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Lower Strength Alcohol Products to Public Health

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A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Nutrition and Metabolism".

Deadline for manuscript submissions: closed (30 September 2022) | Viewed by 31443

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Prof. Dr. Peter Anderson

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Guest Editor

Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
Interests: alcohol policy; alcohol epidemiology; primary health care; public health
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

In policy circles at both national and international levels there is increasing discussion about the potential contribution of lower-strength alcohol products to public health. From the perspective of public health science and practice, there is ambivalence toward the potential contribution of lower-strength alcohol products to improving health. On one hand, concern has been expressed that lower-strength products could be viewed as additions to existing alcohol consumption, rather than replacements, and that lower-strength products could act as gateways to higher-strength products. On the other hand, as with salt and sugar reduction initiatives, lower-strength products could be replacements for higher-strength products, in which case alcohol consumption would be reduced and health would improve. There are also broader environmental issues. Life-cycle assessments might indicate additional environmental consequences from the production of lower-strength products, as additional steps are often required in the production processes. A recent scoping review of lower-strength products concluded that, at present, the evidence base for the potential public health impact of low- and no-alcohol products could be considered inadequate to inform policy [Nutrients 2021, 13, 3153. https://doi.org/10.3390/nu13093153].

The purpose of this Special Issue is to help fill in the evidence gap with state-of-the-art papers and reviews on lower-strength alcohol products and public health, drawing on broader literature from other nutrition initiatives and cost–benefit and life-cycle assessment analyses.

Prof. Dr. Peter Anderson
Guest Editor

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Keywords

no-alcohol products
lower-strength alcohol products
salt and sugar reduction initiatives
cost-benefit analyses
life cycle assessments
alcohol labelling
alcohol policy
reformulation alcoholic beverages

Published Papers (10 papers)

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Editorial

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2 pages, 178 KiB

Open AccessEditorial

Lower-Strength Alcohol Products and Public Health

by Peter Anderson

Nutrients 2023, 15(10), 2240; https://doi.org/10.3390/nu15102240 - 9 May 2023

Viewed by 1041

Abstract

The World Health Organization has called on economic operators to “substitute, whenever possible, higher-alcohol products with no-alcohol and lower-alcohol products in their overall product portfolios, with the goal of decreasing the overall levels of alcohol consumption in populations and consumer groups, while avoiding the circumvention of existing regulations for alcoholic beverages and the targeting of new consumer groups with alcohol marketing, advertising and promotional activities” (see [...] Full article

(This article belongs to the Special Issue Lower Strength Alcohol Products to Public Health)

Research

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13 pages, 321 KiB

Open AccessArticle

Reduction of Alcoholic Strength: Does It Matter for Public Health?

by Jürgen Rehm, Pol Rovira, Jakob Manthey and Peter Anderson

Nutrients 2023, 15(4), 910; https://doi.org/10.3390/nu15040910 - 11 Feb 2023

Cited by 4 | Viewed by 2279

Abstract

In this work, reduction of alcoholic strength was discussed as a means to reduce consumption and alcohol-attributable harm. Statistical modelling was conducted to (1) estimate its potential for the largest six Western and Central European countries (France, Germany, Italy, Poland, Spain, UK); (2) calculate the increase in taxation necessary to reach this potential, and (3) estimate the mortality gains achieved with the introduction of no- or low-alcohol beverages in the UK and Spain. The high public health potential of reducing alcoholic strength was demonstrated via modelling a scenario in which the strength of all beverages was reduced by 10%, which would avert thousands of deaths in these six European countries per year. However, methods by which to achieve these gains were not clear, as the alcohol industry has shown no inclination toward reductions in the alcoholic strength of beer, wine, or spirits via a reformulation on a large scale. The increase of excise taxation to achieve the public health gains of such a reduction would result in markedly increasing prices—a situation unlikely to be implemented in Europe. Finally, the introduction of beer and wine with an alcoholic strength below 0.5% led to some substitutions of higher-strength beverages, but did not show a marked public health impact. New taxation initiatives to achieve the potential of a reduction of alcoholic strength will need to be implemented. Full article

(This article belongs to the Special Issue Lower Strength Alcohol Products to Public Health)

