Epidemiology of Alcoholic Liver Disease

Alcohol is one of the main causes of end-stage liver disease worldwide, and alcoholic liver disease is the second most common reason for liver transplantation in the United States. Beginning in the 1970s, there was a gradual decline in alcoholic cirrhosis-related mortality in many countries. However, in the past few years, alcoholic liver disease mortality rates in several countries have stabilized or started to increase. There are significant ethnic and gender differences in alcoholic cirrhosis-related mortality rates. Furthermore, alcohol use increases the risk for liver disease in those infected with hepatitis C. A better understanding of the epidemiology of alcoholic liver disease will allow for improved diagnosis and management of this common problem.

Alcoholic liver disease - alcoholism - epidemiology

REFERENCES

• 1 Ledermann S. Alcool, Alcoolisme, Alcoolisation: Donnees Scientifiqiues de Caractere Physiologique, Economique et Social. Institut National d’Etudes Demographiques, Traveaux et Documents. Vol. Cahier No. 29 Paris; Presses Universitaires de France 1956
• 2 Corrao G, Ferrari P, Zambon A, Torchio P. Are the recent trends in liver cirrhosis mortality affected by the changes in alcohol consumption? Analysis of latency period in European countries.  J Stud Alcohol. 1997;  58 486-494
• 3 Ramstedt M. Per capita alcohol consumption and liver cirrhosis mortality in 14 European countries.  Addiction. 2001;  96(Suppl 1) S19-S33
• 4 Edwards G, Anderson P, Babor T F et al.. Alcohol Policy and the Public Good. Oxford; Oxford University Press 1994
• 5 Brunn K, Edwards G, Lumio M. Alcohol Control Policies in Public Health Perspective. Helsinki; Finnish Foundation of Alcohol Studies 1975
• 6 Mann R E, Anglin L. The relationship between alcohol-related traffic fatalities and per capita consumption of alcohol, Ontario, 1957-1983.  Accid Anal Prev. 1988;  20 441-446
• 7 Rush B R, Gliksman L, Brook R. Alcohol availability, alcohol consumption and alcohol-related damage. I. The distribution of consumption model.  J Stud Alcohol. 1986;  47 1-10
• 8 Schmidt W. The epidemiology of cirrhosis of the liver: A statistical analysis of mortality data with special reference to Canada. In: Fisher MM, Rankin JG Alcohol and the Liver. New York; Plenum Press 1977: 1-26
• 9 Smart R G, Mann R E. Large decreases in alcohol-related problems following a slight reduction in alcohol consumption in Ontario 1975-83.  Br J Addict. 1987;  82 285-291
• 10 Kim W R, Brown Jr R S, Terrault N A, El-Serag H. Burden of liver disease in the United States: summary of a workshop.  Hepatology. 2002;  36 227-242
• 11 Greenfield T K, Rogers J D. Who drinks most of the alcohol in the US? The policy implications.  J Stud Alcohol. 1999;  60 78-89
• 12 McCullough A J, O’Connor J F. Alcoholic liver disease: proposed recommendations for the American College of Gastroenterology.  Am J Gastroenterol. 1998;  93 2022-2036
• 13 Midanik L J, Room R. The epidemiology of alcohol consumption.  Alcohol Health Res World. 1992;  16 183-190
• 14 Dawson D A, Grant B F, Chou S P, Pickering R P. Subgroup variation in U.S. drinking patterns: results of the 1992 national longitudinal alcohol epidemiologic study.  J Subst Abuse. 1995;  7 331-344
• 15 Grant B F, Harford T C, Dawson D A et al.. Prevalence of DSM-IV alcohol abuse and dependence: United States, 1992. Epidemiologic Bulletin No. 35.  Alcohol Health Res World. 1994;  18 243-248
• 16 Nephew T M, Williams G D, Yi H et al.. Apparent Per Capita Alcohol Consumption: National, State, and Regional Trends, 1977-2000. Bethesda, MD; National Institute on Alcohol Abuse and Alcoholism 2003
• 17 Roizen R, Kerr W C, Fillmore K M. Cirrhosis mortality and per capita consumption of distilled spirits, United States, 1949-1994: trend analysis.  West J Med. 1999;  171 83-87
• 18 Robertson I. Safe drinking.  BMJ. 1994;  308 346
