Zhang DY, Li D, Huang SM, Chen C, Zeng F, Bai FH. Epidemiology and clinical features of alcoholic liver disease in Hainan Province, China. World J Hepatol 2025; 17(11): 112430 [DOI: 10.4254/wjh.v17.i11.112430]
Corresponding Author of This Article
Fei-Hu Bai, PhD, Chief Physician, Department of Gastroenterology, The Second Affiliated Hospital of Hainan Medical University, No. 368 Yehai Avenue, Longhua District, Haikou 570216, Hainan Province, China. baifeihu_hy@163.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Observational Study
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Nov 27, 2025 (publication date) through Dec 4, 2025
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World Journal of Hepatology
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Zhang DY, Li D, Huang SM, Chen C, Zeng F, Bai FH. Epidemiology and clinical features of alcoholic liver disease in Hainan Province, China. World J Hepatol 2025; 17(11): 112430 [DOI: 10.4254/wjh.v17.i11.112430]
Da-Ya Zhang, Fei-Hu Bai, Department of Gastroenterology, The Second Affiliated Hospital of Hainan Medical University, Haikou 570216, Hainan Province, China
Da Li, Shi-Mei Huang, Chen Chen, Fan Zeng, Graduate School, Hainan Medical University, Haikou 571199, Hainan Province, China
Author contributions: Zhang DY and Bai FH participated in the design of this study and performed the statistical analysis, drafted the manuscript; Li D and Huang SM recruited participants; Chen C and Zeng F participated in the data collection; Zhang DY revised the manuscript. All authors read and approved the final manuscript.
Supported by the Hainan Medical University Academic Enhancement Support Program, No. XSTS2025001; National Clinical Key Speciality Capacity Building Project, No. 202330; Hainan Province Clinical Medical Center, No. 2021818; Specific Research Fund of The Innovation Platform for Academicians of Hainan Province, No. YSPTZX202313; Joint Project on Health Science and Technology Innovation in Hainan Province, No. SQ2023WSJK0301; and Hainan Province Education Reform Project, No. hnjg2024-67.
Institutional review board statement: The protocol was approved by the Institutional Ethics Committee of the Second Hospital of Hainan Medical University (No. LW20222161) and performed per Helsinki’s Declaration.
Informed consent statement: All participants provided written informed consent for data collection and storage. All data collected were anonymized at the point of collection using unique study identification numbers. All electronic data were stored on password-protected servers, and physical questionnaires were stored in locked cabinets accessible only to the principal investigators to ensure participant confidentiality.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: The datasets generated and/or analyzed during the current study are available from the corresponding author upon reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Fei-Hu Bai, PhD, Chief Physician, Department of Gastroenterology, The Second Affiliated Hospital of Hainan Medical University, No. 368 Yehai Avenue, Longhua District, Haikou 570216, Hainan Province, China. baifeihu_hy@163.com
Received: July 28, 2025 Revised: September 8, 2025 Accepted: November 4, 2025 Published online: November 27, 2025 Processing time: 123 Days and 20.9 Hours
Abstract
BACKGROUND
Alcohol can cause alcoholic fatty liver, alcoholic steatohepatitis, alcoholic liver cirrhosis (ALC), and hepatocellular carcinoma. China has become the second-largest country in the world in terms of alcohol consumption, lacking national epidemiological data on alcoholic liver disease (ALD).
AIM
To understand the incidence and characteristics of ALD in Hainan Province of China.
METHODS
From October 2022 to April 2023, a stratified proportional multi-stage whole population sampling method was adopted to select permanent residents of Haikou, Sanya, Qionghai, Dongfang, and Wuzhishan in Hainan Province to carry out questionnaire surveys, blood tests, and ultrasound examinations of the liver.
