The facts we all should know

FACT #1

Did you know alcohol does not benefit heart health?

No randomised control trial has ever shown alcohol conferring any benefit to the heart. The belief that it does has been firmly refuted by the World Heart Federation. Alcohol can damage heart muscle and it increases blood pressure contributing to heart disease and stroke.

Show me the science

The impact of alcohol on cardiovascular health: Myths and measures, World Heart Federation, January 2022 https://world-heart-federation.org/wp-content/uploads/WHF-Policy-Brief-Alcohol.pdf

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FACT #2

Did you know alcohol is one of the highest-level carcinogens?

Alcohol is a group 1 carcinogen, the same category as tobacco and asbestos as a cancer-causing agent. It causes at least seven types of cancer with the risk increasing in line with alcohol exposure, with heavy drinkers running up to five times the risk of non-drinkers and even low levels of alcohol consumption bring significant risk.

Show me the science

WHO, International Agency for Research on Cancer
https://monographs.iarc.who.int/agents-classified-by-the-iarc/

Cao Y, Willett WC, Rimm EB, Stampfer MJ, Giovannucci EL. Light to moderate intake of alcohol, drinking patterns, and risk of cancer: results from two prospective US cohort studies. BMJ. 2015 Aug 18;351:h4238. doi: 10.1136/bmj.h4238. PMID: 26286216; PMCID: PMC4540790.
https://pubmed.ncbi.nlm.nih.gov/26286216/

Bagnardi V, Rota M, Botteri E, Tramacere I, Islami F, Fedirko V, Scotti L, Jenab M, Turati F, Pasquali E, Pelucchi C, Galeone C, Bellocco R, Negri E, Corrao G, Boffetta P, La Vecchia C. Alcohol consumption and site-specific cancer risk: a comprehensive dose-response meta-analysis. Br J Cancer. 2015 Feb 3;112(3):580-93. doi: 10.1038/bjc.2014.579. Epub 2014 Nov 25. PMID: 25422909; PMCID: PMC4453639.
https://pubmed.ncbi.nlm.nih.gov/25422909/

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FACT #3

Did you know alcohol can cause breast cancer?

Breast cancer is the most frequently diagnosed cancer type in the WHO European Region, with more than 1,500 women diagnosed every day. Alcohol consumption is one of the major modifiable risk factors for the disease, causing seven of every 100 new breast cancer cases in the region. Low-level drinkers run a slightly higher risk of breast cancer, while heavy drinkers have a 60% higher risk.

Show me the science

Alcohol is one of the biggest risk factors for breast cancer, World Health Organization, October 2021
https://www.who.int/europe/news/item/20-10-2021-alcohol-is-one-of-the-biggest-risk-factors-for-breast-cancer

Bagnardi V, Rota M, Botteri E, Tramacere I, Islami F, Fedirko V, Scotti L, Jenab M, Turati F, Pasquali E, Pelucchi C, Galeone C, Bellocco R, Negri E, Corrao G, Boffetta P, La Vecchia C. Alcohol consumption and site-specific cancer risk: a comprehensive dose-response meta-analysis. Br J Cancer. 2015 Feb 3;112(3):580-93. doi: 10.1038/bjc.2014.579. Epub 2014 Nov 25. PMID: 25422909; PMCID: PMC4453639.
https://doi.org/10.1038/bjc.2014.579

Buykx, P., Li, J., Gavens, L. et al. Public awareness of the link between alcohol and cancer in England in 2015: a population-based survey. BMC Public Health 16, 1194 (2016). https://doi.org/10.1186/s12889-016-3855-6
Tamimi Rm, Spiegelman D, Smith-Warner SA, Wang M, Pazaris M et al. Population attributable risk of modifiable and nonmodifiable breast cancer risk factors in postmenopausal breast cancer. Am J Epidemiol. 2016; 184(12):884-93. Available from:
https://doi.org/10.1093/aje/kww145

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FACT #4

Did you know alcohol promoters downplay the cancer risk?

Expert analysis of the communications of 27 alcohol industry organisations showed most misrepresented the evidence on the association between alcohol and cancer, through a combination of denial, omission, distortion or distraction.

