Alcohol and disease

1
Alcohol and disease

• Murielle Bochud, MD, PhD
• Assistant professor SSPH
• University Institute of Social and Preventive
  Medicine, Lausanne

2
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

3
Drinking categories
In general, there is no significant health
difference between individuals who consume less
than 2 drinks daily and abstainers.
4
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 2006101373-384
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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

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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
Data from Canada
Ref Rehm et al, Addiction 2006101373-384
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The French paradox
There is lower mortality in France with respect
to other countries in relation to wine
consumption
Red wine, and its antioxidant polyphenols, is
thought to be particularly protective against
cardiovascular disease.
St Léger et al, Lancet 197911017-1020
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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
  200528369373)
• Socioeconomic class is a strong determinant of
  mortality

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Types of alcohol beverages
Purchase of healthier food items is related to
purchase of wine over beer. Odds ratios lt1 were
items purchased more commonly with wine. Odds
ratios gt1 indicate items purchased more commonly
with beer.
Johansen et al, BMJ 2006332519522
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J-shaped curve for the relation betwen alcohol
and total mortality
Meta-analysis 34 studies (men and
women) 1015835 subjects 94533 deaths
Ref Di Castelnuovo et al, Arch Intern Med.
20061662437-2445
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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

12

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