PERSONAL HABITS AND INDOOR COMBUSTIONS volume 100 e A review of humAn cArcinogens This publication represents the views and expert opinions of an IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, which met in Lyon, 29 September-6 October 2009 LYON, FRANCE - 2012 iArc monogrAphs on the evAluAtion of cArcinogenic risks to humAns CONSUMPTION OF ALCOHOLIC BEVERAGES Consumption of alcoholic beverages was considered by previous IARC Working Groups in 1987 and 2007 (IARC, 1988, 2010). Since that time, new data have become available, these have been incorporated into the Monograph, and taken into consideration in the present evaluation. 1. Exposure Data fruit, vegetables or parts of palm trees, by a fairly simple production process. 1.1 Types and ethanol content of 1.1.2 Ethanol content of alcoholic beverages alcoholic beverages Percentage by volume (% vol) is used to indi­ 1.1.1 Types of alcoholic beverages cate the ethanol content of beverages, which is The predominant types of commercially also called the French or Gay-Lussac system. produced alcoholic beverages are beer, wine and Alcohol content differs according to the main spirits. Basic ingredients for beer are malted beverage type and may also vary by country. barley, water, hops and yeast. Wheat may be Commonly, 4–5% vol are contained in beer, used. Nearly all wine is produced from grapes, about 12% vol in wine and about 40% vol in although wine can be also made from other fruits distilled spirits. However, lower or higher ethanol and berries. Spirits are frequently produced from content in alcoholic beverages is also possible. cereals (e.g. corn, wheat), beet or molasses, grapes The ethanol content in beer can range from or other fruits, cane sugar or potatoes. Main 2.3% vol to over 10% vol (lower alcohol content beverage types (i.e. beer, wine and spirits) may in home- or locally produced alcoholic bever­ be consumed in combination with each other to ages such as sorghum beer), in wine from 8 to fortify the strength of an alcoholic beverage (e.g. 15% vol, and in spirits from 20% vol (aperitifs) to fortified wine, in which spirits are added to wine) well over 40% vol (e.g. 80% vol in some kinds of (WHO, 2004). absinthe). There is a trend in recent years towards In addition to commercialized products, in higher (13.5–14.5%) alcohol volume in consumed many developing countries different types of wines, associated with technology advances and home- or locally produced alcoholic beverages increasing proportion in overall consumption such as sorghum beer, palm wine or sugarcane of wines produced outside the traditional wine- spirits are consumed (WHO, 2004). Home- growing regions of Europe (IARC, 2010). or locally produced alcoholic beverages are To calculate the amount of ethanol contained produced through fermentation of seed, grains, in a specific drink, the amount (e.g. ml) of 373 IARC MONOGRAPHS – 100E alcoholic beverage consumed for each type of sugars, di- and tribasic carboxylic acids, colouring beverage (e.g. a 330-mL bottle of beer) is multi­ substances, tannic and polyphenolic substances plied by the precentage of alcohol by volume, i.e. and inorganic salts (IARC, 2010). the proportion of the total volume of the beverage Occasionally, toxic additives, that are not that is alcohol (e.g. (330 mL) × (0.04) = 13.2 mL permitted for use in commercial production of ethanol in a bottle of beer). Conversion factors have been identified in alcoholic beverages. These may be used to convert the volume of alcoholic include methanol, diethylene glycol (used as beverage into grams of ethanol, or volumes of sweetener) and chloroacetic acid or its bromine alcohol may be recorded in ‘ounces’. Conversion analogue, sodium azide and salicylic acid, which factors for these different measures WHO,( 2000) are used as fungicides or bactericides (Ough, are as follows: 1987). • 1 mL ethanol = 0.79 g Contaminants may also be present in alco­ • 1 UK oz = 2.84 cL = 28.4 mL = 22.3 g holic beverages. Contaminants are defined as • 1 US fluid oz = 2.96 cL = 29.6 mL = 23.2 g substances that are not intentionally added but are present in alcoholic beverages due to produc­ tion, manufacture, processing, preparation, 1.2 Chemical composition treatment, packing, packaging, transport or The main components of most alcoholic holding, or as a result of environmental contami­ beverages are ethanol and water. Some phys­ nation. Contaminants and toxins found in alco­ ical and chemical characteristics of anhydrous holic beverages are nitrosamines, mycotoxins, ethanol are as follows (O’Neil, 2001): ethyl carbamate, pesticides, thermal processing Chem. Abstr. Services Reg. No.: 64–17.5 contaminants, benzene, and inorganic contami­ nants such as lead, cadmium, arsenic, copper, Formula: C2H5OH Relative molecular mass: 46.07 chromium, inorganic anions, and organometals Synonyms and trade name: Ethanol, ethyl (IARC, 2010). alcohol, ethyl hydroxide, ethyl hydrate, In view of the potential carcinogenicity of absolute alcohol, anhydrous alcohol, dehy­ acetaldehyde and its known toxic properties, drated alcohol recent