Show me the science

Petticrew M, Maani Hessari N, Knai C, Weiderpass E. How alcohol industry organisations mislead the public about alcohol and cancer. Drug Alcohol Rev. 2018 Mar;37(3):293-303. doi: 10.1111/dar.12596. Epub 2017 Sep 7. PMID: 28881410.
https://onlinelibrary.wiley.com/doi/10.1111/dar.12596

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FACT #5

Did you know alcohol worsens common mental health problems?

Alcohol drinking can be both a consequence and a cause of anxiety and depression. The relaxant effect of alcohol wears off quickly and the rebound effect of alcohol withdrawal increases anxiety levels. Alcohol’s effect on mood and on self esteem and relationships typically increases feelings of depression.

Show me the science

Lynn E. Sullivan, David A. Fiellin, Patrick G. O’Connor. The prevalence and impact of alcohol problems in major depression: A systematic review, The American Journal of Medicine, Volume 118, Issue 4, 2005, Pages 330-341,
ISSN 0002-9343.
https://doi.org/10.1016/j.amjmed.2005.01.007

Boden JM, Fergusson DM. Alcohol and depression. Addiction. 2011 May;106(5):906-14. doi: 10.1111/j.1360-0443.2010.03351.x. Epub 2011 Mar 7. PMID: 21382111. https://pubmed.ncbi.nlm.nih.gov/21382111/
Justin J. Anker and Matt G. Kushner. Co-Occurring Alcohol Use Disorder and Anxiety: Bridging the Psychiatric, Psychological, and Neurobiological Perspectives. Alcohol Research, Current Reviews, Volume 40 Issue 130 December 2019. National Institute on Alcohol Abuse and Alcoholism at the National Institutes of Health
https://arcr.niaaa.nih.gov/alcohol-use-disorder-and-co-occurring-mental-health-conditions/co-occurring-alcohol-use-disorder-anxiety
Cosci, F., Schruers, K.R., Abrams, K., & Griez, E.J. (2007). Alcohol use disorders and panic disorder: a review of the evidence of a direct relationship. The Journal of clinical psychiatry, 68 6, 874-80.
https://www.semanticscholar.org/paper/Alcohol-use-disorders-and-panic-disorder%3A-a-review-Cosci-Schruers/108786f783eac96d89d4d7a0fd8ab6b052fdb1e9

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FACT #6

Did you know businesses profits from risky drinking?

The financial interest of alcohol businesses conflicts with reducing risky and heavier drinking, because higher levels of drinking contribute the bulk of their income. In England, for example, those drinking above low risk drinking guideline levels are estimated to account for 68% of total alcohol sales revenue.

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Casswell S, Callinan S, Chaiyasong S, Cuong PV, Kazantseva E, Bayandorj T, Huckle T, Parker K, Railton R, Wall M. How the alcohol industry relies on harmful use of alcohol and works to protect its profits. Drug Alcohol Rev. 2016 Nov;35(6):661-664. doi: 10.1111/dar.12460. Epub 2016 Oct 27. PMID: 27785844.
https://onlinelibrary.wiley.com/doi/abs/10.1111/dar.12460

Bhattacharya A, Angus C, Pryce R, Holmes J, Brennan A, Meier PS. How dependent is the alcohol industry on heavy drinking in England? Addiction. 2018 Dec;113(12):2225-2232. doi: 10.1111/add.14386. Epub 2018 Aug 22. PMID: 30136436.
https://pubmed.ncbi.nlm.nih.gov/30136436/

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FACT #7

Did you know alcohol advertisers spend billions?

Alcohol companies spend billions on marketing—often at a level much higher than other products. This is designed to recruit children and lucrative heavier drinkers through sports sponsorship, film and TV placement, social media influencers as well as traditional media and online advertising.

Show me the science

“Alcohol adspend to beat market with 5.3% growth in 2021 as hospitality opens up”, press release, Zenith Media, May 2021
https://www.zenithmedia.com/alcohol-adspend-to-beat-market-with-5-3-growth-in-2021-as-hospitality-opens-up/

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FACT #8

Why should vital health information be on label?

