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World J Gastroenterol. Jun 21, 2014; 20(23): 7217-7222
Published online Jun 21, 2014. doi: 10.3748/wjg.v20.i23.7217
Influence of unrecorded alcohol consumption on liver cirrhosis mortality
Dirk W Lachenmeier, Yulia B Monakhova, Jürgen Rehm
Dirk W Lachenmeier, Jürgen Rehm, Epidemiological Research Unit, Institute for Clinical Psychology and Psychotherapy, Technische Universität Dresden, 01187 Dresden, Germany
Dirk W Lachenmeier, Yulia B Monakhova, Chemisches und Veterinäruntersuchungsamt (CVUA) Karlsruhe, 76187 Karlsruhe, Germany
Jürgen Rehm, Centre for Addiction and Mental Health (CAMH), Toronto, ON M5S 2S1, Canada
Jürgen Rehm, Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
Author contributions: Lachenmeier DW wrote the first draft; Monakhova YB conducted the statistical calculations, compiled the figures and revised the draft; Rehm J revised the draft; all authors approved the final version of this paper.
Supported by The Ontario Ministry of Health and Long Term Care to CAMH for the salaries of scientists and infrastructure; The contents of this paper are solely the responsibility of the authors and do not necessarily represent the official views of the Ministry of Health and Long Term Care
Correspondence to: Dirk W Lachenmeier, PhD, Chemisches und Veterinäruntersuchungsamt (CVUA) Karlsruhe, Weissenburger Strasse 3, 76187 Karlsruhe, Germany. lachenmeier@web.de
Telephone: +49-721-9265434 Fax: +49-721-9265539
Received: November 27, 2013
Revised: January 10, 2014
Accepted: March 6, 2014
Published online: June 21, 2014
Abstract

Unrecorded alcohol includes illegally distributed alcohol as well as homemade or surrogate alcohol which is unintended for consumption by humans (e.g., cosmetics containing alcohol). The highest unrecorded alcohol consumption occurs in Eastern Europe and some of these countries have an over proportional liver cirrhosis mortality. Compounds besides ethanol have been hypothesized as being responsible for this observation. On the other hand, chemical investigations were unable to prove that unrecorded alcohol regularly contains contaminants above toxicological thresholds. However, illegally produced spirits regularly contain higher percentages of alcohol (above 45% by volume), but for considerably less costs compared with licit beverages, potentially causing more problematic patterns of drinking. In this review, it is investigated whether patterns of drinking rather than product composition can explain the liver cirrhosis mortality rates. Statistical examination of World Health Organization country data shows that the originally detected correlation of the percentage of unrecorded alcohol consumption and liver cirrhosis mortality rates disappears when the data is adjusted for the prevalence of heavy episodic drinking. It may be concluded that there is currently a lack of data to demonstrate causality between the composition of illicit spirits (e.g., higher levels of certain contaminants in home-produced products) and liver toxicity on a population scale. Exceptions may be cases of poisoning with antiseptic liquids containing compounds such as polyhexamethyleneguanidine, which were reported to be consumed as surrogate alcohol in Russia, leading to an outbreak of acute cholestatic liver injury, histologically different from conventional alcoholic liver disease.

Keywords: Epidemiology, Liver cirrhosis, Alcoholic beverages, Unrecorded alcohol, Risk assessment

Core tip: Various constituents and contaminants of unrecorded alcohol (i.e., illicitly or informally produced alcohol) were implicated as over proportionally causing liver disease. Quantitative risk assessments were not able to corroborate these claims by identifying such contaminants above toxicological levels, however. The higher rates of liver disease can be alternatively explained by more detrimental patterns of drinking in regions with a high prevalence of unrecorded alcohol consumption.