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Alcohol drinking patterns and liver cirrhosis risk: analysis of the prospective UK Million Women Study

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Simpson, Rachel F, Hermon, Carol, Liu, Bette, Green, Jane, Reeves, Gillian K, Beral, Valerie, Floud, Sarah·2019·The Lancet Public Health
DOI 10.1016/s2468-2667(18)30230-5PMC PMC6323353
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Abstract

BACKGROUND: Alcohol is a known cause of cirrhosis, but it is unclear if the associated risk varies by whether alcohol is drunk with meals, or by the frequency or type of alcohol consumed. Here we aim to investigate the associations between alcohol consumption with meals, daily frequency of consumption, and liver cirrhosis. METHODS: The Million Women Study is a prospective study that includes one in every four UK women born between 1935 and 1950, recruited between 1996 and 2001. In 2001 (IQR 2000-03), the participants reported their alcohol intake, whether consumption was usually with meals, and number of days per week it was consumed. Cox regression analysis yielded adjusted relative risks (RRs) for incident cirrhosis, identified by follow-up through electronic linkage to routinely collected national hospital admission, and death databases. FINDINGS: During a mean of 15 years (SD 3) of follow-up of 401 806 women with a mean age of 60 years (SD 5), without previous cirrhosis or hepatitis, and who reported drinking at least one alcoholic drink per week, 1560 had a hospital admission with cirrhosis (n=1518) or died from the disease (n=42). Cirrhosis incidence increased with amount of alcohol consumed (≥15 drinks [mean 220 g of alcohol] vs one to two drinks [mean 30 g of alcohol] per week; RR 3·43, 95% CI 2·87-4·10; p<0·0001). About half of the participants (203 564 of 401 806) reported usually drinking with meals and, after adjusting for amount consumed, cirrhosis incidence was lower for usually drinking with meals than not (RR 0·69, 0·62-0·77; p<0·0001; wine-only drinkers RR 0·69, 0·56-0·85; all other drinkers RR 0·72, 0·63-0·82). Among 175 618 women who consumed seven or more drinks per week, cirrhosis incidence was greater for daily consumption than non-daily consumption (adjusted RR 1·61, 1·40-1·85; p<0·0001). Daily consumption, together with not drinking with meals, was associated with more than a doubling of cirrhosis incidence (adjusted RR 2·47, 1·96-3·11; p<0·0001). INTERPRETATION: In middle-aged women, cirrhosis incidence increases with total alcohol intake, even at moderate levels of consumption. For a given weekly intake of alcohol, this excess incidence of cirrhosis is higher if consumption is usually without meals, or with daily drinking. FUNDING: UK Medical Research Council and Cancer Research UK.

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  • In women, cirrhosis risk increases with moderate alcohol consumption (starting at one to two drinks per day) and is higher when alcohol is consumed daily and outside meals.

    “In women, cirrhosis risk increases with moderate alcohol consumption (starting at one to two drinks per day) and is higher when alcohol is consumed daily 94 and outside meals.”

    From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [95]

    The Discussion reports that cirrhosis incidence increased with alcohol intake even at moderate levels, and that risk was higher with daily drinking or drinking outside meals. But the Results use one to two drinks per week—not per day—as the lowest comparison group; the paper does not establish one to two drinks per day as the point where risk begins to increase. (LLM, conf=0.88)

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Research works printed but not linked: 1

  1. [14]The Million Women Study 2018 The University of Oxford Oxford http://www.millionwomenstudy.org/

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Authors
Simpson, R. F., Hermon, C., Liu, B., Green, J., Reeves, G. K., Beral, V., & Floud, S.
Affiliations
  • University of Oxford (GB)
  • UNSW Sydney (AU)
Corresponding author
Simpson, Rachel F
ORCID
Venue
The Lancet Public Health
Publisher
Elsevier BV
Published
2019-01
Volume
4
Issue
1
Pages
e41-e48
ISSN
2468-2667 (ISSN-L)
DOI
10.1016/s2468-2667(18)30230-5
PMC
PMC6323353
OpenAlex
W2901102346
Cited by
154
References
24
Citations by year
2026: 9 · 2025: 18 · 2024: 24 · 2023: 24 · 2022: 23 · 2021: 22 · 2020: 19 · 2019: 13 · 2018: 2
FWCI
10.64
Type
journal article
Language
en
Open access
Licence
Locations
  • The Lancet Public Health (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, other-oa)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
  • UK Medical Research Council (MR/K02700X/1)
  • Cancer Research UK (C570/A16491)
Topics
  • Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
  • Health Sciences › Medicine › Pharmacology › Coffee research and impacts
Keywords
alcohol consumption, liver cirrhosis, alcohol consumption patterns, women's health, alcoholic liver disease
MeSH terms
Alcohol Drinking, Female, United Kingdom, Humans, Liver Cirrhosis, Middle Aged, Prospective Studies, Causality, Incidence, Risk Assessment, Meals

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