Alcohol and disease

Murielle Bochud, MD, PhD

Assistant professor SSPH+

University Institute of Social and Preventive Medicine, Lausanne

How to assess alcohol intake?

• Questionnaire data using recall (not perfect)

• Amount in standard units

• Types of beverages (wine, beer, spirit)

• Transform standard units into gram of alcohol – 1 unit of wine (1 dl) = 10 g alcohol

– 1 unit of beer (3 dl) = 12 g alcohol

– 1 unit of spirits (4 cl) = 12 g alcohol

Drinking categories

In general, there is no significant health difference between individuals who consume less than 2 drinks daily and abstainers.

Alcohol burden

• Alcohol is one of the most important risk factors for burden of disease.

• It explains about 7.6% of all death in men and 3.5% in women (Canada, 2001).

• Alcohol can be a risk factor for certain disease and a protective factor for others:– Main causes of alcohol-attributable death are unintentional

injuries, malignant neoplasms and digestive diseases. – Ischaemic heart disease is the biggest cause of death

prevented by alcohol

Ref: Rehm et al, Addiction 2006;101:373-384

Diseases associated with alcohol intake

• Cancers (liver, mouth and oropharynx, laryngeal, oesophageal, breast, etc)

• Type 2 diabetes

• Neuropsychiatric conditions (alcohol abuse, alcohol psychosis, depression, epilepsy, etc)

• Cardiovascular disease (hypertension, ischaemic heart disease, stroke, cardiomyopathy, arrhythmais, heart failure, etc)

• Digestive diseases (gastritis, liver cirrhosis, acute and chronic pancreatitis, cholelithiasis)

• Intentional (self-inflicted injuries, homocides, suicide, etc) and unintentional (car accidents, falls, fires, drowning, etc) injuries

• Skin diseases: psoriasis

Alcohol attributable fraction (AAF)

Diseases Men Women

Cancers 30.5 9.1

T2DM -4.9 -2.5

Neuropsychiatric conditions 84.7 56.6

Cardiovascular disease -5.0 -4.1

Digestive diseases 53.3 37.4

Unintentional injuries 31.1 16.2

Intentional injuries 19.6 16.4

The AAF is generally defined as the proportion of the disease(s) in the population that will disappear if alcohol is removed

Ref: Rehm et al, Addiction 2006;101:373-384 Data from Canada

The French paradox

There is lower mortality in France with respect to other countriesin relation to wine consumption

St Léger et al, Lancet 1979;1:1017-1020

Red wine, and its antioxidant polyphenols, is thought to be particularly protective against cardiovascular disease.

Could there be confounding factors in the association between wine

and cardiovascular mortality?

• Subjects who drink wine tend to be of a higher socioeconomic class, are more attentive to their health, and have fewer cardiovascular risk factors (Naimi et al, AmJ PrevMed 2005;28:369–373)

• Socioeconomic class is a strong determinant of mortality

Types of alcohol beverages

Purchase of healthier food itemsis related to purchase of wine over beer.

Odds ratios <1 were itemspurchased more commonly with wine.

Odds ratios >1 indicate itemspurchased more commonly with beer.

Johansen et al, BMJ 2006;332:519–522

J-shaped curve for the relation betwen alcohol and total mortality

Ref: Di Castelnuovo et al, Arch Intern Med. 2006;166:2437-2445

Meta-analysis

34 studies (men and women)

1’015’835 subjects

94’533 deaths

What could explain the protective role of moderate alcohol intake?

• moderate alcohol has atheroprotective effect potential due to– favourable changes in blood lipids

– better haemostatic profile

– reduced insulin resistance

– lower levels of systemic inflammatory

To drink or not to drink, that is the question !