O.I.V. 2010/10

Intergovernmental organisation

International OrganisationInternational Organisationof Vine and Wineof Vine and Wine

Jean-Claude RUFJean-Claude RUFOIV Scientific CoordinatorOIV Scientific Coordinator

Seminar: Health benefits of moderate wine consumption – April 9, 2011Limassol -Cyprus

Scientific facts regarding the healthful Scientific facts regarding the healthful benefits and nutritive properties of winebenefits and nutritive properties of wine

O.I.V. 2010/10

Algeria, Argentina, Australia, Austria, Belgium, Brazil, Bulgaria, Chile, Cyprus, Croatia, Slovakia, Slovenia, Spain, Finland, France, Georgia, Hungary, Israel, Italy, Ireland, Greece, Lebanon, Luxembourg, Morocco, Moldova, Portugal, FYR Macedonia, Malta, Montenegro, Norway, New Zealand, Netherlands, Peru, Czech Republic, Romania, Russia, Serbia, South Africa, Sweden, Switzerland, Turkey, Uruguay, Municipality of Yantai (China)*Municipality of Yantai (China)*

OIV Member StatesOIV Member States

O.I.V. 2010/10

i) by specialist scientific monitoring, making it possible to assess the specific characteristics of vine products,

(ii) by promoting and guiding research into appropriate nutritional and health aspects,

(iii)by extending the dissemination of information resulting from such research, beyond the recipients referred to in Article 2, paragraph n, to the medical and healthcare professions;

to help protect the health of consumers and to contribute to food safety:

Safety & Health ObjectivesSafety & Health Objectives

O.I.V. 2010/10

DISCUSSION PAPER ON APPROPRIATE DISCUSSION PAPER ON APPROPRIATE PATTERNS OF WINE CONSUMPTION FOR PATTERNS OF WINE CONSUMPTION FOR

HUMAN HEALTH HUMAN HEALTH

1.- Drinking patternsRisky and harmful drinking patterns including the regular consumption of high amounts of alcohol, as well as high amounts of alcohol consumed on single occasion (binge drinking), should be discouraged

2.- Information and education on appropriate wine consumptionIt is important to provide individuals with relevant, balanced and accurate information by appropriate, effective and proportionate means to allow them to make informed decisions.

A) Harmful effects of abusive consumptionAs alcohol consumption can be a direct or additional detrimental risk factor in many diseases including cancer, other individual risk factors (such as dietary habits, genetic predisposition, obesity, smoking and physical activity) should be taken into account

O.I.V. 2010/10

- What does low risk moderate consumption means?

Based on the results of numerous epidemiological and interventional studies, it can be generally considered that daily intake of up to 300 ml of an average wine for men (approximately 30 g ethanol), and up to 200 ml for women (approximately 20 g),.

DISCUSSION PAPER ON APPROPRIATE DISCUSSION PAPER ON APPROPRIATE PATTERNS OF WINE CONSUMPTION FOR PATTERNS OF WINE CONSUMPTION FOR

HUMAN HEALTH HUMAN HEALTH

O.I.V. 2010/10

-Certain situations when wine consumption should be avoided:

i) Pregnancy and breastfeeding :

ii) BAC and driving

iii) Underage people :

iv) People with an increased risk of harm:people with a family history of alcohol dependence

people with mental health problems

people who use certain medications or recreational drugs

people with specific diseases, especially of the liver and pancreas

DISCUSSION PAPER ON APPROPRIATE DISCUSSION PAPER ON APPROPRIATE PATTERNS OF WINE CONSUMPTION FOR PATTERNS OF WINE CONSUMPTION FOR

HUMAN HEALTH HUMAN HEALTH

O.I.V. 2010/10

People who should seek professional advice about their drinking habits

Specific groups of people may need to seek professional advice about their drinking habits, because of the possibility of adverse interactions and associated harmful effects. These includes:

– people using medications, either over-the-counter or prescription

– people with alcohol-related, mental health or physical conditions that can be made worse or affected by alcohol

– people who are concerned about their drinking habits.

