Alcohol is the main cause of liver disease and associated death. By raising awareness and offering brief interventions, not only to patients but also to family and friends, nurses can potentially save lives, argues Gerri Mortimore
It is difficult to offer a brief intervention about alcohol if you are unable to accurately calculate alcohol units. And if you cannot calculate them, what makes you think your patients will know how to do it?
Many may think that a glass of wine is one unit and a pint of beer is two, but not many understand that, since alcohol units were devised, the strength of alcohol in wine and beer has increased. Without realising it, we may be drinking far more than is recommended. Take wine for example: a unit was originally based on a 125ml glass of wine with an 8.5% alcohol by volume (ABV – this is the percentage proof found on the bottle); now wine is generally served in measures of 175ml or more, and most wines have an ABV of 11-15% – finding one with 8.5% ABV is rare.
To see the difference in units we need to calculate how many units of alcohol are in each glass. To do this, multiply the number of millilitres by the ABV, then divide that number by 1,000. Using this formula, we can see that a 125ml glass of 8.5% ABV wine contains 1.06 units ([125 x 8.5] ÷ 1,000 = 1.06 units). However, a 175ml glass wine with an ABV of 15%, contains 2.63 units of alcohol – and if the glass measures 250ml, the number of units rises to 3.75. One glass of wine every night for a week would then be equal to 26 units – this is nearly double the recommended weekly amount. Over time, this could lead to the development of alcoholrelated liver disease.
We all know that, over time, poor lifestyle choices can lead to chronic ill health and premature death. Nurses are in a unique position to see the evidence of this on a daily basis – but how often do we reflect on our own lifestyle choices as well as advising patients about theirs? Most people would acknowledge that regularly drinking excessive amounts of alcohol can be harmful, but the change in drinking advice and the increased strength of wine and beer is often not appreciated.
In 2016, the Department of Health advised that both men and women should not drink more than 14 units of alcohol in a week. Previously the recommendation was a total of 21 units for men and 14 units for women. Since 1970, death as a result of liver disease has increased by over 400% – it is the only major cause of death that is still increasing year on year. To put this into perspective, liver disease kills more people than diabetes and road deaths combined, and in people who are younger than 65 years, it constitutes the third most common cause of premature death in the UK.
Of course, there are also other causes of liver disease including obesity leading to fatty liver and cirrhosis, and hepatitis B and C leading to cirrhosis with the associated complications of varices, ascites and liver cancer. However, alcohol is the main cause of liver disease and associated death.
You do not have to be labelled as a having an alcohol problem to develop alcohol-related liver harm. Nurses have a key role in health promotion with patients, family members and friends. Simply by raising awareness and offering brief interventions, nurses can potentially save lives or, at the very least, help reduce the cost of treating chronic illness caused by poor lifestyle choices.
Gerri Mortimore is lecturer at the University of Derby.
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