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Alcohol: the forgotten discretionary food

Alcohol has the unique position of being both a food and a drug. We know alcohol is responsible for a lot of acute health harm in terms of drunken accidents and violence, and an increased risk of chronic liver and heart diseases. However, alcohol is also contributing to the more insidious problem of excess kilojoules that cause weight gain, yet it is rarely discussed as a contributor to obesity.

What are the consumption recommendations?

The National Health & Medical Research Council (NH&MRC) is currently reviewing its Guidelines to Reduce Health Risks from Drinking Alcohol. They are currently evaluating the evidence and expect to issue the final revised Guidelines in the first quarter of 2019. Their existing Guidelines (2009) are as follows:

Guideline 1: Reducing the risk of alcohol-related harm over a lifetime.

For healthy men and women, drinking no more than two standard drinks on any one day reduces the lifetime risk of harm from alcohol–related disease or injury

Guideline 2: Reducing the risk of injury on a single occasion of drinking

For healthy men and women, drinking no more than four standard drinks on a single occasion reduces the risk of alcohol-related injury arising from that occasion.

Guideline 3: Children and young people under 18 years of age.

  1. Parents and carers should be advised that children under 15 years of age are at the greatest risk of harm from drinking and that for this age group, not drinking is especially important
  2. For young people aged 15-17 years, the safest option is to delay the initiation of drinking for as long as possible

Guideline 4: Pregnancy and breastfeeding.

  1. For women who are pregnant or planning a pregnancy, not drinking is the safest option.
  2. For women who are breastfeeding, not drinking is the safest option

The Dietary Guidelines for Australians (DGAs) say alcohol is high in kilojoules, is nutrient poor and can lead to weight gain. They reiterate the NH&MRC guidelines to reduce the risk from drinking alcohol , however they also classify alcoholic beverages as discretionary and to be minimised, especially for those aiming to lose weight.

Average energy content of nutrients (Atwater factors)

Nutrient

Energy content kJ/g

Carbohydrate

17

Protein

17

Alcohol

29

Fat

37

 

Australia

How much alcohol are Australians drinking?

There are several sources of alcohol intake data available in Australia. We look at the most recent Australian Bureau of Statistics (ABS) apparent consumption data 2015-16, and the two major national surveys: the National Health Survey (2011-12) and the National Drug Strategy Household Survey 2016 (NDSHS).

THE ABS apparent consumption data found an increase in the amount of alcohol available for consumption in 2015-16, and this was the first increase since 2006-07. There were 9.7 litres of pure alcohol available for consumption per capita in 2015-16, which is the equivalent of 2.1 standard drinks per person over 15 years of age per day. Interestingly, the source of alcohol is changing: the popularity of low alcohol beer has fallen to its lowest level in 20 years, and cider has surged to its highest level since records began. Beer and wine are still on top, providing 39.9% and 37.5% of pure alcohol respectively. Apparent consumption data is likely to be an overestimate of actual consumption because it is not adjusted for storage, wastage or use of alcohol in cooking.

A report on a secondary analysis of the National Health Survey (2011-12) by the CSIRO for Australian Beverages found among discretionary beverages, alcoholic beverages were the highest contributor to energy intake at 5.3% for adults, followed by soft drinks at 1.7% (see Fig 7A). When all discretionary foods and drinks are combined, the contribution of alcoholic beverages comes in equal first with sweet biscuits at 13% of total energy. 

Intakes from different sources in Australian diet 2011-12 (2).png

The Australian Institute of Health & Welfare (AIHW) reports the following statistics based on the National Drug Strategy Household Survey (NDSHS) 2016:

  • The overall volume of alcohol consumed was 9.7 litres of pure alcohol per person, which is higher than the OECD average.
  • 1 in 5 (18.2%) people consumed alcohol at levels placing them at lifetime risk of an alcohol-related disease or injury.
  • 1 in 4 (26%) of people had consumed alcohol at levels placing them at risk of harm on a single occasion, at least monthly.

Have drinking patterns changed?

Based on data generated by the NDSHS, the Centre for Alcohol Policy and Research (CAPR) report into recent trends in alcohol consumption in Australia found evidence of diverging consumption: Australia’s overall level of drinking has declined, however the top ten percent of drinkers are now responsible for an increasing proportion of the total consumption, and the share of alcohol consumed by the top five percent of heavy drinkers has increased.

Who are the problem drinkers?

Perhaps surprisingly, young people, particularly those under 25, have sharply reduced their drinking; however there are increasing rates of very heavy episodic drinking (20 or more drinks) among older adults 30-59. Interestingly, abstaining increased significantly for both men and women between 2001 and 2013, especially among young people. A potential explanation is the ongoing cultural diversification of Australia in which large groups of people are from cultural backgrounds in which alcohol does not play a central role.

Boozing boomers

Research by the University of Adelaide reported a decline in binge drinking in all age groups except for people over 50. They also found an increasing proportion of women drinking in later life, particularly those they call “reactors” whose alcohol consumption is triggered by life events such as retirement, bereavement, change in their home situation and social isolation. The researchers say that alcohol misuse in the older population may increase as baby boomers get older because of their more liberal views toward alcohol and higher use of alcohol.

New Zealand

NZ Intake recommendations

The Health Promotion Agency’s alcohol.org.nz low risk drinking advice is no more than 15 standard drinks of alcohol per week for men or 10 standard drinks for women.  This means a daily limit of 3 standard drinks for men, and 2 standard drinks for women. On occasions when the daily limit might be exceeded, ‘per session’ recommendations are no more than 5 standard drinks for men and 4 for women.

alcohol2.png

How much are New Zealanders drinking

  • The last time it was measured- 2008/09 New Zealand Adult Nutrition Survey - the average kilojoule intake contributed by alcohol was 4.9% in people aged 15 years and older (5.7% for males and 4.2% for females), and this was a slight increase since the 1997 survey.
  • The Ministry of Health reports one in five New Zealanders aged 15 years or more who drank alcohol in the past year had a potentially hazardous drinking pattern. The hazardous drinking rate has increased between 2006/7 and 2015/16.
  • One in eight past-year drinkers consumed a large amount of alcohol (more than 6 standard drinks for men or 4 standard drinks for women on a drinking occasion) at least once a week.
  • Similar to Australia which has experienced a rise in alcohol abstainers, the proportion of New Zealanders who drank alcohol in the past year dropped from 84% to 80%.
  • Unlike Australia, a potentially hazardous drinking pattern was most common in young adults aged 18-24 years.
  • In the last national dietary survey (2009) the most frequently consumed alcoholic beverage across the population was wine (42%), followed closely by beer (36.9%).

NEXT: Are added sugars in core foods a problem? 

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