturally occurring drinking episodes

BACKGROUND

Impaired control over drinking is a central feature of Alcohol Use Disorder (AUD), yet little within-person research on impaired control is available. As a result, there is little research regarding the dynamic impact of social drinking context on impaired control. The current study sought to fill these gaps, testing a sequential mediation model wherein social drinking context predicted episode-specific deviations in perceived impaired control, which indirectly predicted daily negative consequences via drinking more than planned. We also modeled if estimated blood alcohol concentration (eBAC) moderated associations between social context and perceived impaired control.

METHODS

Emerging adults (N = 131; 51.8 % female) completed 21 days of ecological momentary assessments, including assessments of past-night drinking and planned drinking on a given day, and event-contingent reports during acute drinking episodes.

RESULTS

At the episode-level, social drinking context predicted higher perceived impaired control than an individual's daily average. At the daily-level, social drinking context predicted higher perceived impaired control, which indirectly predicted more negative consequences than a person's average via drinking more than planned. There was a residual effect of social context on drinking more than planned and negative consequences, and of perceived impaired control on negative consequences above and beyond drinking more than planned. Episode-level relations between social context and perceived impaired control were potentiated at higher vs. lower eBACs than an individual's daily average, but the same pattern was not observed at the daily-level.

CONCLUSIONS

Just-in-time interventions may benefit from increasing perceptions of control over drinking behavior, particularly during social drinking episodes.

Alcohol-associated liver disease: Natural history, management and novel targeted therapies

Alcohol consumption is a leading cause of preventable morbidity and mortality worldwide and the primary cause of advanced liver disease. Alcohol use disorder is a chronic, frequently relapsing condition characterized by persistent alcohol consumption despite its negative consequences. Alcohol-associated liver disease (ALD) encompasses a series of stages, from fatty liver (steatosis) to inflammation (steatohepatitis), fibrosis, and, ultimately, liver cirrhosis and its complications. The development of ALD is complex, involving both genetic and environmental factors, yet the exact mechanisms at play remain unclear. Alcohol-associated hepatitis (AH), a severe form of ALD, presents with sudden jaundice and liver failure. Currently, there are no approved targeted therapies able to interfere in the pathogenesis of ALD to stop the progression of the disease, making alcohol abstinence the most effective way to improve prognosis across all stages of ALD. For patients with advanced ALD who do not respond to medical therapy, liver transplantation is the only option that can improve prognosis. Recently, AH has become an early indication for liver transplantation in non-responders to medical treatment, showing promising results in carefully selected patients. This review provides an update on the epidemiology, natural history, pathogenesis, and current treatments for ALD. A deeper insight into novel targeted therapies investigated for AH focusing on new pathophysiologically-based agents is also discussed, including anti-inflammatory and antioxidative stress drugs, gut-liver axis modulators, and hepatocyte regenerative molecules.

Determinants of alcohol consumption among men and women aged 15-49 years in Cambodia: Evidence from the Cambodia demographic and health survey 2021-2022

INTRODUCTION

Alcohol consumption is a global health issue linked to over 200 diseases and accounts for 5.3% of all deaths annually. We aimed to determine the sociodemographic factors associated with alcohol consumption among Cambodian women and men aged 15-49 years.

METHODS

We used data from the 2022 Cambodia Demographic and Health Survey, including 19,496 women and 8825 men aged 15-49. Multiple logistic regressions were performed using STATA V18 to examine factors associated with alcohol consumption.

RESULTS

Nearly 70% of men (95% CI 67.6-70.9) and 16.3% of women (95% CI 15.3-17.3) reported consuming alcohol in the past months. Among men, predictors of alcohol consumption, including those aged 19-24 years, had higher odds of consuming alcohol than the younger ages ≤18 years (AOR 2.14; 95% CI 1.65-2.77). Married men consumed alcohol more than unmarried men and smokers had higher odds of alcohol use than non-smokers with AOR 1.80 (95% CI 1.52-2.14). Similar patterns were found among women, including increased ages, marriage and smoking were predictors of alcohol consumption.

DISCUSSION AND CONCLUSIONS

The study highlights the high prevalence of alcohol consumption among the Cambodian adult population, particularly among men. For both sexes, increased ages greater than 18 years, those who were married, had jobs, and smoking were the main predictors of alcohol consumption. Health promotion efforts should be focused on younger adults aged 19-24, who are increasingly engaging in risky behaviours, including alcohol intake and smoking, by raising awareness about the health consequences of harmful alcohol consumption.

Moving diagnosis of liver fibrosis into the community

Chronic liver disease (CLD) is a leading cause of death worldwide, with alcohol consumption and metabolic risk factors accounting for the majority of cases of CLD in many developed countries. Currently, specific strategies for the early diagnosis of CLD are lacking and consequently most cases are diagnosed at an advanced stage, which is associated with negative consequences for disease management and prognosis. Screening for CLD is based on either detection of chronic viral hepatitis B and C, or detection of liver fibrosis in patients with steatotic liver disease related to alcohol or metabolic dysfunction. Non-invasive tools, including serological and imaging-based tests, can be used to detect liver fibrosis. Clinical practice guidelines recommend screening for liver fibrosis using algorithms that combine different non-invasive tests, with widely available but low accuracy tests, such as FIB-4, recommended as a first screening step in the primary care setting, and other tests with lower availability but higher accuracy, such as transient elastography or the enhanced liver fibrosis test, recommended as a second step. There are different pathways for early detection of patients with CLD from primary to specialised care, with primary care providers being key for early detection, management and referral of patients. In addition, interventions targeting metabolic risk factors and alcohol consumption should be carried out in collaboration between specialists and primary care. In this review, we describe liver fibrosis from the community perspective, highlighting gaps in knowledge on how to define the optimal combination of tests, target population, the ideal pathway of care for CLD, and how to increase implementation of programmes for early diagnosis of liver diseases in clinical practice.

