Wednesday, 18 April 2012

Does consuming alcohol increase tumour likelihood? (In Dupuytren's and Ledderhose)


Right so today I am going to look at the link between alcohol and Dupuytren’s disease and of course this means that it has also been linked to Ledderhose disease. I am afraid that most of the papers that I have come across I do not have free access to so I am going to have to go on what I can find or abstracts but hopefully it will become clear that drinking alcohol is not good for you. I don’t drink anyway but then this is only a link not a single cause. 

This paper is great and has lots of information available on various different things that have been linked to Dupuytren’s. 

(1) Hart and Hooper, Postgrad Med J 81:425-428 doi:10.1136/pgmj.2004.027425, http://pmj.bmj.com/content/81/957/425.long

On alcohol it says that initially there was very little to support this and up until the 50s there was actually only a single case but that since then more have come to light. This association between the two was made when some clever people working in a liver unit noticed that there was a higher prevalence of  Dupuytren’s than is observed in the standard population. In fact in one subset of alcoholic patients the incidence was increased to as high as 66% which clearly shows that there is a link. One thing that was then further looked into was whether you had to be an alcoholic for this to be an issue and certainly from the data that was obtained it seemed that there was no increased between those who drank little and those who drank often and that it is only those who drink way too much that have the increased risk. 

So now I want to have a look into a few more papers because there are many out there. 


So this is quite a big paper in terms of numbers and I am going to start off with something that is important. In many of these papers you have to realise that most the results will come down to some statistics number that I don't understand and this is because age has to be factored in. So below they have looked at the age in all of the 97537 miners and have the below statistics. 


Clearly what the above shows is that the older you are the more likely you are to have Dupuytren's, this means that if in the group of people you study 50% of the drinkers are over 50 and 100% of the non-drinkers are under 50 of course you will see an increased likelihood in drinkers. So I am just going to say what the papers find rather than give facts and figures. 

In this particular paper they say that they do find an association of Dupuytren's with heavy drinking, smoking and diabetes. This is quite a large subset of people to have been looked at but it clearly too place across more than one place so standards could vary and because age has had to be factored in it is not always clear. But basically they do show that there is a correlation between alcohol consumption and developing Dupuytren's. 


So this is again looking at a fairly large group of people, 7254, again I will not go into detail but here they see that there is an increased risk of Dupuytren's in response to both alcohol and tobacco but that these increases occur independent of each meaning that doing both further increases your risk. 

(4) Burge et al, 1997, also find the same results as the above paper in that alcohol is related to Dupuytren's and this is further backed up by (5) Bradlow et al 1986

So it would appear to be conclusive right? Well that is what I thought until I came across the next paper. 

(6) Gudmundsson et al, 2001, Scand J Health care, vol 19. Their data is best summarised in my opinion by the below graph. Note that in this the groups have been matched for age and smoking habits and in every way that they could find possible they have matched the patients to try and make it non-biased. 


So as you can hopefully see on the above graph they find that there is very little if any different between the drinking habits of those with and without Dupuytren's disease. 

Summary

From what I have seen, especially from the papers with big numbers it is worth noting that there appears to be a link between drinking (and indeed smoking and perhaps I will do a post on that) but the molecular way in which this happens is unknown and there are papers with opposing evidence so you need to look at both sides of the story 

As far as I am concerned I neither drink nor smoke so neither of these can be factors in me getting Ledderhose, personally as I have said before I think mine is a case of trauma as I have no family history, diabetes or epilepsy.