studies attempted to estimate exposure to Description: Clear, colourless, very mobile, acetaldehyde from alcoholic beverages outside flammable liquid, pleasant odour, burning ethanol metabolism at known levels of alcohol taste exposure. The average exposure to acetaldehyde Melting-point: –114.1 °C as a result of consumption of alcoholic beverages, Boiling-point: 78.5 °C including “unrecorded alcohol,” was estimated 20 at 0.112 mg/kg body weight/day (Lachenmeier Density: d4 0.789 20 et al., 2009a). Levels of acetaldehyde in alcoholic Refractive index: nD 1.361 In addition to ethanol and water, wine, beverages vary from less than 1 g/hl of pure beer and spirits contain volatile and non-vola­ alcohol up to 600 g/hl, and high concentra­ tile compounds. Volatile compounds include tions of acetaldehyde were documented in alco­ aliphatic carbonyl compounds, alcohols, mono­ holic beverages commonly consumed in many carboxylic acids and their esters, nitrogen- and parts of the world, including distilled beverages sulfur-containing compounds, hydrocarbons, from Brazil, the People’s Republic of China, terpenic compounds, and heterocyclic and Guatemala, Mexico, and the Russian Federation, aromatic compounds. Non-volatile extracts as well as calvados and fortified wines and fruit of alcoholic beverages comprise unfermented and marc spirits from Europe (Lachenmeier & 374 Consumption of alcoholic beverages Sohnius, 2008; Linderborg et al., 2008; Kanteres vol100E/100E-06-Table1.2.pdf), the countries et al., 2009; Lachenmeier et al., 2009b). with the highest overall consumption of alcohol per capita among the adult (15+ years) population can be found in the the WHO Regional Office 1.3 Trends in consumption of for European Region (12.2 L of pure alcohol per alcoholic beverages capita), and more specifically in eastern Europe. Volume, pattern and quality of consumed The next highest alcohol consumption is in the alcohol are included in the description of differ­ WHO Region of the Americas (8.7 L of pure ential exposure to alcohol. alcohol per capita). Apart from some countries In a development of the WHO Global Alcohol in Africa and a few countries in other parts of Database, WHO has developed the Global the world, alcohol consumption in the other Information System on Alcohol and Health regions is generally lower. The WHO Eastern (WHO, 2008). In 2008–09, WHO conducted the Mediterranean Region ranks lowest with 0.7 Global Survey on Alcohol and Health, collecting litres of alcohol consumed per adult. Total adult data on alcohol consumption, alcohol-related (15+ years) per capita consumption in litres of harm and policy responses from its Member pure alcohol by region and country is an indi­ States. cator of the alcohol consumption level of the Total adult per capita consumption in litres adult population, irrespective of the number of of pure alcohol is defined as the total amount abstainers (i.e. people who do not drink alcohol) of alcohol consumed per person, taking into in the country. account recorded consumption (i.e. alcoholic Globally, men consume more alcohol than beverages consumed that are recorded in offi­ women. This is reflected in the differences in cial statistics of production, trade or sales) and the number of lifetime abstainers, past year unrecorded consumption (i.e. alcoholic bever­ abstainers and former drinkers (Table 1.2 on-line). ages consumed that are not recorded in official Lifetime abstainers are defined as the proportion statistics and that can come from a variety of of people (15+ years) in a given population who sources such as home- or informally produced have not consumed any alcohol during their life­ alcohol, illegal production and sale, smuggling time, assessed at a given point in time. Past year and cross-border shopping), and subtracting abstainers are people aged 15+ years who did consumption by tourists, if possible. Recorded not consume any alcohol during the past year. A adult per capita consumption is calculated from former drinker is a person who did not consume production, export and import data, or sales data. any alcohol during the past year. Generally, the Unrecorded consumption is computed from percentage of lifetime and past year abstainers is representative surveys, specific empirical inves­ higher in women than in men. The prevalence tigations or expert opinion. The percentage of of lifetime, past-year abstainers, and former lifetime and past-year abstainers provide impor­ drinkers are calculated from large representative tant information about drinking in a population surveys. and complement the indicator on total adult (15+ Table 1.2 (on-line) provides information years) per capita consumption. about the trend (i.e. robust estimate of five-year Overall, there is a wide variation in the change) in per capita consumption (2001–05) of volume of alcohol consumed across countries. recorded alcohol, that is, indicates if consump­ As presented in Table 1.1 and Table 1.2 (available tion remained stable, increased, decreased, or if at http://monographs.iarc.fr/ENG/Monographs/ no conclusion could be drawn.