Showing posts with label alcohol consumption. Show all posts
Showing posts with label alcohol consumption. Show all posts

Tuesday, January 22, 2019

Treating alcohol-related liver disease from a public health perspective

Also See
Journal of Hepatology February 2019
Alcohol-related liver disease: Time for action
Ramon Bataller, Gavin E. Arteel, Christophe Moreno, Vijay Shah
The overall landscape of clinical hepatology has markedly evolved in the last few years. Recent major advances in the management of viral hepatitis B and C with highly effective therapies are decreasing the proportion of patients with viral-related end-stage liver disease in many countries.1 Consequently, increasing attention is being paid to fatty liver diseases (both alcohol-related liver disease [ALD] and non-alcoholic fatty liver disease [NAFLD]) as the main current and future driver of liver-related health burdens.
PDF
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Journal of Hepatology February 2019
Volume 70, Issue 2, Pages 223–236
Treating alcohol-related liver disease from a public health perspective
Theresa Hydes†, William Gilmore†, Nick Sheron, Ian Gilmore


Summary
Herein, we describe the evolving landscape of alcohol-related liver disease (ALD) including the current global burden of disease and cost to working-aged people in terms of death and disability, in addition to the larger spectrum of alcohol-related heath complications and its wider impact on society. We further review the most effective and cost-effective public health policies at both a population and individual level. Currently, abstinence is the only effective treatment for ALD, and yet because the majority of ALD remains undetected in the community abstinence is initiated too late to prevent premature death in the majority of cases. We therefore hope that this review will help inform clinicians of the “public health treatment options” for ALD to encourage engagement with policy makers and promote community-based hepatology as a speciality, expanding our patient cohort to allow early detection, and thereby a reduction in the enormous morbidity and mortality associated with this disease.

Full Article: 

Alcohol-Linked Disease Overtakes Hep C As Top Reason For Liver Transplant

Alcohol-Linked Disease Overtakes Hep C As Top Reason For Liver Transplant
By Rachel Bluth
An estimated 17,000 Americans are on the waiting list for a liver transplant, and there’s a strong chance that many of them have alcohol-associated liver disease. ALD now edges out hepatitis C as the No. 1 reason for liver transplants in the United States, according to research published Tuesday in JAMA Internal Medicine.

One reason for the shift, researchers said, is that hepatitis C, which used to be the leading cause of liver transplants, has become easier to treat with drugs.

Another could be an increasing openness within the transplant community to a candidate’s history of alcohol and addiction and when a candidate combating these issues can qualify for a liver.

For years, conventional wisdom suggested that people with a heavy drinking past who did not have a period of sobriety under their belts would not be good candidates to receive a new liver. But, of almost 33,000 liver transplant patients since 2002 who were studied, researchers from the University of California-San Francisco found 36.7 percent of them had ALD in 2016, up from 24.2 percent in 2002.

“Across the country, and we show in a prior study, people are changing their minds,” said Dr. Brian P. Lee, the study’s lead author and a UCSF gastroenterology and hepatology fellow. “More and more providers are willing to transplant patients with ALD.”

The debate, roiling for decades, culminated in 1997 when a group of doctors and medical societies and the U.S. surgeon general published a paper that recommended patients with alcoholic liver disease be sober at least six months before they could be considered for transplant.

This “six-month rule” became the gold standard. The idea was that a patient who could stay sober for that long had a lower chance of returning to harmful drinking behavior. There was also concern that the public would stop donating organs if they thought livers would be going to people with alcohol addictions.

“Neither of those attitudes are based on any facts or data,” said Dr. Robert Brown, director of the Center for Liver Disease and Transplantation at Weill Cornell and New York Presbyterian.

The changing attitude plays out at many transplant centers where what once was viewed as a hard-and-fast requirement for six months of sobriety is now more nuanced. Specifically, a team of doctors, psychologists and social workers look at a range of factors, including financial stability and family support, to determine if a patient will relapse after the transplant.

An analysis published in 2010 by researchers from the University of Pittsburgh and a 2011 study in France showed that, in any given year, there was little evidence to suggest six months of abstinence before the transplant decreased the chance of relapse.

The central point, experts say, does not necessarily come down to a patient’s record of sobriety before the procedure. Foremost is determining that a patient is unlikely to drink again after receiving a new liver — that he or she is “committed to lifelong abstinence,” said Lee.

Five years after transplantation, patients who were abstinent for six months and those who weren’t had about the same survival rates, according to Lee’s research. After 10 years, the patients who didn’t have six months of sobriety before the procedure had slightly worse survival rates. Lee said more research is needed to find out exactly why.

There is nothing magical about six months, according to Dr. Michael Lucey, medical director of the University of Wisconsin liver transplant program. He said it shows a poor understanding of alcohol abuse as a “very complex behavioral disorder.”

“Drinking isn’t a stable phenomenon,” Lucey said. “People with ALD may have long periods of drinking and abstinence.”

Although advocates are glad that policy is changing, it didn’t change swiftly enough to save Chelsea Oesterle.

Oesterle, who was 24 and had battled alcohol addiction since age 16, went to the emergency room in Peoria, Ill., in 2013, already in liver failure. Doctors told her in the first few days that survival depended on a transplant.

When it became clear she wasn’t going to get that transplant, her mother, Terri Oesterle, had her daughter transferred to another hospital, and between both facilities she spent six weeks hospitalized. During that time, she was never put on a transplant list.

The stigma around her daughter’s condition was palpable, her mother said. Doctors and nurses lectured her about quitting drinking.

“They kept telling her she had to go to rehab,” Terri Oesterle said. “She couldn’t even leave the hospital, how on earth was she supposed to go to a rehab program?”

One doctor point-blank asked Terri Oesterle why she thought her daughter deserved a liver over someone else.

“She was dismissed from the get-go,” Terri Oesterle said. “It’s just heart-wrenching because she was such a sensitive soul. She was so scared and hopeful.”

Chelsea Oesterle died in the hospital July 4, 2013.

Alcohol use disorder has often been thought of as a “self-inflicted” disease that results from bad habits or moral failing, Lucey said. That attitude is changing in the medical community, but vestiges remain.

“For some people, it’s not accepting that alcohol use disorder is an illness,” Lucey said.

While support for the changing approach is growing, Lee, the new study’s lead author, said it continues to be a polarizing issue.

“There are still detractors and still strong opposition,” he said. “Our study suggests that is certainly present, because regional differences are disparate.”

That troubles Lee, because it means a patient’s life is dependent on the attitudes of local providers, creating an unequal system. There’s “certainly value” in a national policy on the issue, he said.

The United Network for Organ Sharing (UNOS), the organization that manages the U.S. transplant list, nearly two decades ago wrestled with the idea of formalizing the six-month rule, but never took final action.

As a result, some centers have such a sobriety rule, others don’t. And even when a transplant center gives its approval, insurers often have their own set of requirements about how long a patient must be abstinent before they will cover the transplant.

Dr. David Klassen, chief medical officer for UNOS, agreed that the “rule” is arbitrary and not evidence-based, but said that it should be up to transplant centers to decide who gets listed for an organ.

“From our perspective, dictating medical care doesn’t lead to the best solutions or the best outcomes,” Klassen said. “I think transplant programs and society as a whole are moving in generally the same direction.”

Wednesday, January 2, 2019

Alcohol and the Liver: The Return of the Prodigal Son

Annals Of Hepatology

OPINIONS 
Alcohol and the Liver: The Return of the Prodigal Son
Octavio Campollo

Full-text article

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Abstract
With the discovery of direct-acting antivirals and the prospective of viral hepatitis becoming curable, alcohol liver disease (ALD) is back to primetime. In the last 20 years, there have been many advances in the understanding of the biology, the psychology and the social and environmental factors associated with this long-known medical problem. Recent information about regional, ethnic, cultural and genetic factors seem to be relevant for the Latin American (LA) population. New approaches based on the new concepts and current information will render better results in the overall management of patients with this problem. Considering alcohol use disorder and ALD as part of the same entity managing it in a multidisciplinary approach seems to be best way to deal with this disease.

Tuesday, November 13, 2018

All adults should be screened for unhealthy alcohol use, new guidelines say

All adults should be screened for unhealthy alcohol use, new guidelines say
CNN
All adults should be screened for unhealthy alcohol use, new guidelines say. The negative consequences of too much alcohol include illness, injury, and death -- unhealthy alcohol use ranks as the third leading preventable cause of death in the US according to the task force. When pregnant women drink, birth defects and developmental problems in their children may follow.

