{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T04:14:01Z","timestamp":1747196041817,"version":"3.40.5"},"reference-count":39,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2021,5,25]],"date-time":"2021-05-25T00:00:00Z","timestamp":1621900800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Most long-term heavy drinkers do not have clinically evident chronic liver disease (CLD). However, at any time-point, their risk of developing CLD remains unknown. We aimed to evaluate the long-term outcomes of a group of heavy drinkers, without evidence of CLD at baseline.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>A cohort of 123 long-term heavy drinkers without CLD were prospectively recruited in 2002 and retrospectively followed until 2018.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>At baseline (2002), median alcohol consumption was 271\u00b1203g\/day during 21.5\u00b120 years, 65% being abstinent during the previous 1.75\u00b15 months. Patients were followed for 14\u00b13 years. During follow-up, 53% reported any alcohol intake. Alcohol consumption during follow-up associated weakly with either 1- or 6-months previous abstinence at baseline. Until 2018, progression to CLD occurred in 6%, associating with years of alcohol intake during follow-up (OR 1.15 [1.01\u20131.31]) and baseline alkaline-phosphatase (OR 1.05 [1.01\u20131.10]). During follow-up, being abstinent for at least 1 year positively associated with CLD-free survival. 27% died (55% of cancer\u2013mostly oropharyngeal cancer, 27% of cardiovascular disease, and 9% of liver disease), with a mean age of 71 years [69\u201374] (10 years less than the expected in the Portuguese population). Achieving abstinence for at least 1 year positively associated with overall survival, while smoking, and hepatic steatosis at baseline associated negatively.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Long-term heavy drinkers seemed to have a decreased life expectancy compared with the overall Portuguese population. Cancer was the main cause of death. Our results suggest that progression to CLD depends mostly on continued alcohol intake. Alcohol abstinence, even if temporary, seems to decrease the risks of CLD and mortality.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0252218","type":"journal-article","created":{"date-parts":[[2021,5,25]],"date-time":"2021-05-25T17:31:22Z","timestamp":1621963882000},"page":"e0252218","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Outcomes of excessive alcohol drinkers without baseline evidence of chronic liver disease after 15 years follow-up: Heavy burden of cancer and liver disease mortality"],"prefix":"10.1371","volume":"16","author":[{"given":"S\u00f3nia","family":"Bernardo","sequence":"first","affiliation":[]},{"given":"Ricardo","family":"Crespo","sequence":"additional","affiliation":[]},{"given":"Sofia","family":"Saraiva","sequence":"additional","affiliation":[]},{"given":"Rui","family":"Barata","sequence":"additional","affiliation":[]},{"given":"Sara","family":"Gon\u00e7alves","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8316-5035","authenticated-orcid":true,"given":"Paulo","family":"Nogueira","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8537-8744","authenticated-orcid":true,"given":"Helena","family":"Cortez-Pinto","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7769-7860","authenticated-orcid":true,"given":"Mariana 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by alcohol intake, sex, and age: a prospective population study","volume":"23","author":"U Becker","year":"1996","journal-title":"Hepatology"},{"issue":"4","key":"pone.0252218.ref007","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1111\/j.1465-3362.2009.00153.x","article-title":"Alcohol as a risk factor for liver cirrhosis: a systematic review and meta-analysis","volume":"29","author":"J Rehm","year":"2010","journal-title":"Drug Alcohol Rev"},{"issue":"4","key":"pone.0252218.ref008","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1111\/j.1600-0676.1995.tb00671.x","article-title":"The measure of life-time alcohol consumption in patients with cirrhosis: reproducibility and clinical relevance","volume":"15","author":"S Arico","year":"1995","journal-title":"Liver"},{"issue":"8397","key":"pone.0252218.ref009","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1016\/S0140-6736(84)90295-2","article-title":"Prospective evaluation of alcohol abuse and alcoholic liver