Transitioning from NAFLD to MAFLD and MASLD: the toxic relationship with alcohol consumption

Alcohol is a well-known toxic etiologic factor for liver injury. Metabolic substrates of alcohol (especially acetaldehyde) have a major responsibility and genetic susceptibility, alterations in microbiota and immune system are important co-factors for this injury. Major injury in liver is hepatocellular lipid accumulation. Therefore the relationship between non-alcoholic and alcoholic fatty liver diseases should have been defined clearly. Recently two major liver committees adopted new terminologies such as metabolic-associated fatty liver disease (MAFLD), metabolic dysfunction-associated steatotic liver disease (MASLD), metabolic dysfunction and alcohol-related liver disease (MetALD), and alcoholic liver disease (ALD) instead of non-alcoholic fatty liver disease (NAFLD). These terminologies were based on the effects of metabolic syndrome on liver. Alcohol consumption was defined differently according to these nomenclatures. MAFLD defined alcohol intake (regardless of amount) as “dual etiology fatty liver disease” and the Delphi consensus defined MASLD, MetALD, or ALD according to daily consumption of alcohol amount.

Atlas of the plasma proteome in health and disease in 53,026 adults

Large-scale proteomics studies can refine our understanding of health and disease and enable precision medicine. Here, we provide a detailed atlas of 2,920 plasma proteins linking to diseases (406 prevalent and 660 incident) and 986 health-related traits in 53,026 individuals (median follow-up: 14.8 years) from the UK Biobank, representing the most comprehensive proteome profiles to date. This atlas revealed 168,100 protein-disease associations and 554,488 protein-trait associations. Over 650 proteins were shared among at least 50 diseases, and over 1,000 showed sex and age heterogeneity. Furthermore, proteins demonstrated promising potential in disease discrimination (area under the curve [AUC] > 0.80 in 183 diseases). Finally, integrating protein quantitative trait locus data determined 474 causal proteins, providing 37 drug-repurposing opportunities and 26 promising targets with favorable safety profiles. These results provide an open-access comprehensive proteome-phenome resource (https://proteome-phenome-atlas.com/) to help elucidate the biological mechanisms of diseases and accelerate the development of disease biomarkers, prediction models, and therapeutic targets.

Spatial variation and determinant factors of alcohol consumption in Ethiopia: Spatial and multilevel analysis of Ethiopian demographic and health survey

BACKGROUND

Alcohol consumption continues to be a public health problem in Ethiopia. Previous investigations have been conducted on alcohol consumption in Ethiopia; however, these investigations were limited to specific localities, which could not represent the existing alcohol consumption in different parts of Ethiopia. Besides, the spatial variation of alcohol consumption was not well investigated in the previous studies, which could hinder the implementation of effective intervention towards alcohol consumption. Hence, this study aimed to determine the spatial distribution and determinant factors of alcohol consumption in Ethiopia.

METHODS

Secondary data from the 2016 Ethiopian demographic health survey was used in this study. A total of 44,023 weight samples were included using a stratified two-stage cluster sampling technique. The spatial variation of alcohol consumption was analyzed using ArcGIS version 10.7.1. The statistical significance of alcohol consumption clusters were identified using Kuldorff's SaTScan version 10.2. A multi-level analysis was also conducted to identify factors associated with alcohol consumption using STATA version 14.

RESULTS

In this study, 33.15% (95%CI: 32.5-33.8) of the study participants consumed alcohol with statistically significant spatial variation across regions of the country. Traditional religion (AOR = 13.7; 95%CI: 2.68-70.3), Regional variations (Amhara region-AOR = 3.56; 95%CI: 1.85-6.8, living in a low proportion of community literacy (AOR = 1.84; 95%CI: 1.1-3.18), cigarette smoking habit (AOR = 15.82; 95%CI: 4.31-58.1), and chewing Khat (AOR = 2.98; 95%CI: 1.22-7.27) were positively linked with alcohol consumption. Hot spot areas of alcohol consumption were found in Tigray, Amhara, and some parts of Oromia regions. The statistical significance of the primary clusters was also observed in Tigray and Amhara regions.

CONCLUSIONS

We found that one-third of Ethiopia's population is consuming alcohol. Having a cigarette smoking habit, chewing khat, high proportion of community literacy, and traditional religion were associated factors for alcohol consumption. Therefore, the federal government of Ethiopia, and ministry of health, and other concerned bodies should work in collaboration to decrease the proportion of people consuming alcohol.

Significance of Laboratory Findings and Esophageal Varices in Male Patients With Decompensated Alcoholic Liver Cirrhosis: A Single-Center Experience

Introduction Alcoholic liver disease represents a growing global pandemic, particularly among younger men, and is one of the leading causes of premature death worldwide. Observing complications during the decompensation stage and monitoring disease progression dynamics using scoring systems are particularly important. Materials and methods This retrospective-prospective, descriptive, and analytical study included 123 male patients with a confirmed diagnosis of alcoholic liver cirrhosis, hospitalized at the Internal Medicine Clinic, University Clinical Centre of the Republic of Srpska in Banja Luka, Department of Gastroenterology and Hepatology. The study period spanned from January 2023 to January 2025, with the note that patient selection and monitoring began much earlier, in June 2021. After hospitalization, patients were followed monthly through a program of outpatient control examinations, with disease outcomes recorded. The study included all male patients over 18 years of age with a confirmed diagnosis of alcoholic liver cirrhosis and signed informed consent. Female patients and those with cirrhosis or other etiologies were excluded. For statistical data analysis, the Statistical Package for the Social Sciences (SPSS) version 29 (IBM Corp., Armonk, NY, USA) was used. The statistical analyses performed included median, standard deviation, analysis of variance, Student's t-test, chi-square test, and survival analysis. Results The mean age of the patients was 59.09±9.316 years. Most of them had anemia: 113 patients (91.86%) with decreased erythrocytes and 109 patients (88.62%) with decreased hemoglobin. Thrombocytopenia was observed in 104 patients (84.55%), while an increased mean corpuscular volume (MCV) was recorded in 68 patients (55.28%). Among biochemical parameters, the most common findings were increased bilirubin in 98 patients (79.67%), aspartate aminotransferase (AST) in 111 patients (90.24%), gamma-glutamyl transferase (GGT) in 109 patients (88.61%), and D-dimer in 110 patients (89.44%), while albumin levels were decreased in 107 patients (87.00%). Hyponatremia (decreased sodium) was observed in 63 patients (51.21%), and hypercalcemia (increased calcium) in 116 patients (94.30%). Jaundice was the most common external sign, present in 98 patients (79.67%), while ascites were noted in 86 patients (69.91%). Death during the first decompensation occurred in 31 patients (25.20%), of whom 17 (54.83%) died in the hospital. The leading cause of mortality is bleeding from esophageal varices.  Conclusion Although a healthy liver performs over 200 distinct functions in the human body, a cirrhotic liver leads, one might say, to an even greater number of dysfunctions. This pathology is extremely complex, characterized by numerous complications and high treatment costs, which, despite all applied measures, do not ensure a favorable long-term prognosis without liver transplantation.