11 pages, 5549 KiB

Open AccessArticle

Representations of Low(er) Alcohol (Craft) Beer in the United States

by Colleen C. Myles, Bren Vander Weil, Delorean Wiley and Bart Watson

Nutrients 2022, 14(23), 4952; https://doi.org/10.3390/nu14234952 - 22 Nov 2022

Cited by 3 | Viewed by 2001

Abstract

Given increasing social interest in health and wellness, rising cultural trends toward sobriety and moderating alcohol intake, and improvements in brewing technology, low(er) alcohol beer is a rising segment in the beer industry for both craft and larger-scale producers. In this paper, we assess the representation of low(er) alcohol beer among craft brewers in the United States. Using a novel quantitatively-informed qualitative analytical approach, we surveyed a randomized, non-representative sample of 400 craft brewery websites in the United States to assess the relative presence of low(er) alcohol beers as well as how these brews are represented by the breweries themselves. To do so, we recorded, both numerically and via website screenshots, the lowest ABV beverage on offer and noted the beer type, the beer name, and the ABV. Ales were the most prominent style of beer on offer, accounting for 62% of the low(er) ABV beers identified. Only 15.5% of the breweries surveyed in this study offered a beer with an ABV of less than 4%; however, an additional 67.9% offered a beer with an ABV of less than 5%. The representations of these low(er) alcohol products focused mostly on taste, health, and demographic indicators. Full article

(This article belongs to the Special Issue Lower Strength Alcohol Products to Public Health)

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11 pages, 1043 KiB

Open AccessArticle

Effects of Substitution of Higher-Alcohol Products with Lower-Alcohol Products on Population-Level Alcohol Purchases: ARIMA Analyses of Spanish Household Data

by Peter Anderson and Daša Kokole

Nutrients 2022, 14(19), 4209; https://doi.org/10.3390/nu14194209 - 10 Oct 2022

Cited by 2 | Viewed by 1583

Abstract

In its action plan (2022–2030) to reduce the harmful use of alcohol, the WHO calls on economic operators to “substitute, whenever possible, higher-alcohol products with no-alcohol and lower-alcohol products in their overall product portfolios, with the goal of decreasing the overall levels of alcohol consumption in populations and consumer groups”. This paper investigates substitution at the level of the consumer, based on Spanish household purchase data. ARIMA modelling of market research data of 1.29 million alcohol purchases from 18,954 Spanish households is used to study the potential impact of lower-strength alcohol products and the impact of beer prices in reducing household purchases of grams of alcohol between the 2nd quarter of 2017 and 1st quarter of 2022. Reducing the alcohol strength of existing higher-strength beers and wines had a much greater associated impact on reducing the purchases of all grams of alcohol than the relatively small increases in purchases of no-alcohol beers (ABV ≤ 1.0%) and zero-alcohol wines (ABV = 0.0%). For beers, the relative price per gram of alcohol decreased with the increasing ABV of the beer. Increasing the price per gram of alcohol in beers with an ABV > 3.5%, adjusted for the ABV of the beer, was associated with much greater increases in purchases of no-alcohol beers (ABV ≤ 1.0%) and much greater decreases in purchases of all grams of alcohol than decreases in the price of no-alcohol beers or increases in the price of beers with an ABV > 3.5% unadjusted for ABV. Thus, a key to reducing purchases of grams of alcohol, which also results in increased purchases of no-alcohol beers, is to increase the price of higher strength beers (ABV > 3.5%) with the price per gram of alcohol increasing as the ABV of the product increases. Full article

(This article belongs to the Special Issue Lower Strength Alcohol Products to Public Health)

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13 pages, 1731 KiB

Open AccessArticle

The Impact of Lower-Strength Alcohol Products on Alcohol Purchases by Spanish Households

by Peter Anderson and Daša Kokole

Nutrients 2022, 14(16), 3412; https://doi.org/10.3390/nu14163412 - 19 Aug 2022

Cited by 8 | Viewed by 1874

Abstract

In its action plan (2022–2030) to reduce the harmful use of alcohol, the WHO calls on economic operators to “substitute, whenever possible, higher-alcohol products with no-alcohol and lower-alcohol products in their overall product portfolios, with the goal of decreasing the overall levels of alcohol consumption in populations and consumer groups”. In this paper, we investigate substitution at the level of the consumer based on Spanish household purchase data. ARIMA modelling of market research data of 1.29 million alcohol purchases from 18,954 Spanish households is used to study the potential impact of lower-strength alcohol products on reducing household purchases of grams of alcohol between the second quarter of 2017 and the first quarter of 2022. For households that recently bought either no-alcohol beer or wine (ABV ≤ 0.5%), the subsequent associated purchases of higher-strength beers and wines, respectively, and total grams of alcohol were reduced, the more so the higher the volume of initial purchases of beers and wines. The introduction of 20% ABV variants of same-branded 40% ABV whisky and gin during early 2021 was associated with reduced purchases of grams of alcohol within all spirits and of total grams of alcohol as a result of switching from other spirits products to the 20% variants, although not associated with reduced purchases of grams of alcohol within all variants of the studied same-branded whisky and gin; instead, an increase was observed in this category. With respect to Spanish household purchase data, the evidence behind the WHO’s call for substitution is substantiated. Further research across different jurisdictions is needed to provide ongoing monitoring of the impact of potential substitution on consumer behavior and public health, including unintended consequences, with findings from research informing future alcohol policies at all levels. Full article

