Symposium 28 Tuesday Sept. 25th 1.30 pm–3.00 pm; Room: Lecture Hall 4
Moderate consumption of alcoholic beverages: is there really a beneficial effect?: Chairpersons: Preedy VR (UK), Fernandez-Solá J (Spain)
 |
Abstract |
|---|
Excessive alcohol ingestion is damaging and may ultimately lead to premature death and disease. It has been argued that there are about 120–200 different alcohol related pathologies in alcohol misusers. However, there is also a substantial body of evidence to suggest that moderate to low consumption of alcohol beverages is beneficial in terms of cardiovascular events and other pathologies such as diabetes. This beneficial effect of alcohol may be due to the influence of life-style factors such as differences in diet. Alternatively, the protective effects of alcoholic beverages may be due to elements in the beverages (such as polyphenolics) or the direct effects of ethanol per se. However, defining the nature and causes of these beneficial effects is problematical for a number of reasons. There is still a paucity of information on the total anti-oxidant capacities in alcoholic beverages and how these relate to non-alcoholic beverages. To a certain extent data pertaining to beer is limited. There is also a lack on information of moderate drinking after a history of excessive alcohol misuse in relation to extra hepatic tissues (such as heart and skeletal muscle). Furthermore, information on the effects of red wine on platelet activity and inflammatory biomarkers is lacking, as are studies on knock out models. Markers of moderate wine consumption are similarly limited. To resolve these issues the organisers have brought together key researcher examining the beneficial effects of alcohol. The symposium is designed not only to impart knowledge, but also encourage debate in a contentious area of alcohol related studies.
Presentation S28-1
Antioxidant capacity of alcoholic beverages: relationships between anti-oxidant assays, wine and beer types, cost and non-alcoholic beverages
Fegredo JA, Wong MCY, Lai AKH, Meynell R, West R, Gum A, Martin C, Wiseman H, Preedy VR (UK)
Aims. Consumption of moderate amounts of alcohol is reported to be beneficial. However, there are two limitations, namely: (I) corresponding information on the anti-oxidant capacity of non-wine beverages is comparatively limited; (II) a variety of anti-oxidant assays have been employed to measure total anti-oxidant capacity (TAC) and inter-assay comparisons are limited.
Methods. We used four different assays to determine the total anti-oxidant capacity (TAC) of wines and beers in relation to other non-alcoholic beverages and compounds, serving size, price, country of origin, colour and beer-type etc.
Results. A number of key findings were generated. For example, in the inter-assay comparisons there were significant positive correlations between the four TAC assays when applied to a selection of beverages, but limitations in the applicability of one assay when applied to beers. In the beverage studies we showed for the first time that accurate measures of colour (such as chroma, as opposed to absorbance measurements with a spectrophotometer) correlated strongly with anti-oxidant capacity of beers; some beers had marked differences in antioxidant capacity (as much as 700 percent difference) compared to other beers; a serving of beer had comparable total antioxidant capacity to that of red wine or orange juice; inexpensive wine had a lower antioxidant capacity than moderately priced wine.
Conclusions. Measures of antioxidant capacity provide a holistic index of the potential benefits of alcoholic and non-alcoholic beverages.
Presentation S28-2
Moderate alcohol consumption allows clinical and functional improvement in alcohol induced skeletal and cardiac damage
Fernandez-Solà J, Estruch R, Sacanella E, Nicolas JM, Urbano-Márquez A (Spain)
Aims. Ethanol consumption exerts a deleterious effect on skeletal and cardiac muscle. This toxic effect is dose dependent and cumulative during lifetime period. This assertion has been clearly demonstrated in clinical and epidemiological studies. Thus, muscle strength and left-ventricle ejection fraction directly decrease according to the lifetime cumulated dose of ethanol consumed by a particular individual. According to this statement, there is a threshold dose where the noxious effect of ethanol appears.
Aim of the study: To corroborate the effect of low-dose alcohol consumption on the induction and reversion of ethanol-induced cardiac and skeletal muscle diseases.
Methods. In different clinical and epidemiological studies, we evaluated alcohol consumption parameters including daily ethanol intake (g), period of consumption (years) and lifetime cumulated dose of alcohol (Kg ethanol per Kg body weight).
Setting. Alcohol Unit of an urban University Hospital.
Measurements: Skeletal muscle function was evaluaded by deltoid myometry in the non-dominant arm. Left ventricular function was evaluated by echocardiograghy considering systolic (LV ejection fraction) and diastolic (E/A index, deceleration time of transmitral flow) function parameters. Individual susceptibility to alcohol induced muscle damage was evaluated by the ACE gene polymorphism (DD/ID/II).