Epidemiology and Outcomes of Alcohol-Associated Hepatitis in Adolescents and Young Adults

Importance

Alcohol-associated hepatitis (AH) has high mortality, and rates are increasing among adolescents and young adults (AYAs).

Objective

To define the sex-specific epidemiology of AH in AYAs and the association between female sex and liver-related outcomes after a first presentation of AH.

Design, Setting, and Participants

A retrospective, population-based cohort study of routinely collected health care data held at ICES from Ontario, Canada, was conducted. Data on AYAs (age, 13-39 years) with first presentation of AH without a history of cirrhosis and/or decompensation from January 1 to December 31, 2022, were included in the analysis.

Exposures

Study year and female sex.

Main Outcome and Measures

Overall and sex-specific yearly rates of AH were compared using Poisson regression and rate ratios (RRs). Associations between female sex and incident cirrhosis and/or decompensation were evaluated using competing risks regression, and liver-related mortality by sex was evaluated with cumulative incidence functions.

Results

A total of 3340 AYAs with AH were identified. Median age was 33 (IQR, 28-36) years, and the population included 1190 (36%) females and 2150 (64%) males. Rates of AH increased by 8% per year (RR, 1.08; 95% CI, 1.07-1.09), with yearly rates increasing faster among females (RR, 1.11; 95% CI, 1.09-1.12) than males (RR, 1.07; 95% CI, 1.06-1.07). A total of 2374 individuals (71%) were alive without cirrhosis 6 months after AH presentation. Of those, 527 (22%) developed incident cirrhosis and/or decompensation after a median follow-up of 4 (IQR, 2-9) years (37% females vs 29% males; P < .001). After adjustment, female sex was associated with a 47% higher subhazard of cirrhosis and/or decompensation compared with male sex (38%) (subhazard, 1.47; 95% CI, 1.23-1.76; P < .001). The cumulative incidence of liver-related mortality at 10 years was higher among females (11.0%; 95% CI, 8.3%-14.2%) than males (6.9%; 95% CI, 5.4%-8.6%) (P = .01).

Conclusions and Relevance

Over the past 2 decades, the rates of AH among AYAs increased significantly, with the greatest increase observed among females. The findings of this study suggest sex-specific interventions to prevent the development of AH and the progression to cirrhosis after an episode of AH are needed.

Regaining control over alcohol intake but not abstinence on disulfiram medication, as a harm reduction approach: 2 case reports

BACKGROUND

Alcohol use disorder (AUD) poses severe health risks, yet many affected individuals opt out of complete abstinence. Therefore, harm reduction strategies have become more prominent in treatment guidelines for AUD. Our two case reports illustrate how disulfiram, initially intended to enforce abstinence, was repurposed to support reduced drinking.

CASE PRESENTATIONS

A 41-year-old patient with a history of severe AUD successfully reduced his alcohol consumption to a low-risk level by leveraging the effects of the disulfiram-alcohol aversive reaction. Another patient, a 63-year-old woman with long histories of AUD and major depressive disorder, experienced fewer depressive episodes and hospitalizations with disulfiram therapy despite periodically intentional discontinuation of medication.

CONCLUSION

Individualized treatment strategies are critical in optimizing outcomes for patients with AUD. Continuous disulfiram therapy, despite its limitations in directly reducing alcohol intake, might offer a new avenue for harm reduction in exceptional cases even if alcohol consumption continues. The cases suggest that maintaining therapy, aiming at reduced drinking, can enhance the therapeutic alliance and help manage comorbid conditions. Regular medical monitoring is essential for safety and efficacy, warranting further study of possible long-term consequences and psychotropic effects of elevated acetaldehyde levels related to the disulfiram-alcohol interaction.

Cigarette smoking and alcohol-related liver disease

China is a major consumer of alcohol and tobacco. Tobacco and alcohol use are closely linked, with up to 90% of alcoholics having a history of tobacco use, and heavy smokers also tending to be alcoholics. Alcohol-related liver disease (ALD), one of the most common and serious complications of chronic alcohol intake, involving hepatic steatosis, hepatitis, hepatic fibrosis, cirrhosis and hepatocellular carcinoma (HCC), has become one of the globally prevalent chronic diseases. An increasing number of studies have focused on the association between smoking and ALD and explored the mechanisms involved. Clinical evidence suggests that smoking has a negative impact on the incidence and severity of fatty liver disease, progression of liver fibrosis, development of HCC, prognosis of patients with advanced liver disease, and alcohol-related liver transplant recipients. The underlying mechanisms are complex and involve different pathophysiological pathways, including free radical exposure, endoplasmic reticulum stress, insulin resistance, and oncogenic signaling. This review discusses the deleterious effects of smoking on ALD patients and the possible underlying mechanisms at several levels. It emphasizes the importance of discouraging smoking among ALD patients. Finally, the pathogenic role of electronic cigarettes, which have emerged in recent years, is discussed, calling for an emphasis on social missions for young people.

