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. 2025 Mar 28;13(3):179-188.
doi: 10.14218/JCTH.2024.00379. Epub 2024 Dec 17.

Dose-dependent Relationship between Alcohol Consumption and the Risks of Hepatitis B Virus-associated Cirrhosis and Hepatocellular Carcinoma: A Meta-analysis and Systematic Review

Yin-Ping Wu  1   2 , Xue-Yan Yang  1   2 , Yu-Xin Tian  1   2 , Jin Feng  3 , Yee Hui Yeo  4 , Fan-Pu Ji  5 , Ming-Hua Zheng  6 , Yu-Chen Fan  1   2
Affiliations

Dose-dependent Relationship between Alcohol Consumption and the Risks of Hepatitis B Virus-associated Cirrhosis and Hepatocellular Carcinoma: A Meta-analysis and Systematic Review

Yin-Ping Wu et al. J Clin Transl Hepatol. .

Abstract

Background and aims: The quantitative effects of alcohol consumption on cirrhosis and hepatocellular carcinoma (HCC) in hepatitis B virus (HBV) infection are unknown. This study aimed to establish a dose-dependent model of alcohol consumption on the risks of cirrhosis and HCC.

Methods: PubMed, Embase, the Cochrane Library, Web of Science, and four Chinese databases were searched for studies published from their inception to 15 May 2024. A random-effects model was used to pool the data on the incidence of cirrhosis and HCC, and a dose-dependent model of alcohol's effect on cirrhosis and HCC was established.

Results: A total of 33,272 HBV patients from 45 studies were included. Compared with non-drinkers, the overall pooled odds ratio (OR) for cirrhosis was 2.61 (95% confidence interval [CI]: 1.46-4.66; I2 = 94%, p < 0.001), and the OR for HCC was 2.27 (95% CI: 1.50-3.43; I2 = 90%, p < 0.001) among drinkers. Compared with low-level drinkers, the estimated pooled OR for cirrhosis was 2.34 (95% CI: 1.59-3.44; I2 = 87%, p < 0.001), and the OR for HCC was 2.42 (95% CI: 1.90-3.09; I2 = 80%, p < 0.001) among high-level drinkers. Furthermore, a linear dose-dependent analysis showed that each daily consumption of 12 g of alcohol increased the risk of cirrhosis by 6.2% and the risk of HCC by 11.5%.

Conclusions: Alcohol dose-dependently increases the risks of cirrhosis and HCC in patients with HBV infection, and patients with daily alcohol consumption of more than 12 g should be strictly monitored.

Keywords: Alcohol; Cirrhosis; Dose-dependent relationship; HBV; Hepatocellular carcinoma; Risk.

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Conflict of interest statement

FPJ has been an Editorial Board Member of Journal of Clinical and Translational Hepatology since 2023, MHZ and YCF have been Associate Editors of Journal of Clinical and Translational Hepatology since 2013. The other authors have no conflict of interests related to this publication.

Figures

Fig. 1
Fig. 1. (A) Study overview: Flow diagram of study selection. (B) Number of patients with chronic hepatitis B.
Brick-red, light green, light purple, light brown, light blue, and orange colors represent the populations with adverse outcomes, liver cirrhosis without HCC, HCC with liver cirrhosis, HCC without liver cirrhosis, liver cirrhosis, and HCC, respectively. HCC, hepatocellular carcinoma.
Fig. 2
Fig. 2. Forest plot showing study-specific and pooled ORs of (A) cirrhosis and (B) HCC for drinkers versus non-drinkers.
Studies are named by author and year of publication.– Horizontal lines represent 95% CI. The black dots in the middle of line segments represent ORs. Quadrilaterals around the black dots represent weight sizes. The solid line with OR = 1 represents the invalid line. The left and right ends of the lower diamond represent the 95% CI of the pooled results. The dashed line through the diamond represents the pooled OR, and its intersection with the abscissa represents the total OR value. OR, odds ratio; CI, confidence interval; HCC, hepatocellular carcinoma.
Fig. 3
Fig. 3. (A) Dose-dependent model of the effect of alcohol consumption on the risk of cirrhosis. The relationship between the risk of cirrhosis in patients with chronic HBV infection and alcohol intake (grams per day) in log (ORs). (B) Dose-dependent model of the effect of alcohol consumption on the risk of HCC. The relationship between the risk of HCC in patients with chronic HBV infection and alcohol intake (grams per day) in log (ORs).
OR, odds ratio; CI, confidence interval; HBV, hepatitis B virus.
See this image and copyright information in PMC

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