Research shows the most effective place for consumer information is on label, making it the only way to respect consumers’ right to know. Any requirement to look online, such as with a QR code,  is a barrier to obtaining information.

Show me the science

Werle, C. O. C., Nohlen, H. U., Pantazi, M., Literature review on means of food information provision other than packaging labels, Publications Office of the European Union, Luxembourg, 2022. https://publications.jrc.ec.europa.eu/repository/handle/JRC128410

Li, T., & Messer, K. D. (2019). To Scan or Not to Scan : The Question of Consumer Behaviour and QR Codes on Food Packages. Journal of Agricultural and Resource Economics, 44(2), 311-327. https://doi.org/10.22004/ag.econ.287977

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FACT #9

Did you know alcohol tax and price policies curb harm?

Alcohol pricing policies and taxation are among the most effective and cost-effective measures to reduce alcohol consumption and harms–but most countries of the WHO European Region still do not use these valuable tools to their full potential. An estimated 10,700 new cancer cases and 4,850 alcohol-related cancer deaths could be avoided annually in the WHO European Region by doubling current excise duties on alcoholic beverages.

Show me the science

No place for cheap alcohol: the potential value of minimum pricing for protecting lives. World Health Organization. Regional Office for Europe, 20 June 2022
https://www.who.int/europe/publications/i/item/9789289058094

Kilian C, Rovira P, Neufeld M, et al. Modelling the impact of increased alcohol taxation on alcohol-attributable cancers in the WHO European Region. The Lancet Regional health. Europe. 2021 Dec;11:100225. DOI: 10.1016/j.lanepe.2021.100225. PMID: 34918000; PMCID: PMC8642705
https://www.thelancet.com/journals/lanepe/article/PIIS2666-7762(21)00210-6/fulltext

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FACT #10

Do you know the health risks of alcohol?

Drinking alcohol can harm your health in many ways, with some risks increasing even with small amounts. Short-term health risks include injuries and alcohol poisoning. In the long-term, it may cause health problems such as cancer, liver disease, high blood pressure, stroke, heart and gastrointestinal problems, as well as mental health issues and poor sleep.

Show me the science

Standing Committee of European Doctors

Health Service Executive, Ireland https://askaboutalcohol.ie/

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FACT #11

Did you know Europe has the highest alcohol consumption in the world?

Europe has the highest level of alcohol consumption in the world, which, together with ultra-processed food consumption and high prevalence of obesity, are the major drivers of liver-related morbidity and mortality. The evidence linking liver-related mortality and population-level alcohol consumption sends a crucial message for disease prevention: alcohol-related cirrhosis is a dose-related condition at the population level, and the most effectual and cost-effective means to reduce mortality rates from alcohol-related liver disease are interventions that reduce population-level alcohol consumption. Models of alcohol-associated liver related illness, including liver cancer (hepatocellular cancer or HCC) and death, may underestimate the incidence of alcohol-association because of under-reporting.

Show me the science

European Association for the Study of the Liver, citing

Tom H Karlsen et al. The EASL–Lancet Liver Commission: protecting the next generation of Europeans against liver disease complications and premature mortality. The Lancet 2022; Vol 399 (January 1): 65-116
https://www.thelancet.com/article/S0140-6736(21)01701-3/fulltext

Daniel Q Huang et al. Global epidemiology of alcohol-associated cirrhosis and HCC trends, projections, and risk factors. Gastroenterology and Hepatology Review; 1-4
https://www.nature.com/articles/s41575-022-00688-6

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FACT #12

Did you know reducing population alcohol consumption would reduce liver disease mortality?

Europe has the highest levels of alcohol consumption per person, the highest prevalence of heavy episodic drinking, and the lowest rates of abstention from alcohol in the world. The evidence linking liver-related mortality and population-level alcohol consumption sends a crucial message for disease prevention: alcohol-related cirrhosis is a dose-related condition at the population level, and the most effectual and cost-effective means to reduce mortality rates from alcohol-related liver disease are interventions that reduce population-level alcohol consumption.

