Sex-related differences in ethanol-induced liver disease: artifactual or real?

The cross-sectional, observational studies from four groups which have reported a difference between males and females in susceptibility to ethanol-induced liver disease are reviewed. Crucial factors of representativeness of sampled groups, certainty of cirrhosis diagnosis, and quantitation of ethanol intake are examined. Attention is given to the direction of differences between males and females in the variables suggestive of differential susceptibility: age at presentation, years of excessive drinking, age at which excessive drinking began, percent of alcoholics of each sex diagnosed as having cirrhosis, age at death due to cirrhosis, daily ethanol intake, and the male to female ratio among cirrhotics as compared to alcoholics. Based on the consistency of findings among the studies reviewed, as demonstrated by replication of results obtained under different conditions of time, place, methodology, and subsamples of alcoholics studied, a conclusion of enhanced susceptibility to ethanol-induced liver disease among women is reached. Finally, factors which may lend biological plausibility to the above susceptibility differential are considered.