By Susan Scutti, CNN
Updated 2:06 PM ET, Tue November 13, 2018
You can expect a "drinking checkup" when you visit the doctor. All adults, including pregnant women, should be screened for unhealthy alcohol use by their primary care physicians, the United States Preventive Services Task Force advises. For those patients who drink above the recommended limits, doctors should provide brief counseling to help them reduce their drinking, according to the new task force statement published Tuesday in the medical journal JAMA.

US Preventive Services Task Force Recommendation Statement 
November 13, 2018 
Screening and Behavioral Counseling Interventions to Reduce Unhealthy Alcohol Use in Adolescents and Adults
JAMA. 2018;320(18):1899-1909. doi:10.1001/jama.2018.16789
The USPSTF recommends screening for unhealthy alcohol use in primary care settings in adults 18 years or older, including pregnant women, and providing persons engaged in risky or hazardous drinking with brief behavioral counseling interventions to reduce unhealthy alcohol use. (B recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening and brief behavioral counseling interventions for alcohol use in primary care settings in adolescents aged 12 to 17 years. (I statement)

Thursday, October 11, 2018

Behind The Headlines - Young people turning their backs on alcohol

What is Behind the Headlines?
Each day the NHS Choices team selects health stories that are making headlines. These, along with the scientific articles behind the stories, are sent to Bazian, a leading provider of evidence-based healthcare information. Bazian's clinicians and scientists analyse the research and produce impartial evidence-based assessments, which are edited and published by NHS Choices.

Wednesday October 10 2018

"Shunning alcohol becomes 'mainstream' among young people as a third are now teetotal," reports The Independent.

A study involving nearly 10,000 young people in the UK found that the proportion of 16- to 24-year-olds who say they never drink alcohol rose from 18% in 2005 to 29% in 2015. The study also found that young people who did drink alcohol were drinking less nowadays and that binge drinking rates were falling.

The researchers said the drop in numbers of young people drinking suggested a shift in attitudes towards alcohol. They say this could be due to increased awareness of the health risks of alcohol, as well as changes in the way young people spend their leisure time.

The researchers observed a decrease in drinking in most groups of young people, including those in employment, in education, and with generally healthy lifestyles, and across all income groups.

However, there was no decrease among smokers, some ethnic groups and people with poor mental health. This may indicate a need to reach out with more support to certain groups.

Current UK guidelines advise men and women to drink no more than 14 units of alcohol a week; equivalent to 6 pints of average-strength beer or 10 small glasses of low-strength wine.

Find out about calculating units of alcohol.

Where did the story come from?
The researchers who carried out the study were from the Department of Epidemiology and Public Health, University College London.

The study was funded by grants from Alliance House Foundation, an organisation that promotes "temperance" or not drinking alcohol. It was published in the peer-reviewed medical journal BMC Public Health and is free to read online.

The story was widely reported. The Telegraph is one of several media outlets that speculated about the reasons for the drop in drinking, suggesting in its headline that "millennials are shunning alcohol" because they think "getting drunk is no longer cool".

But the study didn't actually look into the reasons for the decrease in drinking. More research is needed to investigate the reasons why young people are less likely to drink alcohol.

What kind of research was this?
This was an analysis of repeated cross-sectional surveys of people aged 16 to 24 in England.

The researchers wanted to see how alcohol consumption had changed over time among young people in different subgroups. They also wanted to see how the increase in non-drinking related to the amount of alcohol consumed by those young people who did drink.

Cross-sectional research shows a snapshot of people's behaviour at any one time. Although behaviour can then be linked with factors such as income levels or health habits, we cannot tell from cross-sectional research what causes the behaviour observed. In other words, this study can't tell us what's causing more young people to abstain from drinking.

What did the research involve?
Researchers used data from the Health Survey for England 2005 to 2015, an annual nationwide survey that asks questions about a wide range of health behaviours. For this study, researchers looked only at information from the 9,699 participants aged 16 to 24.

People were asked whether they drank alcohol. If they answered no, they were asked if they had ever consumed alcohol, had previously drunk alcohol or occasionally drank alcohol.

People who said they did drink alcohol were asked if they had done so in the past week, and how many units they had drunk on their heaviest drinking day.

The researchers also looked at:
body mass index (BMI)
smoking status
fruit and vegetable consumption
physical activity levels
wellbeing and mental health
whether the participants had any long-term illness

They looked at the results broken down by:
age group (16 to 17 or 18 to 24)
gender
ethnic background
region where participants lived
whether they lived in a town, city or village
deprivation level of their local area
household social class
whether they were in full-time education or employed

What were the basic results? 
Overall the researchers found that between 2005 and 2015:
the numbers of people aged 16 to 24 who described themselves as non-drinkers rose from 18% to 29%
the numbers who had never drunk alcohol rose from 9% to 17%
the numbers who hadn't had a drink in the last week rose from 35% to 50%
the numbers who drank above recommended weekly limits fell from 43% to 28%
the numbers who had engaged in binge-drinking fell from 27% to 18%

The increase in non-drinking was seen in most subgroups, including both age groups and genders, north and south of the country, urban and rural areas, deprived and non-deprived areas, and those in and not in education or employment.

The numbers of non-drinkers rose among white young people but not among those from ethnic minorities. However, 68% of young people from ethnic minorities described themselves as non-drinkers in 2015, compared to 20% of white young people.

People with different health behaviours showed some difference in terms of drinking. Non-drinking increased among non-smokers but not among young people who smoked. It also increased among those who did high levels of physical activity, but not those who did less exercise.

This may suggest differences in health awareness, though non-drinking rates did increase in people with low fruit and vegetable consumption and regardless of BMI.

The researchers did not see an increase in non-drinking among people with lower scores of health and mental wellbeing.

How did the researchers interpret the results?
The researchers said their results "might suggest that the norms around non-drinking are changing, and this behaviour is becoming more mainstream among young people".

They said "increasing rates of non-drinking among young people are to be welcomed" and noted that the decline in drinking "may influence lower average consumption overall, which tends to reduce problematic drinking".

They said it is "difficult to pinpoint a single factor" behind the decline in drinking, but speculated it may be because of stricter licensing laws, increased awareness of the harms of alcohol, and changes in the way young people spend their leisure time – for example, using social media rather than meeting in a pub or bar.

Conclusion
We don't know for sure from this study why young people are increasingly turning away from drinking alcohol. However, the figures suggest a robust trend, which may or may not continue in future.

The decline in drinking could be due to increasing health awareness among young people and people making healthier lifestyle choices. From a public health point of view, this is probably good news, not least because the numbers of young people engaging in harmful binge drinking is also in decline.

The study has some limitations:
Some of the subgroups considered were quite small, which means the data for these groups may be less reliable. 

Although the participants were surveyed every year, not all of the health questions were asked each year. So in some years there's missing data for the amount of exercise people took, the amount of fruit and vegetables they ate, or for their mental health status. 

Cross-sectional surveys show only a snapshot or series of snapshots in time, so we don't know how the findings relate to changing habits among individuals over time.

Despite the drop in numbers of young people drinking, 28% of young people still reported drinking above recommended levels on at least 1 day in the week they were surveyed, in 2015. The lack of change in drinking habits among young people who smoked was also notable. There are still issues to address and people who may benefit from more support to reduce their alcohol intake.

Current UK guidelines advise men and women to drink no more than 14 units of alcohol a week; equivalent to 6 pints of average-strength beer or 10 small glasses of low-strength wine.

Find out about calculating units of alcohol.

https://www.nhs.uk/news/lifestyle-and-exercise/young-people-turning-their-backs-alcohol/

Analysis by Bazian
Edited by NHS Website

Monday, October 1, 2018

Risk factors for liver disease among adults of Mexican descent in the United States and Mexico

World J Gastroenterol. Oct 7, 2018; 24(37): 4281-4290
Published online Oct 7, 2018. doi: 10.3748/wjg.v24.i37.4281 

Risk factors for liver disease among adults of Mexican descent in the United States and Mexico
Yvonne N Flores, Zuo-Feng Zhang, Roshan Bastani, Mei Leng, Catherine M Crespi, Paula Ramírez-Palacios, Heather Stevens, Jorge Salmeron 

Full-Text 

Core tip: United States (US) Latinos have greater morbidity and mortality from liver disease than non-Hispanic whites, and liver disease is the fifth leading cause of death in Mexico. Known risk factors for chronic liver disease include hepatitis B or C infection, heavy/binge drinking, obesity, diabetes, and metabolic syndrome. We found that Mexican-Americans in the US have a greater risk of obesity, diabetes and heavy/binge drinking than their counterparts in Mexico. The prevalence of heavy/binge drinking was alarmingly high among Mexican-Americans, with over 70% among males and over 50% among US-born females. Our results identify a high prevalence of specific risk factors that should be targeted to reduce the high rates of liver disease-related mortality in this population.

