Skip to main content
    • Aa
    • Aa
  • Get access
    Check if you have access via personal or institutional login
  • Cited by 9
  • Cited by
    This article has been cited by the following publications. This list is generated based on data provided by CrossRef.

    Scobie, L. and Dalton, H. R. 2013. Hepatitis E: source and route of infection, clinical manifestations and new developments. Journal of Viral Hepatitis, Vol. 20, Issue. 1, p. 1.

    Sclair, Seth N. and Schiff, Eugene R. 2013. An Update on the Hepatitis E Virus. Current Gastroenterology Reports, Vol. 15, Issue. 2,

    Kaba, Mamadou Moal, Valérie Gérolami, René and Colson, Philippe 2013. Epidemiology of Mammalian Hepatitis E Virus Infection. Intervirology, Vol. 56, Issue. 2, p. 67.

    Dalton, Harry R. 2012. Hepatitis: Hepatitis E and decompensated chronic liver disease. Nature Reviews Gastroenterology & Hepatology, Vol. 9, Issue. 8, p. 430.

    Kamar, Nassim Bendall, Richard Legrand-Abravanel, Florence Xia, Ning-Shao Ijaz, Samreen Izopet, Jacques and Dalton, Harry R 2012. Hepatitis E. The Lancet, Vol. 379, Issue. 9835, p. 2477.

    Zhang, Yulin Zeng, Hang Liu, Peng Liu, Lin Xia, Junke Wang, Lin Zou, Qinghua Wang, Ling and Zhuang, Hui 2015. Hepatitis E vaccine immunization for rabbits to prevent animal HEV infection and zoonotic transmission. Vaccine, Vol. 33, Issue. 38, p. 4922.

    Haim-Boukobza, Stéphanie Coilly, Audrey Sebagh, Mylène Bouamoud, Mouna Antonini, Teresa Roche, Bruno Yordanova, Olga Savary, Janine Saliba, Faouzi Duclos-Vallee, Jean-Charles Samuel, Didier Ichai, Philippe and Roque-Afonso, Anne-Marie 2015. Hepatitis E infection in patients with severe acute alcoholic hepatitis. Liver International, Vol. 35, Issue. 3, p. 870.

    Arends, J.E. Ghisetti, V. Irving, W. Dalton, H.R. Izopet, J. Hoepelman, A.I.M. and Salmon, D. 2014. Hepatitis E: An emerging infection in high income countries. Journal of Clinical Virology, Vol. 59, Issue. 2, p. 81.

    Blasco-Perrin, H. Madden, R. G. Stanley, A. Crossan, C. Hunter, J. G. Vine, L. Lane, K. Devooght-Johnson, N. Mclaughlin, C. Petrik, J. Stableforth, B. Hussaini, H. Phillips, M. Mansuy, J. M. Forrest, E. Izopet, J. Blatchford, O. Scobie, L. Peron, J. M. and Dalton, H. R. 2015. Hepatitis E virus in patients with decompensated chronic liver disease: a prospective UK/French study. Alimentary Pharmacology & Therapeutics, Vol. 42, Issue. 5, p. 574.


National mortality rates from chronic liver disease and consumption of alcohol and pig meat

  • H. R. DALTON (a1) (a2), R. P. BENDALL (a3), C. PRITCHARD (a4), W. HENLEY (a5) and D. MELZER (a6)
  • DOI:
  • Published online: 29 June 2009

A correlation between national pig-meat consumption and mortality rates from chronic liver disease (CLD) across developed countries was reported in 1985. One possible mechanism explaining this may be hepatitis E infection spread via pig meat. We aimed to re-examine the original association in more recent international data. Regression models were used to estimate associations between national pig-meat consumption and CLD mortality, adjusting for confounders. Data on CLD mortality, alcohol consumption, hepatitis B virus (HBV) and hepatitis C virus (HCV) seroprevalence for 18 developed countries (1990–2000) were obtained from WHO databases. Data on national pig-meat and beef consumption were obtained from the UN database. Univariate regression showed that alcohol and pig-meat consumption were associated with mortality from CLD, but beef consumption, HBV and HCV seroprevalence were not. A 1 litre per capita increase in alcohol consumption was associated with an increase in mortality from CLD in excess of 1·6 deaths/100 000 population. A 10 kg higher national annual average per capita consumption of pork meat was associated with an increase in mortality from CLD of between 4 and 5 deaths/100 000 population. Multivariate regression showed that alcohol, pig-meat consumption and HBV seroprevalence were independently associated with mortality from CLD, but HCV seroprevalence was not. Pig-meat consumption remained independently associated with mortality from CLD in developed countries in the 1990–2000 period. Further work is needed to establish the mechanism.

Corresponding author
*Author for correspondence: Dr H. R. Dalton, Cornwall Gastrointestinal Unit, Royal Cornwall Hospital Trust, Truro, CornwallTR1 3LJ, UK. (Email:
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

2.HR Dalton , Hepatitis E: an emerging infection in developed countries. Lancet Infectious Diseases 2008; 8: 698709.

