barcelona . spain - European Association for the Study of the Liver
barcelona . spain - European Association for the Study of the Liver
barcelona . spain - European Association for the Study of the Liver
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BARCELONA . SPAIN<br />
164 POSTGRADUATE COURSE SYLLABUS ALCOHOLIC LIVER DISEASE 165<br />
APRIL 18 - 19/2012 THE INTERNATIONAL LIVER CONGRESS TM 2012<br />
REFERENCES<br />
Anderson P, Baumberg B. Alcohol in Europe. London, Institute <strong>of</strong> Alcohol Studies, 2006<br />
(http://ec.europa.eu/health/ph_determinants/life_style/alcohol/documents/alcohol_europe.pdf.<br />
Accessed 30 June 2009).<br />
Rehm, J, Ma<strong>the</strong>rs, C, Popova, S, Thavorncharoensap, M, Teerawattananon, Y, Patra,<br />
J. Global burden <strong>of</strong> disease and injury and economic cost attributable to alcohol use<br />
and alcohol use disorders. Lancet 2009; 373(9682): 2223-2233.<br />
Anderson P, Chisholm D, Fuhr DC. Effectiveness and cost-effectiveness <strong>of</strong> policies<br />
and programmes to reduce <strong>the</strong> harm caused by alcohol. Lancet 2009; 373: 2234–46.<br />
Anderson, P. Evidence <strong>for</strong> <strong>the</strong> effectiveness and cost-effectiveness <strong>of</strong> interventions to reduce<br />
alcohol-related harm. Copenhagen, World Health Organization Regional Office <strong>for</strong> Europe, 2009.<br />
Babor T, Caetano R, Casswell S, Edwards G, Giesbrecht N, Graham K, et al. Alcohol:<br />
No ordinary commodity (Second Edition). Ox<strong>for</strong>d, Ox<strong>for</strong>d University Press, 2010.<br />
Casswell S, Thamarangsi T. Reducing <strong>the</strong> harm from alcohol: call to action.<br />
Lancet 2009; 373: 2247–57.<br />
Gordon, R. & Anderson, P. Science and alcohol policy: A case study <strong>of</strong> <strong>the</strong> EU Strategy<br />
on Alcohol. Addiction 2011 106 Supplement 55-66.<br />
Rehm J, Anderson P, Kanteres F, Parry CD, Samokhvalov AV, & Patra J. Alcohol,<br />
social development and infectious disease. 978-1-77052-444-6. Toronto, ON: Centre <strong>for</strong> Addiction<br />
and Mental Health, 2009<br />
Rehm J, Baliunas D, Borges GLG, Graham K, Irving HM, et al. The relation between different<br />
dimensions <strong>of</strong> alcohol consumption and burden <strong>of</strong> disease - an overview. Addiction 2010;<br />
105: 817-843<br />
World Health Organization. Handbook <strong>for</strong> action to reduce alcohol-related harm.<br />
Copenhagen, World Health Organization Regional Office <strong>for</strong> Europe, 2009.<br />
ILLEGALLY PRODUCED SPIRITS IN EASTERN EUROPE: TO WHAT<br />
EXTENT AND AT WHAT RISK<br />
Dirk W. Lachenmeier<br />
Karlruhe, Germany<br />
E-Mail: Lachenmeier@web.de<br />
KEY POINTS<br />
• Unrecorded alcohol comprises homemade, illegally produced, or smuggled alcohol products<br />
as well as surrogate alcohol that is not <strong>of</strong>ficially intended <strong>for</strong> human consumption (e.g.,<br />
mouthwash, perfumes and eau-de-colognes).<br />
• Unrecorded alcohol consumption is highest in Eastern Europe.<br />
• Illegally produced spirits are <strong>of</strong>ten sold at higher alcoholic strength (>45% vol) but <strong>for</strong> half<br />
<strong>the</strong> price <strong>of</strong> legal beverages, potentially leading to more detrimental patterns <strong>of</strong> drinking and<br />
overproportional rates <strong>of</strong> liver cirrhosis.<br />
• There is currently a lack <strong>of</strong> data to demonstrate causality between <strong>the</strong> quality <strong>of</strong> illicit spirits<br />
(e.g., higher levels <strong>of</strong> certain contaminants in home-produced products) and liver toxicity on a<br />
population scale.<br />
• Polyhexamethyleneguanidine (PHMG) contained in surrogate alcohol (antiseptic liquids) from<br />
Russia was associated with an outbreak <strong>of</strong> acute cholestatic liver injury, histologically different<br />
from conventional alcoholic liver disease.<br />
INTRODUCTION<br />
In Central and Eastern Europe, large discrepancies can be found between recorded alcoholic beverage<br />
consumption and alcohol-related mortality (1). One example is Hungary, where mortality from liver disease<br />
is approximately fourfold that <strong>of</strong> countries with similar per capita consumption <strong>of</strong> alcohol (e.g. (2, 3)). One<br />
reason <strong>for</strong> this might be <strong>the</strong> particularly high unrecorded consumption (2).<br />
Despite <strong>the</strong> high levels <strong>of</strong> unrecorded consumption in some countries (up to 40% <strong>of</strong> total consumption),<br />
<strong>the</strong>re are almost no data on long-term consequences, such as chronic diseases, which may stem specifically<br />
from unrecorded consumption. This is partially due to <strong>the</strong> fact that few people consume only unrecorded<br />
alcohol over time (4). Consider <strong>the</strong> example <strong>of</strong> a person who died <strong>of</strong> alcoholic liver cirrhosis in Russia, and<br />
had been mainly consuming unrecorded alcohol products in his final years. Typically, he would have been<br />
drinking only recorded alcohol <strong>for</strong> some time be<strong>for</strong>e switching to surrogate alcohol <strong>for</strong> economic reasons<br />
when drinking became increasingly heavily (5). With this switch and subsequent exposure to ‘o<strong>the</strong>r’ <strong>for</strong>ms<br />
<strong>of</strong> alcohol, <strong>the</strong>re are three potential impacts (4):<br />
• The alcoholic liver cirrhosis would have taken exactly <strong>the</strong> same course<br />
• The alcoholic liver cirrhosis would have taken a different course, <strong>for</strong> example, later onset, longer duration,<br />
or no fatal outcome, if this person had consumed recorded alcohol only.<br />
• The alcoholic liver cirrhosis would not have occurred with consumption <strong>of</strong> recorded alcohol.<br />
It is extremely difficult to determine whe<strong>the</strong>r unrecorded consumption or mainly unrecorded consumption<br />
is causal in <strong>the</strong> onset <strong>of</strong> a chronic disease; i.e., whe<strong>the</strong>r <strong>the</strong> components which differ between recorded<br />
and unrecorded alcohol cause certain health consequences (6). As a result, few studies have investigated<br />
whe<strong>the</strong>r unrecorded consumption causes health consequences over and above those <strong>of</strong> recorded<br />
consumption. Notably, such a study was conducted in India (7), wherein <strong>the</strong> authors concluded that<br />
unrecorded consumption (country liquor) was associated with a general risk <strong>of</strong> alcoholic liver disease,<br />
particularly alcoholic liver cirrhosis, despite having relatively low alcohol concentrations compared with <strong>the</strong><br />
local recorded type. However, this study was not well controlled, and <strong>the</strong>re<strong>for</strong>e confounding by social status<br />
and o<strong>the</strong>r factors cannot be excluded (4).