Beverage Specific Effect of Alcohol on Pancreatitis Mortality in Russia

(ProQuest: . denotes formulae omitted.)INTRODUCTIONPancreatitis is a major public health problem with high associated economic costs.1 The incidence of pancreatitis has increased in many European countries in recent decades.2'' Increase of acute pancreatitis over time was greater in the younger age group which probably represents an increase in alcoholic pancreatitis, as acute pancreatitis among young people is more commonly alcohol related.4 The incidence of acute pancreatitis varies considerably throughout the region and tended to be highest in Scandinavia and Eastern Europe.3,5 The reasons for geographic differences in incidence of pancreatitis are still poorly understood and are most likely due to the differences in risk factors, including alcohol consumption.5 Since an association between alcohol abuse and pancreatitis was reported by Friedreich,6 many studies have confirmed that excessive alcohol consumption is a major risk factor for both acute and chronic pancreatitis. 1,7-9 The strong support for a close link between alcohol and pancreatitis comes from the individual level studies.4,10 Using dada on 17905 men and women who participated in the Copenhagen City Heart Study Kristiansen et al. reported that a high alcohol intake is associated with a high risk of pancreatitis. " Hazard ratios associated with drinking 1-6, 7-13, 14-20,21-34, 35-48, and >48 drinks/week were 1.1, 1.2, 1.3, 1.3, 2.6, 3.0 respectively, compared with 0 drinks/week. A recent systematic review and meta-analysis of epidemiologic studies on alcohol consumption and pancreatitis published between 1980 and 2008 reported a monotonic and approximately exponential dose-response relationship between average volume of alcohol consumption and the risk of pancreatitis.12 The risk curve between alcohol consumption and pancreatitis was relatively flat at low levels of alcohol consumption and increased markedly with increasing levels of consumption. Individuals consuming 36 grams of alcohol daily, had a relative risk of 1.2 (95%; CI: 1.2-1.3), compared with non-drinkers. Whereas those with a daily alcohol intake of 96 grams, had a four-fold increased risk of pancreatitis (RR=4.2; CI: 3.1-5.7), relative to non-drinkers. This study also provided evidence supporting the existence of a threshold effect (about 4 drinks daily) between alcohol consumption and the risk of pancreatitis 12. Collectively, these findings suggest that the total amount of alcohol consumed is a critical factor in producing chronic alcohol-induced pancreatic damage.There is, however, evidence that pattern of drinking and beverage preference may have a modifying influence on pancreatitis risk independently of the amount of alcohol consumed. A follow-up study from Sweden revealed a dose-response association between the amount of spirits consumed on a single occasion and the risk of acute pancreatitis.13 After multivariate adjustments, there was a 52% (95%; CI: 1.1- 2.1 ) in- creased risk of acute pancreatitis for every increment of five standard drinks of spirits consumed on a single occasion. Similarly, Nakamura et al. reported that higher risk for chronic pancreatitis in alcohol-dependent men was associated with drinking spirits rather than lower-alcohol beverages.14 In contrast, Gerloft et al. found that beer dose-dependently increases basal amylase secretion of rat pancreatic acinal cells, while wine and hard liquor had no effect on amylase secretion neither diluted to the ethanol concentration of beer nor undiluted.15 It seems that the risk of alcohol-induced pancreatitis differ by beverage type, in such manner, that particularly spirits, but also beer consumption has stronger effects than does wine drinking.The level of alcohol consumption in Russia is among the highest in the world with an annual sales rate about 10 liters of pure alcohol per capita, while independent estimates show a figure as high as 17 litres.1617 The distinctive trait of Russian drinking culture is a high overall level of alcohol consumption and the heavy episodic (binge) drinking pattern of strong spirits (vodka), leading to an increase in deaths from alcohol poisoning and cardiovascular diseases. …