Epidemiology of periportal fibrosis and relevance of current Schistosoma mansoni infection within the context of repeated mass drug administration in rural Uganda: a population-based, cross-sectional study

BACKGROUND

WHO guidelines for schistosomiasis-related morbidity control and elimination rely on current infection as a proxy indicator for morbidity. We evaluated these guidelines within the context of repeated mass drug administration and periportal fibrosis attributable to chronic intestinal schistosomiasis.

METHODS

We examined 1442 households randomly sampled from 38 villages in Buliisa, Pakwach, and Mayuge districts of Uganda within the SchistoTrack cohort. Periportal fibrosis was diagnosed in 2834 individuals aged 5-90 years using ultrasound and image patterns C-F from the Niamey protocol. Schistosoma mansoni status and intensity were diagnosed by Kato-Katz microscopy and point-of-care circulating cathodic antigen tests. Schistosome infection, co-infections, and comorbidities were examined as exposures for periportal fibrosis. Multivariable logistic regressions were run with SEs clustered by household.

FINDINGS

Between Jan 6 and Feb 3, 2022, 342 (12·1%) of 2834 participants were diagnosed with periportal fibrosis. By Kato-Katz microscopy, 1229 (43·4%) of 2834 participants were infected. 1863 (65·7%) of 2834 participants had trace positive point-of-care circulating cathodic antigen tests, which was higher than prevalence by Kato-Katz microscopy, and 1158 (40·9%) of 2834 participants had trace negative point-of-care circulating cathodic antigen tests. Individual schistosome status, intensity, and prevalence of heavy intensity infections of less than 1% and less than 5% were not correlated with periportal fibrosis likelihood or village prevalence. Periportal fibrosis likelihood linearly increased with age from age 5 years to age 25 years, non-linearly increased from age 26 years to age 45 years, attenuated or remained unchanged from age 46 years to age 60 years, and steadily decreased past 60 years of age. History of liver diseases, HIV, and ultrasound-detected chronic hepatitis or early cirrhosis-like disease were associated with more than two-times increased periportal fibrosis likelihood.

INTERPRETATION

WHO guidelines reliant on current schistosome status and intensity are uninformative for identifying probable cases or communities with periportal fibrosis. History of HIV and underlying chronic hepatitis or early cirrhosis-like disease are risk factors that could be investigated for periportal fibrosis surveillance and management.

FUNDING

NDPH Pump Priming Fund, Wellcome Trust, John Fell Fund, Robertson Foundation, and UK Research and Innovation Engineering and Physical Sciences Research Council.

Alcohol-associated liver cancer

Heavy alcohol intake induces a wide spectrum of liver diseases ranging from steatosis, steatohepatitis, cirrhosis, and HCC. Although alcohol consumption is a well-known risk factor for the development, morbidity, and mortality of HCC globally, alcohol-associated hepatocellular carcinoma (A-HCC) is poorly characterized compared to viral hepatitis-associated HCC. Most A-HCCs develop after alcohol-associated cirrhosis (AC), but the direct carcinogenesis from ethanol and its metabolites to A-HCC remains obscure. The differences between A-HCC and HCCs caused by other etiologies have not been well investigated in terms of clinical prognosis, genetic or epigenetic landscape, molecular mechanisms, and heterogeneity. Moreover, there is a huge gap between basic research and clinical practice due to the lack of preclinical models of A-HCC. In the current review, we discuss the pathogenesis, heterogeneity, preclinical approaches, epigenetic, and genetic profiles of A-HCC, and discuss the current insights into and the prospects for future research on A-HCC. The potential effect of alcohol on cholangiocarcinoma and liver metastasis is also discussed.

Alcohol-associated liver disease-Global epidemiology

Alcohol-associated liver disease (ALD), as highlighted in this narrative review, is a major public health concern, increasingly impacting global disease burden and premature mortality. In 2019, ALD accounted for the loss of 11 million life-years worldwide. The rising number of deaths and disability-adjusted life-years attributed to ALD, particularly pronounced in the United States, are alarming. Projections suggest that the economic impact of ALD, as seen in the United States, could potentially double by 2040. ALD is increasingly prevalent among younger adults (20-45 y) and has become the leading cause of liver transplantation in both United States and Europe. During the COVID-19 pandemic, the existing trend was further amplified as high-risk drinking patterns coincided with a rise in hospital admissions for alcohol-associated hepatitis and increased ALD-related mortality. The prevalence of ALD is estimated at 3.5% in the general population, 26.0% among hazardous drinkers, and 55.1% among those with alcohol use disorders. Alarmingly, 5-year mortality rates for patients with ALD exceed 50%, with even higher rates in more advanced disease stages. Methodological challenges, such as underreporting, diagnostic difficulties, and variability in registry data quality, complicate the accurate assessment of the impact of ALD. Additionally, the contribution of alcohol to the progression of other liver diseases is often under acknowledged in health care registries, leading to a significant underestimation of its broader implications for liver health. Addressing the growing ALD concern requires robust public health initiatives, heightened awareness, refined diagnostic techniques, and comprehensive epidemiological studies. These measures are vital to tackle the increasing prevalence of ALD and mitigate its extensive impact on individuals and health care systems.

Association of moderate alcohol intake with the risks of cirrhosis and steatotic liver disease: Results from a large population-based cohort study

BACKGROUND&AIMS

There is uncertainty about the associations between moderate alcohol consumption and liver-related outcomes. We aimed to explore the associations of moderate drinking with cirrhosis, steatotic liver disease (SLD), and liver cancer in a large cohort study.

