Nutrition, Metabolism & Cardiovascular Diseases (2014) 24, e4ee5
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.elsevier.com/locate/nmcd
LETTER TO THE EDITOR
Moderate alcohol use and health: A nonsense We have read the paper by Poli et al. [1]. They state that moderate drinking of up to one drink per day leads to an increased risk of 20e30% of oral and pharyngeal cancer and of oesophageal squamous cell carcinoma. Moreover, they state that an increased risk of breast cancer appears at intakes of three to six drinks per week. Despite these statements they conclude that moderate alcohol consumption and development of an associated lifestyle culture should be fostered. We do not agree with the Authors. Their message might be dangerous! Recently the International Agency for cancer Research (IARC e WHO: World Health Organization) has evidenced that alcohol consumption is carcinogenic to humans (Group 1), ethanol in alcoholic beverages is carcinogenic to humans (Group 1) and acetaldehyde associated with the consumption of alcoholic beverages, is carcinogenic to humans (Group 1). Alcohol consumption (and not abuse) is associated with increased risks of the following cancer types: oral cavity, pharynx, larynx, oesophagus, upper aerodigestive tract, colorectum, liver and female breast [2,3]. Many different worldwide health associations (Institute National du cancer, Paris; World Cancer Research Fund, American Institute for Cancer research; WHO, Societa’ Italiana di Alcologia, Italy) affirm that, unfortunately, it is not possible to identify a threshold level of alcohol consumption below which no increased risk for cancer is evident. The Cancer Council Australia (CCA) Alcohol Working Group declares that any level of alcohol consumption increases the risk of developing an alcohol-related cancer; the level of risk increases in line with the level of consumption [4]. In Australia, the National Heart Foundation explicitly advises against the consumption of red wine and other types of alcoholic drinks for the prevention or treatment of heart diseases [4]. In 2007, the World Health Organization (WHO) affirmed that from both the public health and clinical viewpoints, there is no merit in promoting alcohol consumption as a preventive strategy. We do agree with WHO (2012): a greater reduction in death from ischaemic heart disease could be obtained by
being physically active and eating a healthier diet than by drinking a low dose of alcohol. The supposed cardiovascular benefits of a low level of alcohol intake cannot be taken as a proof. If physicians were seen to be encouraging alcohol for the prevention of cardiovascular diseases, that would not only be politically and ethically incorrect, but might also lead to a significant increase in alcohol-related medical and social problems [5]. It is mandatory to remind that alcoholic beverages consumption (without abuse) favours the development of about 60 different diseases, and that one unit of alcohol a day (about 12 grams of ethanol) significantly increases the risk of hypertension and dysrhythmias [6,7]. Conclusions drawn by Poli et al. [1] appear to promote moderate alcohol drinking. Since alcohol was found to cause more harm than good, it is ethically inconceivable not to condemn the consumption of a carcinogenic substance.
References [1] Poli A, Marangoni F, Avogaro A, Barba G, Bellentani S, Bucci M, et al. Moderate alcohol use and health: a consensus document. Nutr Metab Cardiovas Dis 2013;23:487e504. [2] IARC Alcohol consumption and ethyl carbamate. IARC Monogr Eval Carcinog Risks Hum 2010;96:1e1428. [3] IARC. A review of human carcinogens. IARC Monogr Eval Carcinog Risks Hum; 2012:377e478. 100 part E. [4] Winstanley MH, Pratt LS, Chapman K. Alcohol and cancer: a position statement from cancer council Australia. Med J Aust 2011;194:479e82. [5] World Health Organization. Regional Office for Europe. Alcohol in the European Union. Consumption, harm and policy approaches; 2012. [6] Testino G. Alcoholic diseases in hepatogastroenterology. Hepato-Gastroenterol 2008;55:371e7. [7] Testino G, Borro P, Ancarani O, Sumberaz A. Human carcinogenesis and alcohol in hepato-gastroenterology. Eur Rev Med Pharmacol Sci 2012;16:512e8.
G. Testino Centro Alcologico Regionale e Regione Liguria, UO Alcologia e Patologie Correlate, Department of General Internal and Specialistic Medicine, IRCCS AOU San Martino-National Institute for Cancer research, Genova, Italy
0939-4753/$ - see front matter ª 2013 Elsevier B.V. All rights reserved. http://dx.doi.org/10.1016/j.numecd.2013.09.007
Letter to the Editor World Health Organization e Collaborative Centre for Health Promotion and Research on Alcohol and Alcohol Related Health problems (Europe Region), Italy V. Patussi World Health Organization e Collaborative Centre for Health Promotion and Research on Alcohol and Alcohol Related Health problems (Europe Region), Italy Centro Alcologico Regionale e Regione Toscana, UO Alcologia, Ospedale Careggi, Firenze, Italy S. Leone School of Toxicology, University of Genoa, Genova, Italy E. Scafato World Health Organization e Collaborative Centre for Health Promotion and Research on Alcohol and Alcohol Related Health problems (Europe Region), Italy Istituto Superiore di Sanita’, Roma, Italy
e5 P. Borro* Centro Alcologico Regionale e Regione Liguria, UO Alcologia e Patologie Correlate, Department of General Internal and Specialistic Medicine, IRCCS AOU San Martino-National Institute for Cancer research, Genova, Italy World Health Organization e Collaborative Centre for Health Promotion and Research on Alcohol and Alcohol Related Health problems (Europe Region), Italy *Corresponding author. Centro Alcologico Regionale e Regione Liguria, UO Alcologia e Patologie Correlate, Department of General Internal and Specialistic Medicine, IRCCS AOU San Martino-National Institute for Cancer research, Genova, Italy. E-mail address: [email protected] 8 July 2013
