There has been a lot of speculation about a potential connection between moderation, diet and lifestyle and this conference for the first time brought together new concrete evidence starting to support this theory. Most importantly, new data on alcohol and health demonstrates that these emerging research trends are based on results from both observational studies and those looking at the possible biological and cellular mechanisms behind the reported positive health effects.

The conference was chaired and organised by Dr Frederico Leighton, from the Universidad Catolica de Chile and brought together over 35 specialists from diverse fields such as chemistry, medicine, epidemiology, psychology, and sociology. Dr. Leighton explained that researchers are in the middle of the task to identify biological facts behind the observed benefits from moderation and that this data is crucial for the current theories about moderation and health to be sustained. Therefore, conference presentations evaluated the biological effects of alcohol and wine phenolics looking at several physiological scenarios including lipid metabolism, hemostasis and vascular physiology.Experts reaffirmed that light consumption of wine, beer and spirits can protect some people from certain diseases and that ethanol, phenolics and perhaps other compounds in alcohol beverages regulate physiological functions in ways that more clearly reveal why moderate consumption may lead to disease prevention.

Research on the Alcohol, Diet and Lifestyle Connection

Staying within the " wine and health" theme of the conference, most of the presentations offered wine-specific research perspectives with intriguing conclusions related to overall lifestyle and dietary interactions and the integral role of alcohol and phenolics.

Several experts suggested that the unique health effects reported for wine might be due to the "healthy lifestyle profile" of the wine consumer. Dr Arthur Klatsky from the Kaiser Permanente Medical Care Program explained, "Light — moderate drinking is probably not related to increased risk of any cardiovascular condition and is consistently related to lower risk of coronary heart disease and ischemic stroke." He further added, "International comparisons and some prospective studies suggest that wine is more protective against coronary heart disease than liquor and beer. Reports of possible non-alcohol beneficial components in wine (especially red) support the hypothesis of extra protection by wine, but a healthier pattern of drinking or more favorable risk traits in wine consumers may also be involved."

Similar messages were presented by Dr. Morton Gronbaek from The Copenhagen City Heart Study who stated, "In the Danish Diet Cancer and Health Study, preference of wine was associated with a higher intake of fruits, fish, vegetables, salad and a higher frequency of use of olive oil for cooking compared with preference of beer and spirits in both men and women." He and others point out that these favorable lifestyle factors have to be considered. Gronbaek, however, also emphasizes, "…Substances in wine are responsible for a beneficial effect on the outcome, in addition to that from light intake of ethanol."

Dr Serge Renaud from INSERM in France stressed that in France studies on middle-aged men "…only wine at moderate intake, was associated with a protective effect on all cause mortality." He explains that "the reason was that in addition to the known effect on cardiovascular diseases, a very moderate intake of wine protected also from cancer and other causes …" In addition, new data from the Lyon Heart Study has found that moderate consumption of wine when combined with a Mediterranean rather than a typical Western diet may prevent a second heart attack. However, Dr Joel de Leiris has cautioned that " further studies are required to confirm the data " and that it needs to be examined whether " the relations found are due to ethanol or to other wine ingredients."

In fact, wine and healthy lifestyle related conclusions were presented not only by scientists from the US, France and Denmark but also from South Africa and Chile, revealing that moderate wine consumption combined with balanced nutrition or a healthy diet may be a missing link in why wine consumers are at lower risk for certain common diseases. For example, the University of Santiago Chile is currently conducting one of the most comprehensive research to date on wine and the Mediterranean Diet and finds, "In conclusion, moderate wine consumption and fruits and vegetables favorably modify cardiovascular risk factors. Red wine provides additional benefits probably due to its antioxidant properties…." Experiments from South Africa by Dr David van Velden and colleagues revealed " important antithrombotic effects detectable after six weeks on a Mediterranean-like diet were further enhanced by moderate wine consumption."

In other words, there is important research evidence emerging that is starting to demonstrate the possible link between diet, nutrition and wine, as well as the possible biological and cellular mechanisms by which alcohol and phenols may exert their beneficial effects. In summary, this research indirectly reveals that when wine, beer and spirits are consumed as part of a healthy diet and lifestyle, the positive effects are most pronounced.

Emerging Research on the Unique Effects of Ethanol and Polyphenols

Dr Andrew Waterhouse from the University of California at Davis outlined how research on wine phenols was one of the most intensively studied and he stated, "The observed mechanisms of action are strengthening the case that wine and other foods rich in phenols can in fact reduce chronic diseases such as heart disease and perhaps even cancer." Following his introduction to the subject area, scientists from many parts of the world presented their unique findings revealing how ethanol and phenols may influence certain disease preventing mechanisms..