AIM
To compare the prevalence of chronic liver disease (CLD) risk factors in a representative sample of Mexican-Americans born in the United States (US) or Mexico, to a sample of adults in Mexico. 

METHODS
Data for Mexican-Americans in the US were obtained from the 1999-2014 National Health and Nutrition Examination Survey (NHANES), which includes persons of Mexican origin living in the US (n = 4274). The NHANES sample was restricted to Mexican-American participants who were 20 years and older, born in the US or Mexico, not pregnant or breastfeeding, and with medical insurance. The data in Mexico were obtained from the 2004-2013 Health Worker Cohort Study in Cuernavaca, Mexico (n = 9485). The following known risk factors for liver disease/cancer were evaluated: elevated aminotransferase levels (elevated alanine aminotransferase was defined as > 40 IU/L for males and females; elevated aspartate aminotransferase was defined as > 40 IU/L for males and females), infection with hepatitis B or hepatitis C, metabolic syndrome, high total cholesterol, diabetes, obesity, abdominal obesity, and heavy alcohol use. The main independent variables for this study classified individuals by country of residence (i.e., Mexico vs the US) and place of birth (i.e., US-born vs Mexico-born). Regression analyses were used to investigate CLD risk factors. 

RESULTS
After adjusting for socio-demographic characteristics, Mexican-American males were more likely to be obese, diabetic, heavy/binge drinkers or have abdominal obesity than males in Mexico. The adjusted multivariate results for females also indicate that Mexican-American females were significantly more likely to be obese, diabetic, be heavy/binge drinkers or have abdominal obesity than Mexican females. The prevalence ratios and prevalence differences mirror the multivariate analysis findings for the aforementioned risk factors, showing a greater risk among US-born as compared to Mexico-born Mexican-Americans. 

CONCLUSION
In this study, Mexican-Americans in the US had more risk factors for CLD than their counterparts in Mexico. These findings can be used to design and implement more effective health promotion policies and programs to address the specific factors that put Mexicans at higher risk of developing CLD in both countries.

Full-text article available online:

Wednesday, September 26, 2018

Heavy drinkers and teetotalers alike may have heightened dementia risk

Of Interest
Alcohol use disorder therapy could improve chronic liver disease outcomes
Fuster D, Samet JH. N Engl J Med. 2018;doi:10.1056/NEJMra1715733.
September 26, 2018
Details from a recently published review discussed expanded use of alcohol use disorder medications and treatments in everyday clinical practice for patients with advanced liver disease.

In HCV, alcohol use increases infection exposure and persistence, causes more extensive liver damage than the infection alone, leads to faster progression of liver fibrosis and results in higher rates of mortality. These effects are common in HBV as well, although alcohol use in patients with HBV also demonstrated an increased risk for hepatocellular carcinoma.

Along with increased fibrosis progression and an increased risk for hepatocellular carcinoma, alcohol use in patients with NAFLD leads to a greater prevalence of steatosis and abnormal liver tests. In hereditary hemochromatosis, alcohol use increases fibrosis progression as well as iron overload.

“Assessment of alcohol use is appropriate for any person with liver disease, given the elevated risks of alcohol-related hepatotoxicity,” Fuster and Samet wrote. “In fact, there is no known safe threshold of alcohol consumption for patients with chronic liver disease, especially those with HCV infection, obesity, or the metabolic syndrome.”


Heavy drinkers and teetotalers alike may have heightened dementia risk 
Lisa Rapaport
(Reuters Health) - Middle-aged adults who avoid alcohol altogether, and those who consume the equivalent of seven glasses of wine or more a week are both more likely than light drinkers to develop dementia in their later years, a long-term study suggests.

Abstinence is also associated with a higher likelihood of having heart disease or diabetes, which explains part of the increased dementia risk for teetotalers, the study found. Abstinence may also be tied to dementia in people who stopped drinking due to misuse or addiction, Sabia said by email...

“Findings on abstainers should not motivate people who do not drink to start drinking alcohol due to the adverse effects of alcohol on mortality, cirrhosis of the liver and cancer,” Sabia noted. “In addition, given the detrimental effect of alcohol for several health outcomes, people who drink in an excessive manner should be encouraged to reduce their alcohol consumption.” 

Recommended Reading
Alcohol abuse kills 3 million a year, most of them men: WHO
Of all deaths attributable to alcohol, 28% were due to injuries, such as those from traffic crashes, self-harm and interpersonal violence; 21% due to digestive disorders; 19% due to cardiovascular diseases, and the remainder due to infectious diseases, cancers, mental disorders and other health conditions...

Friday, September 21, 2018

Alcohol abuse kills 3 million a year, most of them men: WHO

Harmful use of alcohol kills more than 3 million people each year, most of them men.
More than 3 million people died as a result of harmful use of alcohol in 2016, according a report released by the World Health Organization (WHO) today. This represents 1 in 20 deaths. More than three quarters of these deaths were among men. Overall, the harmful use of alcohol causes more than 5% of the global disease burden.

WHO’s Global status report on alcohol and health 2018 presents a comprehensive picture of alcohol consumption and the disease burden attributable to alcohol worldwide. It also describes what countries are doing to reduce this burden.

“Far too many people, their families and communities suffer the consequences of the harmful use of alcohol through violence, injuries, mental health problems and diseases like cancer and stroke,” said Dr Tedros Adhanom Ghebreyesus, Director-General of WHO. “It’s time to step up action to prevent this serious threat to the development of healthy societies.”

Of all deaths attributable to alcohol, 28% were due to injuries, such as those from traffic crashes, self-harm and interpersonal violence; 21% due to digestive disorders; 19% due to cardiovascular diseases, and the remainder due to infectious diseases, cancers, mental disorders and other health conditions.

Despite some positive global trends in the prevalence of heavy episodic drinking and number of alcohol-related deaths since 2010, the overall burden of disease and injuries caused by the harmful use of alcohol is unacceptably high, particularly in the European Region and the Region of Americas.

Globally an estimated 237 million men and 46 million women suffer from alcohol-use disorders with the highest prevalence among men and women in the European region (14.8% and 3.5%) and the Region of Americas (11.5% and 5.1%). Alcohol-use disorders are more common in high-income countries.

Global consumption predicted to increase in the next 10 years
An estimated 2.3 billion people are current drinkers. Alcohol is consumed by more than half of the population in three WHO regions – the Americas, Europe and the Western Pacific. Europe has the highest per capita consumption in the world, even though its per capita consumption has decreased by more than 10% since 2010. Current trends and projections point to an expected increase in global alcohol per capita consumption in the next 10 years, particularly in the South-East Asia and Western Pacific Regions and the Region of the Americas.

How much alcohol are people drinking?
The average daily consumption of people who drink alcohol is 33 grams of pure alcohol a day, roughly equivalent to 2 glasses (each of 150 ml) of wine, a large (750 ml) bottle of beer or two shots (each of 40 ml) of spirits.

Worldwide, more than a quarter (27%) of all 15–19-year-olds are current drinkers. Rates of current drinking are highest among 15–19-year-olds in Europe (44%), followed by the Americas (38%) and the Western Pacific (38%). School surveys indicate that, in many countries, alcohol use starts before the age of 15 with very small differences between boys and girls.

Worldwide, 45% of total recorded alcohol is consumed in the form of spirits. Beer is the second alcoholic beverage in terms of pure alcohol consumed (34%) followed by wine (12%). Worldwide there have been only minor changes in preferences of alcoholic beverages since 2010. The largest changes took place in Europe, where consumption of spirits decreased by 3% whereas that of wine and beer increased.

In contrast, more than half (57%, or 3.1 billion people) of the global population aged 15 years and over had abstained from drinking alcohol in the previous 12 months.