Show me the science

European Association for the Study of the Liver, citation 

Tom H Karlsen et al. The EASL–Lancet Liver Commission: protecting the next generation of Europeans against liver disease complications and premature mortality. The Lancet 2022; Vol 399 (January 1): 65-116
https://www.thelancet.com/article/S0140-6736(21)01701-3/fulltext

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FACT #13

Do you know the best way to reduce alcohol harm in your community?

Limiting the availability of alcohol by reducing the number of outlets and trading hours is one of the most effective strategies to reduce the health and social harm caused by alcohol. This is why licensing restrictions play a critical role in reducing alcohol harm.

Show me the science

Dr Łukasz Wieczorek, The relationship between economic and physical availability of alcohol and the amount of alcohol consumption, and other problems resulting from drinking alcohol – a literature review, Institute of Psychiatry and Neurology, Department of Research on Alcoholism and Toxicomania, Warsaw University
https://www.ograniczdostepnosc.pl/materialy/zwiazek-miedzy-dostepnoscia-ekonomiczna-i-fizyczna-alkoholu-i-wielkoscia-spozycia-oraz-innymi-problemami-wynikajacymi-z-picia-alkoholu-przeglad-literatury
)

Allamani, A., Voller, F., Decarli, A., Casotto, V., Pantzer, K., Anderson, P., Gual, A., Matrai, S., Elekes, Z., Eisenbach-Stangl, I., Schmied, G., Knibbe, R. A., Nordlund, S., Skjælaaen, Ø., Olsson, B., Cisneros Örnberg, J., Österberg, E., Karlsson, T., Plant, M., Plant, M., … Gmel, G. (2011). Contextual determinants of alcohol consumption changes and preventive alcohol policies: a 12-country European study in progress. Substance use & misuse, 46(10), 1288–1303.
https://doi.org/10.3109/10826084.2011.572942

Babor, T., Caetano, R., Casswell, S., Edwards, G., Giesbrecht, N., Graham, K., Grube, J., Hill, L., Holder, H., Homel, R., Livingston, M., Österberg, E., Rehm, J., Room, R., & Rossow, I. (2010). Alcohol: No Ordinary Commodity: Research and Public Policy. : Oxford University Press. Retrieved 19 Nov. 2020, from
https://oxford.universitypressscholarship.com/view/10.1093/acprof:oso/9780199551149.001.0001/acprof-9780199551149

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FACT #14

Did you know that there is no safe level of alcohol consumption during pregnancy?

There is no safe amount of alcohol during pregnancy. Alcohol consumed at any stage of pregnancy can influence the development of the unborn child.

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Wozniak JR, Riley EP, Charness ME. Clinical presentation, diagnosis, and management of fetal alcohol spectrum disorder. Lancet Neurol. 2019 Aug;18(8):760-770. doi: 10.1016/S1474-4422(19)30150-4. Epub 2019 May 31. PMID: 31160204; PMCID: PMC6995665.
https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(19)30150-4/fulltext

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FACT #15

Did you know there is no EU requirement to warn consumers of alcohol’s cancer risks?

Alcohol is a group 1 carcinogenic agent, the highest level of carcinogenicity, but few realise it. Nearly 80% of people surveyed in Ireland were unaware of the link between alcohol and breast cancer. The introduction of health warning labels would improve the health literacy of the population on the inherent risks from alcohol use and ensure they have accurate health information to inform their decisions about alcohol use. This would support citizens’ right to know about the effects of alcohol on their health and wellbeing.

Show me the science

WHO, International Agency for Research on Cancer
https://monographs.iarc.who.int/agents-classified-by-the-iarc/

Healthy Ireland Survey 2021, Department of Health, Ireland, ecember 2021
https://www.gov.ie/en/publication/9ef45-the-healthy-ireland-survey-2021/

Praud, D., Rota, M., Rehm, J., Shield, K., Zatoński, W., Hashibe, M., La Vecchia, C. and Boffetta, P., (2016). Cancer incidence and mortality attributable to alcohol consumption. International journal of cancer, 138(6), pp.1380-1387
https://onlinelibrary.wiley.com/doi/full/10.1002/ijc.29890

Connor, J., 2017. Alcohol consumption as a cause of cancer. Addiction, 112(2), pp.222-228
https://onlinelibrary.wiley.com/doi/abs/10.1111/add.13477

Pimpin, L., Cortez-Pinto, H., Negro, F., Corbould, E., Lazarus, J.V., Webber, L., Sheron, N. and EASL HEPAHEALTH Steering Committee, 2018. Burden of liver disease in Europe: epidemiology and analysis of risk factors to identify prevention policies. Journal of hepatology, 69(3), pp.718-735.
https://pubmed.ncbi.nlm.nih.gov/29777749/

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FACT #16

Did you know the energy content of 1g of alcohol is 7.1 Kcal?