injury in men as predictors of development of cirrhosis","volume":"2","author":"TI Sorensen","year":"1984","journal-title":"Lancet"},{"key":"pone.0252218.ref010","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1111\/j.1749-6632.1975.tb19146.x","article-title":"Cirrhosis in the alcoholic and its relation to the volume of alcohol abuse","volume":"252","author":"WK Lelbach","year":"1975","journal-title":"Ann N Y Acad Sci"},{"issue":"3","key":"pone.0252218.ref011","doi-asserted-by":"crossref","first-page":"610","DOI":"10.1016\/j.jhep.2016.11.011","article-title":"Histological parameters and alcohol abstinence determine long-term prognosis in patients with alcoholic liver disease","volume":"66","author":"C Lackner","year":"2017","journal-title":"J Hepatol"},{"issue":"2","key":"pone.0252218.ref012","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1002\/cld.145","article-title":"Natural history and factors influencing the course of alcohol-related liver disease","volume":"2","author":"S Kendrick","year":"2013","journal-title":"Clin Liver Dis (Hoboken)"},{"issue":"10","key":"pone.0252218.ref013","doi-asserted-by":"crossref","first-page":"1099","DOI":"10.1097\/00042737-200510000-00014","article-title":"Are genetic polymorphisms of tumour necrosis factor alpha, interleukin-10, CD14 endotoxin receptor or manganese superoxide dismutase associated with alcoholic liver disease?","volume":"17","author":"A Martins","year":"2005","journal-title":"Eur J Gastroenterol Hepatol"},{"issue":"6","key":"pone.0252218.ref014","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1007\/BF01497775","article-title":"Alcohol and gamma-glutamyltransferase","volume":"61","author":"M Nishimura","year":"1983","journal-title":"Klinische Wochenschrift"},{"issue":"6","key":"pone.0252218.ref015","doi-asserted-by":"crossref","first-page":"1317","DOI":"10.1002\/hep.21178","article-title":"Development of a simple noninvasive index to predict significant fibrosis in patients with HIV\/HCV coinfection","volume":"43","author":"RK Sterling","year":"2006","journal-title":"Hepatology"},{"issue":"11","key":"pone.0252218.ref016","doi-asserted-by":"crossref","first-page":"2330","DOI":"10.1016\/j.cgh.2019.01.042","article-title":"Validation of a Model for Identification of Patients With Compensated Cirrhosis at High Risk of Decompensation","volume":"17","author":"IN Guha","year":"2019","journal-title":"Clinical Gastroenterology and Hepatology"},{"issue":"8981","key":"pone.0252218.ref017","doi-asserted-by":"crossref","first-page":"987","DOI":"10.1016\/S0140-6736(95)91685-7","article-title":"Determinants of progression to cirrhosis or fibrosis in pure alcoholic fatty liver","volume":"346","author":"MR Teli","year":"1995","journal-title":"Lancet"},{"issue":"3","key":"pone.0252218.ref018","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1016\/j.jhep.2017.04.017","article-title":"Universal screening for alcohol misuse in acute medical admissions is feasible and identifies patients at high risk of liver disease","volume":"67","author":"G Westwood","year":"2017","journal-title":"J Hepatol"},{"key":"pone.0252218.ref019","unstructured":"Estat\u00edstica INd. Causa de morte 2017. Boletim do Instituto Nacional de Estat\u00edstica. 2019."},{"issue":"5","key":"pone.0252218.ref020","doi-asserted-by":"crossref","first-page":"1061","DOI":"10.1016\/j.jhep.2014.12.005","article-title":"Alcohol drinking pattern and risk of alcoholic liver cirrhosis: a prospective cohort study","volume":"62","author":"G Askgaard","year":"2015","journal-title":"J Hepatol"},{"issue":"4","key":"pone.0252218.ref021","doi-asserted-by":"crossref","first-page":"868","DOI":"10.1053\/jhep.2002.32101","article-title":"Lower risk for alcohol-induced cirrhosis in wine drinkers","volume":"35","author":"U Becker","year":"2002","journal-title":"Hepatology"},{"issue":"6","key":"pone.0252218.ref022","doi-asserted-by":"crossref","first-page":"845","DOI":"10.1136\/gut.41.6.845","article-title":"Drinking habits as cofactors of risk for alcohol induced liver damage. The Dionysos Study Group","volume":"41","author":"S Bellentani","year":"1997","journal-title":"Gut"},{"issue":"7","key":"pone.0252218.ref023","doi-asserted-by":"crossref","first-page":"2014","DOI":"10.1007\/s10620-019-05509-6","article-title":"Risk Behaviors Associated with Alcohol Consumption Predict Future Severe Liver Disease","volume":"64","author":"H Hagstrom","year":"2019","journal-title":"Dig Dis