RESULTS
A total of 2704 valid questionnaires were obtained from residents aged 15-93 years old. The rates of drinking, hazardous drinking, and harmful drinking were 31.73%, 14.53%, and 5.03%, respectively. The above rates were higher for males than for females, increasing with income, and the rates for ethnic minorities, such as Li, were higher than for Han Chinese (P < 0.05). Drinking rates increased with literacy (P < 0.05). Drinking rate and hazardous drinking rate decreased with age, were higher for residents of agricultural households than non-agricultural households, and higher for married than unmarried individuals (P < 0.05). The total number of patients with ALD was 142, with a detection rate of 5.25%. ALD detection rate was higher for males than females, decreased with age, and higher with income (P < 0.05). Patients with ALD included 48 (33.8%) cases of mild ALD, 64 (45.1%) cases of alcoholic fatty liver, 18 (12.7%) cases of alcoholic steatohepatitis, and 12 (8.5%) cases of ALC. The proportion of those who consumed more than 80 g of alcohol per day increased as they progressed from mild ALD to ALC stage. Diabetes mellitus and hyperlipidemia were easily combined in some cases, accounting for 25 (17.6%) and 80 (56.3%), respectively. The average daily alcohol consumption of ALD patients of Li ethnicity ≥ 80 g was significantly more than that of Han ethnicity (χ2 = 5.652, P = 0.02), and was predominantly among those who drank large amounts of alcohol intermittently (χ2 = 89.093, P < 0.001).
CONCLUSION
The rates of drinking, hazardous drinking, harmful drinking, and detection of ALD in Hainan Province need to be paid attention to by advocating a healthy lifestyle, such as abstinence and limiting alcohol consumption.
Core Tip: The rates of drinking, hazardous drinking, harmful drinking, and detection of alcoholic liver disease in Hainan Province were 31.73%, 14.53%, 5.03%, and 5.25% respectively. The above rates were higher for males than for females, increasing with income. It is crucial to actively promote healthy lifestyle choices, with a strong emphasis on abstinence from alcohol or, at the very least, the strict limitation of alcohol consumption, to mitigate these associated health risks.
Citation: Zhang DY, Li D, Huang SM, Chen C, Zeng F, Bai FH. Epidemiology and clinical features of alcoholic liver disease in Hainan Province, China. World J Hepatol 2025; 17(11): 112430
Alcohol can cause alcoholic fatty liver, alcoholic steatohepatitis (AH), alcoholic liver cirrhosis (ALC), and hepatocellular carcinoma (HCC)[1]. The age-standardized mortality rate of alcohol-related HCC is continuously increasing[2]. The overall prevalence of alcoholic liver disease (ALD) in Asia has increased significantly from 3.82% to 6.62%, and the alcohol-attributable proportions of ALC and HCC are 12.57% and 8.30%, respectively[3]. ALD is expected to become one of the major causes of chronic liver disease in Asia[3]. China has become the second-largest country in the world in terms of alcohol consumption[4,5]. China lacks national epidemiological data on ALD, but regional epidemiological survey results show that the proportion of regular alcohol drinkers among adults in China was 66.2% and the prevalence of ALD was 8.74% in 2015, which were 2.5 times and 3.9 times higher than in 2000, respectively[6]. Recent data show that the rates of alcohol consumption, hazardous drinking, harmful drinking, and ALD detection in Tongzhou District, Beijing were 45.29%, 3.63%, 4.03%, and 4.03%, respectively[7]. Since March 2020, with the coronavirus disease 2019 (COVID-19) pandemic, many factors such as home, isolation, unemployment, medical crowding, and fear of the epidemic have led to an increase in the proportion of intermittent heavy or heavy drinking, and a significant increase in hospitalizations for AH and ALC decompensation, and for alcohol-related slow plus acute liver failure[8]. Alcohol consumption, alcohol-related deaths, and the incidence of decompensated ALC were modeled to show an increasing trend in 1, 3, and 5 years after the COVID-19 pandemic[8]. Our team conducted an epidemiological survey of alcohol consumption and ALD in Hainan Province to provide a scientific basis for the development of effective diagnostic and treatment measures.
