Archive for February, 2015

Hispanics at Greater Risk for Cirrhosis

Alcoholic liver disease (ALD) refers to a broad spectrum of liver injuries, including alcoholic fatty liver, alcoholic hepatitis, and alcoholic cirrhosis. ALD is among the most common liver diseases in the United States; however, it varies significantly by ethnicity. A new study examining the role of ethnicity in determining the age of onset and severity of ALD, and comparing risk factors for its progression among ethnic groups, has found that ethnicity is a major factor affecting the age and severity of different subtypes of ALD.

“Alcoholic liver disease is a spectrum of conditions that range from hepatic steatosis, which is fat deposition in the liver and it is reversible with sobriety, to alcoholic hepatitis which is a more severe condition characterized by extensive and severe inflammation in the liver and often requires hospitalization,” explained Valentina Medici, associate professor of internal medicine at UC Davis Health System as well as corresponding author for the study. “The final stage is alcoholic cirrhosis, characterized by fibrosis or deposition of scar tissue in the liver. ALD develops in response to a long duration of high amounts of alcohol, but not all individuals develop ALD.”

Alcohol Liver Disease Kills

“ALD is very common,” added Christopher L. Bowlus, professor and acting chief of the division of gastroenterology and hepatology at UC Davis Health System, “and affects individuals of all ages, races, and socioeconomic status. It is the most common cause of liver-related death, accounting for over 15,000 deaths every year. However, not everyone is affected by alcohol the same way. Even if the same amount of alcohol is consumed, the liver damage from alcohol in some people can be more severe than in others, suggesting that other factors, such as genes and environment, can influence the development of liver damage.”

Medici and her colleagues conducted a retrospective chart review of all patients with ALD who were admitted or were followed as outpatients at UC Davis Medical Center between 2002 and 2010. After excluding hepatitis-B infected and HIV-positive subjects, researchers reviewed the charts of 791 ALD patients, including 130 with alcoholic fatty liver, 154 with alcoholic hepatitis, and 507 with alcoholic cirrhosis.

Hispanics Develop Liver Disease Earlier

“For the first time, we showed that Hispanics present at a four to 10 years younger age than Caucasians and African/Americans, and that ethnicity could predict the age of presentation of alcoholic fatty liver and alcoholic hepatitis,” said Medici. “In addition, alcoholic Hispanics tend to be more frequently obese and diabetic than the other ethnicities. Also, Hispanics with alcoholic cirrhosis were more likely to be hospitalized than Caucasians, indicative of a possibly more severe disease.”

“The development of ALD in Hispanics several years younger than whites … did not appear to be due to other possible factors such as chronic viral hepatitis C, diabetes or obesity, all of which are can cause liver damage,” said Bowlus. “Genetic and environmental factors may play an important role as they can accelerate the onset and progression of ALD. There might also be differences in the pattern of drinking and type of alcohol consumed.”

Obesity, Diabetes Are Factors

“The data in our paper showed that Hispanics with all stages of liver disease had greater body mass index in the obesity range and that those with alcoholic cirrhosis had increased incidence of type II diabetes and the metabolic syndrome,” said Medici. “The co-existence of insulin resistance and metabolic syndrome that occurs with increased BMI is known to contribute to liver injury independent of alcohol use in the condition known as non-alcoholic fatty liver disease (NAFLD). Others have shown that the presence of diet-induced NAFLD contributes to the incidence and severity of co-existent alcoholic liver disease in alcohol consumers. However, it is important to notice that, when excluding subjects with obesity and diabetes from the analysis, Hispanics with ALD were still younger than Whites/Caucasians. Therefore, Hispanics have most likely many risk factors that contribute to the development of their liver disease.”

“The findings in this study are important for two reasons,” said Bowlus. “First, they demonstrate the difference ethnicity has on the clinical manifestation of ALD. Second, they lay the ground work for future clinical and laboratory studies to understand the interactions between alcohol, genes, and the environment.”

Take Preventive Steps

“Hispanics may find it important to know that heavy drinkers can develop ALD at a younger age, that obesity contributes to this risk, and that preventive steps should be taken if their relatives or friends engage in risky drinking behavior,” said Medici. “In addition, primary-care physicians in the community will want to screen regularly for the presence and extent of alcohol drinking, as well as the potential contributing factors of obesity and ethnicity as high risk factors for the development of alcoholic liver disease in their high alcohol-consuming patients.”

