title: Binge drinking and the risk of liver events: A population-based cohort study.
abstract: Binge drinking or heavy episodic drinking is increasingly prevalent, but the health effects are incompletely understood. We investigated whether binge drinking increases the risk for liver disease above and beyond the risk due to average alcohol consumption.
  
  
  
  6366 subjects without baseline liver disease who participated in the Finnish population-based Health 2000 Study (2000-2001), a nationally representative cohort. Follow-up data from national registers until 2013 were analysed for liver-related admissions, mortality and liver cancer. Binge drinking (≥5 drinks per occasion, standard drink 12 g ethanol) was categorised as weekly, monthly, or as less often or none. Multiple confounders were considered.
  
  
  
  Eighty-four subjects developed decompensated liver disease. Binge drinking frequency showed a direct association with liver-disease risk after adjustment for average daily alcohol intake and age. After adjustment, the hazard ratios (HRs) for weekly and monthly binge drinking were 3.45 (P=.001) and 2.26 (P=.007) and were higher after excluding regular heavy drinkers. The HR for weekly binging was 6.82 (P=.02) in women; 2.34 (P=.03) in men; and 4.29 (P=.001) in subjects with the metabolic syndrome. Weekly binge drinking and the metabolic syndrome produced supra-additive increases in the risk of decompensated liver disease. Weekly, and to a lesser extent monthly, binging retained significance in sequential multivariate models that additionally adjusted for beverage preference and lifestyle, metabolic, and socioeconomic factors.
  
  
  
  Binge drinking is associated with an increased risk for liver disease independently of average alcohol intake and confounders. The rising prevalence of binge drinking and the metabolic syndrome is particularly concerning.
authors.affiliation: Transplantation and Liver Surgery Clinic, Helsinki University Hospital, Helsinki University, Helsinki, Finland.
authors.forename: Fredrik
authors.identifier: 0000-0002-3833-0705
authors.initials: F
authors.lastname: Åberg
authors.affiliation: Department of Oral and Maxillofacial Diseases, Helsinki University Hospital, Helsinki University, Helsinki, Finland.
authors.forename: Jaana
authors.initials: J
authors.lastname: Helenius-Hietala
authors.affiliation: Department of Health, National Institute for Health and Welfare, Turku, Finland.
authors.forename: Pauli
authors.initials: P
authors.lastname: Puukka
authors.affiliation: Department of Health, National Institute for Health and Welfare, Turku, Finland.
authors.forename: Antti
authors.initials: A
authors.lastname: Jula
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D063425:Binge Drinking / Q000453:epidemiology*; D002423:Cause of Death; D015331:Cohort Studies; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D008107:Liver Diseases / Q000453:epidemiology*; D008297:Male; D024821:Metabolic Syndrome / Q000453:epidemiology; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors
keywords: alcohol; chronic liver disease; cirrhosis; heavy drinking