More countries need to take action
“All countries can do much more to reduce the health and social costs of the harmful use of alcohol,” said Dr Vladimir Poznyak, Coordinator of WHO’s Management of Substance Abuse unit. “Proven, cost-effective actions include increasing taxes on alcoholic drinks, bans or restrictions on alcohol advertising, and restricting the physical availability of alcohol.”

Higher-income countries are more likely to have introduced these policies, raising issues of global health equity and underscoring the need for greater support to low- and middle-income countries.

Almost all (95%) countries have alcohol excise taxes, but fewer than half of them use other price strategies such as banning below-cost selling or volume discounts. The majority of countries have some type of restriction on beer advertising, with total bans most common for television and radio but less common for the internet and social media.

“We would like to see Member States implement creative solutions that will save lives, such as taxing alcohol and restricting advertising. We must do more to cut demand and reach the target set by governments of a 10% relative reduction in consumption of alcohol globally between 2010 and 2025,” added Dr Tedros.

Reducing the harmful use of alcohol will help achieve a number of health-related targets of the Sustainable Development Goals (SDGs), including those for maternal and child health, infectious diseases, noncommunicable diseases and mental health, injuries and poisonings.

Alcohol abuse kills 3 million a year, most of them men: WHO
Kate Kelland
(Reuters) - More than 3 million people died in 2016 due to drinking too much alcohol, meaning one in 20 deaths worldwide was linked to harmful drinking, the World Health Organization (WHO) said on Friday.

Of Interest
September 2018
Defining ‘Safe’ Alcohol Consumption, published online at HepMag.com.
How much is too much?
This conversation is especially important in light of the BMJ study that uncovered a concerning trend in rising mortality among those aged 25-34 due to excessive alcohol consumption. While obesity and hepatitis C infection may contribute, the rise in liver disease among young Americans due to alcohol is particularly troubling.

Saturday, August 25, 2018

No Amount Of Alcohol Is Good For Your Health

NPR - Heard on All Things Considered
The Latest Scientific Advice On Drinking Alcohol: Don't
A new study published in The Lancet finds alcohol is associated with 2.8 million deaths each year worldwide. Researchers conclude that there is no safe level of alcohol and say the risks outweigh the potential benefits
Source: https://www.npr.org/2018/08/24/641706025/the-latest-scientific-advice-on-drinking-alcohol-dont




Article
No Amount Of Alcohol Is Good For Your Health, Global Study Says
August 24, 20183:42 PM ET
Samantha Raphelson
No amount of alcohol is safe, according to The Global Burden of Diseases study, which analyzed levels of alcohol use and its health effects in 195 countries from 1990 to 2016.
Source: https://www.npr.org/2018/08/24/641618937/no-amount-of-alcohol-is-good-for-your-health-global-study-claims

The Lancet
Alcohol use and burden for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016
Open Access
Published: August 23, 2018
DOI:https://doi.org/10.1016/S0140-6736(18)31310-2

Linked Article
No level of alcohol consumption improves health
Full-Text
PDF

Summary
Background
Alcohol use is a leading risk factor for death and disability, but its overall association with health remains complex given the possible protective effects of moderate alcohol consumption on some conditions. With our comprehensive approach to health accounting within the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we generated improved estimates of alcohol use and alcohol-attributable deaths and disability-adjusted life-years (DALYs) for 195 locations from 1990 to 2016, for both sexes and for 5-year age groups between the ages of 15 years and 95 years and older.

Methods
Using 694 data sources of individual and population-level alcohol consumption, along with 592 prospective and retrospective studies on the risk of alcohol use, we produced estimates of the prevalence of current drinking, abstention, the distribution of alcohol consumption among current drinkers in standard drinks daily (defined as 10 g of pure ethyl alcohol), and alcohol-attributable deaths and DALYs. We made several methodological improvements compared with previous estimates: first, we adjusted alcohol sales estimates to take into account tourist and unrecorded consumption; second, we did a new meta-analysis of relative risks for 23 health outcomes associated with alcohol use; and third, we developed a new method to quantify the level of alcohol consumption that minimises the overall risk to individual health.

Findings
Globally, alcohol use was the seventh leading risk factor for both deaths and DALYs in 2016, accounting for 2·2% (95% uncertainty interval [UI] 1·5–3·0) of age-standardised female deaths and 6·8% (5·8–8·0) of age-standardised male deaths. Among the population aged 15–49 years, alcohol use was the leading risk factor globally in 2016, with 3·8% (95% UI 3·2–4·3) of female deaths and 12·2% (10·8–13·6) of male deaths attributable to alcohol use. For the population aged 15–49 years, female attributable DALYs were 2·3% (95% UI 2·0–2·6) and male attributable DALYs were 8·9% (7·8–9·9). The three leading causes of attributable deaths in this age group were tuberculosis (1·4% [95% UI 1·0–1·7] of total deaths), road injuries (1·2% [0·7–1·9]), and self-harm (1·1% [0·6–1·5]). For populations aged 50 years and older, cancers accounted for a large proportion of total alcohol-attributable deaths in 2016, constituting 27·1% (95% UI 21·2–33·3) of total alcohol-attributable female deaths and 18·9% (15·3–22·6) of male deaths. The level of alcohol consumption that minimised harm across health outcomes was zero (95% UI 0·0–0·8) standard drinks per week.

Interpretation
Alcohol use is a leading risk factor for global disease burden and causes substantial health loss. We found that the risk of all-cause mortality, and of cancers specifically, rises with increasing levels of consumption, and the level of consumption that minimises health loss is zero. These results suggest that alcohol control policies might need to be revised worldwide, refocusing on efforts to lower overall population-level consumption.

Funding Bill & Melinda Gates Foundation.

Saturday, June 30, 2018

HepCure Webinar Series - Hep C & Fatty Liver, Treatment, Alcohol Use, Elderly Patients and More

Watch experts discuss important HCV related topics in this easy to access webinar series presented by HepCure.

June 26, 2018
Transplant & HCV
On Tuesday, June 26th, Dr. Thomas Schiano of Mount Sinai Medical Center presented on: “Transplant & HCV”
Watch, here….
Download Slides, here.....

June 19, 2018
Nonalcoholic Fatty Liver Disease and Hepatitis C
On June 19th Dr. Amon Asgharpour of the Icahn School of Medicine at Mount Sinai. Dr. Asgharpour presented “Nonalcoholic Fatty Liver Disease and Hepatitis C.”


Watch, here.….
Download Slides, here...…

Of Interest
Michael Carter
Published: 18 June 2018
Fatty liver improves rapidly after hepatitis C cure
Liver stiffness and liver fat (steatosis) in people with chronic hepatitis C virus (HCV) infection both improve significantly after treatment with direct-acting antivirals (DAAs) resulting in sustained virological response (SVR), investigators from Japan report in Alimentary Pharmacology and Therapeutics. Both measures of liver health were assessed six months after SVR. Improvement was associated with a reduction in ALT levels and an increase in platelet count.

On This Blog
June 18, 2018
Hepatitis C Weekend Video: NASH What Is It

Elsewhere
July 1, 2018
In the July Issue of the patient-friendly HCV Advocate newsletter, Lucinda Porter, RN., writes a must read article about: Avoiding Fatty Liver.

June 2018
Hepatitis C and Alcohol
On Tuesday, June 5th, Peter Hauser, MD, Director of the National VA Telemental Health Hub Long Beach presented on: “Hepatitis C and Alcohol”.


Watch, here...
Download Slides, here....

May 2018 - HCV Treatment
“Ace the Case” 

Program presented last month led by Dr. Douglas Dieterich of the Icahn School of Medicine at Mount Sinai. This webinar is patient based, with question and answer participation.

Topics
Late relapse in people with HCC
Reinfection
Chemo On HCV
Treating Patients with HCV & Depression & More....
Watch, here.....

HCV in the Elderly Patient
On May 29th, Dr. Roxana Bodin of Westchester Medical Center Health presented on: “HCV in the Elderly Patient”


Watch, here...
Download Slides here.....

Of Special Interest
"Innovation as Usual: Sustainable Financing for Viral Hepatitis Elimination" with Dr. Henry Chang. This webinar will discuss the global target to eliminate viral hepatitis as a major public health problem by the year 2030.
Watch, here.....
Download Slides, here...

