The article “Burden of liver diseases in the world” by Asrani et al. reviewed the epidemiology of various liver diseases throughout the world. Cirrhosis can have varied etiology, moreover, in Western and industrialised countries alcohol and non-alcoholic fatty liver disease have overshadowed viral hepatitis as the primary causes. However, in China and other Asian countries hepatitis B continues to be a primary cause.

However, the authors of the present study disagree with this statement and listed 7 Asian countries in the top 10 countries with high global burden of alcohol-related cirrhosis mortality.

India occupies a major region of Asia, and is home to almost one-third of the population of Asia. In India, the epidemiology of cirrhosis of the liver has altered significantly over the past few years. It has been corroborated by a study from Northern India that evaluated aspartate aminotransferase to platelet ratio index and hepatic venous pressure gradient in cirrhotic patients. The results of the study showed that alcohol was the most common (49%) cause of cirrhosis in their study. Another study conducted by Punekar et al. from Central India also showed that alcohol was the most common cause (46%) of cirrhosis in their study patients. Furthermore, another study revealed that alcohol was the predominant cause of cirrhosis in 60.93% in Southern India, and other studies from Kolkata in the East and Mumbai in the West also demonstrated that alcohol was a primary etiology for cirrhosis in 43.5% and 48% of patients, respectively. Besides, author’s study conducted in Eastern India also reported that alcohol was responsible for majority of chronic liver disease cases.

Thus, it can be concluded that alcohol-related liver disease rather than hepatitis is the major cause of cirrhosis in Asia.

Source: Singh SP, Panigrahi S, Mishra D, Khatua CJ. Alcohol-associated liver disease, not hepatitis B, is the major cause of cirrhosis in Asia. Journal of Hepatology. MAY 01, 2019;70(5): P1031-1032.