Influence of unrecorded alcohol consumption on liver cirrhosis mortality

Table 1 Compounds potentially associated with toxicity in unrecorded alcohol

Compounds in unrecorded alcohol	Occurrence	Toxic effect	Risk assessment
Ethanol	Main components of every alcoholic beverage; often found in higher strength in unrecorded alcohols	Several acute and chronic health effects including liver cirrhosis	Major risk factor of unrecorded alcohol on a population scale
Methanol	Minor constituent in all alcoholic beverages, higher in some fruit spirits; acute toxic concentrations due to adulteration	Poisoning at high concentrations	Extremely high risk for consumers of highly contaminated products; poisoning outbreaks are uncommon but cause high morbidity/mortality
Higher alcohols (e.g., propanol, butanol)	Minor constituents in all alcoholic beverages, higher concentrations in certain fruit spirits	Similar to ethanol	Lack of causality with effects of unrecorded alcohol (exposure below thresholds)
Acetaldehyde	Minor constituents in all alcoholic beverages, higher concentrations in certain fruit spirits	Carcinogenicity	Could constitute higher chronic risk if contained at higher levels, but epidemiological evidence is missing
Ethyl carbamate	High levels in stone fruit spirits	No human data. Hepatocellular tumors in rodents	See acetaldehyde
Diethyl phthalate	Denatured alcohols	Developmental effects, hepatotoxicity in animals	See acetaldehyde
Coumarin	Flavoring in cosmetic alcohol	Hepatotoxicity in animals	See acetaldehyde
Polyhexamethyleneguanidine	Antiseptic liquids in Russia	Potentially causing cholestatic hepatitis in humans	Unclear causality, but observational studies suggest a plausible risk