Alcohol can cause weight gain in four ways: It stops your body from burning fat, it is high in kilojoules, it can make you feel hungry, and it can lead to poor food choices. Studies show that close to 10% of an adult’s energy intake comes from alcohol in the UK. Information about the energy content (calories/kJ) on the labels of alcoholic beverages can therefore be justified in terms of consumer rights. One gram of alcohol is 1.3ml.

Show me the science

Alcohol and obesity: A systematic review scoping study, Foundation for Alcohol Research and Education, February 1, 2013
https://fare.org.au/alcohol-and-obesity-a-systematic-review-scoping-study/

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FACT #17

Did you know alcohol is the drug most often linked to sexual violence?

Despite the attention paid to drugs like GHB or burundanga, alcohol is the most commonly consumed drug in situations of sexual violence in nightlife and party environments. Alcohol acts as an enhancer and facilitator of structural gender inequality which mainly affects women and gender-diverse people.

Show me the science

Plaza, L., Ferrer, R. & Vale Pires, C. (2022). Sexism Free Night – Research Report. Sexism Free Night European Project.
http://www.sexismfreenight.eu

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FACT #18

Did you know that alcohol can harm your unborn baby?

Alcohol crosses the placental barrier affecting normal foetal development, causing damage to the brain and to the growth of vital organs. A baby whose mother has consumed alcohol during pregnancy can be born with Foetal Alcohol Spectrum Disorder and suffer serious cognitive, motor, psychological problems.

Show me the science

CDC. Centers for Disease Control and Prevention. Foetal Alcohol Spectrum Disorders (FASDs)
https://www.cdc.gov/ncbddd/fasd/facts.html

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FACT #19

Did you know alcohol is a causal factor in more than 200 disease and injury conditions?

Drinking alcohol is associated with a risk of developing health problems such as mental and behavioural disorders, including alcohol dependence, and major noncommunicable diseases such as liver cirrhosis, some cancers, and cardiovascular diseases.

Show me the science

World Health Organisation, Alcohol fact sheet
https://www.who.int/news-room/fact-sheets/detail/alcohol

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FACT #20

Do you know the ten policy options to reduce the harmful use of alcohol?

The WHO global strategy gives policy options and interventions for action at the national level focusing on ten action areas:

  • Leadership, awareness and commitment
  • Health services’ response
  • Community action
  • Drink-driving policies and countermeasures
  • Availability of alcohol
  • Marketing of alcoholic beverages
  • Pricing policies
  • Reducing the negative consequences of drinking and alcohol intoxication
  • Reducing the public health impact of illicit alcohol and informally produced alcohol
  • Monitoring and surveillance

 

Show me the science

Ten areas governments could work with to reduce the harmful use of alcohol
https://www.who.int/news-room/feature-stories/detail/10-areas-for-national-action-on-alcohol

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FACT #21

Did you know that 30% of deaths from gastrointestinal diseases are directly attributable to alcohol?

Alcohol consumption, in particular, is a risk factor in 200 disease and injury conditions, with nearly 30% of deaths from gastrointestinal diseases directly attributed to alcohol. The European region has the world’s highest proportion of total ill health and premature death linked directly to alcohol consumption.

Show me the science

– UEG. Alcohol and Digestive Cancers Across Europe: Time for Change (2017):
https://ueg.eu/files/352/371bce7dc83817b7893bcdeed13799b5.pdf

– World Health Organisation. 2014. Global status report on alcohol and health 2014. Available at:
https://apps.who.int/iris/bitstream/handle/10665/112736/9789240692763_eng.pdf;jsessionid=E166515EF9677642EEEA37BCE1F079B7?sequence=1

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FACT #22

Did you know that even one alcoholic drink a day increases the risk of oesophageal cancer?