Additional Topics
The HCV-Opioid Syndemic in Appalachia: Evidence from a Cohort of Rural Drug Users
Hepatitis C in Children and Adolescents
Cirrhosis & HCV

View All
Webinar Archive

Follow On Twitter
@hepcure 

HepCure Patient App
The patient app is a free resource for patients with hepatitis C, which allows them to track medication adherence, symptoms, and gain access to resources. It is available to download for free on iOS (App Store) and Android (Google Play) operating systems. While the app can be used by patients independently from the dashboard, it can also be linked with the provider dashboard. Providers can push lab data to patients and track treatment adherence and symptom data input by patients in real time.
Learn more here...…

Monday, June 25, 2018

Two drinks a day: too risky?

On Health Report 
Two drinks a day: too risky? 
If you're drinking two standard alcoholic drinks per day, you might be a heavy drinker - at least, according to new research.

A study of almost 100,000 adults in the US suggests one to three drinks per week is the safest amount to minimise the risk of cancer and death.

Hosted by Dr Norman Swan with guest Andrew Kunzmann on ABC radio.

Listen: To the program

Links
Research

Thursday, June 21, 2018

60,000 adults in the UK have cirrhosis, nearly 75% percent don't know it


7 in 10 people with liver disease in the UK don’t even know they have it 
Although over 60,000 adults in the UK have cirrhosis (scarring) of the liver, nearly 75% percent don't know it, according to research published in the Lancet. For many, the first indication is following admission to Accident and Emergency when the disease is advanced and chance of survival is very low. This week, 18th to 24th June, is Love Your Liver week, and the British Liver Trust has launched a new version of an online screening tool so that people can find out if they are at risk.

Although over 60,000 adults in the UK have cirrhosis (scarring) of the liver, nearly 75% percent don't know it, according to research published in the Lancet. For many, the first indication is following admission to Accident and Emergency when the disease is advanced and chance of survival is very low. This week, 18th to 24th June, is Love Your Liver week, and the British Liver Trust has launched a new version of an online screening tool so that people can find out if they are at risk.

Liver disease is one of the leading causes of premature death in England and is responsible for more than 1 in 10 deaths of people in their 40s.

Professor Nick Sheron, a liver expert from the University of Southampton involved in the research, said: "Liver disease develops silently with no signs or symptoms and is the second leading cause of years or working life lost. If current trends continue it become the leading cause of premature mortality in the UK. Yet, most people with fatal advanced liver disease only become aware that they have a liver problem when they are admitted as an emergency. We MUST diagnose these people much earlier."

Liver problems develop silently with no obvious symptoms in the early stages yet the disease is largely preventable through lifestyle changes. The Love Your Liver awareness campaign, promoted by the British Liver Trust, aims to reach the one in five people in the UK who may have the early stages of liver disease, but are unaware of it.

More than 90% of liver disease is due to three main risk factors: obesity, alcohol and viral hepatitis.

Judi Rhys, Chief Executive, British Liver Trust said, “Helping people understand how to reduce their risk of liver damage is vital to address the increase in deaths from liver disease. Although the liver is remarkably resilient, if left too late damage is often irreversible. I would urge everyone to take our online screener on our website to see if they are at risk.”

The British Liver Trust’s Love Your Liver campaign focuses on three simple steps to Love Your Liver back to health:

- Drink within recommended limits and have three consecutive alcohol-free days every week
- Cut down on sugar, carbohydrates and fat and take more exercise
- Know the risk factors for viral hepatitis and get tested or vaccinated if at risk

Finding out your risk of liver disease only takes a few minutes. It could be the most important thing you do today. Take the British Liver Trust’s screener here

Liver disease is one of the leading causes of premature death in England and is responsible for more than 1 in 10 deaths of people in their 40s.

Professor Nick Sheron, a liver expert from the University of Southampton involved in the research, said: "Liver disease develops silently with no signs or symptoms and is the second leading cause of years or working life lost. If current trends continue it become the leading cause of premature mortality in the UK. Yet, most people with fatal advanced liver disease only become aware that they have a liver problem when they are admitted as an emergency. We MUST diagnose these people much earlier."

Liver problems develop silently with no obvious symptoms in the early stages yet the disease is largely preventable through lifestyle changes. The Love Your Liver awareness campaign, promoted by the British Liver Trust, aims to reach the one in five people in the UK who may have the early stages of liver disease, but are unaware of it.

More than 90% of liver disease is due to three main risk factors: obesity, alcohol and viral hepatitis.

Judi Rhys, Chief Executive, British Liver Trust said, “Helping people understand how to reduce their risk of liver damage is vital to address the increase in deaths from liver disease. Although the liver is remarkably resilient, if left too late damage is often irreversible. I would urge everyone to take our online screener on our website to see if they are at risk.”

Finding out your risk of liver disease only takes a few minutes. It could be the most important thing you do today. Take the British Liver Trust’s screener here

Tuesday, May 22, 2018

More patients with severe alcoholic hepatitis receiving liver transplants

More patients with severe alcoholic hepatitis receiving liver transplants
Medical centers willing to perform transplants without mandated six-month wait

Washington, DC (May 22, 2018) -- Increasingly, liver transplant centers are changing a long-standing practice of delaying potentially life-saving liver transplantation for patients with severe alcoholic hepatitis until after they stopped drinking alcohol for six months, according to a new study scheduled for presentation at Digestive Disease Week® (DDW) 2018.

Study implications
"Liver transplant for severe alcoholic hepatitis is being increasingly accepted, with positive outcomes, and the hope is that more and more patients will be evaluated for transplants," said Saroja Bangaru, MD, chief resident in internal medicine at the University of Texas Southwestern Medical Center, Dallas, and co-author of the study. "The hope is that survival rates are encouraging enough for centers, so that even more of them will reverse past practices."

Severe alcoholic hepatitis has an extremely high mortality rate. The primary treatment option has been the use of steroids, predominantly prednisolone. But, many patients do not respond to steroids, and a significant percentage of them will die within three months.

Historically, centers would not perform transplants until patients had stopped drinking for six months due to concerns about a return to drinking after transplant. Additionally, there was a perceived high risk that patient's continued drinking would cause them to miss medical appointments and failure to take their immunosuppressant medications, which prevent organ rejection, all of which could contribute to transplant failure.

Only in recent years have limited studies begun to show greater success for transplants for severe alcoholic hepatitis, Bangaru said. These studies have also shown that a variety of other factors -- aside from recent drinking -- influence whether a patient relapses. These include whether the patient has good social support, suffers from psychiatric ailments and accepts that they have an alcohol problem. "These studies suggest that predicting risk of relapse is much more complicated than just duration of abstinence," Bangaru said.

Study design and results
Researchers gathered data from 45 transplant centers, of which 23 said they were now performing such transplants. Among those, 17 centers reported that patients had a one-year survival rate of more than 90 percent, which is higher than that reported in several previous studies.

The survey found that centers have become more willing to perform transplants, as long as patients are carefully screened. Researchers reported that centers use highly selective criteria in approving candidates for transplant, assessing their medical history, social support system and whether they have additional health problems, particularly psychiatric disorders.

"If patients are selected well, according to these criteria, it allows for the excellent survival that we are seeing post-transplant," Bangaru said. Past policy has done a disservice to those patients who were previously unaware that they had liver disease. "Some patients come in for the first time with severe alcoholic hepatitis, and no one has ever told them to stop drinking. Because they are not eligible for transplant, they have a really high mortality rate."

The survey also concluded that most transplant centers had "inadequate" post-transplant support for patients. While most offered the services of social workers, only a limited number provided psychiatric or group therapy support that could be very important in helping patients avoid relapse and further medical problems.

Next steps
Dr. Bangaru said further study is needed to encourage more transplants, in particular a controlled clinical trial that follows survival rates over one, three and five years, along with an assessment of rates of alcoholic relapse.

DDW presentation details
Dr. Saroja Bangaru will present data from the study, "Increased use of liver transplantation as therapeutic option for severe alcoholic hepatitis," abstract Sa1457, on Saturday, June 2, at noon EDT. For more information about featured studies, as well as a schedule of availability for featured researchers, please visit http://www.ddw.org/press.

