6, 51 In a population-based cohort study of almost 7000 subjects in two northern Italian communities, even among patients with very high daily alcohol intake (>120 g/day), only 13.5% developed ALD.50 The risk of cirrhosis or noncirrhotic chronic liver disease increased with a total lifetime Temozolomide supplier alcohol intake of more than 100 kg, or a daily intake >30 g/day.50 The odds of developing cirrhosis or lesser degrees of liver disease with a daily alcohol intake of >30 g/day were 13.7

and 23.6, respectively, when compared with nondrinkers.50 The type of alcohol consumed may influence the risk of developing liver disease. In a survey of more than 30,000 persons in Denmark, drinking beer or spirits was more likely to be associated with liver disease than drinking wine.18 Another factor that has been identified is the pattern of drinking. Drinking

outside of meal times has been reported to increase the risk of ALD by 2.7-fold compared to those who consumed alcohol only at mealtimes.52 Binge drinking, defined by some researchers as five drinks for men and four drinks for women in one sitting, has also been shown to increase the risk of ALD and all-cause mortality.53, this website 54 Women have been found to be twice as sensitive to alcohol-mediated hepatotoxicity and may develop more severe ALD at lower doses and with shorter duration of alcohol consumption than men.55 Several studies have shown differing blood alcohol levels in women versus men after consumption of

equal amounts of alcohol.56 This might be explained by differences in the relative amount of gastric alcohol dehydrogenase, a higher proportion of body fat in women, or changes in alcohol absorption with the menstrual cycle.57 Based on epidemiological evidence of a threshold effect of alcohol, a suggested “safe” limit of alcohol intake had been 21 units per week in men and 14 units per week in women who have no other chronic liver disease58, 59 (where a unit is defined as the equivalent of 8 g of ethanol). However, other data suggest that a lower quantity may be toxic in women, implying a lower threshold of perhaps 上海皓元医药股份有限公司 no more than 7 units per week.47 A higher risk of liver injury may be associated with an individual’s racial and ethnic heritage.60 The rates of alcoholic cirrhosis are higher in African-American and Hispanic males compared to Caucasian males and the mortality rates are highest in Hispanic males.61 These differences do not appear to be related to differences in amounts of alcohol consumed.62 The presence and extent of protein calorie malnutrition play an important role in determining the outcome of patients with ALD. Mortality increases in direct proportion to the extent of malnutrition, approaching 80% in patients with severe malnutrition (i.e., less than 50% of normal).63 Micronutrient abnormalities, such as hepatic vitamin A depletion or depressed vitamin E levels, may also potentially aggravate liver disease.