For professionals:

• Alcoholic liver disease is the primary liver disease among Caucasians, while the most common liver disease is hepatitis virus infection (Hepatitis A, B, C, D) among Orientals.

Epidemiological aspect

• In Canada and U.S.A. the mortality of liver cirrhosis ranks the third to fifth main causes of dealth of adult populations, and is mostly due to alcohol consumption.

• In European countries, the prevalence of liver disease correlates well with the amount of alcohol consumption, therefore we may estimate the amount of alcohol consumption from the yearly death rate of liver cirrhosis.

• In Western countries, total alcohol consumption showed a trend of decrease before the WWII, but after the WWII it kept the tendency of increase till the highest in 1975. Since 1975 the trend showed distinct decline again, and the prevalence of liver disease varied in correlation with the change in the amount of alcohol consumption.

• In Taiwan, the alcohol consumtion has increased since the early 1960's. By 1991 it has increased 11 % as compared with that of 1976. It means per capita yearly consumption of 3.5 liters 100 % pure alcohol. However, it is only 1/4 ~ 1/5 or 1/2 of the amount cosumed in France or U.S.A.

• The alcoholic liver disease is unrelated to the type of alcohol beverages consumed. Beer, brandy, wine, wiskey, and all kinds of liquors will induce the liver disease samely. They cause liver disease depends on the total amount and duration of alcohol consumption.

Amount of alcohol that may be of risk

• The amount of daily alcohol consumption that may induce liver cirrhosis:
  • Drinking 180 gm/d over 25 yrs is considered to be highly dangerous, but someone considered the risky amount to be 120 gm/day.

  • While some researcher report : 80 gm/d is dangerous, and even 40 gm/day is dangerous enough to induce liver damage.

  • The possibility of alcohol to induce cirrhosis in males :

                   1       < 40 gm/d 
                   1.83	  40 - 59 gm/d
                   100	  > 100 gm/d
    	

• Females are easier to become cirrhotic than males, and the risky amount of alcohol for females is much smaller i.e.1/2 of that for males.

• Rate of elimimation of ethanol:

  	100 mg/Kg B.W/hour  =  6 gm/hr/ 60 Kg Body weight
  			  =100 cc whiskey/ 7 hrs for person with BW of 60 kg
  	

• The rate of elimination differs depending on genetic, individual and external factors. On heavy alcohol consumption, the rate of elimination may increase by 100 %.

• Food delays gastric empting and intestinal absorption of ethanol, thus intake of food before drinking will decrease the rise of blood alcohol levels.

• Alcoholic beverages with higher ethanol concentration is more easily absorbed in the digestive tract.

• Only small amount of ethanol dissolves in fat tissues, therefore the blood concentration of ethanol will be higher in fatty than in skinny persons when they drink the same amount of alcohol.

• 90 - 95 % of ethanol convert to carbondioxide and water in the liver.

  	1 - 3%  eliminated from lung,  1%  eliminated from urine

• The enzymes that metabolize ethanol:

            
                ADH: (Alcohol dehydrogenase) Class I, II, III, & IV (?) .
                ALDH: (Acetoaldehyde dehydrogenase) 10 classes; ALDH 1 and 2, 
  			main ALDH in liver; ALDH 3~ 10.
                MEOS: (Microsomal ethanol oxydizing system)
  	      			 Cytochrome P-450 (CYP2E1)
  

• Acetaldehyde: metabolite of ethanol after metabolised by ADH.
• Isoenzyme of ALDH2, ALDH2 activity defect type causes discomfort symptoms like by cyanamide: flush, palpitation, and headache, therefore limit the alcohol intake, and as a result prevents the occurence of alcohol dependance. More in Orientals, "Oriental flush" .
• CYP2E1: Inuced by alcohol and many other kinds of drugs, therefore it is considered to be involved in alcohol metabolism.

Histopathoplogical features of alcoholic liver disease

• 1) Fatty liver:
  • Fatty degeneration (deposit, accumulation of fat) in the liver cells: commonly seen in alcoholic liver disease.
  • Weight of the liver may be over 2.0 - 2.5 Kg.
  • The hepatocytes are enlarged with large fat vacuoles displacing the nucleus eccentrically.

• 2) Fibrosis:
  • Perivenular necrosis and fibrosis.

• 3) Alcoholic hepatitis:
  • Inflammatory necrosis = steatonecrosis-Mallory type, steatohepatitis
  • PMN (polymorphonuclear cell) reaction, mostly around the perivenular region
  • Mallory's alcohol hyaline body

• 4) Cirrhosis:

  • Micronodular or Laennec's cirrhosis

Pure ethanol concentration of alcoholic beverages in Taiwan (1992)

(A) Rice wine
	Chennianshausing	17.5%
	Huadiau		 	17.0%
	Huangjiou	 	17.0%
	Shausing		16.0%
	Hunglu		 	16.0%

(B) Beer
	Taiwanpijiou	 	4.5%
	Shengpijiou	 	4.5%
	Chuanmaipijiou	 	3.5%
	Shiagti	 		2.5%

(C) Kauliang
	Dachiujiou 		65%
	Matsutianma	 	60%
	Jinmenteji	 	59%	
	Kauliagjiou		58%
	Mautai			55%
   	Shuagluujiapi		46%
	Juyeching		45%
	Meigueilu		44%
	Shenerjiou		30%
	Hubojiou		25%

(D) Rice liquer
	Shausingshaujiou	45%
	Weisujijiou		41%
	Chiuhuajiou		40%
	Molihuajiou 		40%
	Luongfongjiou		35%
	Mijioutou		35%
	Chiagchunjiou		35%
	Daushiagjiou		22%
	Mijiou			22%

(E) Wines
	Chinjiou		43%
	Bailandijiou		41%
	Lanmujiou		40%
	Futejiajiou		40%
	Binlejiou		18%
	Tejiumeijiou		16%
	Meijiou			14%
	Lijhjiou	 	13.5%
	Huongputaujiou	 	10.5%
	Putaumijiou	 	10.5%
	Meigueihuongjiou	10.5%
	Baiputaujiou	 	10.5%
	Putaudanjiou	  	2.0%