Sci"},{"issue":"10","key":"pone.0252218.ref024","doi-asserted-by":"crossref","first-page":"1484","DOI":"10.1038\/s41395-018-0133-5","article-title":"Type and Pattern of Alcohol Consumption is Associated With Liver Fibrosis in Patients With Non-alcoholic Fatty Liver Disease","volume":"113","author":"T Mitchell","year":"2018","journal-title":"Am J Gastroenterol"},{"issue":"5","key":"pone.0252218.ref025","doi-asserted-by":"crossref","first-page":"998","DOI":"10.1016\/j.jhep.2016.06.018","article-title":"Heavy daily alcohol intake at the population level predicts the weight of alcohol in cirrhosis burden worldwide","volume":"65","author":"E Stein","year":"2016","journal-title":"J Hepatol"},{"key":"pone.0252218.ref026","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1016\/S0016-5085(19)34895-4","article-title":"Urea Cycle Enzymatic Abnormalities in Patients in Endogenous Hepatic Coma","volume":"45","author":"G Ugarte","year":"1963","journal-title":"Gastroenterology"},{"issue":"11","key":"pone.0252218.ref027","doi-asserted-by":"crossref","first-page":"990","DOI":"10.1136\/gut.21.11.990","article-title":"Synthesis of urea after stimulation with amino acids: relation to liver function","volume":"21","author":"H Vilstrup","year":"1980","journal-title":"Gut"},{"key":"pone.0252218.ref028","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1186\/1471-230X-11-115","article-title":"Early liver biopsy, intraparenchymal cholestasis, and prognosis in patients with alcoholic steatohepatitis","volume":"11","author":"L Spahr","year":"2011","journal-title":"BMC Gastroenterol"},{"issue":"6","key":"pone.0252218.ref029","doi-asserted-by":"crossref","first-page":"2141","DOI":"10.1002\/hep.29631","article-title":"Interaction between alcohol consumption and metabolic syndrome in predicting severe liver disease in the general population","volume":"67","author":"F Aberg","year":"2018","journal-title":"Hepatology"},{"key":"pone.0252218.ref030","doi-asserted-by":"crossref","first-page":"c1240","DOI":"10.1136\/bmj.c1240","article-title":"Effect of body mass index and alcohol consumption on liver disease: analysis of data from two prospective cohort studies","volume":"340","author":"CL Hart","year":"2010","journal-title":"BMJ"},{"issue":"5","key":"pone.0252218.ref031","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1111\/apt.13067","article-title":"The combined effects of alcohol consumption and body mass index on hepatic steatosis in a general population sample of European men and women","volume":"41","author":"K Lau","year":"2015","journal-title":"Aliment Pharmacol Ther"},{"key":"pone.0252218.ref032","doi-asserted-by":"crossref","first-page":"c912","DOI":"10.1136\/bmj.c912","article-title":"Body mass index and risk of liver cirrhosis in middle aged UK women: prospective study","volume":"340","author":"B Liu","year":"2010","journal-title":"BMJ"},{"issue":"1","key":"pone.0252218.ref033","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1002\/hep.510250120","article-title":"Excess weight risk factor for alcoholic liver disease","volume":"25","author":"S Naveau","year":"1997","journal-title":"Hepatology"},{"issue":"4","key":"pone.0252218.ref034","first-page":"225","article-title":"Sociocultural influences on smoking and drinking","volume":"24","author":"JK Bobo","year":"2000","journal-title":"Alcohol Res Health"},{"issue":"3","key":"pone.0252218.ref035","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1016\/j.drugalcdep.2005.05.008","article-title":"The co-occurrence of smoking and drinking among young adults in college: national survey results from the United States","volume":"80","author":"ER Weitzman","year":"2005","journal-title":"Drug Alcohol Depend"},{"issue":"10100","key":"pone.0252218.ref036","doi-asserted-by":"crossref","first-page":"1423","DOI":"10.1016\/S0140-6736(17)32336-X","article-title":"Measuring progress and projecting attainment on the basis of past trends of the health-related Sustainable Development Goals in 188 countries: an analysis from the Global Burden of Disease Study 2016","volume":"390","author":"GS Collaborators","year":"2017","journal-title":"Lancet"},{"issue":"8","key":"pone.0252218.ref037","doi-asserted-by":"crossref","first-page":"1358","DOI":"10.1111\/add.13799","article-title":"Alcohol dependence and risk of somatic diseases and mortality: a cohort study in 19 002 men and women attending alcohol treatment","volume":"112","author":"C 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