• 19 Pincock S. Binge drinking on rise in UK and elsewhere. Government report shows increases in alcohol consumption, cirrhosis, and premature deaths.  Lancet. 2003;  362 1126-1127
• 20 Campollo O, Martinez M D, Valencia J J, Segura-Ortega J. Drinking patterns and beverage preferences of liver cirrhosis patients in Mexico.  Subst Use Misuse. 2001;  36 387-398
• 21 Coombs D W, Globetti G. Alcohol use and alcoholism in Latin America: changing patterns and sociocultural explanations.  Int J Addict. 1986;  21 59-81
• 22 Park S C, Oh S I, Lee M S. Korean status of alcoholics and alcohol-related health problems.  Alcohol Clin Exp Res. 1998;  22 170S-172S
• 23 Saunders J B, Aasland O G, Amundsen A, Grant M. Alcohol consumption and related problems among primary health care patients: WHO collaborative project on early detection of persons with harmful alcohol consumption-I.  Addiction. 1993;  88 349-362
• 24 Liu J D, Leung K W, Wang C K et al.. Alcohol-related problems in Taiwan with particular emphasis on alcoholic liver diseases.  Alcohol Clin Exp Res. 1998;  22 164S-169S
• 25 Fujimoto M, Uemura M, Kojima H et al.. Prognostic factors in severe alcoholic liver injury. Nara Liver Study Group.  Alcohol Clin Exp Res. 1999;  23 33S-38S
• 26 Hasumura Y, Takeuchi J. Alcoholic liver disease in Japanese patients: a comparison with Caucasians.  J Gastroenterol Hepatol. 1991;  6 520-527
• 27 Rehm J, Rehn N, Room R et al.. The global distribution of average volume of alcohol consumption and patterns of drinking.  Eur Addict Res. 2003;  9 147-156
• 28 Stickel F, Hoehn B, Schuppan D, Seitz H K. Review article: nutritional therapy in alcoholic liver disease.  Aliment Pharmacol Ther. 2003;  18 357-373
• 29 Stroffolini T. Alcohol, HCV infection, and liver cirrhosis: is the cup half full or half empty?.  J Hepatol. 1998;  28 728-730
• 30 De Bac C, Stroffolini T, Gaeta G B, Taliani G, Giusti G. Pathogenic factors in cirrhosis with and without hepatocellular carcinoma: a multicenter Italian study.  Hepatology. 1994;  20 1225-1230
• 31 Corrao G, Zambon A, Torchio P et al.. Attributable risk for symptomatic liver cirrhosis in Italy. Collaborative Groups for the Study of Liver Diseases in Italy.  J Hepatol. 1998;  28 608-614
• 32 Harwood H. Updating Estimates of the Economic Costs of Alcohol Abuse in the United States: Estimates, Update Methods and Data. Bethesda, MD; National Institute on Alcohol Abuse and Alcoholism 2000
• 33 Jamal M M, Morgan T R. Liver disease in alcohol and hepatitis C.  Best Pract Res Clin Gastroenterol. 2003;  17 649-662
• 34 Bloomfield K, Stockwell T, Gmel G, Rehn N. International Comparisons of Alcohol Consumption.  Alcohol Res Health. 2003;  27 95-109
• 35 Kaskutas L A, Graves K. An alternative to standard drinks as a measure of alcohol consumption.  J Subst Abuse. 2000;  12 67-78
• 36 Pearson H. Public health: The demon drink.  Nature. 2004;  428 598-600
• 37 International Drinking Guidelines. Washington DC; International Center for Alcohol Policies 2003
• 38 Adams W L, Yuan Z, Barboriak J J, Rimm A A. Alcohol-related hospitalizations of elderly people. Prevalence and geographic variation in the United States.  JAMA. 1993;  270 1222-1225
• 39 Curtis J R, Geller G, Stokes E J, Levine D M, Moore R D. Characteristics, diagnosis, and treatment of alcoholism in elderly patients.  J Am Geriatr Soc. 1989;  37 310-316
• 40 Kirkpatrick B, Johnson M S, Earp J A, Fletcher R H. Accuracy of chart diagnoses of alcoholism in patients with a history of psychosis.  Psychiatr Med. 1988;  6 65-71
• 41 Coulehan J L, Zettler-Segal M, Block M, McClelland M, Schulberg H C. Recognition of alcoholism and substance abuse in primary care patients.  Arch Intern Med. 1987;  147 349-352
• 42 Moore R D, Malitz F E. Underdiagnosis of alcoholism by residents in an ambulatory medical practice.  J Med Educ. 1986;  61 46-52
