Abstract and Introduction
Background & Aims. Binge drinking or heavy episodic drinking is increasingly prevalent, but the health effects are incompletely understood. We investigated whether binge drinking increases the risk for liver disease above and beyond the risk due to average alcohol consumption.
Methods. 6366 subjects without baseline liver disease who participated in the Finnish population-based Health 2000 Study (2000–2001), a nationally representative cohort. Follow-up data from national registers until 2013 were analysed for liver-related admissions, mortality and liver cancer. Binge drinking (≥5 drinks per occasion, standard drink 12 g ethanol) was categorised as weekly, monthly, or as less often or none. Multiple confounders were considered.
Results. Eighty-four subjects developed decompensated liver disease. Binge drinking frequency showed a direct association with liver-disease risk after adjustment for average daily alcohol intake and age. After adjustment, the hazard ratios (HRs) for weekly and monthly binge drinking were 3.45 (P=.001) and 2.26 (P=.007) and were higher after excluding regular heavy drinkers. The HR for weekly binging was 6.82 (P=.02) in women; 2.34 (P=.03) in men; and 4.29 (P=.001) in subjects with the metabolic syndrome. Weekly binge drinking and the metabolic syndrome produced supra-additive increases in the risk of decompensated liver disease. Weekly, and to a lesser extent monthly, binging retained significance in sequential multivariate models that additionally adjusted for beverage preference and lifestyle, metabolic, and socioeconomic factors.
Conclusions. Binge drinking is associated with an increased risk for liver disease independently of average alcohol intake and confounders. The rising prevalence of binge drinking and the metabolic syndrome is particularly concerning.
Chronic liver disease represents a major health burden worldwide.[1,2] In Europe alone, an estimated 29 million people suffer from chronic liver conditions, and there are 170 000 annual deaths from liver cirrhosis plus another 47 000 annual deaths from liver cancer.
Alcohol is the strongest risk factor for liver cirrhosis. At the population level, there is a clear dose-response relationship between alcohol consumption and the incidence of liver cirrhosis. However, only 15%-20% of heavy alcohol drinkers develop liver cirrhosis.[4–6] Therefore, average alcohol exposure alone is insufficient to explain alcohol use as a risk factor for liver disease. Individual susceptibility to alcoholic liver disease and the effect of alcohol in the context of co-existent risk factors for liver disease remain incompletely understood. The pattern of alcohol intake and spirit type has been suggested to modify the risk of liver disease.
The phenomenon of drinking too much too fast, termed binge drinking, is growing in Western countries, especially in the UK and northern Europe. Although there is no standard definition of binge drinking, the most widely used definition is the consumption of five or more drinks on a single occasion or day, or sometimes modified to ≥5 drinks for men and ≥4 drinks for women in about 2 hours.[7–10] Around 20% of adults in Europe and 17% in USA report binge drinking up to once a week.
Most epidemiological studies of liver outcomes analyse average alcohol intake; fewer specifically address binge drinking, and few of these have been conducted in countries with a high prevalence of binge drinking. It is widely acknowledged that the common quantity-frequency measures of alcohol intake used in most studies fail to capture a habit of weekend binging superimposed on top of regular low intake on weekdays.[7,8,11]
Animal studies suggest that binge drinking alone induces liver damage and increases liver injury in chronically alcohol-exposed livers,[9,12,13] but human data are limited. Several authors have noted the need for further study to define the impact of binge drinking on the risk of liver disease,[9,10,12,14–16] and recent guidelines prioritise this specific research topic.
Finland has a drinking culture that is characterised by irregular heavy drinking, typically concentrated on weekends and outside of mealtimes, and it has lower proportional wine consumption than in southern European countries. Metabolic risk factors are common in Finland, but the prevalence of chronic viral hepatitis is very low. Finland has one of the highest liver-mortality rates in Europe, and liver deaths are rising. There is a paucity of longitudinal Finnish studies that look at liver-related outcomes.
We analysed the impact of binge drinking on the risk of liver-related outcomes in a Finnish cohort that is representative of the entire Finnish population with long-term follow-up.
Liver International. 2017;37(9):1373-1381. © 2017 Blackwell Publishing