Alcohol consumption and risk of liver cirrhosis: a systematic review and meta-analysis
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OBJECTIVES: To systematically summarize the risk relationship between different levels of alcohol consumption and incidence of liver cirrhosis. METHODS: MEDLINE and Embase were searched up to March 6, 2019, to identify case-control and cohort studies with sex-specific results and more than 2 categories of drinking in relation to the incidence of liver cirrhosis. Study characteristics were extracted and random-effects meta-analyses and meta-regressions were conducted. RESULTS: A total of 7 cohort studies and 2 case-control studies met the inclusion criteria, providing data from 2,629,272 participants with 5,505 cases of liver cirrhosis. There was no increased risk for occasional drinkers. Consumption of one drink per day in comparison to long-term abstainers showed an increased risk for liver cirrhosis in women, but not in men. The risk for women was consistently higher compared to men. Drinking ≥5 drinks per day was associated with a substantially increased risk in both women (relative risk [RR] = 12.44, 95% confidence interval [CI]: 6.65-23.27 for 5-6 drinks, and RR = 24.58, 95% CI: 14.77-40.90 for ≥7 drinks) and men (RR = 3.80, 95% CI: 0.85-17.02, and RR = 6.93, 95% CI: 1.07-44.99, respectively). Heterogeneity across studies indicated an additional impact of other risk factors. DISCUSSION: Alcohol is a major risk factor for liver cirrhosis with risk increasing exponentially. Women may be at higher risk compared to men even with little alcohol consumption. More high-quality research is necessary to elucidate the role of other risk factors, such as genetic vulnerability, body weight, metabolic risk factors, and drinking patterns over the life course. High alcohol consumption should be avoided, and people drinking at high levels should receive interventions to reduce their intake.
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Recent meta-analyses found no protective effects against cirrhosis at any level of drinking when compared to long-term abstainers.
“Recent meta-analyses found no protective effects against cirrhosis at any level of drinking when compared to long-term abstainers.”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [93]
In men, there is some evidence for a threshold effect at higher daily levels, although precise estimates of this threshold are not available.
“However, in men, there is some evidence for a threshold effect at higher daily levels, although precise estimates of this threshold are not available.”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [93]
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- Authors
- Roerecke, M., Vafaei, A., Hasan, O. S. M., Chrystoja, B. R., Cruz, M., Lee, R., Neuman, M. G., & Rehm, J.
- Affiliations
- Centre for Addiction and Mental Health (CA)
- In Vitro Drug Safety and Biotechnology, Toronto, Ontario, Canada;
- University of Toronto (CA)
- Corresponding author
- Roerecke, Michael
- Venue
- American Journal of Gastroenterology
- Published
- 2019-08-20
- Volume
- 114
- Issue
- 10
- Pages
- 1574-1586
- ISSN
- 0002-9270 (ISSN-L)
- 1572-0241
- PMC
- PMC6776700
- OpenAlex
- W2970671727
- Cited by
- 391
- References
- 82
- Citations by year
- 2026: 45 · 2025: 70 · 2024: 77 · 2023: 75 · 2022: 67 · 2021: 37 · 2020: 17 · 2019: 2
- FWCI
- 4.56
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- The American Journal of Gastroenterology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Alcohol Abuse and Alcoholism (R21AA023521)
- 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 › Hepatology › Liver Disease and Transplantation
- Keywords
- alcohol consumption, liver cirrhosis, sex differences, occasional drinking, daily drinking, heavy drinking, alcohol as risk factor, incidence, alcoholic liver disease
- MeSH terms
- Alcohol Drinking, Humans, Liver Cirrhosis, Risk Factors, Sex Factors, Incidence
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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