Results. Considering the heart effects, diastolic disfunction has been corroborated to start at 0.1 g/kg/daily dose of ethanol (3–4 weekly drinks), whereas the threshold for systolic LV dysfunction is 9 kg EToH per kg body weight. Similarly, weekly consumption of 5 drinks increases the risk of ventricular arrhythmias and sudden death. When considering the skeletal muscle, the threshold dose to induce chronic alcoholic skeletal myopathy is 10 kg EToH/kg body weight, with a minimum consumption period of 10 years. Thus, low-dose consumption is able to induce skeletal and cardiac muscle damage if we exceed the threshold cumulative dose of ethanol consumption. Of course, we should also consider the factors as gender and genetic susceptivility that clearly increase the risk to develop these diseases. For instance, women are clearly more sensitive to the damaging effects of alcohol than men (RR 1.6 from women compared to men) at a similar lifetime cumulative dose. The presence of ‘DD’ phenotype of ACE gene increases 16 times the risk to develop alcoholic dilated cardiomyopathy. Once alcoholic cardiac or skeletal damage is established, it is clear that abstinence is able to improve follow-up, and partially reverse the functional and structural myocyte damage. However, not all patients ara able to enter into abstinence. Controlled programs have a success rate of lower than 50% at five years. So, on those patients who are not able to get abstinence, it has been proposed to apply controlled drinking at low-dose ethanol to still achieve some benefit. In our experience, controlled drinking up to 60 g/day is able to significantly improve deltoid muscle strength at a five year follow-up, similar to that obtained on the abstainers. Similarly, alcoholic cardiomyopathy clearly improves with abstinence from alcohol. Thus, maintenance on controlled drinking doses allows to significantly improve LEVF at one year, in a similar magnitude to that obtained in abstainers.
Conclusions. Low-dose ethanol is safe to induce alcohol skeletal or cardiac damage if we do not exceed the lifetime threshold dose of ethanol, according to the individual susceptibility. Once instaured, consumption of low-daily dose (up to 60 g/day) may obtain regression of functional involvement in such a similar magnitude as abstinence. Low-dose consumption on a controlled drinking situation should be considered on those chronic alcohol abusers who are not able to achieve complete abstinence.
Presentation S28-3
Scientific evidence of the beneficial effects of moderate alcohol consumption on health
Estruch R, Sacanella E, Vazquez-Agell M, Mena MP, Monagas M, Fernandez-Solä J (Spain)
Aims. Numerous epidemiologic studies have found an association between moderate alcohol consumption and a reduced risk of coronary heart disease and ischemic stroke.
On the other hand, other types of evidence are related to the biologic plausibility of this hypothesis. Since atherosclerosis seems to be an inflammatory disease, the aims of the clinical trials performed were to evaluate the effects of red and white wines compared to those of an alcoholic beverage with low polyphenol content, on inflammatory biomarkers related to atherosclerosis.
Methods. Two randomized, crossover trials studies were performed. In study 1, 20 men consumed 30 g ethanol/day as cava (sparkling wine) or gin over 28 days, after a 15-day washout period. In study 2, 35 women consumed 20 g ethanol/day as white or red wine for 28 days. Serum and urine samples were collected after each 28-day period in both studies. Adhesion molecules involved in lymphocyte and monocyte—endothelium interactions were determined on the cell surface, and adhesions of human monocytes to endothelial cells were also measured in basal and stimulated conditions.
Results. Serum levels of C-reactive protein, intercellular adhesion molecule-1, CD40L, and interleUkin-6 decreased after either alcoholic beverage (P< 0.01; all). However, red wine and cava showed higher anti-inflammatory properties probably due to their polyphenolic content.
Conclusions. Although there is increasing evidence on the beneficial effects of moderate alcohol consumption on the health, without data from large randomized clinical trials, it is unclear how a physician can be in a position to advise his or her patients.
Presentation S28-4
Urinary resveratrol metabolites as a biomarker of moderate wine consumption
Zamora-Ros R, Urpi M, Sarda Rosa M, Lamuela-Raventos Estruch, R, Vazquez-Agell M, Serrano-Martinez M, Jaeger W, Andres-Lacueva C (Spain and USA)
Aims. Background: Nutritional biomarkers may be better measures of dietary exposure than self-reported dietary data. We evaluated resveratrol metabolites, potential biomarkers of wine consumption, in humans after moderate consumption of sparkling, white, or red wines.
Methods. We performed 2 randomized, crossover trials and a cohort study. In the first study, 10 healthy men consumed 30 g of ethanol/day as sparkling wine or gin for 28 days. In the second trial, 10 healthy women consumed 20 g of ethanol/day as white or red wine for 28 days. We also evaluated 52 participants in a study on the effects of a Mediterranean diet on primary prevention of cardiovascular disease (the PREDIMED Study). We used liquid chromatography-tandem mass spectrometry to analyze urinary total resveratrol metabolites (TRMs) and predictive values and ROC curve analyses to assess the diagnostic accuracy.
Results. We observed significant increases in TRMs [72.4 (95% confidence interval, 48.5–96.2; P = 0.005), 211.5 (166.6–256.3; P = 0.005), and 560.5 nmol/g creatinine (244.9–876.1; P = 0.005)] after consumption of sparkling, white, or red wine, respectively, but no changes after the washout or gin periods. In the cohort study, the reported daily dose of wine consumption correlated directly with TRMs (r = 0.654; P < 0.001). Using a cutoff of 90 nmol/g, we were able to use TRMs to differentiate wine consumers from abstainers with a sensitivity of 72% (60%–84%); and a specificity of 94% (87%–100%).
Conclusions. Resveratrol metabolites in urine may be useful biomarkers of wine intake in epidemiologic and intervention studies.