Gempa Merenggut Pelaminanku
El Retiro, Guadalajara, JaliscoMexico. Alcoholism and cirrhosis, which are two of the most serious health problems worldwide, have a broad spectrum of clinical outcomes. Both diseases are influenced by genetic susceptibility and cultural traits that differ globally but are specific for each population. In contrast to other regions around the world, Mexicans present the highest drinking score and a high mortality rate for alcoholic liver disease with an intermediate category level of per capita alcohol consumption.
Mexico has a unique history of alcohol consumption that is linked to profound anthropological and social aspects. The Mexican population has an admixture genome inherited from different races, Caucasian, Amerindian and African, with a heterogeneous distribution within the country.
Furthermore, they may be inherited as risk or non-risk haplogroups that confer susceptibility or resistance either to alcohol addiction or abusive alcohol consumption and possibly liver disease. Thus, in this era of genomics, personalized medicine will benefit patients if it is directed according to individual or population-based data. Additional association studies will be required to establish novel strategies for the prevention, care and treatment of liver disease in Mexico and worldwide.
Core tip: Alcoholism and liver disease tossico encephalopathy ad alcolismo mkb 10 leading global health problems. However, the severity and tossico encephalopathy ad alcolismo mkb 10 of liver disease appear to vary between individuals and populations.
In the present review, we analyze the general scope of alcohol consumption and its relationship with the pattern of drinking score in different countries. We focus on the development of alcoholism in Mexico, which has a strong historical background, and emphasize the need to understand the tossico encephalopathy ad alcolismo mkb 10 and environmental factors affecting each population or geographical region of the world. The human history of alcohol consumption has been documented for several thousand years[ 1 ].
Alcohol was undoubtedly the result of a fortuitous coincidence that occurred when fruits, grains and flower stalks were fermented for a long time. People may have begun to experience pleasure and happiness after tasting alcoholic beverages[ 12 ]. Alcoholic beverages are obtained from different sources, depending on the region of the world.
Traditionally, must and wines are produced from grapes of the Middle East and Europe, whisky is made from various grains and sake is obtained from rice in Asia. Historically, alcohol-based beverages have served as a source of needed nutrients and tossico encephalopathy ad alcolismo mkb 10 been widely used for their medicinal, antiseptic and analgesic tossico encephalopathy ad alcolismo mkb 10.
However, during the last century, alcohol abuse has increased in several countries, thereby augmenting the rate of accidents and liver diseases. The range of liver diseases secondary to alcohol consumption is extensive, including acute alcoholic hepatitis, alcoholic liver disease ALDcirrhosis and hepatocellular carcinoma[ 5 ]. Different factors may affect the development of alcoholic liver damage, including the dose, duration and type of alcohol consumption, drinking patterns, gender and ethnicity[ 16 - 8 ].
Other associated risk factors include obesity, iron overload, concomitant viral hepatitis tossico encephalopathy ad alcolismo mkb 10 179 ] and genetic factors[ 78 ]. Nonetheless, the degree of the association among alcohol consumption, morbidity and mortality due to ALD varies among individuals and populations worldwide.
Alcohol consumption and ALD are linked to specific genetic and environmental factors that are prevalent in each population. However, which factors and how they are involved tossico encephalopathy ad alcolismo mkb 10 both alcohol addiction and the adaptation of hepatic genes capable of metabolizing large amounts of ethanol without developing liver disease are challenging questions.
In this comprehensive review, we revisit the information on the worldwide consumption of alcohol and patterns of drinking associated with liver disease, emphasizing the history of alcoholism in Mexico and the differences in the genetic and environmental backgrounds with respect to alcoholism and liver disease among the different countries, with a focus on the genetic factors involved in alcohol dependence and alcohol abuse as well as liver-metabolizing enzymes.
The low alcohol consumption category includes several countries within the Eastern Mediterranean region and Asia, generally representing those countries where religious beliefs prohibit alcohol consumption. However, there have been different trends in the last 50 years regarding alcohol consumption in countries worldwide. Furthermore, sincethe WHO has been in the process of drafting a global strategy to reduce the harmful use of alcohol[ 11 ]. These observations led us to analyze the effectiveness of these strategies to avoid or decrease alcohol consumption and to improve the understanding of the biological and social events involved in the tossico encephalopathy ad alcolismo mkb 10 habits of alcohol in Mexico compared with other regions of the world.
