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• W2608024824 abstract "As a dimension of exposure, alcohol quality (better termed ‘alcohol composition') is currently considered only for liver cirrhosis. However, in relation to methanol admixture, it may be an important factor in causing mortality and morbidity, especially in unrecorded surrogate alcohols. Rehm et al. 1 provide the first systematic review of alcohol consumption and health outcomes attributable to alcohol that considers ‘quality of alcohol’ as one of the dimensions of exposure. There appears to be some limited evidence, based mainly on experimental data or in-vitro studies 2-5, that compounds such as so-called higher alcohols (i.e. propanol, butanol, etc.) have exacerbated effects on end-points such as liver disease or immunotoxicity compared to ethanol. These studies have confirmed experimental research in animals from 1896 (‘Richardson's law’) that alcohol toxicity increases with chain length 6 (see also review in 7). Toxicological data 7, 8 also corroborate the conclusion by Rehm et al. 1 that there is insufficient evidence to link a sizable portion of liver cirrhosis mortality to unrecorded alcohol. In addition, there is no evidence to link liver cirrhosis mortality to the quality of recorded alcohol (which may also regularly contain higher alcohols or other contaminants with potential effects on the liver such as ethyl carbamate). Ethanol itself is the major health risk in recorded and unrecorded alcoholic beverages 9. Further to these findings, one additional important factor of alcohol quality needs to be considered; namely, methanol. Methanol has not been considered systematically in the burden of disease of alcoholic beverages. For example, it is unclear if the ICD-10 alcohol quality-related subcategories of T51 (e.g. T51.1 methanol or T51.2 propanol) (compare Table 1 in Rehm et al. 1) are all subsumed under the ‘toxic effect of alcohol’. In some countries, such as India or Russia, acute methanol poisonings due to unrecorded alcohol consumption could potentially add to the burden of disease. For example, according to a statement of Russia's Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing, a growing number of methanol poisoning cases has been reported in the past few years, with approximately 1200 cases recorded annually (which is approximately 34% of all alcohol-related poisoning cases) 10. This statistic does not even include the recent large-scale methanol poisoning outbreak in Irkutsk in December 2016, which led to 77 fatalities 11. Similar instances have been reported regularly all over the world (see review in 12). The epidemiological and toxicological evidence appears to be sufficient to assume that methanol in unrecorded alcohol is linked causally to mortality and morbidity. It is, however, a common misconception that methanol contamination in ranges toxic to the consumer are caused by negligent behaviour in small-scale artisanal alcohol fermentation or distillation. During yeast fermentation, only very low amounts of methanol are formed and higher amounts occur only when pectin-containing fruits are used 7. Small-scale distillation cannot separate methanol from ethanol due to the similarity in boiling points 12. However, studies of artisanal alcohol produced in worst-case conditions confirm that methanol is present in levels that do not raise concern 13-15. The aforementioned methanol poisoning outbreaks were always linked to admixture or substitution with chemically pure methanol from other sources (see e.g. 16). Ethanol ingestion is an intentional behaviour and the risk (at least for the informed consumers) is known to the consumer and probably accepted to a certain degree 17. However, for alcoholic beverage composition-related risks (i.e. risks not due to ethanol), consumers are not aware of the risk and would probably tolerate much less risk—if any at all (e.g. similar to consumers' demands for zero contaminants in drinking water). Hence we need to improve the methodology for measuring the risks related to alcohol composition independent of the risks due to ethanol, which requires advanced methodologies for cumulative risk assessment. Of course, strictly speaking, it is debatable whether methanol intoxication has anything to do with ‘alcohol quality’. While alcohol quality is a somewhat vague term in general 18, higher quality typically implies ‘better taste’ or perhaps a better purification or absence of off-flavours and contaminants. We suggest that the term ‘alcohol composition’ rather than ‘alcohol quality’ is used as a novel dimension in future comparative risk assessment efforts. Most of the above risks could also be avoided completely if alcohol composition policies were enforced (such as the methanol prohibition in alcohol-containing products that actually exists in Russia and most parts of the world). Evidence-based alcohol policy approaches in countries with consumption of surrogate alcohol need to include measures mitigating methanol poisoning 19, including strict enforcement of regulations for medicinal, cosmetic and industrial alcohol. None." @default.
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• W2608024824 date "2017-04-26" @default.
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• W2608024824 title "Commentary on Rehm <i>et al</i> . (2017): Composition of alcoholic beverages—an under‐researched dimension in the global comparative risk assessment" @default.
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• W2608024824 doi "https://doi.org/10.1111/add.13790" @default.
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