Burton Robyn, Leggio Lorenzo, Louvet Alexandre, Sheron Nick, Singal Ashwani K
Roger Williams Institute of Liver Studies, Kings College London, London, United Kingdom.
Institute for Social Marketing and Health, University of Stirling, Scotland, United Kingdom.
Am J Gastroenterol. 2025 Mar 26. doi: 10.14309/ajg.0000000000003427.
Alcohol-associated liver disease (ALD) is the leading cause of morbidity, disease-adjusted life years lost, and mortality worldwide. The significant burden and cost to the healthcare systems from ALD are largely preventable, given that alcohol use is the most important determinant of risk and severity of ALD. In this article, we will review the emerging evidence for public health policies (minimum unit price of alcohol, limiting, or banning alcohol advertising), aiming to reduce the availability of alcohol at the population level (primary prevention), preventing ALD especially advanced form of cirrhosis in at-risk individuals (secondary prevention), and improving liver outcomes and long-term survival in patients with advanced ALD of cirrhosis and/or alcohol-associated hepatitis (tertiary prevention). We will highlight the critical role of clinicians in promoting the public health policies, widespread screening for alcohol use disorder and for ALD, and integrating liver with addiction care for patients with ALD.
酒精性肝病(ALD)是全球发病、疾病调整生命年损失和死亡的主要原因。鉴于饮酒是ALD风险和严重程度的最重要决定因素,ALD给医疗系统带来的巨大负担和成本在很大程度上是可以预防的。在本文中,我们将回顾公共卫生政策(酒精最低单位价格、限制或禁止酒精广告)的新证据,旨在在人群层面减少酒精的可及性(一级预防),预防高危个体发生ALD尤其是晚期肝硬化(二级预防),并改善晚期肝硬化和/或酒精性肝炎的ALD患者的肝脏结局和长期生存率(三级预防)。我们将强调临床医生在促进公共卫生政策、广泛筛查酒精使用障碍和ALD,以及为ALD患者整合肝脏与成瘾治疗方面的关键作用。