MATERIALS AND METHODS
Study population and design
According to the actual situation in Hainan Province, in accordance with the principles of representativeness and cost-effectiveness, five places in Hainan Province, namely, Haikou, Sanya, Qionghai, Dongfang, and Wuzhishan were selected as the locations of the streaming survey from October 2022 to April 2023. Four towns or districts in each place, four streets and townships in each town or district, and one or two neighbourhood committees (village committees) were regarded as the survey sites. A total of 2908 subjects who met the survey criteria were sampled in accordance with the principle of stratified and proportional multi-stage whole group sampling. 204 people were excluded due to incomplete information, and a total of 2704 valid questionnaires were obtained, with a qualification rate of 92.98%, among which Haikou, Sanya, Qionghai, Dongfang, and Wuzhishan were 562, 601, 542, 551, and 448, respectively. Inclusion criteria: Permanent residents who had lived (or worked) in Hainan Province for more than 5 years and had Hainan medical insurance, aged ≥ 15 years. Exclusion criteria: (1) Pregnant women; (2) People with a large amount of ascites; and (3) People who can’t cooperate with relevant examinations. The study protocol was approved by the Ethics Committee of the Second Affiliated Hospital of Hainan Medical University (No. LW20222161), and the study participants had read and signed the informed consent form.
Content of the survey
Before the survey, the investigators were uniformly trained to standardise the operation method, and the ALD epidemiological survey scale was completed by means of a centralised questionnaire or a telephone questionnaire. The ALD survey scale included general information (gender, age, ethnicity, household registration, marital smoking, cultural level, personal income in yuan/month, and comorbidity with chronic diseases) and alcohol consumption (the amount of alcohol consumed each time, the frequency of drinking and the years of drinking, and the type and mode of regular alcohol consumption, etc.). According to the ALD prevention and treatment guidelines[9], a free physical examination was performed for those whose questionnaire suggested long-term alcohol consumption. The physical examination items included: (1) Biochemical indexes: Blood routine, liver function, blood glucose, blood lipids, Hepatitis B Screening, etc.; and (2) Ultrasound examination: Ultrasound examination of the upper abdomen after abstaining from eating and drinking for more than 8 hours. ALD diagnoses were based on ultrasound imaging (for fatty liver and cirrhosis) combined with clinical and laboratory criteria [e.g., aspartate aminotransferase (AST)/alanine transaminase (ALT) > 2, elevated gamma-glutamyl transferase (GGT) for steatohepatitis]. Histological confirmation was not feasible in this population-based study.
Definition
Drinking is defined as the consumption of any beverage containing ethanol in the 12 months prior to the survey, and the percentage of people with drinking behaviour in the total population is the drinking rate[10]. Hazardous drinking is defined as drinking behaviour in which the average daily alcohol intake of male drinkers is ≥ 41 g and ≤ 61 g, and drinking behaviour in which the average daily alcohol intake of female drinkers is ≥ 21 g and ≤ 41 g. Hazardous drinking was defined as ≥ 14 standard drinks per week for men or ≥ 7 for women, consistent with the World Health Organization guidelines. Harmful drinking is drinking behaviours in which the average daily alcohol intake of male drinkers is > 61 g, and drinking behaviours in which the average daily alcohol intake of female drinkers is > 41 g. Harmful drinking was defined as a pattern of alcohol use that has already caused physical or psychological harm, based on the International Classification of Diseases-10 criteria. “Agricultural household registration” refers to the hukou system in China, which may reflect rural residence and associated lifestyles. Agricultural Hukou: Granted to individuals and families living in rural areas. Traditionally, this was tied to the right to farm a plot of land allocated by the collective. Non-agricultural Hukou: Granted to residents of towns and cities. This status historically provided access to state-provided benefits like government jobs, food rations, housing, healthcare, and education.
