Alcohol intake and markers of inflammation

Hugo Kesteloot*

Department of Epidemiology, School of Public Health, K.U. Leuven, Kapucijnenvoer 33, 3000 Leuven, Belgium

* Correspondence to: Prof. Hugo Kesteloot, Department of Epidemiology, School of Public Health, K.U. Leuven, Kapucijnenvoer 33, 3000 Leuven, Belgium. Tel.: +32 16336894; fax: +32 16336884 (E-mail: hugo.kesteloot{at}med.kuleuven.ac.be).

This editorial refers to "Overall alcohol intake, beer, wine, and systemic markers of inflammation in western Europe: results from three MONICA samples (Augsburg, Glasgow, Lille)"{dagger} by A. Imhof et al. on page 2092

Alcohol has gradually evolved from a universal villain to a potentially beneficial agent, which can be protective against cardiovascular disease when used in moderation. It should be remembered, however, that alcohol abuse is still a major public health and social problem of which the consequences go far beyond the subjects directly involved. The work of Ancel Keys has shown that the Mediterranean diet has many beneficial aspects and that the Mediterranean populations have a long life expectancy.1 This diet is characterised by a high intake of olive oil, fruit and vegetables, fish, and a low intake of saturated fat and meat. The diet also contains a consequential amount of wine, especially red wine. Part of the beneficial effects of the Mediterranean diet has been attributed specifically to the intake of wine. Whether the type of alcohol intake, wine, beer or spirits and the potential differences between red and white wine, or whether only the total amount of alcohol independent of the medium is of importance for the benefit, has been the subject of many studies, without a definitive conclusion.2

Wine contains many different polyphenols with anti-oxidant properties and reasonable but variable amounts of potassium and alcohol, which increases HDL-cholesterol. However, it should be noted that Albania, the poorest country of Europe, has a lower mortality than Denmark, the country with the highest income within the European Union and Albania being a Muslim country, presumably has a low intake of alcohol.3 The Mediterranean countries also have a high sex ratio (M/F) of mortality from all causes, a fact which remains unexplained.4

Systemic markers of inflammation have been associated with a higher prevalence of cardiovascular disease. In this issue of the Journal, 5 Imhof et al. reports the relationship between alcohol intake and the type of alcohol, with these markers: CRP, fibrinogen, albumin, lipids and white blood cell counts. The conclusion of this study is that the moderate intake of alcohol (<40 g/d) has a beneficial effect on these markers. The effects are more marked for men compared to women and wine is marginally better than beer. The study confirms several earlier findings: heavy drinkers (>80 g/d) are heavy smokers, are less educated and have no difference in BMI with non-drinkers. The authors cite several limitations of their study. I would add some more: no difference is made between red and white wine; no interaction terms for sex have been introduced in their multivariate analysis; in view of the imprecision of the data the regression dilution bias should be considered; no dietary data are provided which could act as confounders. The study also shows the difficulties encountered in multi-centre studies. Even in a study as important and interesting as MONICA, the recording of the level of alcohol intake was not sufficiently standardized. An adequate standardization of all parameters is the ultimate challenge in such studies. The paper remains, however, of considerable value in view of the current interest in the importance of systemic markers of inflammation in cardiovascular medicine. However, atherosclerosis remains primarily a metabolic disease of nutritional origin while inflammation has the potential to accelerate progression. More studies on the problem are warranted.

Footnotes

{dagger} doi:10.1016/j.ehj.2004.09.032. Back

References

  1. Keys A, editors. Coronary heart disease in seven countries. Circulation 1970;41(suppl 1):1–8.
  2. Sasaki S, Kesteloot H. Wine and non-wine alcohol: differential effect on all-cause and cause-specific mortality Nutr Metab Cardiovasc 1994;4:177-182.[ISI]
  3. Kesteloot H. All-cause and cardiovascular mortality worldwide: lessons from geopathology J Cardiol 2001;37:1-14.[ISI]
  4. Kesteloot H. Is the Mediterranean diet especially beneficial for women? On the sex ratio of mortality Acta Cardiol 2002;57:247-248.[ISI][Medline]
  5. Imhof A, Woodward M, Doering A, et al. Overall alcohol intake, beer, wine, and systemic markers of inflammation in Western Europe: results from three MONICA samples (Augsburg, Glasgow, Lille) Eur Heart J 2004;25:2092-2100.[CrossRef][Medline]

Related articles in EHJ:

Overall alcohol intake, beer, wine, and systemic markers of inflammation in western Europe: results from three MONICA samples (Augsburg, Glasgow, Lille)
A. Imhof, M. Woodward, A. Doering, N. Helbecque, H. Loewel, P. Amouyel, G.D.O. Lowe, and W. Koenig
EHJ 2004 25: 2092-2100. [Abstract] [Full Text]  




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