METHODS

A total of 215,559 non-drinkers and moderate drinkers (<20 g/day alcohol for females or < 30 g/day for males) were enrolled between 2006 and 2010 and followed up to 2022. The primary outcome is incident cirrhosis, and the secondary outcomes are the incidence of steatotic liver disease and liver cancer. Hazard ratios (HRs) and 95 % confidence intervals (CIs) were calculated for liver-related outcomes in relation to moderate drinkers, as well as the quantity and type of their alcohol intake. All analyses were stratified by sex.

RESULTS

A total of 705 cirrhosis, 2010 SLD, and 350 liver cancer cases were documented during a median follow-up period of 12.7 years. Compared with non-drinkers, moderate drinkers had a lower risk of SLD (HR: 0.77; 95 % CI: 0.66, 0.89). Among the moderate drinkers, alcohol intake [per standard deviation (SD) increment] was associated with an increased risk of incident cirrhosis (HR: 1.11; 95 % CI: 1.02, 1.20), but the association was attenuated after restricting alcohol intake to no more than 16 g/day. Wine consumption (per SD increment of the percentage of wine consumption of total alcohol intake) had an inverse association with incident cirrhosis and SLD (HR: 0.82; 95 % CI: 0.75, 0.89 for cirrhosis; HR: 0.91; 95 % CI: 0.87, 0.96 for SLD). The inverse associations between moderate wine use and SLD were likely to be sex-dependent (P for interaction = 0.01).

CONCLUSIONS

The excessive alcohol threshold of 30 g/day for males may be set high for liver health. Further work is needed to make sex-specific recommendations on moderate drinking for liver health.

An analysis of the burden of liver cirrhosis: Differences between the global, China, the United States and India

BACKGROUND

Cirrhosis continues to be the most common cause of chronic liver disease-related deaths globally, which puts significant strain on global health. This report aims to investigate the patterns of cirrhosis in China, the United States, India and worldwide from 1990 to 2019 through an epidemiological analysis of the disease utilizing data from the Global Burden of Disease Study (GBD) 2019 database.

METHODS

Download the GBD database's statistics on liver cirrhosis deaths and Disability-Adjusted Life Years for the years 1990-2019 worldwide as well as for China, the United States and India. Utilize techniques like age-period-cohort interaction, decomposition analysis, study of health inequities, Joinpoint model and Bayesian Average Annual Percentage Change model to process the data.

RESULTS

The main age group affected by cirrhosis disease, according to the results, is 50-69 years old. According to the Joinpoint model, there has been a negative worldwide Average Annual Percent Change (AAPC) in the burden of cirrhosis between 1990 and 2019. Only the USA's AAPC is positive out of the three nations that were evaluated (albeit its 95% confidence interval spans 0). These are China, India and the United States. Forecasting models indicate that the prevalence of cirrhosis will keep rising in the absence of government action. According to decomposition analysis, the main factors contributing to the rising burden of cirrhosis are population ageing and size, whereas changes in the disease's epidemiology slow the disease's growth. Research on health disparities indicates that, between 1990 and 2019, there was a downward trend in health disparities between various locations.

CONCLUSION

Health organizations across different areas should take aggressive measures to address the worrisome prevalence of cirrhosis.

Advances in the management of alcohol-associated liver disease

Alcohol-associated liver disease (ALD) is a significant global health challenge, encompassing a spectrum from steatotic liver disease to cirrhosis and alcohol-associated hepatitis, and contributed to 25% of global cirrhosis deaths in 2019. The identification of both modifiable (e.g. heavy drinking, metabolic syndromes) and non-modifiable risk factors (e.g. genetic predispositions) is crucial for effective disease management. Alcohol use assessment and treatment, by using both behavioral therapy and pharmacotherapeutic modalities, nutrition support, and optimization of liver disease modifiers, form the cornerstone of management. Advances in medical therapies, such as fecal microbiota transplantation and novel agents such as IL-22, are being explored for their therapeutic potential. A unifying theme in ALD care is the need for a personalized approach to management, accounting for the spectrum of the disease and individual patient characteristics, to tailor interventions effectively. Finally, it is essential to address the challenges to effective ALD treatment, including socioeconomic, logistical, and stigma-related barriers, to improve patient outcomes. This review discusses the current knowledge on ALD, including epidemiology, pathophysiology, risk factors, and management strategies, highlighting the critical role of integrated care models.

Epidemiology of Alcohol-Associated Liver Disease Including Increasing Burden in Young Adults and Females Especially Since Covid-19 Pandemic

Alcohol-associated liver disease (ALD) was already on the rise globally when the advent of coronavirus disease 2019 further accelerated this trend. ALD has emerged as the leading cause for liver transplantation in the United States. The pandemic has not only intensified the prevalence of ALD but has also highlighted significant disparities in its impact, particularly, among young adults and women. This review aims to dissect the complex landscape of ALD, focusing on gender, race, and emerging risk factors in the context of the current global health crisis.

Treatment of Alcohol Use Disorder: Behavioral and Pharmacologic Therapies

The prevalence of alcohol use disorder (AUD) has significantly increased over the last decade, leading to an increase in alcohol-associated liver disease (ALD) rates worldwide. Despite this prominence, AUD in ALD remains undertreated and carries significant implications in the progression to end-stage ALD and increased mortality. In efforts to bridge this gap, interprofessional and integrated AUD treatment is necessary for patients with ALD to ensure early detection and an appropriately targeted level of care. Although pharmacotherapy, psychotherapy, and psychosocial interventions independently play a role in treating AUD, a combination of these evidence-based modalities often results in lasting change.

Decreased prevalence of alcohol use and related sociodemographic factors in an urban district of Shanghai, China: Evidence from three cross-sectional surveys (2010-2021)

BACKGROUND

Alcohol use contributes considerably to the global impact of disease. However, limited research has been conducted recently to explore the changes in the prevalence of alcohol use, especially in urban Shanghai, China.