Digestive Disease Week® (DDW) is the largest international gathering of physicians, researchers and academics in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery. Jointly sponsored by the American Association for the Study of Liver Diseases (AASLD), the American Gastroenterological Association (AGA) Institute, the American Society for Gastrointestinal Endoscopy (ASGE) and the Society for Surgery of the Alimentary Tract (SSAT), DDW takes place June 2-5 at the Walter E. Washington Convention Center in Washington, DC. The meeting showcases more than 5,000 abstracts and hundreds of lectures on the latest advances in GI research, medicine and technology. 
More information can be found at http://www.ddw.org.
https://www.eurekalert.org/pub_releases/2018-05/ddw-mpw051818.php

Monday, May 7, 2018

Study: Alcohol-related cirrhosis patients are sicker, costlier and often female

Michigan Medicine - University of Michigan

Study: Alcohol-related cirrhosis patients are sicker, costlier and often female
A new review of private insurance data finds that alcohol is a major contributor to cirrhosis cases — and that women drinkers are disproportionately affected.

More than one-third of cirrhosis cases are related to alcohol, a seven-year national study of more than 100 million privately insured people has found.

Among that group, 294,215 people had cirrhosis; 105,871 (36 percent) had alcohol-related cirrhosis. The latter group was sicker and admitted or readmitted to a hospital more often, incurring nearly twice the health care costs per person: $44,835 versus $23,329.

“When I look at this data, it tells me that this is a big problem,” says Jessica Mellinger, M.D., a Michigan Medicine gastroenterologist and health services researcher at the Institute for Healthcare Policy & Innovation.

And it could be a particularly big problem for women, who in recent years have been diagnosed with alcohol use disorders at a rate nearly twice that of men.

Mellinger’s study, published in the journal Hepatology, found that women showed a 50 percent increase in alcohol-related cirrhosis during that seven-year period; men showed a 30 percent increase.

Although biology doesn’t explain why women appear to be consuming more alcohol then they used to, it does shed light on the effects.

“Women process alcohol differently than men and they are more susceptible to damage in the liver than men,” says Mellinger. “They can develop cirrhosis with less alcohol and in a shorter time frame. The hypothesis is that certain hormones make women more susceptible, though we don’t know exactly why they are so much more susceptible.”

"Women process alcohol differently than men and they are more susceptible to damage in the liver than men. They can develop cirrhosis with less alcohol and in a shorter time frame."
Jessica Mellinger M.D.

A costly, widespread issue 
To conduct their study, Mellinger and her team examined privately insured individuals ages 18 to 64 by using the Truven MarketScan Commercial Claims and Encounters database. It is the largest dataset of claims for people with private insurance obtained through their employers.

The study’s goal was to determine the prevalence, health-care utilization and costs of alcohol-related cirrhosis among privately insured people in the United States. The research showed:

Patients with alcohol-related cirrhosis aren’t uncommon. The figures nearly surpass those of some common cancers.

Health care for these patients is costly, sometimes as much as the cost for cancer patients.

Cirrhosis has already progressed when many patients see a doctor for symptoms, preventing a chance for early diagnosis and treatment.

But it only looked at one segment of the population.

“At the time we did this study, we also considered using data sets from Medicare and Medicaid, but they were restricting reporting of claims related to substance abuse, and we knew we’d be missing information,” says Mellinger.

Since that time, the Centers for Medicare and Medicaid Services began reporting substance abuse; that information is now open to researchers. Mellinger expects alcohol-related cirrhosis statistics to increase significantly after that patient data is reviewed.

The reason: “Many people with [alcohol-related cirrhosis] are too sick to remain employed, so more of these patients are insured through government-sponsored insurance such as Medicare and Medicaid,” she says, noting that another limitation of the study was a lack of information about race and ethnic groups.

Alcohol-use treatment programs vital 
Prior research has shown that there is no ethical justification for deprioritizing patients from receiving a transplant because they have alcohol-related liver disease.

SEE ALSO: Risky Bingeing: Women in Appalachia Report Higher Rates of Alcohol Misuse

“But first they will need alcohol cessation treatment before they can be transplanted with success,” says Mellinger. “Alcohol-use treatment is effective and many patients do stop drinking, obtain transplant and do well afterward.”

Although there is stigma to alcohol-related cirrhosis, it is common and it’s not a moral failure, she adds. “Many people in the medical community think that alcohol use is not treatable, but it is. There is a lot of collaboration at U-M to provide the right help for patients with alcohol-related liver disease.”

Getting that help is crucial: When patients have advanced liver disease, the only action that affects whether they live or die is if they stop drinking.

“Once you have cirrhosis, or scar tissue on the liver, it’s permanent,” says Mellinger, who works closely with the University of Michigan psychiatry department and the University of Michigan Addiction Treatment Services. “But even though the damage is still there, your liver function can improve dramatically” if you stop drinking.

Set to embark on further study with all insurance payers, Mellinger hopes her current work will help physicians better understand that alcohol-related cirrhosis is a growing problem that demands attention and resources.

“We’re only touching the tip of the iceberg,” she says. “By demonstrating that alcohol-related cirrhosis is a high-burden health care problem that could be prevented, we hope that it will increase funding for early detection of alcohol use and for greater utilization of alcohol-use treatment programs.”

University of Michigan Addiction Treatment Services offers a broad array of services, including a recovery program for health care workers who battle alcohol and substance addiction. 

Friday, May 4, 2018

Even one drink a day linked to lower life expectancy

Behind The Headlines
People who drink above UK alcohol guidelines 'lose one to two years of life'
April 13 2018
"Just one alcoholic drink a day could shorten your life," reports BBC News. A huge study of almost 600,000 drinkers showed that people who drank more than 12.5 units (100g) of alcohol a week were likely to die sooner than those who drank no more than this amount. The results applied equally to women and men.

Reuters Health
Even one drink a day linked to lower life expectancy
May 3, 2018
Lisa Rapaport
(Reuters Health) - Even light drinkers who enjoy a single beer or glass of wine every night may still be more likely to die prematurely than people who drink less, a recent study suggests.

Compared to people who drink less than 100 grams of pure alcohol a week - roughly the equivalent of five to six glasses of wine or beer - those who consume 100 grams to 200 grams of alcohol weekly have an estimated life expectancy at age 40 that’s about six months shorter, the study found.

Study
Published in April online in The Lancet

Saturday, April 14, 2018

Behind the Headlines - People who drink above UK alcohol guidelines 'lose one to two years of life'

What is Behind the Headlines?
Each day the NHS Choices team selects health stories that are making headlines. These, along with the scientific articles behind the stories, are sent to Bazian, a leading provider of evidence-based healthcare information. Bazian's clinicians and scientists analyse the research and produce impartial evidence-based assessments, which are edited and published by NHS Choices.

People who drink above UK alcohol guidelines 'lose one to two years of life'
Friday April 13 2018
"Just one alcoholic drink a day could shorten your life," reports BBC News.

A huge study of almost 600,000 drinkers showed that people who drank more than 12.5 units (100g) of alcohol a week were likely to die sooner than those who drank no more than this amount. The results applied equally to women and men.

The current UK guidelines advise limiting alcohol intake to 14 units a week for women and men. This is equivalent to drinking no more than 6 pints of average-strength beer (4% ABV) or 7 medium-sized glasses of wine (175ml, 12% ABV) a week.

These limits are lower than the levels for many other countries, but this latest study suggests they are about right.

The researchers calculated life would be shortened by an average of 1.3 years for women and 1.6 years for men for people aged 40 who drank above the UK weekly limit in comparison with those drinking below the limit.

The study also looked at the likelihood of having a range of non-fatal, but potentially life-changing, cardiovascular conditions, including heart attacks, heart failure and stroke.

Drinking more alcohol was linked to higher chances of all cardiovascular conditions except heart attacks, where it was linked to a lower chance. However, greater risks from other causes of death outweighed any advantage that might bring.

This high-quality study provides further evidence to support the current UK guidelines advising people to drink no more than 14 units a week. Find out more about calculating units of alcohol.

Where did the story come from?
The study was carried out by a collaboration of 120 researchers worldwide, from regions including Australia, Europe, Japan, the UK and the US. It was funded by the UK Medical Research Council, British Heart Foundation, National Institute for Health Research in the UK, European Union and European Research Council.

It was published in the peer-reviewed medical journal The Lancet on an open-access basis so is free to read online.

The study was covered widely in the UK media, with many outlets reporting variations on the life expectancy that could be lost for every drink or number of drinks consumed.

The Daily Telegraph wrote: "Six glasses of wine a week is too much despite government guidelines suggesting it is a safe limit." While the study did suggest 12.5 units is the threshold above which risks start to rise, the difference in risk between people drinking 12.5 and 14 units was small. There's also no agreed classification for the size of a glass of wine.