• 43 Savolainen V T, Penttila A, Karhunen P J. Delayed increases in liver cirrhosis mortality and frequency of alcoholic liver cirrhosis following an increment and redistribution of alcohol consumption in Finland: evidence from mortality statistics and autopsy survey covering 8533 cases in 1968-1988.  Alcohol Clin Exp Res. 1992;  16 661-664
• 44 Fisher E S, Baron J A, Malenka D J, Barrett J, Bubolz T A. Overcoming potential pitfalls in the use of Medicare data for epidemiologic research.  Am J Public Health. 1990;  80 1487-1490
• 45 Hsia D C, Krushat W M, Fagan A B, Tebbutt J A, Kusserow R P. Accuracy of diagnostic coding for Medicare patients under the prospective-payment system.  N Engl J Med. 1988;  318 352-355
• 46 Simpura J, Tigerstedt C, Hanhinen S et al.. Alcohol misuse as a health and social issue in the Baltic Sea region. A summary of findings from the Baltica Study.  Alcohol Alcohol. 1999;  34 805-823
• 47 Teli M R, Day C P, Burt A D, Bennett M K, James O F. Determinants of progression to cirrhosis or fibrosis in pure alcoholic fatty liver.  Lancet. 1995;  346 987-990
• 48 Diehl A M. Alcoholic liver disease: natural history.  Liver Transpl Surg. 1997;  3 206-211
• 49 Sherlock S. Alcoholic liver disease.  Lancet. 1995;  345 227-229
• 50 Zakim D, Boyer T D, Montgomery C. In: Zakim D, Boyer TD Hepatology: A Textbook of Liver Diseases. Philadelphia; WB Saunders 1990: 821-869
• 51 Morgan M Y. Alcoholic liver disease: natural history diagnosis clinical featues evaluation management prognosis and prevention. In: McIntyre N, Benhamou JP, Birchier J, Rizzetto M, Rodes J Oxford Textbook of Clinical Hepatology Oxford; Oxford Medical Publications 1991: 815-855
• 52 Leevy C M. Fatty liver: a study of 270 patients with biopsy proven fatty liver and review of the literature.  Medicine (Baltimore). 1962;  41 249-276
• 53 Sorensen T I, Orholm M, Bentsen K D et al.. Prospective evaluation of alcohol abuse and alcoholic liver injury in men as predictors of development of cirrhosis.  Lancet. 1984;  2 241-244
• 54 Worner T M, Lieber C S. Perivenular fibrosis as precursor lesion of cirrhosis.  JAMA. 1985;  254 627-630
• 55 Day C P. Alcohol-risks and mechanisms of damage.  J R Coll Physicians Lond. 1994;  28 254-259
• 56 Lelbach W K. Epidemiology of alcoholic liver disease.  Prog Liver Dis. 1976;  5 494-515
• 57 Day C P. Who gets alcoholic liver disease: nature or nurture?.  J R Coll Physicians Lond. 2000;  34 557-562
• 58 Adang R P, Wensing J W, Stockbrugger R W. Alcohol consumption and alcohol-related liver disease in The Netherlands.  Scand J Gastroenterol Suppl. 1998;  225 70-74
• 59 Levi A J, Chalmers D M. Recognition of alcoholic liver disease in a district general hospital.  Gut. 1978;  19 521-525
• 60 Galambos J T. Natural history of alcoholic hepatitis. 3. Histological changes.  Gastroenterology. 1972;  63 1026-1035
• 61 Alexander J F, Lischner M W, Galambos J T. Natural history of alcoholic hepatitis. II. The long-term prognosis.  Am J Gastroenterol. 1971;  56 515-525
• 62 Bird G L, Williams R. Factors determining cirrhosis in alcoholic liver disease.  Mol Aspects Med. 1988;  10 97-105
• 63 Pares A, Caballeria J, Bruguera M, Torres M, Rodes J. Histological course of alcoholic hepatitis. Influence of abstinence, sex and extent of hepatic damage.  J Hepatol. 1986;  2 33-42
• 64 Division of Epidemiological Surveillance and Health Situation and Trend Assessment .Global Estimates for Health Situation: Assessment and Project-1990. Geneva; World Health Organization 1990
• 65 Stinson F S, Grant B F, Dufour M C. The critical dimension of ethnicity in liver cirrhosis mortality statistics.  Alcohol Clin Exp Res. 2001;  25 1181-1187
• 66 Singh G K, Hoyert D L. Social epidemiology of chronic liver disease and cirrhosis mortality in the United States, 1935-1997: trends and differentials by ethnicity, socioeconomic status, and alcohol consumption.  Hum Biol. 2000;  72 801-820