DISCUSSION PAPER ON APPROPRIATE DISCUSSION PAPER ON APPROPRIATE PATTERNS OF WINE CONSUMPTION FOR PATTERNS OF WINE CONSUMPTION FOR

HUMAN HEALTH HUMAN HEALTH

O.I.V. 2010/10

Relative risk of cardiovascular mortality

0

0,5

1

1,5

2

0 21 32 54 98 131 200

0

0,5

1

1,5

2

0 21 32 54 98 131 200

Alcool g / jour

VinBière

0

0,5

1

1,5

2

0 21 32 54 98 131 200

0

0,5

1

1,5

2

0 21 32 54 98 131 200

Alcool g / jour

VinBière

0

0,2

0,4

0,6

0,8

1

1,2

0 1-7 8-21 > 21

Bière

Vin

Verres / semaine

Spiritueux

0

0,2

0,4

0,6

0,8

1

1,2

0 1-7 8-21 > 21

Bière

Vin

Verres / semaine

Spiritueux

0.2 0.4 0.6 0.8 1 1.2

Yano,1977 CHD total

Kozarevic, 1980 CHD total

Friedman,1986CHD mortality

Stampfer, 1988 CHD total

Rimm, 1991 CHD total

Klatsky, 1990 CHD total

Wannamethee, 1999CHD total

Rosenberg,1981 MI

Kaufman,1985 MI

Marques-Vidal, 1996- MI

Sacco, 1999 Ischemic sroke

Gaziano, 1999 MI

Thrift,1999

OVERALL RR=0.66 (0.57 to 0.75) Phet=0.09

0.2 0.4 0.6 0.8 1 1.2

Intracranial hemorrhage

OVERALL

Pro

specti

ve s

tudie

sCase

-contr

ol st

udie

s

RR=0.66 (0.57 to 0.75) Phet=0.09

Faible risque Risque élevé0.2 0.4 0.6 0.8 1 1.2

Yano,1977 CHD total

Kozarevic, 1980 CHD total

Friedman,1986CHD mortality

Stampfer, 1988 CHD total

Rimm, 1991 CHD total

Klatsky, 1990 CHD total

Wannamethee, 1999CHD total

Rosenberg,1981 MI

Kaufman,1985 MI

Marques-Vidal, 1996- MI

Sacco, 1999 Ischemic sroke

Gaziano, 1999 MI

Thrift,1999

OVERALL RR=0.66 (0.57 to 0.75) Phet=0.09

0.2 0.4 0.6 0.8 1 1.2

Intracranial hemorrhage

OVERALL

Pro

specti

ve s

tudie

sCase

-contr

ol st

udie

s

RR=0.66 (0.57 to 0.75) Phet=0.09

Faible risque Risque élevé

O.I.V. 2010/10

Alcohol/wine and CHD

The most widely known relationship between moderate drinking and positive health effects relates to CHD

A inverse association has been described by many different studies conducted in different countries since at least 30 years.

Regular moderate drinking 30 grams of alcohol/day is associated with a large reduction in the risk of CHD

Some studies have found that moderate wine drinkers have additionnal beneficial health effects

O.I.V. 2010/10

Evidence obtained from the meta-analysis or other studies indicates an average significant reduction of30 -35 % of overall vascular risk associated with drinking wine.

Beer drinking was also associated with a reduced risk of vascular events, although at an extent lower than that observed with wine. An average significant reduction of 20 % of overall vascular risk associated with drinking beer

Wine and CHD

O.I.V. 2010/10

Relative risk of Cancer mortality

0

2

4

6

8

10

12

0 <1 1-6 7-21 22-41 42-69 >69

RR

of u

pper

dig

estiv

e tr

act c

ance

r

verres / semaine

0

2

4

6

8

10

12

0 <1 1-6 7-21 22-41 42-69 >69

RR

of u

pper

dig

estiv

e tr

act c

ance

r

verres / semaine

0

0,5

1

1,5

2

2,5

0 21 32 54 98 131 200

Bière

Vin

Alcool g / jour

0

0,5

1

1,5

2

2,5

0 21 32 54 98 131 200

Bière

Vin

Alcool g / jour

0

0,2

0,4

0,6

0,8

1

1,2

1,4

1,6

1,8

2

0 1-7 8-21 > 21

0

0,2

0,4

0,6

0,8

1

1,2

1,4

1,6

1,8

2

0 1-7 8-21 > 21

Bière

Vin

Verres / semaine

Spiritueux

0

0,2

0,4

0,6

0,8

1

1,2

1,4

1,6

1,8

2

0 1-7 8-21 > 21

0

0,2

0,4

0,6

0,8

1

1,2

1,4

1,6

1,8

2

0 1-7 8-21 > 21

Bière

Vin

Verres / semaine

Spiritueux

O.I.V. 2010/10

Alcohol/Wine and Cancer

The main studies comparing wine and other alcoholic drinks indicate for cancer mortality:

A positive association between alcohol consumption and the relative risk of several cancer for consumption of 3 or more drinks/day

A relative risk of 0.75-0.8 - 20 to 25% of reduction compared to the abstainers for consumption of 2-3 glasses per day

A significant benefit of wine compared to beer

Importance to distinguish the various types of alcoholic drinks

O.I.V. 2010/10

Relative risk of Total mortality

0% Wine

100% Wine1-30% wine

>30% Wine

0

0,5

1

1,5

2

0 21 32 54 98 131 200

0

0,5

1

1,5

2

0 21 32 54 98 131 200

Alcool g / jour

0

0,5

1

1,5

2

0 21 32 54 98 131 200

0

0,5

1

1,5

2

0 21 32 54 98 131 200

Alcool g / jour

0

0,2

0,4

0,6

0,8

1

1,2

1,4

1,6

0 1-7 8-21 > 21

0

0,2

0,4

0,6

0,8

1

1,2

1,4

1,6

0 1-7 8-21 > 21

Bière

Vin

Verres / semaine

Spiritueux

0

0,2

0,4

0,6

0,8

1

1,2

1,4

1,6

0 1-7 8-21 > 21

0

0,2

0,4

0,6

0,8

1

1,2

1,4

1,6

0 1-7 8-21 > 21

Bière

Vin

Verres / semaine

Spiritueux

O.I.V. 2010/10

Evidence obtained from the main studies indicates an average significant reduction of 30 -35 % of overall mortality associated with wine.

Wine drinking seems to be also associated with a more favourable reduction than for other alcoholic beverages

Alcohol/Wine and Total Mortality

O.I.V. 2010/10

0 1 2 3 4 5

0

3

6

9

Hours after dinner

RO

OH

(µ

M)

Decreased formation of lipid peroxides in post prandial by wine phenolics

Rich fat diet

Rich fat diet + 250 ml red wine

Ursini F. et al © 2001 Circulation.

Polyphenols and antioxidant capacity

O.I.V. 2010/10

Actions and inter-actions

Lipidic effects

Anti-thrombotic effects

Antioxidant effects

Nitric oxide effects

O.I.V. 2010/10

Polyphenols and atherosclerosisBentzon et al. © Circulation 2001

Biological studies comparing wine and other alcoholic beverages show:

No reduction of atherosclerotic events with wine consumption.

When the disease is developed there is no difference in disease progression

Action in prevention and not in reduction of the pathology

O.I.V. 2010/10

Polyphenols and vascular risk

• Inhibition of platelet aggregation

• Inhibition of proliferation of smooth muscle cells

• Increase of vasodilatation properties

• Inhibition of monocytes activation

• Inhibition of activation of adhesion proteins

• decrease of lipid oxidation

O.I.V. 2010/10

Favorable Changes in Risk Factors

WINE

Alcohol

Phenolics

HDL

Fibrinogen Factor VIIThrombosis

Platelet aggregation

LDL oxidationEndothelial Function (NO)DNA damage

Plasma lipid peroxidesAntioxidant capacityChemoprevention

O.I.V. 2010/10

Relationship betwen alcohol/wine consumption

and diets

Tjonneland A. © Am J. Clin. Nutr. 1999

O.I.V. 2010/10

O.I.V. 2010/10

WHO Global strategy to WHO Global strategy to reduce the harmful use of reduce the harmful use of

alcoholalcohol

Delegations from all 193 Member States of (WHO) have adopted during the 63rd World Health Assembly from 17 to 21 May 2010, a resolution to reduce the harmful use of alcohol.

According to the WHO for 2004, every year, the harmful use of alcohol

would kill 2.5 million people, including 320 000 young people between 15 and 29 years of age.

It is the eighth leading risk factor for deaths globally,

harmful use of alcohol would be responsible for almost 4% of all deaths in the world.

O.I.V. 2010/10

(a) raise global awareness of the magnitude and nature of the health, social and economic problems caused by harmful use of alcohol,

(b)Stimulate knowledge base on the magnitude and determinants of alcohol-related harm and on effective interventions to reduce and prevent such harm;

(c) increase technical support to, and enhanced capacity of, Member States for preventing the harmful use of alcohol

(d)Stimulate partnerships and better coordination among stakeholders and increased mobilization of resources required for appropriate and concerted action to prevent the harmful use of alcohol;

(e) improve systems for monitoring and surveillance at different levels, and more effective dissemination and application of information for advocacy, policy development and evaluation purposes.

