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 2006;101:373-384

5. 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

6. Alcohol attributable fraction (AAF) DiseasesMenWomen Cancers30.59.1 T2DM-4.9-2.5 Neuropsychiatric conditions84.756.6 Cardiovascular disease-5.0-4.1 Digestive diseases53.337.4 Unintentional injuries31.116.2 Intentional injuries19.616.4 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

7. The French paradox There is lower mortality in France with respect to other countries in 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.

8. 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

9. 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

10. 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

11. 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 !