• 67 Grant B F. Liver Cirrhosis Mortality in the United States. U.S. Alcohol Epidemiologic Data Reference Manual, Vol. 2. Alcohol Epidemiologic Data System. Washington, DC; National Institute of Alcohol Abuse and Alcoholism 1985
• 68 Saadatmand F, Stinson F S, Grant B F, DuFour M. Surveillance Report #54: Liver Cirrhosis Mortality in the United States, 1970-1997. Bethesda, MD; National Institute on Alcohol Abuse and Alcoholism 2000
• 69 Bellentani S, Saccoccio G, Costa G et al.. Drinking habits as cofactors of risk for alcohol induced liver damage. The Dionysos Study Group.  Gut. 1997;  41 845-850
• 70 Lelbach W K. Cirrhosis in the alcoholic and its relation to the volume of alcohol abuse.  Ann N Y Acad Sci. 1975;  252 85-105
• 71 Pequignot G, Tuyns A J, Berta J L. Ascitic cirrhosis in relation to alcohol consumption.  Int J Epidemiol. 1978;  7 113-120
• 72 Monzoni A, Masutti F, Saccoccio G et al.. Genetic determinants of ethanol-induced liver damage.  Mol Med. 2001;  7 255-262
• 73 Derr R F, Porta E A, Larkin E C, Rao G A. Is ethanol per se hepatotoxic?.  J Hepatol. 1990;  10 381-386
• 74 Corrao G, Arico S, Zambon A et al.. Is alcohol a risk factor for liver cirrhosis in HBsAg and anti-HCV negative subjects? Collaborative Groups for the Study of Liver Diseases in Italy.  J Hepatol. 1997;  27 470-476
• 75 Corrao G, Arico S. Independent and combined action of hepatitis C virus infection and alcohol consumption on the risk of symptomatic liver cirrhosis.  Hepatology. 1998;  27 914-919
• 76 Patek Jr A J, Toth I G, Saunders M G, Castro G A, Engel J J. Alcohol and dietary factors in cirrhosis. An epidemiological study of 304 alcoholic patients.  Arch Intern Med. 1975;  135 1053-1057
• 77 Corrao G, Arico S, Lepore R et al.. Amount and duration of alcohol intake as risk factors of symptomatic liver cirrhosis: a case-control study.  J Clin Epidemiol. 1993;  46 601-607
• 78 Plant M, Miller P, Thornton C, Bloomfield K. Life stage, alcohol consumption patterns, alcohol-related consequences, and gender.  Subst Abus. 2000;  21 265-281
• 79 Varavasovsky Z. Alcohol Policy and Prevention in Hungary. Presented at the 41st Scottish Alcohol Problems Research Symposium Pitlochry, Scotland; April 4, 1996
• 80 Plant M L. Women and Alcohol: Contemporary and Historical Perspectives. London; Free Association Books 1997
• 81 Fisher N C, Hanson J, Phillips A, Rao J N, Swarbrick E T. Mortality from liver disease in the West Midlands, 1993-2000: observational study.  BMJ. 2002;  325 312-313
• 82 Kerr W C, Fillmore K M, Marvy P. Beverage-specific alcohol consumption and cirrhosis mortality in a group of English-speaking beer-drinking countries.  Addiction. 2000;  95 339-346
• 83 Gruenewald P J, Ponicki W R. The relationship of alcohol sales to cirrhosis mortality.  J Stud Alcohol. 1995;  56 635-641
• 84 Holder H D, Parker R N. Effect of alcoholism treatment on cirrhosis mortality: a 20-year multivariate time series analysis.  Br J Addict. 1992;  87 1263-1274
• 85 Smart R G, Mann R E. Recent liver cirrhosis declines: estimates of the impact of alcohol abuse treatment and alcoholics anonymous.  Addiction. 1993;  88 193-198
• 86 Smart R G, Mann R E, Suurvali H. Changes in liver cirrhosis death rates in different countries in relation to per capita alcohol consumption and Alcoholics Anonymous membership.  J Stud Alcohol. 1998;  59 245-249
• 87 Mann R E, Smart R G, Anglin L, Adlaf E M. Reductions in cirrhosis deaths in the United States: associations with per capita consumption and AA membership.  J Stud Alcohol. 1991;  52 361-365
• 88 Qiao Z K, Halliday M L, Coates R A, Rankin J G. Relationship between liver cirrhosis death rate and nutritional factors in 38 countries.  Int J Epidemiol. 1988;  17 414-418
• 89 Leifman H, Romelsjo A. The effect of changes in alcohol consumption on mortality and admissions with alcohol-related diagnoses in Stockholm County-a time series analysis.  Addiction. 1997;  92 1523-1536
