Alcohol and disease
Murielle Bochud, MD, PhD
Assistant professor SSPH+
University Institute of Social and Preventive
Medicine, Lausanne
How to assess alcohol intake?
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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 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 1979;1:1017-1020
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 items
is related to purchase of wine over beer.
Odds ratios <1 were items
purchased more commonly with wine.
Odds ratios >1 indicate items
purchased more commonly with beer.
Johansen et al, BMJ 2006;332:519–522
J-shaped curve for the relation betwen alcohol
and total mortality
Meta-analysis
34 studies
(men and women)
1’015’835 subjects
94’533 deaths
Ref: Di Castelnuovo et al, Arch Intern Med. 2006;166:2437-2445
What could explain the protective role of
moderate alcohol intake?
• moderate alcohol has atheroprotective effect potential due to
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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 !