RATES FOR CIRRHOSIS, DRINKING DON'T ADD UP

Seemingly contradictory measures in state surprise and puzzle
researchers

If drinking were a game of craps, Wisconsinites would be beating the
house.

Much to the chagrin of local researchers, a study has found that while
Wisconsin leads the nation in percentage of drinkers and is among the
leaders in total consumption, the state has one of the lowest death
rates for cirrhosis of the liver.

"Surprised?" said Patrick Remington, one of two authors of the report
in today's Wisconsin Medical Journal. "Yes, we were surprised."

Wisconsin ranked the highest among the 50 states in the overall
percentage of drinkers -- 69%. Nationwide, half the states had an
overall drinking percentage of 51% or higher.

The state's per capita consumption -- the amount of alcohol consumed,
then divided among every man, woman and child -- ranked it fourth in
the country at 3.4 gallons a person. That compares with the national
per capita consumption of about 2.5 gallons a person, or 26% less than
Wisconsin.

Yet liver cirrhosis causes about 350 deaths a year in Wisconsin,
ranking the state 43rd in the nation for cirrhosis mortality rates
from 1990 to 1994. Cirrhosis of the liver is directly linked to
drinking -- albeit excessive drinking.

Call it the Wisconsin Paradox. It is reminiscent of the so-called
French Paradox, a nation whose diet is among the highest in fat in the
world, yet whose residents have among the lower rates of heart
disease. Part of the answer may lie in France's wine consumption.
Moderate amounts of alcohol consumption, and specifically red wine,
have been linked to lower risk of heart disease.

But the Wisconsin Paradox, as it relates to drinking and cirrhosis,
has left researchers groping for an explanation.

One possibility: Even though in raw numbers the amount of alcohol
consumed here is high, the high percentage of drinkers means that what
each Wisconsin drinker actually consumes is less than drinkers in
other states.

"If you have two states with the same level of drinking but in one
state you have more drinkers, in that state each drinker is not
consuming as much," said Remington.

The risk of cirrhosis increases with chronic heavy drinking, estimated
to be six to 12 drinks daily for men, and four to eight drinks daily
for women, over a period of 15 to 20 years for men and 10 to 15 years
for women, according to the research report.

"The fact that in the U.S. as a whole, 50% of alcohol is consumed by
the 10% of heaviest drinkers, probably does not apply to Wisconsin,"
according to the researchers, Remington and Mari Gasiorowicz.
Remington is an associate professor of preventive medicine at the
University of Wisconsin Medical School. Gasiorowicz is a senior
outreach specialist at the University of Wisconsin-Madison's
department of professional development and applied studies.

That assumption is offered despite the fact that Wisconsin also is No.
1 in the country in the rate of binge drinking and chronic drinking.
But the chronic drinking rate was based on a survey that defined it as
two or more drinks daily.

The takes the report to its final conclusion: "Given the large body of
research indicating that chronic heavy drinking is the primary risk
factor for cirrhosis, finding that chronic heavy drinking as measured

(in Wisconsin) . . . is minimally correlated with cirrhosis mortality
merits further study."