Margin of Exposure Analyses and Overall Toxic Effects of Alcohol with Special Consideration of Carcinogenicity.

Alex O Okaru,Dirk W Lachenmeier

doi:10.3390/nu13113785

Abstract

Quantitative assessments of the health risk of the constituents of alcoholic beverages including ethanol are reported in the literature, generally with hepatotoxic effects considered as the endpoint. Risk assessment studies on minor compounds such as mycotoxins, metals, and other contaminants are also available on carcinogenicity as the endpoint. This review seeks to highlight population cancer risks due to alcohol consumption using the margin of exposure methodology. The individual and cumulative health risk contribution of each component in alcoholic beverages is highlighted. Overall, the results obtained consistently show that the ethanol contributes the bulk of harmful effects of alcoholic beverages, while all other compounds only contribute in a minor fashion (less than 1% compared to ethanol). Our data provide compelling evidence that policy should be focused on reducing total alcohol intake (recorded and unrecorded), while measures on other compounds should be only secondary to this goal.

Highlights

The epidemiological association of alcoholic beverages with cancer remains a topic that has continued to attract global attention for over a century with the first documented cases, cancer of the esophagus, being reported in 1910 [1,2]
Other International Agency for Research on Cancer (IARC)-classified carcinogenic compounds such as acetaldehyde, formaldehyde, acrylamide, aflatoxins, ochratoxin A, arsenic, lead, cadmium, ethyl carbamate, furan, safrole, 4-methylimidazole, N-nitrosodimethylamine (NDMA), 3-Monochloropropane-1,2-diol (3-MCPD), and benzene have occurred in alcoholic beverages
This review identifies ethanol as the main oncogenic component in alcoholic beverages and lays emphasis on the need for policy geared towards the reduction in drinking per se and not target on other minor carcinogens that may require strict implementation of industry best practices, i.e., as low as reasonably achievable (ALARA) guidelines and good manufacturing practices

Summary

Introduction

The epidemiological association of alcoholic beverages with cancer remains a topic that has continued to attract global attention for over a century with the first documented cases, cancer of the esophagus, being reported in 1910 [1,2]. The principal component of alcoholic beverages, is classified as a human carcinogen (group 1) by IARC. Other IARC-classified carcinogenic compounds such as acetaldehyde, formaldehyde, acrylamide, aflatoxins, ochratoxin A, arsenic, lead, cadmium, ethyl carbamate, furan, safrole, 4-methylimidazole, N-nitrosodimethylamine (NDMA), 3-Monochloropropane-1,2-diol (3-MCPD), and benzene have occurred in alcoholic beverages. The contribution of these compounds to cancer is either synergistic or independent of each other. This review identifies ethanol as the main oncogenic component in alcoholic beverages and lays emphasis on the need for policy geared towards the reduction in drinking per se and not target on other minor carcinogens that may require strict implementation of industry best practices, i.e., as low as reasonably achievable (ALARA) guidelines and good manufacturing practices

The Margin of Exposure Method and Its Application to Alcoholic Beverages

Occurrence of Carcinogenic Compounds in Alcoholic Beverages

Comparative Risk Assessment of Compounds in Alcoholic Beverages

Overall Toxic Effects of Alcoholic Beverages

Findings

Conclusions