WHO Global strategy: WHO Global strategy: ObjectivesObjectives

O.I.V. 2010/10

Leadership, awareness, and commitmentHealth services’responseCommunity actionDrink-drivind policies and countermeasuresAvailability of alcoholMarketing of alcoholic beveragesPricing policiesReducing the negative consequences of drinking and alcohol intoxicationReducing the public health impact of illicit alcohol and informally produced alcoholMonitoring and surveillance

WHO Global strategy: WHO Global strategy: 10 Areas of action10 Areas of action

O.I.V. 2010/10

WHO Global Strategy : Other WHO Global Strategy : Other strategies, and programmesstrategies, and programmesWHO Global Strategy : Other WHO Global Strategy : Other strategies, and programmesstrategies, and programmes

This global strategy builds upon regional initiatives

WHO European Region (resolution EUR/RC55/R1),

Western Pacific Region (resolution WPR/RC57.R5),

South-East Asia Region (resolution SEA/RC59/R8),

Eastern Mediterranean Region (resolution EM/RC53/R.5)

African Region (document AFR/RC58/3).

O.I.V. 2010/10

UE Alcohol StrategyUE Alcohol Strategy

Adopted by the Commission in October 2006Endorsed by

Council Conclusions November 2007EP Report August 2007

Priorities:1) Protect young people, children and the unborn child2) Reduce injuries and deaths from alcohol-related road traffic accidents3) Prevent alcohol-related harm among adults and reduce the negative impact on the workplace4) Inform, educate and raise awareness on the impact of harmful and hazardous alcohol consumption, and on appropriate consumption patterns5) Develop, support and maintain a common evidence base

O.I.V. 2010/10

This strategy will be put into practice through:

A Committee on National Policy and Action

The main objective of this group will be to further coordinate government-driven policies aimed at reducing alcohol-related harm at national and local level

A European Alcohol and Health Forum

The creation of a European Alcohol and Health Forum is hoped to become one of the cornerstones in the work to reduce alcohol-related harm. The overall objective is to provide a common platform for all interested stakeholders at EU level that are willing to step up actions aimed at reducing alcohol harm, notably in different areas:

UE Alcohol StrategyUE Alcohol Strategy

O.I.V. 2010/10

• Strategies aiming to curb under-age drinking;

• Information and education programmes on the effect of harmful drinking and on responsible patterns of consumption;

• Possible development of efficient common approaches throughout the Community to provide adequate consumer information;

• Actions to better enforce age limits for selling and serving alcohol;

• Interventions promoting effective behavioural change among children and adolescents;

• Cooperation to promote responsibility in, and prevent irresponsible, commercial communication and sales.

European Alcohol and European Alcohol and Health ForumHealth Forum

O.I.V. 2010/10

NOTES:

that the level of alcohol-related harm, especially among vulnerable people, on roads and at workplaces, is still high in the Member States,

15 % of the EU adult population is estimated to drink at harmful levels on a regular basis

between five and nine million children in families in the EU are adversely affected by alcohol

harmful and hazardous use of alcohol is a causal factor in approximately 16 % of cases of child abuse,

an estimated 60 000 underweightbirths each year are attributable to harmful and hazardous use of alcohol,

NOTES:

that the level of alcohol-related harm, especially among vulnerable people, on roads and at workplaces, is still high in the Member States,

15 % of the EU adult population is estimated to drink at harmful levels on a regular basis

between five and nine million children in families in the EU are adversely affected by alcohol

harmful and hazardous use of alcohol is a causal factor in approximately 16 % of cases of child abuse,

an estimated 60 000 underweightbirths each year are attributable to harmful and hazardous use of alcohol,

O.I.V. 2010/10

Recommendations on Recommendations on alcohol/wine and healthalcohol/wine and health

Don’t recommend alcohol as medicine

Inform patients that beneficial effects are achieved at moderate consumption

Don’t discourage moderate drinking, but consider individual circumstances

Always discourage binge drinking

Inform of harmful effects of abusive consumption

O.I.V. 2010/10

Thank you for

your attention

Thank you for

your attention

Ευχαριστούμε Ευχαριστούμε