OBJECTIVES

To estimate the prevalence changes of alcohol use and explore related sociodemographic factors among urban residents of Xuhui district, Shanghai, China.

METHODS

Using a multistage probability proportionate-to-size sampling method, three waves of household investigations via a structured questionnaire were conducted in Xuhui district, Shanghai, China, between 2010 and 2021. Data were collected by face-to-face interviews among residents aged 15 or older who responded to the 2010, 2015, and 2021 Health Status and Health Service Utilization Survey. Age and sex standardized prevalence of alcohol use was calculated, and the linear trend was tested using logistic regression models. Multilevel mixed-effects logistic regression models with robust covariance matrix estimators were used to estimate related factors of alcohol use.

RESULTS

A total of 24 552 participants aged 15-109 years were included. The standardized overall prevalence of current regular alcohol use statistically declined from 8.8 % in 2010 to 5.5 % in 2021. This decreasing trend was statistically significant, especially among men aged 30-59 and ≥ 75 years old. However, the prevalence of overall alcohol use, regardless of frequency, increased from 19.6 % in 2015 to 24.0 % in 2021. Multivariate regression analysis showed that men had a significantly higher likelihood of regular alcohol use than women. Also, age was positively related to regular alcohol use, while education level was negatively related to this behavior.

CONCLUSIONS

Alcohol use was still common, although a significant decreasing trend in the prevalence of regular alcohol use was observed overall, in this study population. The findings call for strengthened health education and alcohol control in the context of the harmful effects of alcohol use at any level.

Predictive factors of cognitive impairment in alcohol use disorder inpatients

BACKGROUND

Cognitive impairments are common in patients with AUD and worsen the prognosis of addiction management. There are no clear guidelines for screening cognitive impairments in hospitalized patients with AUD.

METHODS

Fifty-seven patients with an AUD history who were admitted to an acute hospital and assessed by the addiction care team were included. Those patients were screened for cognitive impairments using the Montreal Cognitive Assessment (MoCA) test. We collected clinical information regarding addiction history, comorbidities, and current treatments. Chi-square tests, t-tests, and Mann-Whitney tests were performed to determine factors associated with a pathological MoCA score (<26).

RESULTS

A pathological MoCA score was positively associated with spatial-temporal disorientation, difficulty in recalling addiction history, patient underreporting of AUD and a date of last alcohol consumption lower than 11 days ago, and negatively associated with a reason for hospitalization due to alcohol-related health issues. No medication was associated with cognitive impairments.

CONCLUSIONS

Clinical elements from assessment by the addiction care team allow for relevant indication for screening cognitive impairments.

Alcohol Use Disorder and Alcohol-Associated Liver Disease: New Definitions, Screening, and Treatment

Alcohol-associated liver disease (ALD) poses a significant global health burden and is a leading cause of liver-related morbidity and mortality. ALD encompasses a spectrum of disease states ranging from asymptomatic steatosis to acute hepatitis and cirrhosis. Alcohol use disorder (AUD) significantly increases the risk of developing ALD, and insight into AUD can provide a more complete understanding of ALD and the patients affected by these interrelated diseases. Accurate and timely identification of AUD, even in primary care, through validated screening tools combined with blood tests and imaging techniques facilitates early detection of ALD. Although liver transplantation (LT) remains the most effective treatment for end-stage ALD, patient outcomes post-LT have evolved because of shifting perspectives on ALD transplant eligibility, comprehensive pre-LT evaluations, and advancements in post-LT ALD detection. Nonetheless, addressing disparities in LT practices for ALD is paramount for ensuring equitable access to this life-saving intervention. This article offers an updated synopsis of ALD definitions, screening methodologies, and contemporary management approaches, particularly in the context of LT.

Deciphering the multifaceted role of microRNAs in hepatocellular carcinoma: Integrating literature review and bioinformatics analysis for therapeutic insights

Hepatocellular carcinoma (HCC) poses a significant global health challenge, necessitating innovative therapeutic strategies. MicroRNAs (miRNAs) have emerged as pivotal regulators of HCC pathogenesis, influencing key processes such as self-renewal, angiogenesis, glycolysis, autophagy, and metastasis. This article integrates findings from a comprehensive literature review and bioinformatics analysis to elucidate the role of miRNAs in HCC. We discuss how dysregulation of miRNAs can drive HCC initiation, progression, and metastasis by modulating various signaling pathways and target genes. Moreover, leveraging high-throughput technology and bioinformatics tools, we identify key miRNAs involved in multiple cancer hallmarks, offering insights into potential combinatorial therapeutic strategies. Through our analysis considering p-values and signaling pathways associated with key features, we unveil miRNAs with simultaneous roles across critical cancer characteristics, providing a basis for the development of high-performance biomarkers. The microRNAs, miR-34a-5p, miR-373-3p, miR-21-5p, miR-214-5p, miR-195-5p, miR-139-5p were identified to be shared microRNAs in stemness, angiogenesis, glycolysis, autophagy, EMT, and metastasis of HCC. However, challenges such as miRNA stability and delivery hinder the translation of miRNA-based therapeutics into clinical practice. This review underscores the importance of further research to overcome existing barriers and realize the full potential of miRNA-based interventions for HCC management.

FGF1 attenuates sepsis-induced coagulation dysfunction and hepatic injury via IL6/STAT3 pathway inhibition

BACKGROUND & AIMS

Sepsis, a globally prevalent and highly lethal condition, remains a critical medical challenge. This investigation aims to assess the relevance of FGF1 as a potential therapeutic target for sepsis.

METHODS

Sepsis was induced in C57BL/6 mice through LPS administration to establish an in vivo animal model. Various in vitro assays were conducted using human umbilical vein endothelial cells to elucidate the role of FGF1 in the disruption of the coagulation system and liver injury associated with sepsis, as well as to explore its underlying molecular mechanisms.

