Familial predisposition to alcoholic liver disease: a case-control study.

OBJECTIVES: The variable susceptibility to alcoholic liver disease (ALD) may be genetic in origin, but clear candidate genes have not yet emerged. This study aimed to assess familial clustering of ALD using a case-control strategy. METHODS: We recruited two cohorts of heavy drinkers (>60 U/week for men or >40 U/week for women): 291 individuals with decompensated ALD (Child's grade B or C) and 208 controls with similar alcohol consumption but no evidence of liver disease. Data were collected, through a questionnaire and a follow-up telephone call, on drinking behaviour and the presence of liver disease in parents and siblings of cases and controls. The results in the relatives of cases were compared with those in the relatives of the controls. RESULTS: The odds ratio (OR) of heavy drinking in the relatives of the cases compared with the controls was 0.91 [95% confidence interval (CI), 0.73-1.1]. OR in the relatives of the cases versus the controls was 1.27 for definite ALD (95% CI, 0.63-2.6), 1.09 for all ALD (95% CI, 0.58-2.0) and 1.0 for all liver diseases (95% CI, 0.60-1.7). Multiple subgroup analyses yielded similar OR values, not exceeding 1.5. CONCLUSION: These data do not suggest a strong familial predisposition to the development of ALD and rather suggest that the main cofactors are environmental.

Severity of alcohol dependence in decompensated alcoholic liver disease: comparison with heavy drinkers without liver disease and relationship to family drinking history.

AIM: The aim of this study was to compare alcohol dependence severity in patients with severe alcoholic liver disease (ALD) with that in heavy drinkers without liver disease. METHODS: Short alcohol dependence data and lifetime alcohol questionnaires applied to unselected heavy alcohol drinkers (>60 units/week (M) or 40 units/week (F) for >5 years) with either (a) decompensated ALD (patients n = 136) or (b) no evidence of serious liver disease by clinical, biochemical and ultrasound evaluation ('controls' n = 148). RESULTS: The SADD alcohol dependence severity score (range 0-42) in patients with ALD was >28 (severe dependence) in 36 cases (26%); slightly higher than that in heavy-drinking controls taken as a whole; similar to that in controls who were seeking healthcare but higher than that in controls who were not; and lower than that in controls who attended specialist alcohol services. In ALD patients and controls, the SADD score was higher in those with three or more heavy-drinking first-degree relatives than in those with none. In multiple regression analysis, the SADD score showed independent associations with young age, clinically manifest alcohol dependence, seeking healthcare and the presence of multiple heavy drinking relatives, but not with ALD. CONCLUSIONS: Alcohol dependence severity in patients with ALD varies and tends to be lower than that in heavy drinkers seeking treatment at alcohol treatment centres but is not as low as implied in some previous studies. Alcohol dependence severity is associated with young age and family drinking history but is not specifically associated with the development of liver disease.