**2.4.2 Alcohol use**

WHO has estimated that alcohol consumption causes 3.5% of global deaths (6.2% among males, and 1.1% among females) (WHO, 2011f), and it is responsible for 4.5% of DALYs (WHO, 2011f).

The link between alcohol intake and cancer is well documented. There is a positive correlation between oral, pharyngeal, laryngeal, esophageal, liver, colorectal (in men) (WCRF & AICR, 2007; WHO, 2009a, 2011f; Testino & Borro, 2010; Baan et al., 2007) and breast cancer and intake of more than 30 g of alcohol/day (3 standard drinks/day) (Allen et al., 2009; Boyle & Boffetta, 2009). Heavy drinking may correlate with higher risk of lung and pancreatic cancer, but the epidemiological evidence supporting this hypothesis is weak (WCRF & AICR, 2007; WHO, 2011f; Testino & Borro, 2010).

Heavy drinking is defined as intake of more than 80 g of alcohol per day, or more than 5 to 6 standard drinks per day (Pöschl & Seitz, 2004).

More than 30 codes of ICD-10 include the term "alcohol" in their name or definition, documenting the importance of alcohol-related health impairment (WHO, 1999).

Health effects of alcohol vary depending on the age, gender and other characteristics of consumers, but they also depend on the setting and context of drinking (Pöschl & Seitz, 2004).

International Agency for Cancer Research has stated that "acetaldehyde associated with alcoholic beverages is carcinogenic to humans (Group 1)" and confirmed the Group 1 classification of alcohol consumption and of ethanol in alcoholic beverages (Secretan et al., 2009).

Acetaldehyde is the first and the most toxic metabolite of alcohol metabolism. Alcohol dehydrogenase [ADH] oxidizes alcohol to acetaldehyde, which is then converted to acetate by aldehyde dehydrogenase [ALDH]. Ethanol also inhibits DNA methylation and interacts with retinoid metabolism. Tissue-specific levels of ethanol are in correlation with the amount of alcohol ingested, but they also depend on the genotype coding for ethanolmetabolizing enzymes, predominantly ALDH (Seitz & Stickel, 2007; Boffeta & Hashibe, 2006; Seitz & Becker, 2007).

Effects of acetaldehyde, elevated estrogen levels, production of oxygen radicals and changes in folate and vitamin B6 metabolism, may be mechanisms responsible for the genotoxicity of alcohol (Seitz & Stickel, 2007; Boffeta & Hashibe, 2006; Seitz & Becker, 2007).

Persons with achlorhydric gastritis who consume alcohol are at greater risk of stomach cancer. Absence of hydrochloric acid creates an environment favorable for thriving of ADHcontaining bacteria that can metabolize carbohydrates to ethanol and acetaldehyde (Seitz & Becker, 2007).

choices. Being aware of the health risks related to tobacco use is not merely enough – motivational campaigns should be designed in order to cut down smoking prevalence by 8.0 to 10.0% per year, and achieve the resulting prevalence of less than 10.0% in all social

WHO has estimated that alcohol consumption causes 3.5% of global deaths (6.2% among males, and 1.1% among females) (WHO, 2011f), and it is responsible for 4.5% of DALYs

The link between alcohol intake and cancer is well documented. There is a positive correlation between oral, pharyngeal, laryngeal, esophageal, liver, colorectal (in men) (WCRF & AICR, 2007; WHO, 2009a, 2011f; Testino & Borro, 2010; Baan et al., 2007) and breast cancer and intake of more than 30 g of alcohol/day (3 standard drinks/day) (Allen et al., 2009; Boyle & Boffetta, 2009). Heavy drinking may correlate with higher risk of lung and pancreatic cancer, but the epidemiological evidence supporting this hypothesis is weak

Heavy drinking is defined as intake of more than 80 g of alcohol per day, or more than 5 to 6

More than 30 codes of ICD-10 include the term "alcohol" in their name or definition,

Health effects of alcohol vary depending on the age, gender and other characteristics of consumers, but they also depend on the setting and context of drinking (Pöschl & Seitz,

International Agency for Cancer Research has stated that "acetaldehyde associated with alcoholic beverages is carcinogenic to humans (Group 1)" and confirmed the Group 1 classification of alcohol consumption and of ethanol in alcoholic beverages (Secretan et al.,

Acetaldehyde is the first and the most toxic metabolite of alcohol metabolism. Alcohol dehydrogenase [ADH] oxidizes alcohol to acetaldehyde, which is then converted to acetate by aldehyde dehydrogenase [ALDH]. Ethanol also inhibits DNA methylation and interacts with retinoid metabolism. Tissue-specific levels of ethanol are in correlation with the amount of alcohol ingested, but they also depend on the genotype coding for ethanolmetabolizing enzymes, predominantly ALDH (Seitz & Stickel, 2007; Boffeta & Hashibe,

Effects of acetaldehyde, elevated estrogen levels, production of oxygen radicals and changes in folate and vitamin B6 metabolism, may be mechanisms responsible for the genotoxicity of

Persons with achlorhydric gastritis who consume alcohol are at greater risk of stomach cancer. Absence of hydrochloric acid creates an environment favorable for thriving of ADHcontaining bacteria that can metabolize carbohydrates to ethanol and acetaldehyde (Seitz &

alcohol (Seitz & Stickel, 2007; Boffeta & Hashibe, 2006; Seitz & Becker, 2007).

documenting the importance of alcohol-related health impairment (WHO, 1999).

(WCRF & AICR, 2007; WHO, 2011f; Testino & Borro, 2010).

standard drinks per day (Pöschl & Seitz, 2004).

groups (Yach et al., 2005).

**2.4.2 Alcohol use** 

(WHO, 2011f).

2004).

2009).

2006; Seitz & Becker, 2007).

Becker, 2007).

The WHO Global Strategy to Reduce the Harmful Use of Alcohol (WHO, 2010b) aims to raise awareness of health, social and economic aspects of alcohol abuse, and the relationship between alcohol and disease development. It points to the importance of effective stakeholders involvement in preventing harmful effects of alcohol. It also aims to provide support for national efforts to reduce the overall effects of alcohol abuse.

USDA recommendations for alcohol intake not linked to increase of cancer risks are 28 g of alcohol per day for healthy adult men, and half of that amount for healthy women (USDA & U.S. Department of Health and Human Services, 2011). The European Code Against Cancer recommends up to 20 or 30 g/day of alcohol for healthy men and, again, half of that amount for healthy women (Boyle et al., 2003). AICR made recommendations simple by advising 2 standard drinks for healthy men and 1 standard drink for healthy women (WCRF & AICR, 2007).

Tobacco and alcohol use are major risk factors for malignancies of different localizations, but mainly of the gastrointestinal tract (Testino & Borro, 2010; Pelucchi et al., 2008; Seitz & Cho, 2009) and the two also act in synergy increasing the cancer risk. Tobacco smoking combined with alcohol use increase the tissue levels of acetaldehyde, while alcohol helps in activation of different procarcinogens in tobacco smoke by induction of cytochrome-P450-2E1 dependent microsomal biotransformation system in mucose cells of the upper digestive tract and liver (IARC, 2004; Testino and Borro, 2010; Seitz & Cho, 2009). Pancreatic cancer risk is 4.3-fold higher in people who smoke more than 20 cigarettes per day and drink more than 21 standard drinks per week, than in non-smoking people who drink less than 7 standard drinks per week (Talamini et al., 2010).