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.elsevier.com/locate/nmcd
LETTER TO THE EDITOR
Moderate alcohol use and health: A nonsense We have read the paper by Poli et al. [1]. They state that moderate drinking of up to one drink per day leads to an increased risk of 20e30% of oral and pharyngeal cancer and of oesophageal squamous cell carcinoma. Moreover, they state that an increased risk of breast cancer appears at intakes of three to six drinks per week. Despite these statements they conclude that moderate alcohol consumption and development of an associated lifestyle culture should be fostered. We do not agree with the Authors. Their message might be dangerous! Recently the International Agency for cancer Research (IARC e WHO: World Health Organization) has evidenced that alcohol consumption is carcinogenic to humans (Group 1), ethanol in alcoholic beverages is carcinogenic to humans (Group 1) and acetaldehyde associated with the consumption of alcoholic beverages, is carcinogenic to humans (Group 1). Alcohol consumption (and not abuse) is associated with increased risks of the following cancer types: oral cavity, pharynx, larynx, oesophagus, upper aerodigestive tract, colorectum, liver and female breast [2,3]. Many different worldwide health associations (Institute National du cancer, Paris; World Cancer Research Fund, American Institute for Cancer research; WHO, Societa’ Italiana di Alcologia, Italy) affirm that, unfortunately, it is not possible to identify a threshold level of alcohol consumption below which no increased risk for cancer is evident. The Cancer Council Australia (CCA) Alcohol Working Group declares that any level of alcohol consumption increases the risk of developing an alcohol-related cancer; the level of risk increases in line with the level of consumption [4]. In Australia, the National Heart Foundation explicitly advises against the consumption of red wine and other types of alcoholic drinks for the prevention or treatment of heart diseases [4]. In 2007, the World Health Organization (WHO) affirmed that from both the public health and clinical viewpoints, there is no merit in promoting alcohol consumption as a preventive strategy. We do agree with WHO (2012): a greater reduction in death from ischaemic heart disease could be obtained by
being physically active and eating a healthier diet than by drinking a low dose of alcohol. The supposed cardiovascular benefits of a low level of alcohol intake cannot be taken as a proof. If physicians were seen to be encouraging alcohol for the prevention of cardiovascular diseases, that would not only be politically and ethically incorrect, but might also lead to a significant increase in alcohol-related medical and social problems [5]. It is mandatory to remind that alcoholic beverages consumption (without abuse) favours the development of about 60 different diseases, and that one unit of alcohol a day (about 12 grams of ethanol) significantly increases the risk of hypertension and dysrhythmias [6,7]. Conclusions drawn by Poli et al. [1] appear to promote moderate alcohol drinking. Since alcohol was found to cause more harm than good, it is ethically inconceivable not to condemn the consumption of a carcinogenic substance.
References [1] Poli A, Marangoni F, Avogaro A, Barba G, Bellentani S, Bucci M, et al. Moderate alcohol use and health: a consensus document. Nutr Metab Cardiovas Dis 2013;23:487e504. [2] IARC Alcohol consumption and ethyl carbamate. IARC Monogr Eval Carcinog Risks Hum 2010;96:1e1428. [3] IARC. A review of human carcinogens. IARC Monogr Eval Carcinog Risks Hum; 2012:377e478. 100 part E. [4] Winstanley MH, Pratt LS, Chapman K. Alcohol and cancer: a position statement from cancer council Australia. Med J Aust 2011;194:479e82. [5] World Health Organization. Regional Office for Europe. Alcohol in the European Union. Consumption, harm and policy approaches; 2012. [6] Testino G. Alcoholic diseases in hepatogastroenterology. Hepato-Gastroenterol 2008;55:371e7. [7] Testino G, Borro P, Ancarani O, Sumberaz A. Human carcinogenesis and alcohol in hepato-gastroenterology. Eur Rev Med Pharmacol Sci 2012;16:512e8.
G. Testino Centro Alcologico Regionale e Regione Liguria, UO Alcologia e Patologie Correlate, Department of General Internal and Specialistic Medicine, IRCCS AOU San Martino-National Institute for Cancer research, Genova, Italy
0939-4753/$ - see front matter ª 2013 Elsevier B.V. All rights reserved. http://dx.doi.org/10.1016/j.numecd.2013.09.007
Letter to the Editor World Health Organization e Collaborative Centre for Health Promotion and Research on Alcohol and Alcohol Related Health problems (Europe Region), Italy V. Patussi World Health Organization e Collaborative Centre for Health Promotion and Research on Alcohol and Alcohol Related Health problems (Europe Region), Italy Centro Alcologico Regionale e Regione Toscana, UO Alcologia, Ospedale Careggi, Firenze, Italy S. Leone School of Toxicology, University of Genoa, Genova, Italy E. Scafato World Health Organization e Collaborative Centre for Health Promotion and Research on Alcohol and Alcohol Related Health problems (Europe Region), Italy Istituto Superiore di Sanita’, Roma, Italy
e5 P. Borro* Centro Alcologico Regionale e Regione Liguria, UO Alcologia e Patologie Correlate, Department of General Internal and Specialistic Medicine, IRCCS AOU San Martino-National Institute for Cancer research, Genova, Italy World Health Organization e Collaborative Centre for Health Promotion and Research on Alcohol and Alcohol Related Health problems (Europe Region), Italy *Corresponding author. Centro Alcologico Regionale e Regione Liguria, UO Alcologia e Patologie Correlate, Department of General Internal and Specialistic Medicine, IRCCS AOU San Martino-National Institute for Cancer research, Genova, Italy. E-mail address: [email protected] 8 July 2013