RESULTS

In in vivo experiments, FGF1 ameliorated coagulation system disruption in septic mice by reducing the levels of pro-inflammatory and coagulation-related factors in the bloodstream. FGF1 also enhanced liver function in septic mice, mitigating liver inflammation and cell apoptosis, fostering liver vascular regeneration, increasing liver blood perfusion, and improving mouse survival. In vitro experiments demonstrated that FGF1 could inhibit LPS-induced inflammatory responses and apoptosis in endothelial cells, fortify endothelial cell barrier function, decrease endothelial cell permeability, promote endothelial cell proliferation, and restore endothelial cell tube-forming ability. Both in vivo and in vitro experiments substantiated that FGF1 improved sepsis by inhibiting the IL-6/STAT3 signaling pathway.

CONCLUSION

In summary, our study indicates that FGF1 mitigates excessive inflammatory responses in sepsis by suppressing the IL-6/STAT3 signaling pathway, thereby improving systemic blood circulation and ameliorating liver damage in septic organisms. Consequently, this research identifies FGF1 as a potential clinical target for the treatment of human sepsis.

Alcohol consumption and liver phenotype of individuals with alpha-1 antitrypsin deficiency

BACKGROUND AND AIMS

Alpha-1 antitrypsin deficiency is an inherited disorder caused by alpha-1 antitrypsin (AAT) mutations. We analysed the association between alcohol intake and liver-related parameters in individuals with the heterozygous/homozygous Pi*Z AAT variant (Pi*MZ/Pi*ZZ genotype) found in the United Kingdom Biobank and the European Alpha1 liver consortium.

METHODS

Reported alcohol consumption was evaluated in two cohorts: (i) the community-based United Kingdom Biobank (17 145 Pi*MZ, 141 Pi*ZZ subjects, and 425 002 non-carriers [Pi*MM]); and (ii) the European Alpha1 liver consortium (561 Pi*ZZ individuals). Cohort (ii) included measurements of carbohydrate-deficient transferrin (CDT).

RESULTS

In both cohorts, no/low alcohol intake was reported by >80% of individuals, while harmful consumption was rare (~1%). Among Pi*MM and Pi*MZ individuals from cohort (i), moderate alcohol consumption resulted in a <30% increased rate of elevated transaminases and ~50% increase in elevated gamma-glutamyl transferase values, while harmful alcohol intake led to an at least twofold increase in the abnormal levels. In Pi*ZZ individuals from both cohorts, moderate alcohol consumption had no marked impact on serum transaminase levels. Among Pi*ZZ subjects from cohort (ii) who reported no/low alcohol consumption, those with increased CDT levels more often had signs of advanced liver disease.

CONCLUSIONS

Pi*MZ/Pi*ZZ genotype does not seem to markedly aggravate the hepatic toxicity of moderate alcohol consumption. CDT values might be helpful to detect alcohol consumption in those with advanced fibrosis. More data are needed to evaluate the impact of harmful alcohol consumption.

Causal effects of smoking, alcohol consumption, and coffee intake on hepatobiliary and pancreatic diseases: A Mendelian randomization study

BACKGROUND

Hepatobiliary and pancreatic diseases, such as cirrhosis, hepatocellular carcinoma, cholelithiasis, and pancreatitis, are major global health challenges. Lifestyle factors like smoking, alcohol consumption, and coffee intake are commonly studied for their health impacts. However, observational studies often face issues with confounding factors and reverse causality, making it difficult to establish causal relationships.

METHODS

This research uses Mendelian randomization (MR) to investigate the causal effects of smoking, alcohol use, and coffee intake on 10 hepatobiliary and pancreatic diseases. Genetic data from the Sequencing Consortium of Alcohol and Nicotine Use (GSCAN) and self-reported GWAS were used to derive instrumental variables (IVs). The outcomes were obtained from the FinnGen and UK Biobank cohorts. Univariable and multivariable MR analyses were conducted to assess the associations.

RESULTS

Genetic predisposition to tobacco use was associated with increased risks of acute pancreatitis, alcoholic hepatitis, chronic pancreatitis, cirrhosis, gallstones, liver cancer, and pancreatic cancer. Alcohol consumption was linked to acute pancreatitis, chronic pancreatitis, alcoholic liver disease, hepatic cancer, and cholangitis. Coffee intake showed minimal associations, with a slight protective effect against non-alcoholic steatohepatitis.

CONCLUSIONS

This study confirms the harmful effects of inhaling tobacco and consuming alcohol on hepatobiliary and pancreatic diseases. It highlights the need for public health strategies to reduce tobacco use and heavy alcohol consumption. Coffee intake showed minimal effects, suggesting further research is needed to understand its relationship with hepatobiliary health.

Effect of diabetes on mortality and liver transplantation in alcoholic liver cirrhotic patients with acute decompensation

BACKGROUND

Previous studies have investigated the influence of diabetes on alcoholic liver cirrhosis patients, leaving its impact unclear. Thus, we conducted a study to reveal the association of diabetes and clinical outcomes of such patients.

MATERIALS AND METHODS

We prospectively collected data from multicenter pertaining to 965 patients diagnosed with alcoholic liver cirrhosis, all of whom were admitted due to acute decompensation between 2015 and 2019. Risk of major precipitating factors and incidences of death or liver transplantation in patients with and without diabetes was comparatively assessed. Propensity score (PS) matching was performed at a 1:2 ratio for accurate comparisons.

RESULTS

The mean age was 53.4 years, and 81.0% of the patients were male. Diabetes was prevalent in 23.6% of the cohort and was positively correlated with hepatic encephalopathy and upper gastrointestinal bleeding, although not statistically significant. During a median follow-up of 903.5 person-years (PYs), 64 patients with and 171 without diabetes died or underwent liver transplantation, with annual incidence of 33.6/100 PYs and 24.0/100 PYs, respectively. In the PS-matched cohort, the incidence of death or liver transplantation was 36.8/100 PYs and 18.6/100 PYs in the diabetes and matched control group, respectively. After adjusting for various factors, coexisting diabetes significantly heightened the risk of death or liver transplantation in the short and long term, in addition to prolonged prothrombin time, low serum albumin, elevated total bilirubin and creatinine, and decreased serum sodium levels.