(This article belongs to the Special Issue Lower Strength Alcohol Products to Public Health)

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Review

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17 pages, 2367 KiB

Open AccessReview

Impact of Sizes of Servings, Glasses and Bottles on Alcohol Consumption: A Narrative Review

by Eleni Mantzari and Theresa M Marteau

Nutrients 2022, 14(20), 4244; https://doi.org/10.3390/nu14204244 - 12 Oct 2022

Cited by 3 | Viewed by 2504

Abstract

This review summarises the evidence on the impact of serving and container size on how much people drink, interventions that have the potential to reduce alcohol consumption across populations, thereby improving health. A rapid search identified 10 published reports of 15 studies and 1 review. Four studies focused on serving size, eight studies and the review on glass size, two studies on bottle size and one on both glass and bottle size. Twelve studies and the review focused on wine, one study on beer and two on both. All were conducted in England, by just two research groups. Removing the largest serving size of wine decreased wine sales by 7.6% (95% CI −12.3%, −2.9%) in a study in 21 licenced premises, reflecting findings from two prior studies in semi-naturalistic settings. Adding a serving size for beer that was a size smaller than the largest was assessed in one study in 13 licenced premises, with no evident effect. Reducing the size of wine glasses in restaurants decreased wine sales by 7.3% (95% CI −13.5%, −1.5%) in a mega-analysis of eight datasets from studies in five licensed premises. Using smaller wine glasses at home may also reduce consumption, but the evidence from just one study is less certain. No studies have assessed the impact of glass size for drinking beer. The effect of bottles smaller than the standard 750 mL on wine consumed at home was assessed in two studies: 500 mL bottles reduced consumption by 4.5% (95% CI −7.9%, −1.0%) in one study, but in another, using 375 mL bottles there was no evident effect. No studies assessed the impact of bottle or other container size for drinking beer. Reducing the size of servings, glasses and bottles could reduce wine consumption across populations. The impact of similar interventions for reducing consumption of other alcoholic drinks awaits evaluation. Further studies are also warranted to assess the generalisability of existing evidence. Full article

(This article belongs to the Special Issue Lower Strength Alcohol Products to Public Health)

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12 pages, 458 KiB

Open AccessReview

Defining No and Low (NoLo) Alcohol Products

by Alex O. Okaru and Dirk W. Lachenmeier

Nutrients 2022, 14(18), 3873; https://doi.org/10.3390/nu14183873 - 19 Sep 2022

Cited by 13 | Viewed by 4056

Abstract

Reducing the alcoholic strength in beverages as a strategy to reduce harmful alcohol use has been proposed by multilateral institutions such as the World Health Organization and governments worldwide. Different industrial and artisanal techniques are used to achieve low-alcohol content beverages. Therefore, regulations regarding the content of alcohol in beverages and strategies to monitor compliance are important, because they are the main reason for classification of the beverages and are central to their categorization and market labelling. Furthermore, analytical techniques with adequate sensitivity as low as 0.04% vol are necessary to determine the alcohol ranges necessary for classification. In this narrative review, the definitions of no and low (NoLo) alcohol products are described and the differences in the legal definitions of these products in several regions of the world are highlighted. Currently, there is clearly confusion regarding the terminology of “no”, “free”, “zero”, “low”, “light”, or “reduced” alcohol products. There is an urgent need for global harmonization (e.g., at the Codex Alimentarius level) of the definitions from a commercial perspective and also to have common nomenclature for science and for consumer information. Full article

(This article belongs to the Special Issue Lower Strength Alcohol Products to Public Health)

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24 pages, 1210 KiB

Open AccessReview

Lower Strength Alcohol Products—A Realist Review-Based Road Map for European Policy Making

by Peter Anderson, Daša Kokole, Eva Jané Llopis, Robyn Burton and Dirk W. Lachenmeier