The risk of developing cancer rises exponentially with the amount of alcohol consumed. Studies assessing dose-response alcohol consumption and site-specific cancer risk reveals, regardless of the type of beverage, even light drinking of up to one alcoholic drink a day increases the risk of oesophageal cancer.

Show me the science

UEG. Alcohol and Digestive Cancers Across Europe: Time for Change (2017)
https://ueg.eu/files/352/371bce7dc83817b7893bcdeed13799b5.pdf

Bagnardi V, Rota M, Botteri E, Tramacere I, Islami F, Fedirko V, Scotti L, Jenab M, Turati F, Pasquali E, Pelucchi C, Galeone C, Bellocco R, Negri E, Corrao G, Boffetta P, La Vecchia C. Alcohol consumption and site-specific cancer risk: a comprehensive dose-response meta-analysis. Br J Cancer. 2015 Feb 3;112(3):580-93. doi: 10.1038/bjc.2014.579. Epub 2014 Nov 25. PMID: 25422909; PMCID: PMC4453639
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4453639/

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FACT #23

Did you know that there is an increased colorectal cancer risk even with moderate alcohol consumption?

The International Agency for Research on Cancer (IARC) added colorectal cancer to the list of cancers causally related to alcohol in 2007. Meta-analysis examining the association between alcohol consumption and colorectal cancer risk shows there is an increased risk of 21% in those who consume between one and four alcoholic drinks a day and as much as a 52% increased risk in those who consume more than four drinks a day.

Show me the science

– UEG. Alcohol and Digestive Cancers Across Europe: Time for Change (2017)
https://ueg.eu/files/352/371bce7dc83817b7893bcdeed13799b5.pdf

Baan R, Straif K, Grosse Y, Secretan B, El Ghissassi F, Bouvard V, Altieri A, Cogliano V; WHO International Agency for Research on Cancer Monograph Working Group. Carcinogenicity of alcoholic beverages. Lancet Oncol. 2007 Apr;8(4):292-3. doi: 10.1016/s1470-2045(07)70099-2. PMID: 17431955
https://pubmed.ncbi.nlm.nih.gov/17431955/

Fedirko V, Tramacere I, Bagnardi V, Rota M, Scotti L, Islami F, Negri E, Straif K, Romieu I, La Vecchia C, Boffetta P, Jenab M. Alcohol drinking and colorectal cancer risk: an overall and dose-response meta-analysis of published studies. Ann Oncol. 2011 Sep;22(9):1958-1972. doi: 10.1093/annonc/mdq653. Epub 2011 Feb 9. PMID: 21307158
https://pubmed.ncbi.nlm.nih.gov/21307158/

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FACT #24

Did you know that alcohol is the most common cause of pancreatitis in Europe?

Alcohol is the most common cause of acute and chronic pancreatitis in Eastern, Northern and Western Europe. The biological mechanisms accounting for how alcohol intake may cause pancreatitis are still unclear and require further research. Chronic pancreatitis harbors an increased risk of pancreatic cancer. Pancreatitis leads to a huge socio-economic burden for societies around the globe.

Show me the science

Stephen E.Roberts et al, Pancreatology. 2017. The incidence and aetiology of acute pancreatitis across Europe
https://www.sciencedirect.com/science/article/abs/pii/S1424390317300170?via%3Dihub

– UEG. Alcohol and Digestive Cancers Across Europe: Time for Change (2017)
https://ueg.eu/files/352/371bce7dc83817b7893bcdeed13799b5.pdf

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FACT #25

Did you know changes to alcohol habits during covid will lead to thousands more deaths?

Recent studies conducted in England suggest changes in alcohol consumption during the pandemic are likely to lead to thousands of additional cases, premature deaths and hospital admissions for conditions such as liver cirrhosis, colon and rectum cancer, liver cancer and oesophageal cancer, with the largest increases in harm expected in the most disadvantaged communities.

