Faculty of Public Health - Andalas University - OCS, 13th IEA SEA Meeting and ICPH - SDev

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Personal or family history of diabetes predispose to severe hepatotoxic effects of alcohol
Ajeet Singh Bhadoria

Last modified: 2018-09-13


Background: Familial aggregation of diabetes in non-alcoholic fatty liver disease is well documented. However, relevance of it in alcoholic cirrhosis is not well studied. We aimed to explore the association of family and personal history of diabetes with age at diagnosis, severity and complications of alcoholic cirrhosis.

Materials and methods: In a cross-sectional study, all consecutive patients with alcoholic cirrhosis presenting to a tertiary care centre were included. Family and personal history, demographic characteristics, medical history, anthropometric measurements and laboratory data were recorded. The amount and duration of alcohol consumption was also carefully recorded. Informed consents were obtained and ethical clearance was taken.

Results:Out of 1,084 alcoholic cirrhotics (age 48.5±10.1 years, all males), family history for diabetes was documented in 643 (59.3%) patients. These patients had younger age at diagnosis, increased incidence of jaundice, ascites, variceal bleed and hepatic encephalopathy with consequently higher liver severity scores like MELD and CTP score. These patients developed cirrhosis despite shorter median duration (8 years, IQR 3-14 vs. 19, IQR 16-23) and lesser amount of alcohol consumption (46 grams/day, IQR 27-96 vs. 132, IQR 98-158). Patients with both family and personal history of diabetes had a higher risk by 3.6 times (95% CI 2.4-5.8) of an early age at diagnosis, 11.2 times (95% CI 6.7-17.1) of progression to cirrhosis with lesser amount of alcohol consumption and 5.1 times (95% CI 2.1-6.8) with lesser duration of alcohol consumption.

Conclusions: Presence of inherited diabetes predisposes to early development and more severe alcoholic cirrhosis, with a shorter duration of exposure to alcohol. Studies are needed to understand the molecular and metabolic pathways related to this association. Health education regarding deleterious effects of alcohol among those who have a family history of diabetes should be ensured.There also exists growing evidence regarding gut microbiome playing potential exemplary role in causing liver cirrhosis, and liver cancer. It well explains about the biological plausibility of familial clustering because of genetics and environment combination that might influence intestinal flora.