Statistical analysis
SPSS 25.0 software was used to analyze the data. The continuous variables were expressed as mean ± SD, and an independent sample t-test was used for comparison between the groups. The categorical variables were expressed as frequencies and percentages [n (%)], and comparisons between the groups were made using χ2 tests or trend χ2 tests.
RESULTS
Basic information
A total of 2704 subjects were included in the study, including 949 males and 1755 females, ranging from 15 to 93 years old, with an average age of (48.69 ± 14.24) years old. This study included 1989 Han Chinese, 668 Li, 29 Hmong, 11 Mongols, 2 Hui, 1 Tujia, 2 Zhuang, and 2 Yi. The rates of drinking, hazardous drinking, harmful drinking, and ALD were 858 (31.73%), 393 (14.53%), 136 (5.03%), and 142 (5.25%), respectively (Figure 1).
Figure 1
Epidemiology and clinical features of alcoholic liver disease in Hainan Province, China.
Distributional characteristics of alcohol consumption
The drinking rate of each age group ranged from 19.61% to 35.90%, with a decreasing trend with age, and the difference was statistically significant (χ2 = 36.458, P < 0.001). The drinking rate of males (52.79%) was higher than that of females (20.34%) (χ2 = 299.416, P < 0.001). The drinking rate of people with agricultural household registration was higher than that of people with non-agricultural household registration (χ2 = 4.352, P = 0.037). As the literacy level increased, the drinking rate tended to increase (χ2 = 22.915, P < 0.001). Married individuals had a higher drinking rate than unmarried individuals (χ2 = 22.985, P < 0.001). The drinking rate of those with personal income of 5000 yuan and above was higher than that of those with less than 5000 yuan (χ2 = 20.406, P < 0.001). Ethnic minorities, such as the Li, had a higher drinking rate than the Han (χ2 = 224.498, P < 0.001) (Table 1). These significant variables were further assessed by including them in a multifactorial logistic regression model, as depicted in Supplementary Table 1. Li ethnic [odds ratio (OR) = 6.459; 95% confidence interval (CI): 3.299-12.643], junior high school (OR = 1.746, 95%CI: 1.215-2.511), high school/secondary school (OR: 1.858, 95%CI: 1.327-2.602), college/university and above (OR = 1.492, 95%CI: 1.063-2.094), married (OR = 2.617, 95%CI: 1.295-5.287) were found to be positively associated with drinking rate.
Table 1 Univariate analysis of factors drinking rate among permanent residents of Hainan Province, n (%).
Features
Number of investigators
Drinking rate
χ2
P value
Age
36.458
0.000
≥ 15-25
110
37 (33.6)
> 25-35
465
164 (35.3)
> 35-45
557
200 (35.9)
> 45-55
643
222 (34.5)
> 55~65
562
163 (29.0)
> 65
367
72 (19.6)
Sex
299.416
0.000
Male
949
501 (52.8)
Female
1755
357 (20.3)
Ethnicity
224.498
0.000
Han
1989
472 (23.7)
Li
668
356 (53.3)
Other ethnic minorities (Mongolian, Miao, Hui, etc.)
Hazardous drinking behaviour and harmful drinking behaviour
The rates of hazardous drinking and harmful drinking were higher for males than females (χ2 = 260.116, P < 0.001; χ2 = 177.521, P < 0.001), higher for those with personal incomes of 5000 yuan and above than those with incomes of less than 5000 yuan (χ2 = 30.984, P < 0.001; χ2 = 23.613, P < 0.001), and higher for ethnic minorities, such as Li, than Han Chinese (χ2 = 112.022, P < 0.001; χ2 = 40.352, P < 0.001). Hazardous drinking rate showed a decreasing trend with age (χ2 = 16.138, P = 0.006), agricultural households were higher than non-agricultural households (χ2 = 4.853, P = 0.028), and married individuals were higher than unmarried individuals (χ2 = 8.933, P < 0.011) (Tables 2 and 3). These significant variables were further assessed by including them in a multifactorial logistic regression model, as depicted in Supplementary Tables 2 and 3. Li ethnic (OR = 4.720; 95%CI: 2.267-9.828), Married individuals (OR = 2.408, 95%CI: 1.042-5.566) were found to be positively associated with Hazardous drinking rate, and Female individuals (OR = 0.063, 95%CI: 0.037-0.108) were found to be negatively associated with Harmful drinking rate (Supplementary Tables 2 and 3).