“No one should feel that they are free from ALD,” added Bowlus. “If you drink beyond a moderate amount, there is a risk you will develop serious ALD. If you are Hispanic, you should be particularly concerned because you may be at even greater risk of serious liver damage from alcohol.”

February 21st, 2015  in Alcohol No Comments »

Low IQ Linked to Heavy, Binge Drinking

Although several studies have shown an association between intelligence and various health-related outcomes, the research on cognitive abilities and alcohol-related problems has been inconsistent. A new study of the association between IQ-test results and drinking, measured as both total intake and pattern of use, has found that a lower IQ is clearly associated with greater and riskier drinking among young adult men, although their poor performance on the IQ-test may also be linked to other disadvantages.

“Previous results in this area have been inconsistent,” said Sara Sjölund, a doctoral student at the Karolinska Institutet in Stockholm, Sweden as well as corresponding author for the study. “In two studies where the CAGE questionnaire – a method of screening for alcoholism – was used, a higher cognitive ability was found to be associated with a higher risk for drinking problems. Conversely, less risk has been found when looking at outcomes such as, for example, International Classification of Diseases diagnoses of alcoholism, alcohol abuse, and dependence.”

Less Intelligent More Likely to Binge Drink

“In this study of a general population, intelligence probably comes before the behavior, in this case, alcohol consumption and a pattern of drinking in late adolescence,” said Daniel Falkstedt, assistant professor in the department of public health sciences at Karolinska Institutet. “It could be the other way around for a minority of individuals, that is, when exposure to alcohol has led to cognitive impairment, but this is less likely to be found among young persons of course.”

Sjölund and her colleagues analyzed data collected from 49,321 Swedish males born during 1949 to 1951 and who were conscripted for Swedish military service from 1969 to 1971. IQ results were available from tests performed at conscription, and questionnaires also given at conscription provided data on total alcohol intake (consumed grams of alcohol/week) and pattern of drinking, as well as medical, childhood and adolescent conditions, and tobacco use. Adjustments were made for socio-economic position as a child, psychiatric symptoms and emotional stability, and the father’s alcohol habits.

Higher IQ, Healthier Choices

“We found that lower results on IQ tests in Swedish adolescent men are associated with a higher consumption of alcohol, measured in both terms of total intake and binge drinking,” said Sjölund. “It may be that a higher IQ results in healthier lifestyle choices. Suggested explanations for the association between IQ and different health outcomes, could be childhood conditions, which could influence both IQ and health, or that a socio-economic position as an adult mediates the association.”

“By taking into account as little as four measured characteristics of the men, including their backgrounds,” added Falkstedt, “the authors seem to be able to explain a large part of the association between IQ and heavy drinking. I think this may be a main message of this large cohort study: poor performance on IQ tests tend to go along with other disadvantages, for instance, poorer social background and emotional problems, which may explain the association with risky alcohol consumption. In reality, other differences of importance are likely to exist among the men, which could further explain the IQ-alcohol association.”

Both Sjölund and Falkstedt noted that results may vary among cultures and countries.

Other Factors Come Into Play

“I think that large parts of the association between IQ and alcohol consumption may be indirect and mediated by experiences in everyday life and differences in social situations,” said Falkstedt. “It is not necessarily about making intelligent or unintelligent choices. For instance, in countries with weak social-safety nets and high alcohol consumption among low-wage workers and the unemployed, I assume the association could be stronger than in economically more-equal countries, perhaps also among the young.”

“I hope that our findings add to the general understanding of drinking behaviours and what factors that may influence them,” said Sjölund. “However, we must be very careful in making any attempt to generalize our results to women, since their level of consumption and patterns of drinking likely differ in comparison with men.”

“I think a higher intelligence may give some advantage in relation to lifestyle choices,” noted Falkstedt. “However, I think it is very important to remember that intelligence differences already existing in childhood and adolescence may put people at an advantage or disadvantage and may generate subsequent differences in experiences, and accumulation of such experiences over many years. Therefore, another important explanation of ‘bad choices’ among lower-IQ individuals may be feelings of inadequacy and frustration, I think. A number of studies have shown that a lower IQ in childhood or adolescence is associated with an increased risk of suicide over many years in adulthood.”

February 21st, 2015  in Alcohol No Comments »