3.GG Schlauder , Novel hepatitis E virus (HEV) isolated from Europe: evidence for additional genotypes of HEV. Journal of Medical Virology 1999; 57: 243251.

4.HR Dalton , Autochthonous hepatitis E in southwest England. Journal of Viral Hepatitis 2007; 14: 304309.

5.S Ijaz , Non-travel-associated hepatitis E: demographic, clinical and molecular epidemiological characteristics. Journal Infectious Diseases 2005; 192: 11661172.

6.JM Mansuy , Hepatitis E in the South west of France in individuals who have never visited an endemic area. Journal of Medical Virology 2004; 74: 419424.

7.M Buti , Hepatitis E virus infection in acute hepatitis in Spain. Journal of Virological Methods 1995; 55: 4954.

8.M-A Widdowson , Cluster of cases of acute hepatitis associated with hepatitis E virus infection acquired in the Netherlands. Clinical Infectious Diseases 2003; 36: 2933.

10.HR Dalton , Hepatitis E in New Zealand. Journal of Gastroenterology and Hepatology 2007; 22: 12361240.

11.HR Dalton , Locally acquired hepatitis E in chronic liver disease. Lancet 2007; 369: 1260.

12.JM Peron , Fulminant liver failure from autochthonous hepatitis E in France: description of seven patients with acute hepatitis E and encephalopathy. Journal of Viral Hepatology 2007; 14: 298303.

13.SS Hamid , Hepatitis E virus superinfection in patients with chronic liver disease. Hepatology 2002; 36: 474478.

14.J Ramachandran , Hepatitis E superinfection produces severe decompensation in patients with chronic liver disease. Journal of Gastroenterology and Hepatology 2004; 19: 134138.

15.K Acharya , Hepatitis E virus infection in patients with cirrhosis is associated with rapid decompensation and death. Journal of Hepatology 2007; 46: 387394.

16.N Kamar , Hepatitis E virus and chronic hepatitis in organ-transplant recipients. New England Journal of Medicine 2008; 358: 811817.

17.EB Haagsma , Chronic hepatitis E virus infection in liver transplant recipients. Liver Transplantation 2008; 14: 547553.

24.A Gelman , J Hill . Data Analysis using Regression and Multilevel/Hierarchical Models. Cambridge University Press, 2006.

25.E Mezey . Dietary fat and alcoholic liver disease. Hepatology 1998; 28: 901905.

26.AA Nanji , CL Medenhall , SW French . Beef fat prevents alcoholic liver disease in the rat. Alcoholism: Clinical and Experimental Research 1989; 13: 1519.

27.AA Nanji , SW French . Dietary linoleic acid is required for the development of experimentally induced alcoholic liver injury. Life Sciences 1989; 44: 223227.

28.RJ Pawlosky , BM Flynn , N Salem . The effects of low dietary level of polyunsaturates on alcohol-induced liver injury in Rhesus monkeys. Hepatology 1997; 26: 13861392.

29.CS Lieber , Phosphatidylcholine protects against fibrosis and cirrhosis in the baboon. Gastroenterology 1994; 106: 152159.

30.M Banks , Evidence for the presence of hepatitis E virus in pigs in the UK. Veterinary Record 2004; 154: 223227.

31.X-J Meng , Prevalence of antibodies to hepatitis E virus in pigs from countries where hepatitis E is common or is rare in the human population. Journal of Medical Virology 1999; 59: 297302.

32.O Garkavenko , Detection and characterisation of swine hepatitis E virus in New Zealand. Journal of Medical Virology 2001; 65: 525529.

33.AR Feagins , Detection and charcterisation of infectious hepatitis E virus from commercial pigs liver sold in local grocery stores in the USA. Journal of General Virology 2007; 88: 912917.

34.SU Emerson , VA Arankalle , RH Purcell . Thermal stability of hepatitis E virus. Journal of Infectious Diseases 2005; 192: 930933.

35.XJ Meng , Prevalence of antibodies to hepatitis E virus in veterinarians working with swine and in normal blood donors in the United States and other countries. Journal of Clinical Microbiology 2002; 40: 117122.

37.HR Dalton , Autochthonous hepatitis E in Southwest England: natural history, complications and seasonal variation, and HEV IgG seroprevalence in blood donors, the elderly and patients with chronic liver disease. European Journal of Gastroenterology and Hepatology 2008; 20: 784790.

38.J Wakefield . Ecologic studies revisited. Annual Review of Public Health 2008; 29: 7590.

39.A Skrondal , S Rabe-Hesketh . Generalized Latent Variable Modeling. Multilevel, Longitudinal and Structural Equation Models. CRC Press: Chapman and Hall, 2004.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Epidemiology & Infection
  • ISSN: 0950-2688
  • EISSN: 1469-4409
  • URL: /core/journals/epidemiology-and-infection
Please enter your name
Please enter a valid email address
Who would you like to send this to? *