As statistics expert Professor David Spiegelhalter explained, the study "estimates that, compared to those who only drink a little, people who drink at the current UK guidelines suffer no overall harm in terms of death rates".

What kind of research was this? 
This was a meta-analysis of individual-level data from 83 prospective cohort studies carried out in 19 countries. This type of research – especially when carried out at this scale and with the care the authors took to ensure their methods were robust – is a good way to summarise the best research we have on a particular subject.

However, the studies analysed were all observational studies, as it wouldn't be ethical to carry out studies where some people were encouraged to drink an unhealthy amount of alcohol. This means we have to be cautious when saying alcohol was the direct cause of the additional deaths, because other confounding factors may have affected the results.

What did the research involve? 
Researchers gathered data from 83 studies, starting between 1964 and 2010, that had information about drinkers who didn't have cardiovascular disease at the start of the study, their level of alcohol consumption and additional health data, and that followed up the participants.

After making adjustments for potential factors that might affect the results – such as age, sex, smoking and physical exercise – they carried out statistical analyses to calculate how different levels of alcohol consumption affected people's risk of:
developing cardiovascular disease
death from any cause

The researchers used a big dataset of life expectancy models to calculate how the relative risks of drinking different amounts of alcohol would affect the life expectancy of people aged 40.

What were the basic results?
Of the 599,912 people in the study, 40,310 died and 39,018 got cardiovascular disease during an average 7.5 years of follow-up. About half of the people in the study reported drinking more than 12.5 units of alcohol a week.

Looking at different levels of alcohol consumption, the researchers found:
people drinking up to 12.5 units of alcohol a week had the lowest risk of death from any cause

above that level, the risk of death rose to a more than 30% increased risk for those drinking more than 37 units a week

each additional 12.5 units of alcohol consumed each week increased the risk of stroke by 14% (hazard ratio [HR] 1.14, 95% confidence interval [CI] 1.10 to 1.17)

each additional 12.5 units of alcohol consumed each week decreased the risk of heart attack by 6% (HR 0.94, 95% CI 0.91 to 0.97)

the risk of all other cardiovascular conditions increased with each additional 12.5 units of alcohol consumed

When they applied their figures to life expectancy at age 40, the researchers calculated that compared with people drinking up to 12.5 units a week:
those who drank 12.5 to 25 units a week were likely to live 6 months less
those who drank 25 to 44 units were likely to live 1 to 2 years less
those who drank more than 44 units were likely to live 4 to 5 years less

Looking at UK limits (14 units a week), the researchers said that compared with those who drank within current limits:
men who drank above the limits would lose an average of 1.6 years (95% CI 1.3 to 1.8)
women who drank above the limit would lose an average of 1.3 years (95% CI 1.1 to 1.5)

How did the researchers interpret the results? 
The researchers said their main finding was that the lowest risk for avoiding harm from alcohol was found in people drinking no more than 100g, or 12.5 units, of alcohol a week.

They said their detailed analysis of cardiovascular conditions helped to explain the complex links between drinking alcohol and cardiovascular disease, which increased risk of conditions mainly caused by high blood pressure but slightly decreased risks of heart attacks – possibly because of links between alcohol and cholesterol.

They concluded: "These data support adoption of lower limits of alcohol consumption than are recommended in most current guidelines."

Conclusion
This was an impressive study that analysed a lot of high-quality data. It offers strong evidence to support recommendations that people drink within relatively low alcohol limits, like those recently introduced in the UK.

The work regarding cardiovascular disease and heart attacks is useful and challenges the widespread belief that alcohol reduces the risk of cardiovascular conditions. While that may be true for heart attacks, it's isn't for stroke or other conditions.

The study did have a couple of limitations that are worth noting.

In many of the individual studies included in the meta-analysis, the participants were asked only once about how much alcohol they drank – and people are notoriously bad at accurately reporting their drinking. However, if people in the studies routinely underestimated their alcohol consumption, that would mean the meta-analysis results tend towards underestimating the harm alcohol causes.

And while the researchers did their best to account for a range of factors that could have affected the results, it's always hard to control for those completely.

Overall, the study adds weight to the recommendations that both women and men drink within the UK limits of 14 units of alcohol a week.

Analysis by Bazian
Edited by NHS Choices

Links to the headlines 

Thursday, April 12, 2018

Watch - Liver Congress™ 2018 - First Press Conference HEPAHEALTH Project Report

The International Liver Congress™ 2018 (ILC) - Press Conference 1

First official press conference of The ILC 2018 in Paris, France, chaired by EASL Governing Board member Prof Massimo Pinzani on Wednesday, 11 April 2018.

This press conference highlighted the HEPAHEALTH Project Report.
Twitter #Hepahealth


https://www.youtube.com/watch?v=zPkg2zy1QYo

HEPAHEALTH Project Report -- risk factors and the burden of liver disease in Europe and selected Central Asian countries
11 April 2018, Paris, France: The HEPAHEALTH Project Report, which was presented today in a press conference at The International Liver Congress trade; 2018 in Paris, France, is the second overview commissioned by EASL on the burden of liver disease in Europe. The report encompasses 35 countries in total: the EU region, Iceland, Kazakhstan, Norway, Russia, Serbia, Switzerland and Uzbekistan.

The aims of the report were to: report on the latest epidemiological burden of liver disease in the wider European region; present the data on the main risk factors for liver disease; and, carry out a review of review on public health interventions.

Since EASL published its first overview in 2013, the situation has not improved. In particular, liver cancer mortality has increased and only a few countries have seen a decrease or even a stabilisation in rates since 1980.

The European region is the highest consumer of alcoholic beverages in the world and efforts to reduce alcohol consumption are stalling in many countries. Likewise, rates of obesity have risen across almost every country the report surveyed since 2013 and the rates of Non-Alcoholic Fatty Liver Disease (NAFLD) are increasing accordingly. In Southern and Eastern Europe viral hepatitis is the leading cause of liver disease mortality.

Two key points stand out in the findings of the report: 

Liver disease kills early: Two thirds of all potential years of life lost due to liver disease were working years of life. This contrasts with other diseases, such as stroke, where the majority of deaths occur after the age of 65.

A geographical and income divide: Liver disease mortality has decreased across Western and Central Europe since 1970. Most of the countries with high stable or increasing rates of liver disease are located in the poorer parts of the European Union and the countries of the former Soviet Union. The UK and Finland deviate from the rest of Western European and Nordic trends: Both countries have seen steep increases in liver disease mortality since 1970.

What needs to be done? 

Vaccinations for Hepatitis B virus and screening of blood products across the EU since the early 1990s has helped to drastically reduce the number of HBV infections. Better harm reduction policies and micro-elimination strategies must be implemented across the region if there is to be an impact on Hepatitis C Virus infection rates. -The new generation of direct acting antivirals will largely eliminate cases of HCV provided that governments ensure that all patients who need them have access to treatment.

It is clear that prevention is the key to reducing other liver diseases, particularly for alcohol and obesity related liver disease where effective treatments do not exist or are not very effective. European countries must do more to promote a reduction in alcohol consumption and to reduce levels of obesity. The European Union and its member states used to be a world leader in progressive public health policies: It is time for them to get back in the saddle and save another generation from liver disease.

https://www.eurekalert.org/pub_releases/2018-04/eaft-hpr041218.php

Wednesday, April 11, 2018

EASL Practice Guidelines - Hepatitis C 2018, Decompensated Cirrhosis, Hepatocellular Carcinoma, Alcoholic Liver Disease & Hepatitis E

The International Liver Congress 2018

Clinical practice guidelines: Hepatitis C 2018, Decompensated Cirrhosis, Hepatocellular Carcinoma, Alcoholic Liver Disease & Hepatitis E Infection

April 11, 2018
The European Association for the Study of the Liver (EASL) just released - Updated EASL Recommendations on Treatment of Hepatitis C 2018 -
*Shared by @HenryEChang via Twitter.

