Obesity, type 2 diabetes, age, and female gender: significant risk factors in the development of alcoholic liver cirrhosis

Background: Recent epidemiological studies show that alcoholic liver cirrhosis (ALC) continues to increase in spite of a gradual decrease in the alcohol intake beyond 1999, indicating that there are other risk factors for the development of ALC.

Methods: A nationwide survey of liver cirrhosis (LC) was undertaken by asking major hospital institutions to provide the number of patients with LC admitted between 2007 and 2008 together with their etiologic findings including the daily intake of alcohol, period of drinking, and other relevant demographic measurements.

Results: The intake of alcohol in female ALC patients was lower together with a shorter drinking period versus male patients. The prevalence of diabetes mellitus (DM) in ALC patients was higher in habitual drinkers (<110 g/day) than in heavy drinkers (≥110 g/day), 49.5 versus 20.3%, respectively (P < 0.001). In male ALC patients, the prevalence of DM was higher in habitual drinkers, 55.2 versus 20.6% for the female gender (P < 0.001). The same tendency was seen in patients with a body mass index ≥25. The prevalence of obesity was higher in habitual drinkers than in heavy drinkers, 49.7 versus 31.1%, respectively. More than 90% of the male habitual drinkers either had DM or were obese, whereas less than half of the female habitual drinkers had a concomitant complication. More than 70% of the male ALC patients were over 60 years.

Conclusion: Obesity, DM, age, and female gender appear to be additional significant risk factors for ALC. Our impression is that these additional risk factors might help to identify alcoholic patients who may progress to ALC even without excessive alcohol intake.