Trends of per-capita alcohol consumption in different countries. A: Countries that decreased consumption per capita since to ; B: Countries that increased consumption per capita since to To address these concerns, we examined the mortality related to ALD within several countries. Interestingly, there is a discrepancy between mortality related to ALD and the per-capita alcohol consumption[ 12 ]; e. However, global comparisons among different populations are limited because not all countries report mortality related to ALD[ 12 ].
The pattern of drinking score is a composite scale that ranges from 1 to 5 and focuses primarily on the degree of risk associated with how the alcohol is consumed rather than the amount of alcohol consumed. To build this scale, the following indicators are used: quantity of alcohol consumed by occasion, festive drinking, proportion of drinking events that involve becoming drunk, proportion of drinkers who drink daily, drinking with meals and drinking in public places[ 13 ].
For example, the countries with the highest pattern of drinking score are Kazakhstan, Mexico, the Russian Federation, South Africa and Ukraine, and the countries with a lower-risk pattern of drinking are Portugal, Spain, France, Italy and Germany[ 13 ]. Taken together, alcohol consumption indicators, mortality rates and pattern of drinking scores, which all may contribute to ALD, are heterogeneous worldwide[ 1213 ].
Thus, because ALD is a multifactorial problem, researchers should consider the anthropological and historical aspects prevalent among the different societies. To understand the interaction between the evolutionary and genetic changes associated with specific environments, it is necessary to know when and how these events occurred among the different populations.
In the tossico encephalopathy ad alcolismo mkb 10 of Mexico, the establishment of a sedentary lifestyle required approximately years[ 1415 ].
During this period, the Mesoamericans began the domestication of the well-known staple foods of Mexico, such as maize Zea mays L. This process was accompanied by the discovery and consumption of fermented alcoholic beverages made from a number of endemic agave plants Agave spp. The tale of Mayahuel.
Quetzalcóatl and Mayahuel fell in love and together promised that they would give their people a magic plant to recover their happiness. Mayahuel and Quetzalcóatl were hidden in the form of a tree with two arms branches ; tossico encephalopathy ad alcolismo mkb 10 arm was Mayahuel, and the other was Quetzalcóatl.
Nothing could be done for Mayahuel, so Quetzalcóatl buried the leftover pieces in the ground and wept for his loss deeply. Finally, from these parts, the maguey was born. Thus, Mayahuel in the Nahuatl language stands for all that surrounds the maguey[ 1617 ]. Mayahuel may be considered a dual deity. On the other hand, she was associated with drunkenness and adultery.
This mythological symbol had such great influence that one day of the month was devoted to the rabbit, and those born on that specific date were destined to either be a drunk or commit adultery[ 1718 ]. Unfortunately, these laws were not reinforced after the 15 th century, granting a tolerance of the abusive consumption of alcoholic beverages during the colonial period[ 423 ]. Mexico is one of the leading countries with a high mortality rate due to liver diseases in the world[ 10 ].
The National Health Secretariat reported an average of cases of cirrhosis per year from to [ tossico encephalopathy ad alcolismo mkb 10 ]. The primary etiologies of cirrhosis are alcohol, followed by hepatitis C infection and non-alcoholic steatohepatitis[ 25 - 27 ]. For Mexico, the WHO reported that the amount of alcohol consumed is 8. However, if this parameter is applied only to drinkers, alcohol consumption increases to However, the pattern of drinking score shows a better scope of alcoholism among the Mexican population.
By examining the amount of alcohol consumed by occasion, we observed that tossico encephalopathy ad alcolismo mkb 10 consumption occurs primarily during the weekends[ 28 ], unlike in Europe where they drink wine almost daily, at lunch or dinner.
Hepatologists may advise their patients not to drink any alcoholic beverage to maintain a healthy liver. However, a large proportion of adults around the tossico encephalopathy ad alcolismo mkb 10 drink alcoholic beverages[ 156 ]. Thus, the recommendation to avoid liver damage is that the amount of alcohol consumed should be equal or less than 2 drinks per occasion g ethanolnot more than 4 drinks per day and not more than 10 to 12 drinks per week, allowing the liver to rest at least 1 or 2 d[ 156 ].
