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—Ä^ TNO Nutrition and Food Research Biomedical and social aspects of alcohol use: a review of the literature Dirk G. van der Heij & Gertjan Schaafsma (Editors) TNONutrition andFood Research, Zeist, Netherlands Pudoc Wageningen 199 CIP-data Koninklijke Bibliotheek, Den Haag Biomedical Biomedical and social aspects of alcohol use: a review of the literature / Dirk G. van der Heij and Gertjan Schaafsma (eds.). - Wageningen : Pudoc [etc.]. - III. Met reg. ISBN 90-220-1051-I geb. NUGI 735 Trefw. alcoholgebruik. BIBLIOTHEEK r^oBOUWUNIVERS: WAGENINGEN ISBN 90-220-1051-1 NUGI 735 © Centre for Agricultural Publishing and Documentation (Pudoc), Wageningen, Netherlands, 1991. All rights reserved. Nothing from this publication may be reproduced, stored in acomputerize d system or published in any form or in any manner, including electronic, mechanical, reprographic or photographic, without prior written permissionfro m the publisher, Pudoc,P.O . Box 4,670 0A A Wageningen,Netherlands . The individual contributions in this publication andan y liabilities arising from them remain the responsibility of the authors. Insofar asphotocopie s from this publication are permitted byth e Copyright Act 1912,Articl e I6B andRoya l Netherlands Decree of 20Jun e 1974(Staatsbla d 351) asamende d in Royal Netherlands Decree of 23Augus t 1985 (Staatsblad 471) andb y Copyright Act 1912,Articl e 17,th e legally defined copyright feefo r anycopie s should be transferred to the Stichting Reprorecht (P.O. Box 882, 1180A W Amstelveen, Netherlands). For reproduction of parts of this publication incompilation s sucha santhologie s or readers (Copyright Act 1912, Article 16), permission must be obtained from the publisher. Printed in the Netherlands. Preface The useo f alcohol-containing beverages hasbee n connectedwit hbot h positive and negativesocia l and health consequences. From timeimmemorial , wine andbee r have belonged to the everyday menu in many countries and cultures. The use of distilled beverages isa comparativel y recent phenomenon. In many cultures, the appreciation for alcohol hasbee n high for centuries, and many artists and scientists still find support in alcoholicbeverage s as asourc e of inspiration. Therol eo f alcoholic beveragesi n gastronomy isundisputed . Besides, many medicinal properties have been ascribed to thesebeverages . However, positive asth e effects of alcohol consumption maybe , iti sundeniabl y true that somepeopl emisus ealcohol . Thisma y explain, at least in part, the ambivalence in the attitude towards alcohol usei n present-day society. On the onehand , this attitude ispositiv ebecaus eo f the sensory and aesthetic properties of alcoholicbeverage s and their highlyvalue d rolei n awid e rangeo f cultural expressions. On the other hand, society's attitude isnegativ e because of the risks of misuseinheren t in the useo f any product. Somegovernment s havetrie d to influence thebalanc ebetwee n positive and negative effects of alcohol use in the communityb yformulatin g alcohol control policies. These relate to price and excisemeasures , to restrictions imposed on advertising and availability, and to education and information. Thesepolicie s are largelybase d on research data obtained byinvestigatin g thereason s for and consequences of excessivealcoho l use. Byfa r the majority - probably even asmuc h as99 %- of scientific literaturepertain s to alcohol abuse and alcoholism. As early as 1980, theDutc h alcohol industry and alcohol tradejudge d it desirable tohav e available an overview of scientific literature on moderate alcohol use and its social andbiomedica l implications and assigned theTN O Toxicology and Nutrition Institute at Zeist to carry out thiswork . This literature survey, entitled 'Biomedical and social aspects ofth eus eo f alcoholicbeverages' ,wa swritte nb yM sI rW.G . Vrij- Standhardt and Ms Ir E.L. Rasmussen-Conrad. Itwa scomplete d in 1981 und updated in 1984. This state-of-the-art report prompted alcohol production and trade companies to embark on various activitiesi n thefield s ofpubli c education, training and education of staff in alcohol production and trade, starting an alcohol documentation centre and acurren t awareness newsletter 'Alcohol Selectief'. The report also provided the scientific basisfo r discussionswit hbot h the Dutch government andE C authorities on alcohol control measures. Finally, itresulte di n theidentificatio n of the topic 'alcohol and cardiovascular diseaseprotection ' asa n area for experimental researchwhic hha sprove d tob ever y fruitful. From thever ystar t in 1980, allthes eactivitie shav ebee n based at the TNO Toxicology and Nutrition Institute, under theguidanc eo f the SAR ('Stuurgroep Alcohol Research', SteeringGrou p for Alcohol Research). The