CONCLUSIONS

Diabetes increases the risk of death or liver transplantation in patients with alcoholic liver cirrhosis.

FIB-4 as a Time-varying Covariate and Its Association With Severe Liver Disease in Primary Care: A Time-dependent Cox Regression Analysis

BACKGROUND AND GOALS

The Fibrosis-4 Index (FIB-4) has demonstrated a strong association with severe liver disease (SLD) outcomes in primary care, but previous studies have only evaluated this relationship using 1 or 2 FIB-4 scores. In this study, we determined the association of FIB-4 as a time-varying covariate with SLD risk using time-dependent Cox regression models.

STUDY

This retrospective cohort study included primary care patients with at least 2 FIB-4 scores between 2012 and 2021. The outcome was the occurrence of an SLD event, a composite of cirrhosis, complications of cirrhosis, hepatocellular carcinoma, and liver transplantation. The primary predictor was FIB-4 advanced fibrosis risk, categorized as low-(<1.3), indeterminate-(1.3≤FIB to 4<2.67), and high-risk (≥2.67). FIB-4 scores were calculated and the index, last, and maximum FIB-4s were identified. Time-dependent Cox regression models were used to estimate hazard ratios (HR) and their corresponding 95% CI with adjustment for potentially confounding covariates.

RESULTS

In the cohort, 20,828 patients had a median of 5 (IQR: 3 to 11) FIB-4 scores each and 3% (n=667) suffered an SLD outcome during follow-up. Maximum FIB-4 scores were indeterminate-risk for 34% (7149) and high-risk for 24% (4971) of the sample, and 32% (6692) of patients had an increase in fibrosis risk category compared with their index value. The adjusted Cox regression model demonstrated an association between indeterminate- (hazard ratio 3.21; 95% CI 2.33-4.42) and high-risk (hazard ratio 20.36; 95% CI 15.03-27.57) FIB-4 scores with SLD outcomes.

CONCLUSIONS

Multiple FIB-4 values per patient are accessible in primary care, FIB-4 fibrosis risk assessments change over time, and high-risk FIB-4 scores (≥2.67) are strongly associated with severe liver disease outcomes when accounting for FIB-4 as a time-varying variable.

Hepatoprotective effects and mechanisms of l-theanine and epigallocatechin gallate combined intervention in alcoholic fatty liver rats

BACKGROUND

Chronic excessive alcohol consumption can lead to alcoholic fatty liver, posing substantial health risks. l-Theanine (LTA) and epigallocatechin gallate (EGCG) in tea exert antioxidant and hepatoprotective effects. However, the combined effects of LTA and EGCG on rats with alcoholic fatty liver, and the underlying mechanisms of such effects, remain unclear. In this study, Sprague Dawley (SD) rats were fed with alcohol for 6 weeks to induce alcoholic fatty liver. Subsequently, for another 6 weeks, the rats were administered LTA (200 mg kg-1 day-1), EGCG (200 mg kg-1 day-1), or a combination of LTA with EGCG (40 mg kg-1 day-1 l-Thea +160 mg kg-1 day-1 EGCG), respectively.

RESULTS

The combined use of LTA and EGCG for alcoholic fatty liver disease had more significant effects than their individual administration. This combination reduced the activity of serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) as well as the levels of hepatic triglyceride (TG), malondialdehyde (MDA), and reactive oxygen species (ROS) in the rats. The combined intervention also increased hepatic superoxide dismutase (SOD) and glutathione peroxidase activity. Reductions in hepatic fat accumulation and inflammatory responses were observed. The mechanism underlying these effects primarily involved the inhibition of fatty acid synthesis and the alleviation of lipid peroxidation through the downregulation of the mRNA and protein expression of TNF-α, SREBP1c, and CYP2E1 and the upregulation of the mRNA and protein expression of ADH1, ALDH2, Lipin-1, PPARαPPARα, AMPK, and PGC-1α, thereby promoting the oxidative decomposition of fatty acids and reducing the synthesis of cholesterol and glucose.

CONCLUSION

l-Theanine and EGCG appear to be able to alleviate alcoholic fatty liver by modulating lipid metabolism and ameliorating oxidative stress, indicating their potential as natural active ingredients in anti-alcoholic fatty liver food products. © 2024 Society of Chemical Industry.

Alcohol-related diseases: from metabolism to the main effect on the body

Alcohol consumption can cause, beyond addiction, roughly 200 different diseases and at least fourteen types of cancer. In 2016 the WHO estimated that 29% of alcohol-related deaths were mainly due to oncological diseases, liver cirrhosis (20%), and cardiovascular disorders (19%). The aim of this review was to focus on the absorption and metabolism of ethanol and discuss the main conditions caused by alcohol consumption (i.e., liver and cardiovascular diseases, and tumors). This narrative review is based on a detailed analysis of the scientific literature published before January 31, 2024 (PubMed, Web of Science, Scopus, Google Scholar). Approximately 90% of the absorbed alcohol reaches the liver where it is metabolized to acetaldehyde, a highly reactive and toxic compound. The excessive use of alcohol causes damage to several organs and systems, mainly the liver (e.g., steatosis, steato-hepatitis, fibrosis, and cirrhosis), cardiovascular system (cardiomyopathy, arrythmias, arterial hypertension, and stroke), and significantly contribute to the onset of neoplastic lesions to various organs including the esophagus, liver and breast. Even moderate drinking appears not to reduce mortality risk. Alcohol intake is one of the main risk factors for several pathological conditions and social problems, thus drastically impacting on public health. Proper awareness of the high risk related to alcohol consumption is of crucial importance to reduce the harm to public health.