Pattern of alcohol consumption in relation to meals and the risk of liver cirrhosis in a large prospective study of UK women

Introduction Alcohol is an important cause of liver cirrhosis. Many previous studies have examined the effect of the amount of alcohol consumed on the risk of cirrhosis, but there has been little research on the effect of mealtime habits and the type of alcohol consumed. Methods In total, 710,623 middle-aged UK women answered questions relating to alcohol consumption on a re-survey questionnaire three year after recruitment. They were followed up for incident cases and deaths attributed to liver cirrhosis by record linkage to national hospital and death records. Cox regression models were used to produce adjusted relative risks and 95% confidence intervals (CIs) for cirrhosis depending on amount, type of alcohol consumed and mealtime habits, and taking into account changes in alcohol consumption over time and regression dilution bias. Results Thirty-eight percent ( n  = 266,699) of participants consumed less than one drink per week and amongst those consuming a larger amount, 58% ( n  = 255,417) drank less than seven drinks per week. During a mean of 14.3 (SD 2.7) years of follow-up, 2939 cases or deaths from cirrhosis were reported. Those consuming an average of 17.5 g alcohol/day (7–14 drinks/week) and 31.8 g alcohol/day (15 + drinks/week) had a significantly higher risk [RR: 1.54 (95% CI: 1.33–1.79) and RR: 3.62 (95% CI: 3.09–4.25), respectively] compared to the reference group of 3.9 g alcohol/day (1–2 drinks/week). Those consuming alcohol with meals had a lower risk of cirrhosis than those drinking outside of meals or in a varied manner ( P  = 0.01). Relative to consumptions of 1–2 drinks/week with meals, those consuming 15 or more drinks/week with meals had a relative risk for cirrhosis of 2.58 (95% CI: 1.92–3.46) whereas those drinking a comparable amount without meals or in a varied way had a relative risk of 4.37 (95% CI: 3.44–5.53). This pattern remained true for women who drank wine and no other type of alcoholic beverage and for all other alcohol consumers. Conclusions The relative risk of liver cirrhosis increases with even moderate levels of alcohol consumption, although drinking alcohol with meals appears to have a lesser effect on cirrhosis risk than drinking at other times.