Risk factors for alcoholic liver disease in China.
OBJECTIVE
To examine the association of daily alcohol intake, types of alcoholic beverage consumed, drinking patterns and obesity with alcoholic liver disease in China.


METHODS
By random cluster sampling and a 3-year follow-up study, 1 270 alcohol drinkers were recruited from different occupations in the urban and suburban areas of Xi'an City. They were examined by specialists and inquired for information on: Medical history and family medical history, alcohol intake, types of alcoholic beverage consumed, drinking patterns by detailed dietary questionnaires. Routine blood tests and ultrasonography were done.


RESULTS
Multivariate analysis showed that: (1) The risk threshold for developing alcoholic liver disease was ingestion of more than 20 g alcohol per day, keeping on drinking for over 5 years in men. The highest OR was at the daily alcohol consumption > or =160 g, the occurrence rate of ALD amounted to 18.7% (P<0.01). No ALD occurred when ingestion of alcohol was less than 20 g per day. (2) 87.9% of all drank only at mealtimes. The cumulative risk of developing ALD was significantly higher in those individuals who regularly drank alcohol without food than in those who drank only at mealtimes, especially for those who regularly drank hard liquors only and multiple drinks (P<0.05). (3) The alcohol consumption in those with BMI > or =25 was lower than in those with BMI<25, but the risk increased to 11.5%, significantly higher than that of general population, 6.5% (P<0.01). (4) Abstinence and weight reduction could benefit the liver function recovery.


CONCLUSIONS
In the Chinese population the ethanol risk threshold for developing ALD is 20 g per day, and this risk increases with increased daily intake. Drinking 20 g of ethanol per day and for less than 5 years are safe from ALD. Drinking alcohol outside mealtimes and drinking hard liquors only and multiple different alcohol beverages both increase the risk of developing ALD. Obesity also increases the risk. Abstinence and weight reduction will directly affect the prognosis of ALD. Doctor's strong advice might influence the prognosis indirectly.
Lu
Xiao-Lan
XL
Department of Gastroenterology, Second Hospital of Xi'an Jiaotong University, 157 Xiwulu, Xi'an 710004, Shaanxi Province, China. xiaolan-lu@163.com
Luo
Jin-Yan
JY
Tao
Ming
M
Gen
Yan
Y
Zhao
Ping
P
Zhao
Hong-Li
HL
Zhang
Xiao-Dong
XD
Dong
Nei
N
D000410:Alanine Transaminase / Q000097:blood; D000428:Alcohol Drinking; D000434:Alcoholic Beverages; D001219:Aspartate Aminotransferases / Q000097:blood; D015992:Body Mass Index; D002681:China / Q000453:epidemiology; D005843:Geography; D006801:Humans; D008108:Liver Diseases, Alcoholic / Q000453:epidemiology*; D008111:Liver Function Tests; D009765:Obesity / Q000453:epidemiology; D009790:Occupations; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013997:Time Factors
D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase