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Alcohol consumption in young men increases risk for severe liver disease later

Alcohol consumption in young men was associated with an increased, dose-dependent risk for severe liver disease up to 39 years later in life, according to results of a recently published study.

“The exact amount of alcohol needed to inflict liver damage is unclear and is affected by internal factors including genetics and external factors including drinking patterns, type of alcohol and diet,” Hannes Hagström, MD, PhD, of the Karolinska Institutet, Stockholm, and colleagues wrote. “The current study suggests that the risk of alcohol consumption on the development of severe liver disease later in life is already present from an early age. It is likely that this increased risk is caused by a longer exposure to alcohol, compared to starting to drink later in life, and that individuals with a longer history of alcohol consumption have increased risk of severe liver disease.”

Hagström and colleagues analyzed data from a nationwide population-based study conducted between 1969 and 1970 of all Swedish men aged 18 years to 20 years compulsorily enlisted for conscription. Of the 49,321 men conscripted during that period, 43,296 were available for follow-up in 2009.

Based on questionnaires on alcohol consumption, mean daily alcohol consumption among the cohort was 8.6 grams. Specifically, 43.2% reported consumption of 1 gram to 5 grams per day, 4.6% reported consumption of more than 60 grams per day, and 6.1% abstained from alcohol.

During a mean follow-up of 37.8 years (range, 0.1-39 years), 2,661 men received an alcohol abuse diagnosis. Of these, 243 subsequently received a diagnosis with severe liver disease (9.1%). Of the total 383 men diagnosed with severe liver disease, 208 died during follow-up. Mean time from conscription to first diagnosis of severe liver disease was 25.5 years (range, 3-39 years).

Compared with men who abstained from alcohol, the risk for an alcohol abuse diagnosis was moderately elevated among men who reported a consumption of 1 gram to 5 grams per day at baseline (HR = 1.48; 95% CI, 1.13-1.95) and highly elevated among men who reported a consumption of more than 60 grams per day at baseline (HR = 5.22; 95% CI, 3.72-7.32).

Alcohol consumption correlated with severe liver disease later in life as a continuous variable (HR = 1.03 for each additional gram per day; 95% CI, 1.03-1.04) and in a dose-dependent pattern at 6 grams to 10 grams of alcohol per day (HR = 2.01; 95% CI, 1.03-3.91) and more than 60 grams per day (HR = 11.05; 95% CI, 5.22–23.4) compared with those who abstained.

After adjusting for BMI, smoking, use of narcotics, cognitive ability and cardiovascular capacity, the researchers observed a significant association between severe liver disease later in life and alcohol as a continuous variable (HR = 1.017 for each additional gram per day; 95% CI, 1.01-1.023) and in a dose-dependent pattern at 31 grams to 40 grams of alcohol per day (HR = 2.31; 95% CI, 1.06-5.05).

The researchers addressed two limitations of the study: the lack of data on continued alcohol consumption over the follow-up period and the lack of data on binge drinking.

“Despite a long follow-up period and a very low rate of missing data, this study has some limitations which are discussed by the authors,” Alexandre Louvet, MD, PhD, and, Aleksander Krag, MD, PhD, from the Odense University Hospital, Denmark, wrote in a related editorial. “Cirrhosis develops after several years of excessive alcohol consumption, and the analysis of its occurrence must take the individual’s behavior over time into account. In this setting, drinking at a young age and/or binge drinking is only one part of a lifetime of alcohol consumption.”

Louvet and Krag stressed that education and information are not sufficient sources to reduce alcohol consumption in the general population, but targeted interventions have demonstrated success on an individual level.

“In their conclusion, safe levels of alcohol consumption must be revised for the general population and public health policies must be adapted accordingly. General recommendations by physicians must be accompanied by alcohol-control policies, especially access to alcohol, prices and advertising.” – by Talitha Bennett

Disclosure: The authors report no relevant financial disclosures.