Dr Francoise Booyse from the University of Alabama at Birmingham discussed research results that show how the cardiovascular protection of moderate consumption of alcohol or red wine "may be mediated in part, by a combination of diverse altered vascular, cellular and biological functions including an increase in fibrinolysis."

Results from Israel by Dr Michael Aviram shows that wine phenols "substantially decrease LDL oxidation and aggregation." From Argentina, Dr Alberto Boveris concluded, "red wine and other flavonoid rich foods provide antioxidants that effectively prevent postprandial oxidative stress in the vascular space." Research from Chile by Dr. Frederico Leighton and colleagues showed that a "Mediterranean diet characterized by high consumption of vegetables, fish, olive oil as the primary source of fat and moderate consumption of wine, may have a positive effect on endothelial function."

Dr Fulvio Ursini from the University of Padova stressed, "Wine, taken with food, minimizes the post- prandial rise of plasma lipid hydro peroxides and abolishes the post_ pandrial increase of LDL oxidability." Dr Giovanni de Gaetano from Italy concluded that "ethanol itself has potential positive effects and that wine may give additional benefits due to its greater antioxidant and anti-inflammatory effects." Along those lines, Dr. Yuji Naito from Japan suggested,"These anti- inflammatory properties of red wine extracts suggest that red wine may have potential benefits in arteriosclerosis."

Relating it all back to the Mediterranean Diet, Dr. Pierre Louis Teissedre from France presented findings on how various foodstuffs contributed to antioxidant flavonoids in the blood and concluded, " Among these vegetal foodstuffs, red wine appears to be the most effective in producing this effect in a sample of free- living population in the south of France."

Investigators agreed that these and other findings are beginning to clarify the diverse mechanisms by which wine phenols, ethanol and alcohol beverages in general may contribute to the observed favorable health outcomes.

Research Challenges and the Importance of Sensible Drinking Advise

The scientific community is in agreement that forthcoming research is essential in identifying further specifics on why and how moderate wine,beer and spirits consumption effect favourable health outcomes in diverse populations.

Furthermore, it was emphasized that drinking is not recommended for everyone as there may be potential risks associated for certain individuals even with moderation. The subject of women’s health and alcohol was specifically discussed. Dr. Curtis Ellison from the Boston University School of Public Medicine explained, " The only common cancer often reported to be related to moderate alcohol consumption is breast cancer in women, and studies have shown a slight increase (about 6%) with consumption as low as one drink per day." Dr Ellison added that many dietary and lifestyle factors relate to breast cancer and he elaborated on recent findings that have shown that low intake or low serum levels of folate or other vitamins have been shown to increase the risk of cancer from alcohol consumption. He concluded, " (1) with the possible exception of breast cancer, moderate drinkers are not at increased risk of cancer, (2) laboratory studies suggest that wine and/ or its polyphenols may have a role in protecting against cancer, and (3) research in the future should focus on genetic, dietary, and other factors that modify the relation of alcohol to cancer." Dr. Ellison also reiterated the importance of moderation as part of an overall healthy diet and lifestyle.

In summary, experts emphasized that public advice should always stress moderate wine, beer and spirits consumption, not for any health advantages, but rather as an adjunct to an enjoyable meal. Social issues related presentations highlighted that these overall conclusions in many respects coincide with the moderation guidelines given by several countries around the world. Specifically, guidelines from the US, Australia and Canada were reviewed. which clearly caution about abuse and highlight moderation as the only option for those healthy adults who choose to drink . Furthermore, most Guidelines do not encourage non-drinkers to start drinking or current drinkers to increase their daily consumption and identify individuals or population groups that should not drink at all such as young adults.. As the debate on both health and social issues-related questions with respect to moderation continues, participating experts also stressed that physicians should provide individualized advice which is in line with several of the public policy messages from around the world.

This excellent conference identified the research milestones of the last decade and the future research needs that will help to clarify remaining questions with respect to moderate consumption of wine, beer and spirits and how they can be an important adjunct to a healthy lifestyle.

Not all the excellent presentations by the participating experts could be outlined in this summary. However, the presentations will be published into scientific proceedings in the Spring and in the meantime further specifics can be viewed at www.vinsalud2002.com.