• 90 Ramstedt M. Alcohol consumption and liver cirrhosis mortality with and without mention of alcohol-the case of Canada.  Addiction. 2003;  98 1267-1276
• 91 Skog O J. The risk function for liver cirrhosis from lifetime alcohol consumption.  J Stud Alcohol. 1984;  45 199-208
• 92 Norstrom T. The abolition of the Swedish alcohol rationing system: effects on consumption distribution and cirrhosis mortality.  Br J Addict. 1987;  82 633-641
• 93 Halliday M L, Coates R A, Rankin J G. Changing trends of cirrhosis mortality in Ontario, Canada, 1911-1986.  Int J Epidemiol. 1991;  20 199-208
• 94 Saunders J B, Latt N. Epidemiology of alcoholic liver disease.  Baillieres Clin Gastroenterol. 1993;  7 555-579
• 95 Seeley J R. Death by liver cirrhosis and the price of beverage alcohol.  Can Med Assoc J. 1960;  83 1361-1366
• 96 Smart R G. The effect of licencing restrictions during 1914-1918 on drunkenness and liver cirrhosis deaths in Britain.  Br J Addict Alcohol Other Drugs. 1974;  69 109-121
• 97 Thaler H. Alcoholic cirrhosis. What do we really know about its etiology?.  Tokai J Exp Clin Med. 1990;  15 275-284
• 98 Tivis L J, Brandt Jr E N. Alcohol consumption among the elderly: dispelling the myths.  J Okla State Med Assoc. 2000;  93 275-284
• 99 Adams W L, Magruder-Habib K, Trued S, Broome H L. Alcohol abuse in elderly emergency department patients.  J Am Geriatr Soc. 1992;  40 1236-1240
• 100 Stinson F, DuFour M, Bertolucci D. Alcohol related morbidity in the aging population.  Alcohol Health Res World. 1989;  13 80-87
• 101 Ninth Special Report to the U.S. Congress on Alcohol and Health. Washington, D.C.; National Institute of Alcohol Abuse and Alcoholism 1997
• 102 Caetano R, Kaskutas L A. Changes in drinking patterns among whites, blacks and Hispanics, 1984-1992.  J Stud Alcohol. 1995;  56 558-565
• 103 Stinson F, Yi H, Grant B F et al.. Drinking in the United States: Main Findings From the National Longitudinal Alcohol Epidemiologic Survey. U.S. Alcohol Epidemiologic Data Reference Manual, Vol. 6. Bethesda, MD; National Institute on Alcohol Abuse and Alcoholism 1998
• 104 Stewart S H. Racial and ethnic differences in alcohol-associated aspartate aminotransferase and gamma-glutamyltransferase elevation.  Arch Intern Med. 2002;  162 2236-2239
• 105 Douds A C, Cox M A, Iqbal T H, Cooper B T. Ethnic differences in cirrhosis of the liver in a British city: alcoholic cirrhosis in South Asian men.  Alcohol Alcohol. 2003;  38 148-150
• 106 Cochrane R, Bal S. The drinking habits of Sikh, Hindu, Muslim and white men in the West Midlands: a community survey.  Br J Addict. 1990;  85 759-769
• 107 Wickramasinghe S N, Corridan B, Izaguirre J, Hasan R, Marjot D H. Ethnic differences in the biological consequences of alcohol abuse: a comparison between south Asian and European males.  Alcohol Alcohol. 1995;  30 675-680
• 108 McKeigue P M, Karmi G. Alcohol consumption and alcohol-related problems in Afro-Caribbeans and south Asians in the United Kingdom.  Alcohol Alcohol. 1993;  28 1-10
• 109 Cyr M G, McGarry K A. Alcohol use disorders in women. Screening methods and approaches to treatment.  Postgrad Med. 2002;  112 31-32 39-40 43-47
• 110 National Household Survey on Drug Abuse. Washington, DC; Substance Abuse and Mental Health Services Administration 2001
• 111 Schenker S. Medical consequences of alcohol abuse: is gender a factor?.  Alcohol Clin Exp Res. 1997;  21 179-181
• 112 Wilsnack S C, Wilsnack R W, Hiller-Sturnhofel S. How women drink: epidemiology of women drinking and problem drinking.  Alcohol Health Res World. 1994;  18 173-181
• 113 Norton R, Batey R, Dwyer T, MacMahon S. Alcohol consumption and the risk of alcohol related cirrhosis in women.  Br Med J (Clin Res Ed). 1987;  295 80-82
• 114 Women and alcohol.  Lancet. 1986;  353
• 115 Blume S B. Women and alcohol. A review.  JAMA. 1986;  256 1467-1470
• 116 Allamani A, Voller F, Kubicka L, Bloomfield K. Drinking cultures and the position of women in nine European countries.  Subst Abus. 2000;  21 231-247
