People who are heavy drinkers and have a specific genetic makeup are six times more likely to develop alcohol-related cirrhosis, according to new research from UCL, the Royal Free Hospital, the Universities of Oxford and Cambridge. The study, published December 14 in the journal Nature Communications, is the first to assess how an individual's drinking patterns, genetic profile (via a polygenic risk score) and having type 2 diabetes affect their risk of developing alcohol-related cirrhosis (ARC).

The observation that drinking patterns are more important than the amount consumed, and that risk is increased if genetic makeup and type 2 diabetes are both present, provides more accurate information for identifying those most susceptible to liver disease.

Liver disease is one of the leading causes of premature death worldwide, with 2%-3% of the global population suffering from cirrhosis (scarring of the liver) or liver disease. Alcohol-related deaths have increased by 20% since the COVID-19 pandemic.

Research details and results

In the study, researchers analyzed data from 312,599 active drinking adults in the UK Biobank cohort to assess the impact of drinking patterns, genetic susceptibility and type 2 diabetes on the likelihood of developing ARC.

A baseline hazard ratio (HR) of 1 was set using data from participants who reported alcohol consumption within the daily limit, had low genetic susceptibility to ARC, and did not have diabetes.

Heavy drinkers (that is, drinking 12 units a day at some time during the week) are three times more likely to develop ARC. People with a high genetic susceptibility have a four-fold higher risk of developing ARC, and people with type 2 diabetes have a two-fold higher risk.

"Many studies looking at the relationship between liver disease and alcohol have focused primarily on the amount of alcohol consumed," said the study's first author, Dr. Linda Wufa, of the UCL School of Epidemiology and Public Health. "We took a different approach and looked at drinking patterns and found that this was a better reflection of liver disease risk than alcohol consumption alone. Another key finding was that the more risk factors involved, the higher the 'excess risk' due to the interaction of these factors."

When heavy drinking and genetic susceptibility are high, the risk of developing ARC is six times greater than the baseline risk. If you add type 2 diabetes to the mix, the risk is even greater.

"Only one in three alcoholics will develop severe liver disease," said the study's senior author, Dr. Gautam Mehta of UCL Medicine and the Royal Free Hospital in the UK. "While genetic factors play a role, this study highlights that drinking patterns are also a key factor. For example, our results show that drinking 21 units in a row is more harmful than an average of 10 drinks per week. Genetic information is likely to be widely used in health care in the coming years, and adding genetic information can more accurately predict risk."

Although polygenic risk scores are not yet widely used clinically, they may become more commonly used as a way to define personalized disease risk.

Dr Steven Bell, senior author of the study from the University of Cambridge, said: "Deaths from liver disease, particularly alcohol-related deaths, have increased significantly since the COVID-19 pandemic, so it is important that we adopt innovative strategies to tackle this escalating crisis. This study gives us new tools that are crucial for identifying those most at risk, allowing us to target interventions more effectively to those who will benefit most."

Pamela Healy, chief executive of the British Liver Trust, said: "This research is important because it reveals that it's not just how much you drink overall, but how you drink it. Drinking large amounts, drinking quickly or drinking just to get drunk can have serious consequences for liver health." The UK's drinking culture has undergone a disturbing shift over the past two decades as alcohol has become increasingly more accessible and affordable. The UK needs to tackle rising alcohol consumption with a joint 'alcohol strategy' that includes taxation, tighter controls on alcohol advertising and marketing, and increased awareness of the dangers of binge drinking."

Compiled source: ScitechDaily