Table 2 Hazardous drinking rate among permanent residents of Hainan Province, n (%).
Features
Number of investigators
Hazardous drinking rate
χ2
P value
Age
16.138
0.006
≥ 15-25
110
7 (6.4)
> 25-35
465
70 (15.1)
> 35-45
557
85 (15.3)
> 45-55
643
109 (17.0)
> 55-65
562
86 (15.3)
> 65
367
36 (9.8)
Sex
260.116
0.000
Male
949
279 (29.4)
Female
1755
114 (6.5)
Ethnicity
112.022
0.000
Han
1989
204 (10.3)
Li
668
174 (26.0)
Other ethnic minorities (Mongolian, Miao, Hui, etc.)
A total of 142 people were detected with ALD, with a detection rate of 5.25%. 13.59% (129/949) of subjects were males with ALD, and 0.74% (13/1755) were females with ALD, with a statistically significant difference (χ2 = 204.484, P < 0.001). The detection rate in all age groups ranged from 0% to 7.72%, and tended to decrease with age (χ2 = 15.862, P = 0.008). With the increase in personal income, the detection rate tended to increase (χ2 = 44.791, P < 0.001). Comparing the detection rate between the agricultural and non-agricultural population, the difference was not statistically significant (P = 0.265). The difference in detection rates was not statistically significant with increasing literacy (P = 0.723). The difference in detection rates among different marital status (P = 0.118) and among different ethnic groups (P = 0.292) was not statistically significant (Table 4 and Supplementary Table 4).
Table 4 Alcoholic liver disease detection rate among permanent residents of Hainan Province, n (%).
Features
Number of investigators
ALD detection rate
χ2
P value
Age
15.862
0.008
≥ 15-25
110
0 (0)
> 25-35
465
24 (5.2)
> 35-45
557
43 (7.7)
> 45-55
643
37 (5.8)
> 55-65
562
24 (4.3)
> 65
367
14 (3.8)
Sex
204.484
0.000
Male
949
129 (13.6)
Female
1755
13 (0.7)
Ethnicity
2.439
0.292
Han
1989
105 (5.3)
Li
668
32 (4.8)
Other ethnic minorities (Mongolian, Miao, Hui, etc.)
ALD patients were classified into 48 (33.8%) cases of mild ALD, 64 (45.1%) cases of alcoholic fatty liver, 18 (12.7%) cases of AH, and 12 (8.5%) cases of ALC. Years of drinking, mode and type of drinking: 108 (76.1%) cases had been drinking for ≥ 10 years; 86 (60.6%) cases of persistent small amount of drinking, 37 (26.1%) cases of intermittent large amount of drinking; The proportion of those who drank ≥ 80 g of alcohol per day increased when progressing from mild ALD to ALC stage; there were 111 (78.2%) cases of drinking white wine alone, 7 (4.9%) cases of beer, and 24 (16.9%) cases of mixing alcohol (white wine, beer, homebrew, etc.). The most significant changes in blood tests were GGT (31.0%), followed by AST (23.2%), ALT (21.1%), and total bilirubin (19.7%). Some of the cases were prone to comorbidity with diabetes mellitus (17.6%) and hyperlipidaemia (56.3%), respectively (Table 5).
Table 5 Alcoholic liver disease types in Hainan Province, (n).