• 117 Sato N, Lindros K O, Baraona E et al.. Sex difference in alcohol-related organ injury.  Alcohol Clin Exp Res. 2001;  25 40S-45S
• 118 Pequignot G, Tuyns A J. Compared toxicity of ethanol on various organs. In: Stock C, Sarles H Alcohol and the Gastrointestinal Tract. Paris; ISERM 1980: 17-32
• 119 Becker U, Deis A, Sorensen T I et al.. Prediction of risk of liver disease by alcohol intake, sex, and age: a prospective population study.  Hepatology. 1996;  23 1025-1029
• 120 Lelbach W K. Quantitative aspects of drinking in alcoholic liver cirrhosis. In: Khanna HM, Israel Y, Kalant H Alcoholic Liver Pathology. Toronto; Addiction Research Foundation of Ontario 1975: 1-18
• 121 Krasner N, Davis M, Portmann B, Williams R. Changing pattern of alcoholic liver disease in Great Britain: relation to sex and signs of autoimmunity.  BMJ. 1977;  1 1497-1500
• 122 Marbet U A, Bianchi L, Meury U, Stalder G A. Long-term histological evaluation of the natural history and prognostic factors of alcoholic liver disease.  J Hepatol. 1987;  4 364-372
• 123 Adachi Y, Bradford B U, Gao W, Bojes H K, Thurman R G. Inactivation of Kupffer cells prevents early alcohol-induced liver injury.  Hepatology. 1994;  20 453-460
• 124 Adachi Y, Moore L E, Bradford B U, Gao W, Thurman R G. Antibiotics prevent liver injury in rats following long-term exposure to ethanol.  Gastroenterology. 1995;  108 218-224
• 125 Nanji A A, Khettry U, Sadrzadeh S M, Yamanaka T. Severity of liver injury in experimental alcoholic liver disease. Correlation with plasma endotoxin, prostaglandin E2, leukotriene B4, and thromboxane B2.  Am J Pathol. 1993;  142 367-373
• 126 Parlesak A, Schafer C, Schutz T, Bode J C, Bode C. Increased intestinal permeability to macromolecules and endotoxemia in patients with chronic alcohol abuse in different stages of alcohol-induced liver disease.  J Hepatol. 2000;  32 742-747
• 127 Enomoto N, Yamashina S, Schemmer P et al.. Estriol sensitizes rat Kupffer cells via gut-derived endotoxin.  Am J Physiol. 1999;  277 G671-G677
• 128 Ikejima K, Enomoto N, Iimuro Y et al.. Estrogen increases sensitivity of hepatic Kupffer cells to endotoxin.  Am J Physiol. 1998;  274 G669-G676
• 129 Yin M, Ikejima K, Wheeler M D et al.. Estrogen is involved in early alcohol-induced liver injury in a rat enteral feeding model.  Hepatology. 2000;  31 117-123
• 130 Ammon E, Schafer C, Hofmann U, Klotz U. Disposition and first-pass metabolism of ethanol in humans: is it gastric or hepatic and does it depend on gender?.  Clin Pharmacol Ther. 1996;  59 503-513
• 131 Gentry R T, Baraona E, Lieber C S. Agonist: gastric first pass metabolism of alcohol.  J Lab Clin Med. 1994;  123 21-27
• 132 Marshall A W, Kingstone D, Boss M, Morgan M Y. Ethanol elimination in males and females: relationship to menstrual cycle and body composition.  Hepatology. 1983;  3 701-706
• 133 Frezza M, di Padova C, Pozzato G et al.. High blood alcohol levels in women. The role of decreased gastric alcohol dehydrogenase activity and first-pass metabolism.  N Engl J Med. 1990;  322 95-99
• 134 Mishra L, Sharma S, Potter J J, Mezey E. More rapid elimination of alcohol in women as compared to their male siblings.  Alcohol Clin Exp Res. 1989;  13 752-754
• 135 Li T K, Beard J D, Orr W E, Kwo P Y, Ramchandani V A, Thomasson H R. Variation in ethanol pharmakinetics and perceived gender and ethnic differences in alcohol elimination.  Alcohol Clin Exp Res. 2000;  24 415-416
• 136 Kwo P Y, Ramchandani V A, O'Connor S et al.. Gender differences in alcohol metabolism: relationship to liver volume and effect of adjusting for body mass.  Gastroenterology. 1998;  115 1552-1557
• 137 Li T K, Beard J D, Orr W E et al.. Variation in ethanol pharmacokinetics and perceived gender and ethnic differences in alcohol elimination.  Alcohol Clin Exp Res. 2000;  24 415-416
