Risks Large Number of Somatic Diseases

At the other end of the range of intake, the ascending leg has been explained by the increased risk of cirrhosis and development of certain types of cancers with a high alcohol intake. The mechanisms by which alcohol induces cirrhosis have been intensively studied but sparsely enlightened. It is well documented that women, most likely due to smaller size and different distribution of body fat and water, are at higher risk of developing cirrhosis than men, but other risk factors for alcoholic cirrhosis are not well established (Figure 2).

Alcohol consumption, drinks/wk

Figure 2 Relative risk of alcohol-induced cirrhosis according to sex and alcohol intake. Relative risk is set at 1.00 among nondrinkers (<1 drink/week). (Reproduced with permission from Becker U et al. (1996) Prediction of risk of liver disease in relation to alcohol intake, sex and age: A prospective population study. Hepatology 23: 1025-1029.)

Alcohol consumption, drinks/wk

Figure 2 Relative risk of alcohol-induced cirrhosis according to sex and alcohol intake. Relative risk is set at 1.00 among nondrinkers (<1 drink/week). (Reproduced with permission from Becker U et al. (1996) Prediction of risk of liver disease in relation to alcohol intake, sex and age: A prospective population study. Hepatology 23: 1025-1029.)

The types of cancer related to a high alcohol intake are those in direct contact with the alcohol; those of the oropharynx and oesophagus and those related to cirrhosis (liver cancer). There is a strong dose-dependent increase in risk of upper digestive tract cancer with increasing alcohol intake. Heavy drinkers of alcohol (5-10 drinks per day) have a 1015 times higher risk of these relatively rare cancers. Of larger public health relevance are the more frequent cancers—breast and colorectal cancer, which have both been suggested to be related to alcohol. Hence, the risk of breast cancer is doubled for heavy drinking women compared to that for nondrinking women. It is controversial whether a small, frequent daily intake implies an increased risk, although meta-analyses have suggested a 7-9% increased risk per drink per day. Also, the risk of colon cancer is increased among heavy drinkers. The relative risk is twice as high for heavy drinkers compared to nondrinkers, but it is very likely that only colorectal cancer risk is increased, and newer studies have suggested that the risk is mainly increased among beer drinkers. Although not directly related to somatic diseases, other more frequent causes of death among heavy alcohol drinkers, such as traffic accidents, violence, and suicides, substantially add to the ascending leg of the J-shaped curve.

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