Low magnesium content in water supplies may contribute to the development of alcoholic liver disease, say the authors of a UK study.
Roger Williams (The Institute of Hepatology, London) and colleagues found that areas of the country with low mineral water content or "soft" water had higher rates of admissions for alcoholic liver disease than areas with high mineral water content or "hard" water.
The researchers used data recorded from 28 strategic health authorities (SHAs) across England on hospital admissions for patients with a primary diagnosis of alcoholic liver disease. They also recorded admissions for osteoporosis, as calcium and magnesium deficiency are known factors in the disease's development.
Each SHA was categorized as a soft or hard water area where 0-150 ppm calcium carbonate content was soft and greater than 150 ppm was hard.
The researchers also collected information on regional drinking habits and classified SHA populations as low, average, and heavy drinking areas relative to England as a whole.
The authors found that there was an inverse correlation between water hardness and alcoholic liver disease admissions. Soft water was associated with a significant fivefold increase in the odds of hospital admission for alcoholic liver disease compared with hard water at 121% versus 87% of the national rate. Alcohol consumption was, unsurprisingly, much more strongly associated with liver disease than water hardness, leading to a ninefold increase in the odds of admission compared with low alcohol use at 120% versus 89% of the national rate.
However, populations in the soft water-predominant areas had higher alcohol consumption than those in hard water regions, and the strong effect of alcohol consumption was also a confounding factor in the analyses.
To help overcome this, the authors identified two regions of England where the relationship between water hardness and alcohol consumption was reversed. One SHA had soft water but low alcohol consumption in the population. Despite this, hospital admissions for liver disease were in line with the national average at 99.1%. Conversely, another SHA that had hard water but high levels of alcohol consumption in the population had alcoholic liver disease admissions at 85.4% of the national average.
The authors write in Alcohol & Alcoholism that magnesium water content is the most likely explanation for their findings as the mineral is depleted by alcohol abuse and deficiency is associated with liver damage. When levels are already low due to abuse, poor oral intake could therefore become an important factor in disease, they suggest.
Speaking to medwireNews, Williams said that the research helped explain why some people are more likely to develop liver disease than others despite consuming similar quantities of alcohol. "There is no doubt from the analyses we've done that soft water is an additional factor in the development of liver disease." However, he said that further research would be needed to clarify the role of magnesium.
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