• 138 Bhattacharya R, Shuhart M C. Hepatitis C and alcohol: interactions, outcomes, and implications.  J Clin Gastroenterol. 2003;  36 242-252
• 139 Degos F. Hepatitis C and alcohol.  J Hepatol. 1999;  31(Suppl 1) 113-118
• 140 Befrits R, Hedman M, Blomquist L et al.. Chronic hepatitis C in alcoholic patients: prevalence, genotypes, and correlation to liver disease.  Scand J Gastroenterol. 1995;  30 1113-1118
• 141 Brillanti S, Masci C, Siringo S et al.. Serological and histological aspects of hepatitis C virus infection in alcoholic patients.  J Hepatol. 1991;  13 347-350
• 142 Coelho-Little M E, Jeffers L J, Bernstein D E et al.. Hepatitis C virus in alcoholic patients with and without clinically apparent liver disease.  Alcohol Clin Exp Res. 1995;  19 1173-1176
• 143 Arico S, Corrao G, D’Amicis A, Klatsky A L. Alcoholic liver cirrhosis after the advent of hepatitis C virus: some reflections on its epidemiology and on the concept of attributable risk. Collaborative GESIA and AISF Groups. Gruppo Epidemiologico della Societa Italiana di Alcologia and Associazione Italiana per lo Studio del Fegato.  Ital J Gastroenterol Hepatol. 1997;  29 75-80
• 144 Pagliaro L, Saracci R, Bardelli D, Filippazzo M G. Chronic liver disease, alcohol consumption, and HBsAg in Italy: a multi-regional case-control study.  Ital J Gastroenterol Hepatol. 1982;  14 90-95
• 145 Bellentani S, Tiribelli C, Saccoccio G et al.. Prevalence of chronic liver disease in the general population of northern Italy: the Dionysos Study.  Hepatology. 1994;  20 1442-1449
• 146 Trevisani F, D’Intino P E, Caraceni P et al.. Etiologic factors and clinical presentation of hepatocellular carcinoma. Differences between cirrhotic and noncirrhotic Italian patients.  Cancer. 1995;  75 2220-2232
• 147 Ostapowicz G, Watson K J, Locarnini S A, Desmond P V. Role of alcohol in the progression of liver disease caused by hepatitis C virus infection.  Hepatology. 1998;  27 1730-1735
• 148 Pares A, Barrera J M, Caballeria J et al.. Hepatitis C virus antibodies in chronic alcoholic patients: association with severity of liver injury.  Hepatology. 1990;  12 1295-1299
• 149 Mendenhall C L, Seeff L, Diehl A M et al.. Antibodies to hepatitis B virus and hepatitis C virus in alcoholic hepatitis and cirrhosis: their prevalence and clinical relevance. The VA Cooperative Study Group (No. 119).  Hepatology. 1991;  14 581-589
• 150 Brillanti S, Barbara L, Miglioli M, Bonino F. Hepatitis C virus: a possible cause of chronic hepatitis in alcoholics.  Lancet. 1989;  2 1390-1391
• 151 Freni M A, Ajello A, Resta M L et al.. HCV infection, hepatic HLA display and composition of the mononuclear cell inflammatory infiltrate in chronic alcoholic liver disease.  Eur J Clin Invest. 1991;  21 586-591
• 152 Tanaka T, Yabusako T, Yamashita T et al.. Contribution of hepatitis C virus to the progression of alcoholic liver disease.  Alcohol Clin Exp Res. 2000;  24 112S-116S
• 153 Oshita M, Hayashi N, Kasahara A et al.. Increased serum hepatitis C virus RNA levels among alcoholic patients with chronic hepatitis C.  Hepatology. 1994;  20 1115-1120
• 154 Takada A, Matsuda Y, Takase S et al.. A national surveillance study on alcoholic liver disease in Japan (1986-1991).  Nippon Shokakibyo Gakkai Zasshi. 1994;  91 887-898
• 155 Tsutsumi M, Takase S. Alcoholic liver disease: new aspects of studies.  Nihon Arukoru Yakubutsu Igakkai Zasshi. 1998;  33 171-180
• 156 Mochida S, Ohnishi K, Matsuo S, Kakihara K, Fujiwara K. Effect of alcohol intake on the efficacy of interferon therapy in patients with chronic hepatitis C as evaluated by multivariate logistic regression analysis.  Alcohol Clin Exp Res. 1996;  20 371A-377A
• 157 Okazaki T, Yoshihara H, Suzuki K et al.. Efficacy of interferon therapy in patients with chronic hepatitis C. Comparison between non-drinkers and drinkers.  Scand J Gastroenterol. 1994;  29 1039-1043
• 158 Calabrese E, Gonnelli E, Ambu S et al.. Role of hepatitis B virus infection in alcoholic patients.  Ric Clin Lab. 1986;  16 543-548
