Liver experts’ consensus: European citizens are drinking themselves to death

New research and measures to tackle societal alcohol consumption were announced at a liver disease conference in Athens, Greece, in December 2010. Severe diseases, such as liver cirrhosis, are growing at an alarming rate and are affecting people at a younger age than in the past. Since a number of current policies have not been successful in addressing health issues linked with alcohol across Europe, liver experts discussed a range of practical solutions to combat alcohol-related illness and death during a monothematic conference hosted by the European Association for the Study of the Liver (EASL).

Liver disease is the main health burden attributable to alcohol and Europe has the highest rate of alcohol consumption in the world (11 litres of pure alcohol per adult per year). One in fifteen adults suffers from serious health conditions because of alcohol consumption - making it the third largest cause of early death and illness after tobacco and high blood pressure. One in seven European adults (aged 15 or over) consume more than 35cl of alcohol/week (men) or 18cl of alcohol/week (women) on average and over one in five report a heavy drinking episode (44cl of alcohol/week) at least once a week.

One of the key issues addressed at the conference was the increasing number of liver deaths resulting from daily or near-daily heavy drinking in the adult population, in addition to binge drinking in young people. Daily drinking carries more than twice the risk of liver damage compared with intermittent drinking once or twice per week. The risk of liver disease becomes significant at approximately 20cl of alcohol/ week (less than half a pint or a small glass of wine per day), and increases dramatically over 40cl of alcohol/week.

Dr Nick Sheron, University of Southampton, UK, commented: “To evaluate the risks effectively, there is a need for the standardisation of alcohol measures across the EU. There remains a widespread misunderstanding amongst consumers of exactly what comprises a unit of alcohol, making it a challenge for patients to accurately understand how their alcohol intake truly affects their health.”

Professor Helena Cortez-Pinto, Faculdade de Medicina de Lisboa, Portugal said: “As experts in liver disease, we are keen to see steps being taken in the right direction to stop the health and societal burden excessive alcohol consumption brings. We know that policies which focus on community programmes, information and education have not proved to be very effective. Other approaches are very effective, like those policies that sanction drink driving or availability of alcohol, but they are often not implemented fully. Probably the major reason relates to the power imbalance between the commitments of the alcohol industry and those of health experts.”

The European Alcohol and Health Forum (EAHF) is an important instrument European institutions use in decreasing alcohol related harm. The EAHF’s actions are based on its stakeholders’ self-imposed commitments to fight the burden alcohol represents as a health determinant to society. As part of the EAHF, healthcare stakeholders have committed to educate their audiences further and undertake more research on the impact of liver disease and other health issues across Europe. All parties involved also expect to see measurable outcomes based on clear commitments from the industry to decreasing alcohol related harm through responsible marketing and selling and the promotion of safe drinking behaviour.

At the conference, liver experts proposed the reassessment of the concept of alcohol units across Europe by only referring to centilitres of pure alcohol and standardised screening of all patients’ alcohol consumption, particularly amongst obese patients who are at greater risk. Additional new research presented at the event sheds light on why alcohol and dietrelated risk factors have additive effects in the development of liver disease. Obesity is the most significant factor for determining the risk of cirrhosis and fibrosis progression: heavy drinkers with obesity-associated diabetes are nine-times more at risk of developing liver cancer compared to those without.

Professor Chris Day, Newcastle University, UK, said: “These studies offer new insights into the importance a number of health determinants, not just alcohol, play in predicting the risk of cirrhosis. In relation to this, we should ensure that patients understand that, in addition to drinking, being obese and suffering from diabetes exacerbates their risk of developing not only heart conditions, but also liver disease.”

Professor Mark Thursz, EASL Vice-Secretary, said: “Clear messages around healthy drinking need to be developed and communicated to the public. The concept of responsible drinking can be dangerous if it refers only to the detrimental psychosocial effects (addiction, drink driving, disorderly behaviour), as drinking to levels that address these issues is still detrimental to the liver and people’s health. This is why so many policies have not been successful overall in addressing alcohol’s impact on citizen’s health so far.”

“As one of Europe’s key health determinants, alcohol is underaddressed – particularly compared to smoking and obesity. There is a pressing need for the European Institutions to support more comprehensive epidemiological research that will help establish alcohol’s true burden on health. Clear economic and legal sanctions - already the case with obesity - with food labelling, and smoking - advertising and public space bans - are also required.”

As the leading association of liver experts in Europe, EASL aims to promote increased awareness of the health risk alcohol poses and new research about liver disease. It is also committed to playing a key role in the development of alcohol policies aimed at preventing liver disease.

About EASL
EASL is the leading European scientific society involved in promoting research and education in hepatology. EASL attracts the foremost hepatology experts and has an impressive track record in promoting research in liver disease, supporting wider education and promoting changes in European liver policy. EASL’s main focus on education and research is delivered through numerous events and initiatives, including:

The International Liver CongressTM which is the main scientific and professional event in hepatology worldwide.