Differences in ALD among different ethnic groups (Han and Li)
The average daily alcohol consumption of Li patients ≥ 80 g was significantly more than that of Han (χ2 = 5.652, P = 0.02), and was dominated by intermittent heavy drinkers (χ2 = 89.093, P < 0.001). There was no significant difference in the proportion of years of alcohol consumption, types of alcohol consumption, complications, and liver enzyme abnormalities between Li and Han patients (Table 6 and Supplementary Table 5).
Table 6 Comparison of alcoholic liver disease status between Han and other ethnic groups in Hainan Province, (n).
With the development of the social economy and the improvement of living standards, as well as under the influence of “Chinese wine culture”, the incidence of alcohol consumption and ALD in China has been increasing year by year[11,12], with the rate of alcohol consumption rising from 21.0% in 2002 to 30.5% in 2018[13]. The results of this survey showed that the rates of drinking, hazardous drinking, and harmful drinking in Hainan Province were higher than those in southern regions such as Shanghai[14,15] and lower than those in the region of Heilongjiang Province[16,17].
The rates of drinking, hazardous drinking, and harmful drinking among males are much higher than those among females, which is consistent with other studies in China[18]. Since 1990, per capita alcohol consumption in China has increased by 70% in just less than 30 years, and in 2017, per capita alcohol consumption among Chinese men was as high as 11 L/year, compared with only 3 L/year among women[19]. Compared with women, men are socially accepted for drinking due to social needs and the influence of the “Chinese drinking culture”, so they drink more and more frequently, while women’s heavy drinking is socially disapproved, which is conducive to limiting the amount of alcohol consumed by women. Especially for women, alcoholism is more likely to produce liver damage and other diseases with more severe clinical symptoms[20]. However, the gender gap has narrowed significantly in recent decades, and alcohol consumption has gradually risen, especially among young women.
Drinking and hazardous drinking rates are negatively correlated with age. It is fact that the drinking rate is higher due to the need for socialising and youthfulness during young adulthood, but as age increases and socialising decreases, some of the population chooses to abstain from alcohol due to health factors experiencing the harmful effects on the body caused by alcohol consumption, as well as the emergence of chronic diseases, such as high blood pressure and high blood cholesterol[18]. Drinking rate is positively correlated with literacy level because of the highly educated people, who have a wide range of socialising and socialising. High-income groups have high rates of alcohol consumption, hazardous drinking, and harmful drinking because low-income groups have fewer opportunities to drink due to economic and social constraints.
The prevalence of ALD was reported differently in different regions, with 4.34% in Zhejiang Province, 2.2% in Xi’an, 6.1% in Liaoning Province, and 4.12% in Hebei Province. The results of this study showed that the prevalence of ALD in Hainan Province was 5.25%, which was higher than that in some regions of the country. The characteristics of ALD age and gender in this study were basically the same as those of hazardous and harmful drinking, which was related to the consistency of the standard of alcohol consumption in both. Middle-aged and young people are the preferred age group for ALD, which is related to their roles and activities in society. In addition, middle-aged and young adults are good at drinking on an empty stomach, which has a higher risk of ALD because the enterohepatic circulation of ethanol is intensified, which greatly raises the blood alcohol concentration, and the oxidative stress produced by alcohol is enhanced, which increases the damage to the liver. High-income people have more socialising, and as they age, the metabolism of alcohol in the body slows down, resulting in an increased burden on the liver and an increased incidence of ALD.
Long-term alcohol consumption can lead to liver enzyme abnormalities[21]. ALT, AST, and GGT are the most commonly used indicators for detecting liver enzymes. Shen et al[22] found that daily ethanol intake of ≥ 40 g and years of alcohol consumption of ≥ 10 years were closely associated with abnormalities of the indicators of alcoholic liver injury in a 7-year follow-up survey of 461 ALD patients in Zhejiang Province, with a relative risk of 2.014 and 2.085, respectively. In the present study, patients with ALD had abnormal liver enzymes. The probability of abnormal liver enzymes in ALD patients in the study was smaller than previously reported in the literature, which may be related to the fact that the population in this study was from a large epidemiological survey rather than hospitalised patients.