• 159 Inoue K, Kojima T, Koyata H et al.. Hepatitis B virus antigen and antibodies in alcoholics. Etiological role of HBV in liver diseases of alcoholic patients.  Liver. 1985;  5 247-252
• 160 Nalpas B, Berthelot P, Thiers V et al.. Hepatitis B virus multiplication in the absence of usual serological markers. A study of 146 chronic alcoholics.  J Hepatol. 1985;  1 89-97
• 161 Nomura H, Hayashi J, Kajiyama W, Kashiwagi S. Prevalence of liver abnormalities in the general population of Okinawa, Japan.  Fukuoka Igaku Zasshi. 1997;  88 345-351
• 162 Rotily M, Durbec J P, Berthezene P, Sarles H. Diet and alcohol in liver cirrhosis: a case-control study.  Eur J Clin Nutr. 1990;  44 595-603
• 163 Chevillotte G, Durbec J P, Gerolami A et al.. Interaction between hepatitis B virus and alcohol consumption in liver cirrhosis. An epidemiologic study.  Gastroenterology. 1983;  85 141-145
• 164 El-Serag H B, Mason A C. Risk factors for the rising rates of primary liver cancer in the United States.  Arch Intern Med. 2000;  160 3227-3230
• 165 Donato F, Tagger A, Gelatti U et al.. Alcohol and hepatocellular carcinoma: the effect of lifetime intake and hepatitis virus infections in men and women.  Am J Epidemiol. 2002;  155 323-331
• 166 Sun C A, Wu D M, Lin C C et al.. Incidence and cofactors of hepatitis C virus-related hepatocellular carcinoma: a prospective study of 12,008 men in Taiwan.  Am J Epidemiol. 2003;  157 674-682
• 167 Hassan M M, Hwang L Y, Hatten C J et al.. Risk factors for hepatocellular carcinoma: synergism of alcohol with viral hepatitis and diabetes mellitus.  Hepatology. 2002;  36 1206-1213
• 168 Oshima A, Tsukuma H, Hiyama T et al.. Follow-up study of HBs Ag-positive blood donors with special reference to effect of drinking and smoking on development of liver cancer.  Int J Cancer. 1984;  34 775-779
• 169 Ohnishi K, Iida S, Iwama S et al.. The effect of chronic habitual alcohol intake on the development of liver cirrhosis and hepatocellular carcinoma: relation to hepatitis B surface antigen carriage.  Cancer. 1982;  49 672-677
• 170 Nanji A A, French S W. Relationship between pork consumption and cirrhosis.  Lancet. 1985;  1 681-683
• 171 Bode C, Bode J C, Erhardt J G, French B A, French S W. Effect of the type of beverage and meat consumed by alcoholics with alcoholic liver disease.  Alcohol Clin Exp Res. 1998;  22 1803-1805
• 172 Klatsky A L, Armstrong M A. Alcohol, smoking, coffee, and cirrhosis.  Am J Epidemiol. 1992;  136 1248-1257
• 173 Casiglia E, Spolaore P, Ginocchio G, Ambrosio G B. Unexpected effects of coffee consumption on liver enzymes.  Eur J Epidemiol. 1993;  9 293-297
• 174 Corrao G, Lepore A R, Torchio P et al.. The effect of drinking coffee and smoking cigarettes on the risk of cirrhosis associated with alcohol consumption. A case-control study. Provincial Group for the Study of Chronic Liver Disease.  Eur J Epidemiol. 1994;  10 657-664
• 175 Bourliere M, Barthet M, Berthezene P, Durbec J P, Sarles H. Is tobacco a risk factor for chronic pancreatitis and alcoholic cirrhosis?.  Gut. 1991;  32 1392-1395
• 176 Naveau S, Giraud V, Borotto E et al.. Excess weight risk factor for alcoholic liver disease.  Hepatology. 1997;  25 108-111
• 177 Raynard B, Balian A, Fallik D et al.. Risk factors of fibrosis in alcohol-induced liver disease.  Hepatology. 2002;  35 635-638
• 178 Iturriaga H, Bunout D, Hirsch S, Ugarte G. Overweight as a risk factor or a predictive sign of histological liver damage in alcoholics.  Am J Clin Nutr. 1988;  47 235-238
• 179 Yang S Q, Lin H Z, Lane M D, Clemens M, Diehl A M. Obesity increases sensitivity to endotoxin liver injury: implications for the pathogenesis of steatohepatitis.  Proc Natl Acad Sci USA. 1997;  94 2557-2562
• 180 Mokdad A H, Marks J S, Stroup D F, Gerberding J L. Actual causes of death in the United States, 2000.  JAMA. 2004;  291 1238-1245