Show me the science

Rose, TC, Pennington, A, Kypridemos, C, Chen, T, Subhani, M, Hanefeld, J, et al. Analysis of the burden and economic impact of digestive diseases and investigation of research gaps and priorities in the field of digestive health in the European Region—White Book 2: executive summary. United European Gastroenterol J. 2022; 10( 7): 659– 64. https://doi.org/10.1002/ueg2.12298

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FACT #26

Did you know people with lower socioeconomic status are disproportionately affected by alcohol-related harms?

The risk factors for digestive disorders, including alcohol consumption, are socially patterned within most countries, meaning that exposure to these risks and the harm caused by them is to a large extent determined by an individual’s socioeconomic position. Systematic differences in lifestyles between social groups are shaped by structural factors, with those in lower socioeconomic positions having less access to resources and opportunities to achieve healthy lifestyles. Nonetheless behavioural risk factors are still sometimes portrayed as freely chosen–a narrative popular among tobacco, food and alcohol industries which profit from shifting corporate responsibility onto individuals. The introduction of evidence-based alcohol policies in Scotland was a likely contributor to a fall in alcohol related mortality, particularly among the lowest income groups, so health inequality narrowed.

Show me the science

Rose, TC, Pennington, A, Kypridemos, C, Chen, T, Subhani, M, Hanefeld, J, et al. Analysis of the burden and economic impact of digestive diseases and investigation of research gaps and priorities in the field of digestive health in the European Region—White Book 2: executive summary. United European Gastroenterol J. 2022; 10( 7): 659– 64.
https://doi.org/10.1002/ueg2.12298

Monitoring and Evaluating Scotland’s Alcohol Strategy, Monitoring Report 2022, p17
https://www.publichealthscotland.scot/media/13693/mesas-2022_english_jun2022.pdf

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FACT #27

Did you know that stigma attached to alcohol-related liver disease has far reaching harmful consequences?

Stigma is a public health, medical, and ethical issue, being a consequence of health inequities as well as a key driver in perpetuating them. People with, or at risk of developing, liver disease frequently belong to highly stigmatised groups. This is particularly the case when it results from alcohol use. Stigma has a major impact on liver diseases in Europe, leading to discrimination, reduction in healthcare seeking behaviour, and reduced allocation of resources, which all result in poor clinical outcomes. This, ultimately, can worsen social inequalities by negatively affecting employment, social relationships, and educational opportunities.

Show me the science

The EASL-Lancet Commission. 2021. Protecting the next generation of Europeans against liver disease complications and premature mortality.
https://www.thelancet.com/commissions/liver-disease-europe

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FACT #28

Did you know liver disease deaths are largely determined by population alcohol consumption?

Cultural and historical changes in alcohol consumption patterns have a large impact on liver mortality, with a four-fold reduction in France and Italy seen in a period of decreased consumption of cheap wine. Marked increases in liver mortality have also been associated with modest increases in overall alcohol consumption, as seen in the UK with the move to drinking stronger alcohol at home. Effective policies to reduce alcohol consumption may reduce liver mortality quickly, as patients with alcohol-related liver disease usually die from acute-on-chronic liver failure driven by recent excessive alcohol consumption.

Show me the science

Burton R, Henn C, Lavoie D, et al. A rapid evidence review of the effectiveness and cost-effectiveness of alcohol control policies: an English perspective. Lancet 2017; 389: 1558–80.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)32420-5/fulltext

WHO. European action plan to reduce the harmful use of alcohol 2012–2020. 2012.
https://www.euro.who.int/__data/assets/pdf_file/0008/178163/E96726.pdf

Organisation for Economic Co-operation and Development. Preventing harmful alcohol use. May 19, 2021.
https://doi.org/10.1787/6e4b4ffb-en 

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FACT #29

Did you know alcohol-related liver disease is prevantable?

It has been well demonstrated that several alcohol-related policies are both effective and cost-effective. These policies include price-based policies, such as taxation and minimum unit pricing, as well as restricting alcohol availability, marketing and advertising. Policies based on age-related vulnerability, such as restrictions on alcohol access for young people, are also effective.

