It’s a safe assumption that we all know binge drinking is not good for our general health. But a new study shows that one big night a week is significantly more harmful than spreading that same amount of drinks out over the same period.
For the first time, a new study has assessed how an individual’s pattern of drinking, as well as factors such as genetics and type 2 diabetes, can determine their increased risk of developing alcohol-related cirrhosis (ARC).
Liver disease is one of the leading causes of premature death, with 2-3% of the world's population having cirrhosis or liver disease. While, not surprisingly, alcohol use is the main factor in alcohol-related liver disease (ARLD), less than a third of heavy drinkers go on to develop the condition.
Of course, alcohol use has long been linked to cancer, injury and dementia.
"Only one in three people who drink at high levels go on to develop serious liver disease,” said senior author Gautam Mehta, from the University College London’s Division of Medicine and the Royal Free Hospital. “While genetics plays a part, this research highlights that pattern of drinking is also a key factor. Our results suggest, for example, that it would be more damaging to drink 21 units over a couple of sessions rather than spread evenly over a week. Adding genetic information, which may be widely used in health care over the coming years, allows an even more accurate prediction of risk."
Researchers from the University College London (UCL), the Royal Free Hospital, the University of Oxford and the University of Cambridge analyzed the data of 312,599 adult drinkers recorded in the UK Biobank, looking to see if there was evidence of increased risk of liver disease based on lifestyle patterns, as well as the added genetic and diabetes factors.
Average daily consumption was calculated to scale the cohort into four groups: drinking within limits (under 24 g for women, under 32 g for men), above limits but below binge (24 g to less than 48 g for women, 32 g to less than 64 g for men), binge (48 g to less than 72 g for women, 64 g to less than 96 g for men) and heavy binge (more than 72 g for women, more than 96 g for men).
Those who drank within limits accounted for 20% of the population, those who drank above limits 42%, with binge drinkers (23%) and heavy binge drinkers (15%) rounding out the data set.
In the UK, a standard unit of alcohol has around eight grams of alcohol; in the US, it’s around 14 g, or roughly one regular 12-ounce, 5%-strength beer.
What they found was that otherwise healthy adults drinking above daily limits but below binge only had a slightly elevated risk factor for ARLD (hazard ratio of 1.33), while binge-drinkers had more than double the risk (2.37) and heavy binge drinkers nearly four times the risk (3.85).
However, when the researchers then split the groups up by self-reported details of their drinking patterns, to differentiate between consistent drinkers and those who were more likely to go all-out and drink all their units in one or two sessions, the results were eye-opening. While the moderate drinkers had their risk increase from 1.33 to 2.39, binge drinkers shot up to more than five times the risk (5.16), and heavy binge drinkers more than nine times the risk (9.38).
Breaking the data down to focus on ALC specifically, and links with genetic factors, heavy binge drinkers that displayed these bingeing patterns had between three and 13 times greater risk of developing the disease, depending on degree of genetic predisposition.
Similarly, when diabetes was factored in, the data reflected a similar pattern of significantly elevated risks for those who have a ‘feast or famine’ approach to their weekly alcohol intake.
The researchers also found that heavy binge drinkers were more likely to be male, heavy binge drinkers and binge drinkers drank less frequently (one to three times a week), and these two groups were also much more likely to hit the bar without an accompanying meal.
"Many studies that look into the relationship between liver disease and alcohol focus on the volume of alcohol consumed,” said first author Linda Ng Fat, from UCL Epidemiology & Public Health. “We took a different approach by focusing on the pattern of drinking and found that this was a better indicator of liver disease risk than volume alone. The other key finding was that the more risk factors involved, the higher the 'excess risk' due to the interaction of these factors."
The study highlights earlier research into why people who have all-or-nothing patterns of drinking are at such a higher risk of disease related to alcohol. Experimental data has earlier hypothesized that these booze binges trigger an increase in circulating levels of bacterial proteins (lipopolysaccharides) and pro-inflammatory cytokines, which are both key players in ARLD.
“This research is important because it reveals that it's not just how much you drink overall but the way that you drink matters,” said Pamela Healy, Chief Executive of the British Liver Trust. "Drinking a lot, quickly, or drinking to get drunk can have serious consequences for your liver health.”
The researchers hope these findings add important binge drinking risk analysis to an area of study that’s so far lacked data. Factoring in genetic risks may also prove to be a very useful clinical tool in assessing a patient’s disease risk based on how much and when they drink.
"As liver disease, particularly alcohol-related fatalities, has seen a significant surge since the onset of the COVID-19 pandemic, it is imperative that we adopt innovative strategies to address this escalating crisis,” said senior author Steven Bell, from the University of Cambridge. “This study equips us with novel tools that are essential in pinpointing individuals at highest risk, thereby enabling us to direct interventions more effectively towards those who stand to benefit the most."
The study was published in the journal Nature Communications.
Source: UCL via Medical Xpress