Nutrients 2022, 14(18), 3779; https://doi.org/10.3390/nu14183779 - 13 Sep 2022

Cited by 8 | Viewed by 3801

Abstract

This paper reports the result of a realist review based on a theory of change that substitution of higher strength alcohol products with lower strength alcohol products leads to decreases in overall levels of alcohol consumption in populations and consumer groups. The paper summarizes the results of 128 publications across twelve different themes. European consumers are increasingly buying and drinking lower strength alcohol products over time, with some two fifths doing so to drink less alcohol. It tends to be younger more socially advantaged men, and existing heavier buyers and drinkers of alcohol, who take up lower strength alcohol products. Substitution leads to a lower number of grams of alcohol bought and drunk. Although based on limited studies, buying and drinking lower strength products do not appear to act as gateways to buying and drinking higher strength products. Producer companies are increasing the availability of lower strength alcohol products, particularly for beer, with extra costs of production offset by income from sales. Lower strength alcohol products tend to be marketed as compliments to, rather than substitutes of, existing alcohol consumption, with, to date, the impact of such marketing not evaluated. Production of lower strength alcohol products could impair the impact of existing alcohol policy through alibi marketing (using the brand of lower strength products to promote higher strength products), broadened normalization of drinking cultures, and pressure to weaken policies. In addition to increasing the availability of lower strength products and improved labelling, the key policy that favours substitution of higher strength alcohol products with lower strength products is an alcohol tax based on the dose of alcohol across all products. Full article

(This article belongs to the Special Issue Lower Strength Alcohol Products to Public Health)

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12 pages, 484 KiB

Open AccessReview

Functional Alternatives to Alcohol

by David J. Nutt, Robin J. Tyacke, Meg Spriggs, Vanessa Jacoby, Alan D. Borthwick and Delia Belelli

Nutrients 2022, 14(18), 3761; https://doi.org/10.3390/nu14183761 - 13 Sep 2022

Cited by 3 | Viewed by 7571

Abstract

The consumption of alcohol is associated with well-known health harms and many governments worldwide are actively engaged in devising approaches to reduce them. To this end, a common proposed strategy aims at reducing alcohol consumption. This approach has led to the development of non-alcoholic drinks, which have been especially welcome by younger, wealthier, health-conscious consumers, who have been turning away from alcohol to look toward alternatives. However, a drawback of non-alcoholic drinks is that they do not facilitate social interaction in the way alcohol does, which is the main reason behind social drinking. Therefore, an alternative approach is to develop functional drinks that do not use alcohol yet mimic the positive, pro-social effects of alcohol without the associated harms. This article will discuss (1) current knowledge of how alcohol mediates its effects in the brain, both the desirable, e.g., antistress to facilitate social interactions, and the harmful ones, with a specific focus on the pivotal role played by the gamma-aminobutyric acid (GABA) neurotransmitter system and (2) how this knowledge can be exploited to develop functional safe alternatives to alcohol using either molecules already existing in nature or synthetic ones. This discussion will be complemented by an analysis of the regulatory challenges associated with the novel endeavour of bringing safe, functional alternatives to alcohol from the bench to bars. Full article

(This article belongs to the Special Issue Lower Strength Alcohol Products to Public Health)

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Other

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15 pages, 586 KiB

Open AccessSystematic Review

“Doctor, Can I Drink an Alcohol-Free Beer?” Low-Alcohol and Alcohol-Free Drinks in People with Heavy Drinking or Alcohol Use Disorders: Systematic Review of the Literature

by Elsa Caballeria, Maria Teresa Pons-Cabrera, Mercedes Balcells-Oliveró, Fleur Braddick, Rebecca Gordon, Antoni Gual, Silvia Matrai and Hugo López-Pelayo

Nutrients 2022, 14(19), 3925; https://doi.org/10.3390/nu14193925 - 22 Sep 2022

Cited by 8 | Viewed by 3965

Abstract

No- and low-alcohol drinks (NoLo) have been proposed as a potential way forward for the reduction in the alcohol burden of disease. So far, there is scarce synthesized evidence on the effects of these products on people with alcohol use disorder (AUD), or with a heavy or high-risk drinking pattern. The aim of the present study is to systematically review the evidence of the use of NoLo drinks in these populations. A total of 4045 records were screened and 10 studies were included in the review. Craving and desire to drink have been found to increase after the consumption of NoLo drinks in patients with AUD. The increase in craving correlates with the severity of alcohol dependence. In addition, in this population, alcohol-related cues might trigger physiological responses similar to those experienced when using alcohol. Furthermore, as mentioned, in some of the studies, consumption was shown to increase as the %ABV or verbal descriptors indicate lower alcohol. Last, according to the epidemiological data, heavy drinkers tend to use NoLo drinks on top of their usual alcohol consumption rather than as part of regular drinking patterns. Further studies should be conducted in people with AUD or people with a high-risk drinking pattern to provide new insight to guide clinicians, patients, and other stakeholders to make evidence-based informed decisions. Full article

(This article belongs to the Special Issue Lower Strength Alcohol Products to Public Health)

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