In the present study, ALD was found to be prone to comorbid diabetes mellitus and hyperlipidaemia[23,24]. Alcohol causes extensive hepatic tissue damage, and the liver’s function of converting glucose to hepatic glycogen is weakened, which results in an increase in glucose within 1-2 hours after a meal, and stimulates insulin secretion. At the same time, the weakened function of the inactivation of insulin causes a further rise in the concentration of insulin in the blood, which results in hyperinsulinaemia. In addition, hyperinsulinaemia in the presence of insulin resistance promotes sodium reabsorption in the renal tubules, which reduces lipid clearance and elevates triacylglycerol[23,24].
So far, little precise information about the incidence and prevalence of ALD has been reported, and epidemiological investigations on the comparison of the Li and Han ethnic groups suffering from ALD in Hainan Province have not been reported. The Li people of South China, despite having no unified religion or writing system, have a rich drinking culture. They celebrate with alcohol at festivals and important events, producing a wide variety of unique wines like Shanlan rice, banana, and coconut wine. The Li people are known for their warmth, boldness, and hospitality, and alcohol is mainly home-brewed, with a rich and strong wine culture, and there are many young drinkers. The average daily alcohol consumption of ≥ 80 g in the Li people is significantly more than that of the Han people, but there is no significant difference in the incidence of ALD. We speculate that this may be related to some kind of protective mechanism in the body of the Li population, which can be further investigated from the genetic point of view.
In recent years, it has been found that drinking patterns (fasting booze, off-meal drinking), beverage types (higher risk of mixing alcohol), diet (coffee seems to have a protective effect), smoking, iron overload, co-morbidities (viral hepatitis), intestinal microecology, and metabolic factors can exacerbate the occurrence of ALD[25-27]. Currently, most studies for the treatment of ALD aim to promote hepatocyte regeneration, block inflammatory pathways, and improve the microbial flora etc. There are no effective drugs approved for the treatment of ALD patients at home or abroad[24], and large samples of rigorous clinical trial studies are still needed. The age distribution skews toward middle-aged adults (mean approximately 49 years), which may limit generalizability to very young or elderly populations. Future studies with broader age sampling are warranted.
CONCLUSION
The rates of drinking, hazardous drinking, harmful drinking, and ALD detection in Hainan Province need to be a cause for concern, and alcohol cessation is an important prevention and treatment tool for ALD[28]. The most important way to improve the long-term prognosis of ALD is long-term abstinence from alcohol. However, more than 50% of ALD patients do not adhere to alcohol abstinence after a disease episode, resulting in recurrent ALD episodes. For ALD people, they should be informed to quit drinking as early as possible to reduce further damage from alcohol to the liver. For hazardous and harmful drinking people, intervention measures should be carried out as early as possible to reduce the intake of alcohol or even not to ingest it. For other groups of people, they should be educated to strengthen the limitations of alcohol, control the excessive use of alcohol, and reduce the abuse of alcohol, in order to achieve the goal of the reduction of the occurrence of ALD and other chronic diseases.
Footnotes
Provenance and peer review: Unsolicited article; Externally peer reviewed.
Peer-review model: Single blind
Specialty type: Gastroenterology and hepatology
Country of origin: China
Peer-review report’s classification
Scientific Quality: Grade B, Grade B, Grade C
Novelty: Grade B, Grade B, Grade C
Creativity or Innovation: Grade B, Grade B, Grade C
Scientific Significance: Grade B, Grade B, Grade B
P-Reviewer: Hu ZY, PhD, Assistant Professor, China; Zhao CF, MD, PhD, Associate Professor, China S-Editor: Bai SR L-Editor: A P-Editor: Wang CH
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