The Scandinavian Medical Alcohol Board(SMAB) hosted the conference in Stockholm on October 30th 1998 at which some of the leading scientists in the field of alcohol and health discussed important issues about alcohol and womens' health.

• Prof.A.W.Jones,Sweden opened the debate by asking if the female body is more sensitive to alcohol than the male body? Women tend to be smaller than men, and they have more fatty tissue per kg body weight than men: drink-for-drink this increases the exposure of organs and tissue to alcohol. Furthermore, with a body weight of 65kg a male has 38.9L body water while a female has 31L.; alcohol, therefore, is more concentrated in the body fluids of women consuming the same number of drinks as a male. Men also have a more efficient metabolism of alcohol than women due to a higher gastric alcohol dehydrogenase activity, so women will have a higher blood alcohol content from the same dose. Finally a swifter rate of hepatic clearance of alcohol will expose the female body to a higher concentration of acetaldehyde, the toxic metabolite of alcohol. The sum of these physiological factors makes women more sensitive to alcohol than men. protected from coronary heart disease(CHD) as much, or more than men, with relative risks versus non-drinkers of 0.3-0.8.In the Framlingham study CHD mortality over 24 years for non-smokers drinking one unit per day was 1.9% versus 5.5% for non-drinkers. Prof. Ellison then reported that data for stroke is more limited, but for women drinking in moderation there seems to be protection against thromboembolic stroke( the most common stroke in the West and US) but an increased risk for hemorrhagic stroke. Prof. Ellison, in a ten year study, is finding that from age 55 to 75, women who average one unit a day live longer than non-drinkers, even when at a low risk of CHD and at a high risk of breast cancer.
• Dr Luc Letenneur, France, presented his findings on alcohol and dementia. His team studied 3.675 initially non-demented elderly subjects over 8 years. 2,913 participated in the follow up in which subjects were divided between non-drinkers (reference group), mild drinkers (1-2 units per day), moderate drinkers (3-4 units daily) and heavy drinkers. During the 8 year period, there were 278 cases of dementia including 198 cases of Alzheimer's disease. Moderate cosumption of wine was associated with a significantly lower risk of dementia.
• Prof Calle Bengtsson, Sweden discussed alcohol and diabetes. In the prospective population study of women in Gothenburg, which began in 1968/69 the incidence of diabetes was lowest in women who drank at least weekly and highest in abstainers. Fasting serum insulin concentration at baseline was statistically lower in women drinking weekly, suggesting that moderate consumption has a favourable effect on insulin metabolism in women, and may have a protective effect with respect to diabetes.
• Prof. Klaus Jung, Germany, covered the conflicting evidence associating alcohol with weight gain.One theory is that even modest consumption results in weight increase, whereas the opposing opinion is that additional alcohol calories result in effective weight reduction. Alcohol is associated with the induction of the MEOS (microsomal ethanol oxidising system), the increased sympathic tonicity and the associated thermal genesis, as well as an increased ATP breakdown. Prof Jung concluded that alcohol taken moderately at mealtimes is unlikely to influence weight gain.
• Adj. Prof. Judith Gavaler, US has been studying whether moderate alcohol intake reacts with oestrogen replacement therapy (ERT) to alter the levels of oestradiol achieved and thus the response to therapy. In clinical practice, ERT is used to alleviate menopausal symptons and to protect against osteoporosis and CHD. The dose of ERT is frequently titrated on the basis of symptom relief, however, levels of oestradiol are rarely monitored. Prof Gavaler evaluated hormone levels and response rates in a diverse sample of 170 postmenopausal women being treated with conjugated equine oestrogens (CEE). Based on the Ansbacher criterion,anadequate response was defined as an oestradiol level of >45pg/ml. In the total sample, 93 (54.7%) were responders, while a surprising 77 (45.3%) were non-responders. The prevalence of moderate drinking (49% vs. 29%) and the proportion of women drinking >1drink a week (33% vs. 17%) were higher in responders. Both oestradiol and estrone were significantly correlated with CEE dose and total weekly drinks, suggesting that moderate alcohol intake interacts significantly in a complex manner with ERT to modulate response to therapy.

Finally osteoporosis and its clinical consequences as a major health care problem in the West were discussed by Prof. Olof Johnell, Sweden. Prof. Johnell idenified several risk factors associated with osteoporosis and fragility, one of which is alcohol.Most epidemiological studies have shown that minor to moderate intake has no negative effect on bone mass, and can have a better effect on mass than no alcohol.However, alcoholics have been shown to have reduced bone mass and a significant increase in fractures, due both to reduced bone mass and also to a tendency to fall over more often! Prof Johnell concluded that more research is needed. Other subjects discussed included the hepatotoxic effects of alcohol, alcohol and pregnancy and female problem drinkers.

For further information please contact SMAB, details on the back cover of AIM. Dr Erik Skovenborg is Chairman of SMAB and a member of the AIM editorial board