|English: Total recorded alcohol per capita consumption (15+), in litres of pure alcohol (Photo credit: Wikipedia)|
Geographic variability exists in the patterns of alcohol intake throughout the world (6). Approximately two-thirds of the adult Americans drink alcohol (7). The majority drink small or moderate amounts and do so without evidence of clinical disease
(8–10). A subgroup of drinkers, however, drink excessively, develop physical tolerance and withdrawal, and are diagnosed with alcohol dependence (11). A second subset, alcohol abusers and problem drinkers, are those who engage in harmful use of alcohol, which is defined by the development of negative social and health consequences of drinking (e.g., unemployment, loss of family, organ damage, accidental injury, or death) (12). Failure to recognize alcoholism remains a significant problem and impairs efforts at both the prevention and the management of patients with ALD (13,14). Although the exact prevalence is unknown, approximately 7.4% of adult Americans were estimated to meet the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, criteria for the diagnosis of alcohol abuse and/or alcohol dependence in 1994 (15); more recent data suggest 4.65% meet the criteria for alcohol abuse and 3.81% for alcohol dependence (16). In 2003, 44% of all deaths from liver disease were attributed to alcohol (17).
The population-level mortality from ALD is related to the per capita alcohol consumption obtained from national alcoholic beverage sales data. There are conflicting data regarding a possible lower risk of liver injury in wine drinkers (18,19). One epidemiological study has estimated that for every 1 l increase in per capita alcohol consumption (independent of the type of beverage), there was a 14% increase in cirrhosis in men and 8% increase in women (20). These data must be considered in the context of the limitations of measuring alcohol use and defining ALD. The scientific literature has also used a variety of definitions of what constitutes a standard drink (Table 2). Most studies depend on interviews with patients or their families to quantify drinking patterns, a method that is subject to a number of biases, which may lead to invalid estimates of alcohol consumption (21).
Although there are limitations of the available data, the World Health Organization’s Global Alcohol database, which has been in existence since 1996, has been used to estimate the worldwide patterns of alcohol consumption and allow comparisons of alcohol-related morbidity and mortality (22). The burden of alcohol-related disease is the highest in the developed world, where it may account for as much as 9.2% of all disability-adjusted life years. However, even in the developing regions of the world, alcohol accounts for a major portion of the global disease burden, and is projected to take on increasing importance in those regions over time (22,23).
|Class I||Conditions for which there is evidence and/or general agreement that a given diagnostic evaluation, procedure or treatment is beneficial, useful, and effective|
|Class II||Conditions for which there is conflicting evidence and/or a divergence of opinion about the usefulness/efficacy of a diagnostic evaluation, procedure, or treatment|
|Class IIa||Weight of evidence/opinion is in favor of usefulness/efficacy|
|Class IIb||Usefulness/efficacy is less well established by evidence/opinion|
|Class III||Conditions for which there is evidence and/or general agreement that a diagnostic evaluation/ procedure/treatment is not useful/effective and in some cases may be harmful|
|Level of evidence|
|Level A||Data derived from multiple randomized clinical trials or meta-analyses|
|Level B||Data derived from a single randomized trial or nonrandomized studies|
|Level C||Only consensus opinion of experts, case studies, or standard of care|