SAR comprises representatives of theDutc h wine, spirits andbee r industry and trade. Its present composition is: Mr H. Bergsma, chairman; Mr R.J.B. Wallast Groenewoud, secretary; Mr Th.G.Chr. Hooij, DrsN.J . Gratama, DrsJ.J.M . Verhoek and Mr H.E. Jonker Roelants, members. The citical and constructive attitude of all SÂR participants towards the subject matter hasmad e the cooperation with SAR amos t fruitful one. In recent years, manyne w research data havebecom eavailable . That iswh ybot h the SAR and TNO felt it necessary to update the 1984literatur e survey. We feel pleasure and satisfaction inpresentin g thisbook , which isa n updated and thoroughly revised edition of the 1984 report. We aremos t grateful to the authors, MsI r W.G. Vrij-Standhardt, MsDr s E. te Wierik and Dr J. Veenstra, whohav espen t agrea t deal of time and attention to writing the chapters. We alsomention with gratitude the contributions madeb yth e staff ofth eAlcoho l Documention Centre, MsM . van Ruyven and MsE . Vermeulen- Hermans. Many of the drawings and schemesi n thisboo k havebee n aptfully designed and lettered byM rM . van der Vaart. Weacknowledg ewit h appreciation the SAR for generously providing thefund s for thisproject . Wear eindebte d to the publisher, Pudoc, for pleasant cooperation in producing thisvaluabl ereview . The project hasbee n coordinated byD r G. Schaafsma. Finally, wewis h to thank Mr D.G. van der Heij and Dr G. Schaafsma for undertaking thepainstakin gwor k involvedi n editing this book. It isou r hope that 'Biomedical and social aspects of alcohol use'wil lprovid eal l those interested in thevariou s aspects of alcohol consumption with the scientific facts underlying theimplication s of alcohol use. We alsohop e that abette r understanding of allaspect s of moderate alcohol usewil lhel p to formulate effective policies to prevent excessiveus eo f alcohol. Zeist, June 1991 Professor Dr R.J .J . Hermus, Director TNO Toxicology and Nutrition Institute Contents Abbreviations 1 Introduction 3 1. Moderate and excessive drinking, problem drinking and alcoholism/ Definitions IE. teWierik 5 2. Thebiokinetic s of alcohol/ W.G. Vrij-Standhardt 14 3. Alcoholmetabolis m/ W.G. Vrij-Standhardt 32 4. Alcohol and hormone metabolism /W. G. Vrij-Standhardt 47 5. Effects of alcohol on themetabolis m ofmacronutrient s /W. G. Vrij- Standhardt 62 6. Effects of alcohol onvitami n metabolism /E. teWierik and W.G. Vrij- Standhardt 72 7. Effects of alcohol onwate r and mineral balanceIE. teWierik and W.G. Vrij-Standhardt 83 8. Effects of alcohol on thelive rI W.G. Vrij-Standhardt 90 9. Effect of alcohol on thebrai n and thenervou s system/ W.G. Vrij- Standhardt 116 10.Effect s of alcohol on the cardiovascular system/ J. Veenstra 130 11.Effects of alcohol on various organs and tissuesIE. teWierik and W.G. Vrij-Standhardt 157 12.Alcoho l and cancer/ E. teWierik and W. G. Vrij-Standhardt 169 13.Alcoho l and pregnancy/ E. teWierik 180 14.Differences between alcoholicbeverage s/ W.G. Vrij-Standhardt 190 15.Factor s influencing behaviour in relation to alcohol/ E. teWierik 204 16.Alcoho l and traffic /E. teWierik 228 17.Prevention of alcohol abuse:model s of control/ E. teWierik 238 18.Measurest o control alcohol abuse/ E. teWierik 252 Subject index 263 Abbreviations AA Alcoholics Anonymous HBV hepatitis Bviru s AAD alcohol amnestic disorder HDL high-density lipoprotein AC adenylate cyclase HLA human lymphocyte antigen ACTH adrenocorticotropic hormone, HPA hypothalamic-pituitary axis corticotropin IARC International Agency for Research on ADH alcohol dehydrogenase Cancer ALA 6-aminolaevulinicaci d IBS intermediate brain syndrome ALAT alanine aminotransferase IQ intelligence quotient AMP adenosine monophosphate LD50 median lethal dose AP alkaline phosphatase LDL low-density lipoprotein Apo apolipoprotein LH luteinizing hormone ASAT aspartate aminotransferase LHRH luteinizing hormone-releasing AST aspartate aminotransferase hormone ATPase adenosine triphosphatase MAO monoamine oxidase AUC area under the (blood alcohol) curve mAST mitochondrial aspartate AUDIT Alcohol Use Disorders Identification aminotransferase Test (of the WHO) MCV mean corpuscular volume AVP arginine vasopressin MEOS microsomal ethanol-oxidizing system BAC blood alcohol concentration MLPA minimum legal purchase age cAMP cyclic adenosine monophosphate NAD nicotinamide adenine dinucleotide CDAT carbohydrate-deficient transferrin NADH reduced form of NAD CHD coronary heart disease NADP nicotinamide adenine dinucleotide CNS central nervous system phosphate CoA coenzyme A NADPH reduced form of NADP CRF corticotropin-releasing factor PAI-1 plasminogen activator inhibitor 1 CT computerized tomography PGE1 prostaglandin El CVD cardiovascular disease PLP pyridoxal-5' -phosphat
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