You can view the following publications online in the Journal of Hepatology;
EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis
European Association for the Study of the Liver, and others
Publication stage: In Press Corrected Proof
Journal of Hepatology
Published online: April 10, 2018
Full-Text

EASL Clinical Practice Guidelines: Management of alcohol-related liver disease
European Association for the Study of the Liver, and others
Publication stage: In Press Corrected Proof
Journal of Hepatology
Published online: April 5, 2018
Full-Text HTML
PDF

EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma
European Association for the Study of the Liver, and others
Publication stage: In Press Corrected Proof
Journal of Hepatology
Published online: April 5, 2018
Full-Text HTML
PDF


EASL Clinical Practice Guidelines on hepatitis E virus infection
European Association for the Study of the Liver
Publication stage: In Press Corrected Proof
Journal of Hepatology
Published online: March 30, 2018
Full-Text HTML
PDF

Links
Practice Guidelines - Download Slide Decks
EASL Clinical practice guidelines electronic versions
https://ilc-congress.eu/ebooks/#CPGs

Updates - For Patients: The International Liver Congress 2018.
Link to websites offering coverage, meeting highlights, learning activities, and a summary of the meeting. Watch for meeting updates on the sidebar of this blog.

#ILC2018 Alcoholic liver disease replaces hepatitis C infection as leading cause of liver transplantation in patients without hepatocellular carcinoma in the USA

Alcoholic liver disease replaces hepatitis C infection as the leading cause of liver transplantation in patients without hepatocellular carcinoma in the USA

European Association for the Study of the Liver
11 April 2018, Paris, France: Two independent studies have today reported that alcoholic liver disease has now replaced hepatitis C virus (HCV) infection as the leading cause of liver transplantation in the USA in patients without HCC. Non-alcoholic steatohepatitis (NASH) is also on the increase, now ranking second as a cause of liver transplantation due to chronic liver disease.

Chronic HCV infection has remained the leading indication for liver transplantation in the USA for the last two decades.1 However, the availability of second-generation direct-acting antiviral agents (DAAs) in late 2013 led to a decline in the number of HCV-related liver transplant waiting list registrations and surgeries from 2015 onwards.2,3 Alcohol consumption began to increase markedly in the US during the 1990s and early 2000s, with data highlighting dramatic rises in alcohol use and high-risk drinking in recent years.4

The two studies presented this week at The International Liver Congress™ 2018 in Paris, France, were conducted to evaluate recent trends in the aetiology of liver disease among liver transplant recipients in the USA in view of the changing landscape of potential risk factors. In the first study, data from the United Network for Organ Sharing (UNOS) between 2005-2016 were analyzed, looking at four indications for chronic liver disease: alcoholic liver disease (ALD), NASH, HCV infection, and HCV/ALD combined. According to the results of the study, the number of liver transplant recipients with HCV peaked in 2014 (1,905 individuals) and has been declining ever since. In contrast, the number of liver transplants due to ALD and NASH has been steadily increasing and, in 2016, there were 1,624 liver transplants performed as a result of ALD, compared with 1,535 due to HCV, 1,334 due to NASH, and 424 due to HCV/ALD.

'Although we found that, overall, alcoholic liver disease became the leading indication for liver transplantation in the US in 2016, NASH was not far behind', said Dr Jennifer Wang from the California Pacific Medical Center in San Francisco, USA, who presented the study findings. 'Importantly, NASH is now the leading cause of liver transplantation in women, which is not entirely surprising given the higher rates of metabolic syndrome in women and the resultant increased risk of non-alcoholic fatty liver disease'.

'In African Americans and those with hepatocellular carcinoma, HCV remains the leading cause of transplantation and a major burden'.

The second study presented today also evaluated data from the UNOS registry, looking at first liver transplants performed in individuals without HCC between January 2012 and October 2017. As in the first study, HCV infection remained the leading aetiology for liver transplant recipients until 2016, when ALD surpassed it, accounting for 24% of liver transplants performed compared with 19% for NASH and 18% for HCV. In 2017, ALD, NASH, and HCV were responsible for 24%, 18%, and 17% of liver transplants, respectively, according to the results of this study.

'One of our most worrying findings was that patients with ALD are being listed for liver transplantation at a much younger age and with more severe disease than patients with either HCV infection or NASH', said investigator, Dr George Cholankeril from Stanford University Medical Center, California, USA. 'These are very ominous trends and we need to take aggressive action to address these rising rates of liver transplantation in patients with alcoholic liver disease'.

'So far, alcoholic liver disease has received much less attention with regards to clinical and basic research than either hepatitis B or C',5 said Prof. Helena Cortez-Pinto from the University Hospital of Santa Maria, Lisbon, Portugal, and EASL Governing Board Member. 'It is time to change and turn our attention to ALD, both in research and of course in policies that have been shown to reduce consumption, such as increases in taxation, in order to decrease affordability'.

About The International Liver Congress™
This annual congress is the biggest event in the EASL calendar, attracting scientific and medical experts from around the world to learn about the latest in liver research. Attending specialists present, share, debate and conclude on the latest science and research in hepatology, working to enhance the treatment and management of liver disease in clinical practice. This year, the congress is expected to attract approximately 10,000 delegates from all corners of the globe. The International Liver Congress™ 2018 will take place from 11¬-15 April 2018 at the Paris Convention Centre, Paris, France.

About The European Association for the Study of the Liver (EASL)
Since its foundation in 1966, this not-for-profit organization has grown to over 4,000 members from all over the world, including many of the leading hepatologists in Europe and beyond. EASL is the leading liver association in Europe, having evolved into a major European association with international influence, and with an impressive track record in promoting research in liver disease, supporting wider education and promoting changes in European liver policy.

Onsite location reference
Session title: Poster presentations Time, date and location of session: Poster area (Hall 7.2) Presenters: Jennifer Wang and George Cholankeril, USA Abstracts: Alcoholic liver disease surpasses hepatitis C virus in 2016 to become the leading indication for liver transplantation among adults without hepatocellular carcinoma in the United States (13 April 2018 9:00-17:00) and Alcoholic liver disease replaces HCV infection as the leading indication for liver transplantation in the United States (14 April 09:00-17:00)

Author disclosures
Jennifer Wang: None reported
Robert Gish: Dr. Gish has received Grants/Research Support from AbbVie, Benitec Biopharma, Gilead Sciences, and Merck & Co. Dr. Gish has performed as Consultant and/or Advisor to AbbVie, Akshaya Pharmaceuticals, AstraZeneca, Bristol-Myers Squibb, Genentech, Gilead Sciences, Hoffman-LaRoche, Ltd., Ionis Pharmaceuticals, Janssen, Merck & Co., Nanogen Biopharmaceutical, and Presidio Pharmaceuticals. Dr. Gish has current activity with the scientific or clinical advisory boards of AbbVie, AstraZeneca, Genentech, Gilead Sciences, Janssen, Merck & Co., and Nanogen Biopharmaceutical. Dr. Gish is a member of the Speakers Bureau for AbbVie, Bristol-Myers Squibb, Gilead Sciences, and Merck. Dr. Gish is a minor stock shareholder of Cocrystal Pharma.

Benny Liu: None reported Taft Bhuket: None reported
Robert Wong: Dr Wong receives research funding from Gilead Sciences and AbbVie, has served as a consultant and member of the advisory board for Gilead Sciences, and serves on the speaker's bureau for Gilead Sciences, Salix, and Bayer. Dr Wong is also funded by an AASLD Foundational Clinical and Translational Research Award in Liver Diseases.

George Cholankeril and co-authors: None reported
References 1. Cholankeril G, Ahmed A. Alcoholic liver disease replaces hepatitis C virus infection as the leading indication for liver transplantation in the United States. Clin Gastroenterol Hepatol. 2017; doi: 10.1016/j.cgh.2017.11.045 [Epub ahead of print].

2. Goldberg D, et al. Changes in the prevalence of hepatitis C virus infection, nonalcoholic steatohepatitis, and alcoholic liver disease among patients with cirrhosis or liver failure on the waitlist for liver transplantation. Gastroenterology. 2017;152(5):1090-9.e1.

3. Flemming JA, et al. Reduction in liver transplant wait-listing in the era of direct-acting antiviral therapy. Hepatology. 2017;65(3):804-12.

4. Grant BF, et al. Prevalence of 12-month alcohol use, high-risk drinking, and DSM-IV alcohol use disorder in the United States, 2001-2002 to 2012-2013: results from the National Epidemiologic Survey on Alcohol and Related Conditions. JAMA Psychiatry. 2017;74(9):911-23.

5. Ndugga, N, et al. Disparities between research attention and burden in liver diseases: implications on uneven advances in pharmacological therapies in Europe and the USA. BMJ Open. 2017;7(3):e013620; doi: 10.1136/bmjopen-2016-013620 [Epub ahead of print].