Risk factors

The likelihood of developing ALD is dependent upon:

• drinking pattern - daily drinking is more dangerous than intermittent consumption which enables the liver to recover. Also, the likelihood of ALD increases with the number of years of regular drinking.
  
  
• sex - women are more susceptible to hepatic injury and are more likely to relapse after treatment. Blood ethanol levels following a standard dose of alcohol are higher in women than men. Women are also more likely to progress from hepatitis to cirrhosis even if they stop drinking.
  
  
• genetic - twin studies show that half of the variability in susceptibility to ALD is genetic. However, no single genetic marker has been identified. The genetic differences are probably in the enzyme systems which metabolise alcohol i.e. the alcohol dehydrogenase and microsomal ethanol oxidising system. The MEOS is inactive in Orientals and accounts for their poor tolerance.
  
  
• nutrition - poor nutrition and alcohol hepato-toxicity act synergistically. Alcohol may increase requirements for nutrients such as choline and folic acid. Nutritional deficiency, especially of protein, may enhance alcohol toxicity by depleting hepatic amino acids and enzymes.
  
  
• coexistence of viral infections (hepatitis B and C) increases the severity of ALD