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  • Harmful alcohol consumption is defined as more than 4 drinks on any single day or more than 14 drinks per week for men, while for women the threshold is more than 3 drinks on any single day or more than 7 drinks per week.

  • In the United States, a standard drink is defined as any drink that contains about 14 g of pure ethyl alcohol.

  • More than 60% of adult Americans consume alcohol in a more or less regular fashion, and it is estimated that 18 million Americans have an alcohol use disorder.

  • The spectrum of alcoholic liver disease ranges from alcoholic steatosis to alcoholic cirrhosis, while alcoholic hepatitis may occur episodically in the absence or presence of advanced liver disease.

  • Virtually everyone with excessive alcohol intake has alcoholic steatosis, while 10–15% of the affected population develop alcoholic cirrhosis and 10–35% develop one or more episodes of symptomatic alcoholic hepatitis.

  • Patients with alcoholic liver disease are at increased risk of hepatocellular cancer, with an incidence rate of 1–2% per year among patients with cirrhosis.

  • Alcoholic liver injury is suggested by increased serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels with an AST/ALT ratio exceeding 2.0.


Alcohol (ethyl alcohol, ethanol, CH3CH2OH) is one of the most common hepatotoxic agents and humans have consumed it since prehistoric times. Alcoholic liver disease develops in virtually everyone who is engaged in excessive use of alcohol, although the severity of hepatic injury may vary considerably. While steatosis is almost always present, alcoholic liver disease evolves into cirrhosis in 10–15% of the affected population. Patients with advanced alcoholic liver disease are also at risk of hepatocellular carcinoma, which may develop with an annual risk of 1–2%. The natural course of alcoholic liver disease may be complicated by episodes of symptomatic alcoholic hepatitis, which occurs in 10–35% of patients with excessive alcohol consumption. This wide spectrum of alcoholic liver disease outcomes is a result of the complex interplay between variables including the amount of alcohol consumed, the pattern of drinking, individual genetic predisposition, and the presence of comorbidities.

A. Epidemiology

In the United States, the population aged 15 years and older had an annual per capita alcohol consumption of 9.2 L of pure alcohol between 2008 and 2010. More than 60% of adult Americans consume alcohol in a more or less regular manner and it is estimated that 18 million Americans have an alcohol use disorder, classified as either abuse or dependence. Epidemiologic studies have established a dose-effect relationship between alcohol intake and alcoholic liver damage. While any amount of alcohol could have adverse health effects, epidemiologic evidence supports recommendations for a threshold amount of regularly consumed alcohol above which the risk of physical and mental health impairment is increased. In the United States, harmful alcohol consumption has been defined ...

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