Familial predisposition ‘modestly’ affects alcoholic liver disease risk

By Lynda Williams

Environmental factors appear to be the main influence on the risk for alcoholic liver disease (ALD), say researchers who found little evidence for familial predisposition to the condition.

Among a group of heavy drinkers, patients with decompensated ALD were no more likely to have heavy-drinking relatives than those without signs of liver disease, report Dermot Gleeson (Sheffield Teaching Hospitals, UK) and co-authors.

"Our results are in contrast to similar case‑control studies on several other chronic diseases in which disease prevalence in relatives is several fold increased compared with that in the general population," they note.

The study included 291 patients with Child's grade B or C ALD, and 208 patients without biomarker or ultrasound signs of ALD. All of the participants consumed more than 60 U/week of alcohol for men or 40 U/week for women.

In all, 87% of ALD patients and 93% of controls returned a family history questionnaire detailing alcohol consumption and liver disease in 2103 parents and siblings. Follow-up investigation was then used to classify whether relatives had ALD, defined as heavy drinking with jaundice, ascites, gastrointestinal bleeding, or liver cirrhosis.

Relatives of patients and controls had similar drinking habits, with similar proportions of each recorded as being abstinent (15.8 vs 16.1%), light/social (35.4 vs 37.4%), moderate (30.4 vs 27.4%), and heavy (18.3 vs 19.7%) drinkers.

The rate of any liver disease in the relatives of patients and controls was similar, at 3.3% and 3.1%.

Although the prevalence of ALD was slightly higher in the relatives of patients than controls (12.0 vs 9.7%; odds ratio [OR]=1.27), this difference was not statistically significant. A similar pattern for definite ALD was found when excluding information on relatives with unknown cause of death (8.1 vs 7.5%; OR=1.09).

Recognizing the study's relatively small number of heavy-drinking relatives may have weakened its statistical power, the team admits that there could be "some genetic component" in the predisposition to ALD in heavy drinkers.

"However, it can be surmised from our results that this genetic predisposition is likely to be modest," emphasize Gleeson et al.

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