The need to protect young people

Peter Anderson MD, MPH, PhD, FRCPProfessor, Alcohol and Health, Maastricht University NetherlandsVisiting Professor, Alcohol and Health, Newcastle University, England

Brussels, 17 March 2011

1. A point about alcohol 2. Why alcohol matters to young people 3. But, what about us?4. Alcohol’s impact on health5. And, what does this all mean

1. A point about alcohol 2. Why alcohol matters to young people 3. But, what about us?4. Alcohol’s impact on health5. And, what does this all mean

WHO: Disability adjusted life year (DALY)

Measures a combination of ill-health (adjusted for the severity of ill-health) or premature death).

It measures a gap between how healthy we are and how healthy we could be

WHO: Top 10 risk factors for DALYs (world)

1. A point about alcohol 2. Why alcohol matters to young people 3. But, what about us?4. Alcohol’s impact on health5. And, what does this all mean

1. Brain function 2. Problems in later life3. Death

1. Brain function 2. Problems in later life3. Death

As we know, adolescents are vulnerable to the effects of alcohol

Let, us look at the example of the hippocampus, a structure of the forebrain

involved in memory and spatial navigation

In fact, taxi drivers in London have increased hippocampal size

Source: DeBellis et al 2000

alcohol use disorders in adolescence and volume of the hippocampus

Source: DeBellis et al 2000

alcohol use disorders in adolescence lead to reduced volume of the hippocampus

10% reduction

1. Brain function 2. Problems in later life3. Death

Prevalence of past-year alcohol and substance use disorders (AUDs and SUDs), by minimum legal drinking age (MLDA) exposure in US.

Source: Norberg et al 2009

1. Brain function 2. Problems in later life3. Death

Male alcohol-related deaths by age group, England

1. A point about alcohol 2. Why alcohol matters to young people 3. But, what about us?4. Alcohol’s impact on health5. And, what does this all mean

WHO: Top 10 risk factors for DALYs (age group 25-59 years)

Female alcohol-related deaths by age group, England

1. A point about alcohol 2. Why alcohol matters to young people 3. But, what about us?4. Alcohol’s impact on health5. And, what does this all mean

1. Alcohol as an intoxicant 2. Alcohol as a teratogen3. Alcohol as a carcinogen4. Heart attacks and strokes5. How much do you need to drink to die

1. Alcohol as an intoxicant 2. Alcohol as a teratogen3. Alcohol as a carcinogen4. Heart attacks and strokes5. How much do you need to drink to die

The risk of a non-motor vehicle accident injury related to the amount of alcohol consumed during the last 3 hours.

Source: Taylor et al, 2009

The risk of a motor vehicle accident injury related to the amount of alcohol consumed during the last 3 hours.

1. Alcohol as an intoxicant 2. Alcohol as a teratogen3. Alcohol as a carcinogen4. Heart attacks and strokes5. How much do you need to drink to die

1. Alcohol as an intoxicant 2. Alcohol as a teratogen3. Alcohol as a carcinogen4. Heart attacks and strokes5. How much do you need to drink to die

Overall evaluationAlcoholic beverages are carcinogenic to humansEthanol in alcoholic beverages is carcinogenic to humans

As a carcinogen, alcohol increases the risk of cancers of the oral cavity and pharynx, oesophagus, stomach, colon, rectum, liver and female breast in a linear dose–response relationship

Risk of female breast cancer by alcohol consumption

Source: Allen et al, 2009

1. Alcohol as an intoxicant 2. Alcohol as a teratogen3. Alcohol as a carcinogen4. Heart attacks and strokes5. How much do you need to drink to die

The more you drink, the greater the risk of:

Hypertension Arial fibrillation Haemorrhagic stroke

Relation with cardiovascular disease

There is a J-shaped-relationship between alcohol and:

Ischaemic heart disease Ischaemic stroke

Compared with abstainers, light drinkers have reduced risk; beyond the bottom of the the risk increases with a dose-response relationship

Relation with cardiovascular disease

J

In young people, alcohol increases the risk of ischaemic events

In old people, the protection tapers off with age

Relation with cardiovascular disease

For the middle aged, the protective effect

Is no different between exclusively beer or wine drinkers

Disappears the more the abstaining comparison group includes ex-drinkers

Disappears when light drinkers report at least one heavy drinking occasion per month

Relation with cardiovascular disease

Most of the protective effect can be achieved by a consumption of 5g alcohol (half a drink) a day

More protection can be achieved by engaging in other healthier behaviours (e.g., healthy diet, more physical activity)

Relation with cardiovascular disease

1. Alcohol as an intoxicant 2. Alcohol as a teratogen3. Alcohol as a carcinogen4. Heart attacks and strokes5. How much do you need to drink to die

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10.012.014.016.0

10 20 30 40 50 60 70 80

Life

time

risk

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coho

l-re

late

d de

ath

(1/1

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Grams alcohol per day or per week

Men dailyWomen dailyMen weeklyWomen weekly

Lifetime risk of dying from alcohol-related death by gram alcohol/day or /week for Australian men and women.

Source: National Health and Medical Research Council, Australia, 2009

1. A point about alcohol 2. Why alcohol matters to young people 3. But, what about us?4. Alcohol’s impact on health5. And, what does this all mean

Alcohol damages the adolescent brain?

Did you know:

25% of male and 15% of female adolescent deaths are due to alcohol?

Did you know:

Amongst us, alcohol is the top cause of ill-health and premature death?

Did you know:

That alcohol in pregnancy increases the risk of early childhood acute myeloid leukaemia nearly three-fold?

Did you know:

That alcohol produces cancer in at least 8 major organs?

Did you know:

Drinking a bottle of wine a day means a 10% chance that your death is due to alcohol?

Did you know:

Shouldn’t we use every opportunity to inform them?

I do not think people know these facts

Shouldn’t we use every opportunity to warn people about this?

Alcohol produces cancer