Show me the science

Burton R, Henn C, Lavoie D, et al. A rapid evidence review of the effectiveness and cost-effectiveness of alcohol control policies: an English perspective. Lancet 2017; 389: 1558–80.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)32420-5/fulltext

Organisation for Economic Co-operation and Development. Preventing harmful alcohol use. May 19, 2021.
https://doi.org/10.1787/6e4b4ffb-en

Karlsen TH, Sheron N, Zelber-Sagi S, et al. The EASL–Lancet Liver Commission: protecting the next generation of Europeans against liver disease complications and premature mortality. The Lancet 2021; published online Dec 2.
https://www.thelancet.com/article/S0140-6736(21)01701-3/fulltext

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FACT #30

Did you know the relationship between alcohol intake and cirrhosis is exponential?

Alcohol-related harm correlates with the volume and pattern of drinking, with epidemiological studies showing an exponential dose-response relationship between alcohol and liver disease. For most countries in the WHO European region, there is a strong correlation between liver-related mortality rates and population-level alcohol consumption.

Show me the science

Rehm J, Taylor B, Mohapatra S, et al. Alcohol as a risk factor for liver cirrhosis: a systematic review and meta-analysis. Drug Alcohol Rev 2010; 29: 437–45.
https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1465-3362.2009.00153.x

Ndugga N, Lightbourne TG, Javaherian K, et al. Disparities between research attention and burden in liver diseases: implications on uneven advances in pharmacological therapies in Europe and the USA. BMJ Open 2017.
https://bmjopen.bmj.com/content/7/3/e013620

Karlsen TH, Sheron N, Zelber-Sagi S, et al. The EASL–Lancet Liver Commission: protecting the next generation of Europeans against liver disease complications and premature mortality. The Lancet 2021.
https://www.thelancet.com/article/S0140-6736(21)01701-3/fulltext

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FACT #31

Are you aware Europe has the highest alcohol consumption in the world?

Europe has the highest levels of alcohol consumption per person, the highest prevalence of heavy episodic drinking, and the lowest rates of abstention from alcohol in the world. The most effective way to reduce mortality rates from alcohol-related liver disease, which is a dose-related condition, are interventions which reduce population-level alcohol consumption.

Show me the science

Moodie R, Stuckler D, Monteiro C, et al. Profits and pandemics: prevention of harmful effects of tobacco, alcohol, and ultraprocessed food and drink industries. Lancet 2013; 381: 670–79.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)62089-3/fulltext

WHO. Global status report on alcohol and health 2018. September 2018.
https://www.who.int/publications/i/ item/9789241565639

Karlsen TH, Sheron N, Zelber-Sagi S, et al. The EASL–Lancet Liver Commission: protecting the next generation of Europeans against liver disease complications and premature mortality. The Lancet 2021.
https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(21)01701-3.pdf

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FACT #32

Did you know minimum unit pricing for alcohol reduces health inequalities and mortality?

Within the WHO European region, there is an inverse relation between the price of alcohol and liver-related mortality rates, supporting the health benefits of harmonising alcohol taxes at a higher level. Various types of price regulation and taxation strategies have been shown to be effective and cost-effective, and the social policy experiment of minimum unit pricing in Scotland reinforces its effectiveness, especially in terms of reducing health inequalities. The evidence in favour of minimum unit pricing is robust and comes from several sources.

Show me the science

Pimpin L, Cortez-Pinto H, Negro F, et al. Burden of liver disease in Europe: epidemiology and analysis of risk factors to identify prevention policies. J Hepatol 2018; 69: 718–35.

Burton R, Henn C, Lavoie D, et al. A rapid evidence review of the effectiveness and cost-effectiveness of alcohol control policies: an English perspective. Lancet 2017; 389: 1558–80.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)32420-5/fulltext

Stockwell T, Zhao J, Giesbrecht N, Macdonald S, Thomas G, Wettlaufer A. The raising of minimum alcohol prices in Saskatchewan, Canada: impacts on consumption and implications for public health. Am J Public Health 2012; 102: e103–10.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3519328/

Stockwell T, Zhao J, Martin G, et al. Minimum alcohol prices and outlet densities in British Columbia, Canada: estimated impacts on alcohol-attributable hospital admissions. Am J Public Health 201103: 2014–20.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3828694/

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