Furthermore, it has been suggested that the number of alcoholic drinks should be less in women than in men because women have a higher risk for developing ALD[ 156 ]. However, each weekend, approximately 30 million Mexicans have been estimated to consume more than five drinks per occasion more than 80 g of ethanolwith another 10 million consuming at least one alcoholic drink daily.
However, alcohol abuse has been detected in 5 tossico encephalopathy ad alcolismo mkb 10 people with a strong dependence on alcohol[ 28 ]. The average Mexican begins consuming alcohol before the age of 18 years perhaps because tossico encephalopathy ad alcolismo mkb 10 a strong cultural influence.
Studies conducted in the western region of Mexico have shown that However, the distribution of alcoholic beverage preferences is heterogeneous. These preferences are associated with the historical cultural background of each region and may be related to the mortality caused by cirrhosis.
In western Mexico, young people begin to drink beer either during the weekend or at any social or religious event, such as weddings, coming-of-age parties and christenings.
The second stage involves the combination of beer with tequila or any other distilled beverage during a period of 8 to 10 years. During this stage, the amount of alcohol consumed ranges from to g daily. In the third stage, alcohol dependence is severe, and patients may or may not present with cirrhosis.
By this time, they drink an average of g of alcohol per day g [ 2632 - 34 ]. The time between the initiation of alcohol use and the diagnosis of cirrhosis is 23 to 30 years[ 2635 ]. However, we have identified two distinct age peaks of tossico encephalopathy ad alcolismo mkb 10 cirrhosis.
In the first group, patients are young, approximately 30 years old, and a plausible genetic predisposition to liver cirrhosis has been proposed to be involved. In the second group, the average age is approximately 45 years[ 33 ].
Compared to other countries, Mexico, according to our findings, may have the youngest people tossico encephalopathy ad alcolismo mkb 10 alcoholic cirrhosis in the world. The majority of patients with ALD seek medical attention in the advanced stages of the disease with a Child-Pugh score of C and multiple complications, such as encephalopathy, variceal bleeding, infections and ascites[ 252735 ].
These clinical characteristics are present in the two primary age groups of patients with alcoholic cirrhosis[ 33 ]. Furthermore, the patients with alcoholic cirrhosis continue to drink high amounts of alcohol after diagnosis and may die earlier in life due to clinical complications[ 25 ].
This observation may be one of the foremost reasons why hepatocellular carcinoma is rare in Mexico compared tossico encephalopathy ad alcolismo mkb 10 other regions of the world[ 3738 ], in conjunction with other environmental factors[ 39 ]. ALD has been associated with nutritional deficiencies and malnutrition worldwide[ 40 ].
However, preliminary data from a reference center in western Mexico have shown that obesity is also present. These data are consistent with the fact that Mexico has the highest prevalence of obesity[ 41 ], thus adding a new risk factor for liver disease. Thus, the combination of alcoholism, obesity, drugs and, in several cases, viral hepatitis B or C, leads us to explore specific strategies for treatments and prevention programs to detect cirrhosis at early stages of the tossico encephalopathy ad alcolismo mkb 10.
In recent decades, researchers have been using various strategies to identify genes that may be associated with alcohol dependence or alcohol abuse. Studies based on candidate genes[ 42 - 45 ] or linkage disequilibrium were followed by the advances in genotyping that have resulted in the widespread use of genome-wide association studies[ 4647 ]. However, the interactions between genes and several environmental factors have led experts in the field to identify at least two types of alcoholism: 1 a more severe, more genetic and early-onset type of alcoholism; and 2 a less severe, more environmental and late-onset type of alcoholism[ 48 - 52 ].
Regarding the role of genetic factors in the susceptibility to alcohol dependence and alcohol abuse, research has primarily aimed to study the expression of brain and liver genes. The three major enzyme genes express variants with different catalytic activities V max and Michaelis constants K m ; thus, their ability to metabolize substrates is variable. The combination of the allelic profile of these brain and liver genes may affect the risk of or protection against alcohol dependence or alcohol abuse as well as the amount of alcohol metabolized in the liver and the susceptibility to liver damage.
Variances in the distribution of these gene polymorphisms may mark phenotypic differences among populations for the aforementioned features. Alcohol has a stimulatory effect on the dopaminergic neurons of the ventral tegmental area. Dopamine is captured by DRD2 in these neurons tossico encephalopathy ad alcolismo mkb 10 the nucleus accumbens, causing a pleasant effect that is integrated into the mesolimbic system[ 486768 ].