Composition of Unrecorded Distilled Alcohol (bai jiu) Produced in Small Rural Factories in Central China

Global prevalence, incidence, and outcomes of alcohol related liver diseases: a systematic review and meta-analysis

BACKGROUND

Alcohol related liver disease (ARLD) is one of the major chronic liver diseases worldwide. This review aimed to describe the global prevalence, incidence, and outcomes of ARLD.

METHODS

Medline, Embase, The Cochrane Library, and China National Knowledge Infrastructure (CNKI) were searched from inception to May 31, 2022. The language was restricted to English or Chinese. According to the criteria, articles describing the basic characteristics of the population were selected. Two reviewers extracted the data independently.

RESULTS

A total of 372 studies were identified: 353 were used for prevalence analysis, 7 were used for incidence analysis, and 114 were used to for outcome analysis. The prevalence of ARLD worldwide was 4.8%. The prevalence in males was 2.9%, which was higher than female (0.5%). Among the ethnic groups, the percentage was highest in Caucasians (68.9%). Alcoholic liver cirrhosis comprised the highest proportion in the disease spectrum of ARLD at 32.9%. The prevalence of ascites in ARLD population was highest (25.1%). The ARLD population who drinking for > 20 years accounted for 54.8%, and the average daily alcohol intake was 146.6 g/d. About 59.5% of ARLD patients were current or former smokers, and 18.7% were complicated with hepatitis virus infection. The incidence was 0.208/1000 person-years. The overall mortality was 23.9%, and the liver-related mortality was 21.6%.

CONCLUSION

The global prevalence of ARLD was 4.8% and was affected by sex, region, drinking years, and other factors. Therefore, removing the factors causing a high disease prevalence is an urgent requisite.

TRIAL REGISTRATION

PROSPERO Nr: CRD42021286192.

The transition of alcohol control in China 1990-2019: Impacts and recommendations

The harmful use of alcohol is a severe public health issue globally. Chinese per-capita alcohol consumption has increased sharply in recent decades, which has contributed to a rise in alcohol-related problems. In this article we present an analysis of Chinese alcohol policy, beginning with a characterization of alcohol consumption in China followed by an examination of how the nation's alcohol control policy has evolved over the past 30 years, identifying shortcomings and obstacles to improvement. Finally, we present several recommendations informed by the Global Strategy to Reduce the Harmful Use of Alcohol and the SAFER Technical Package-Five Areas of Intervention at National and Subnational Levels (SAFER initiative), to the areas of taxation, alcohol availability, alcohol marketing regulation, and treatment.

Alcohol Use in China: Unrecorded and Recorded Bai Jiu in Three Rural Regions

In China, approximately 70% of beverage alcohol is consumed in the form of spirits. An estimated 25% of all alcohol consumed is unrecorded, mostly spirits (bai jiu), produced outside regulatory systems in small neighborhood distilleries, mostly in rural areas. Unrecorded bai jiu drinkers are generally older, male, prefer higher-strength bai jiu, and drink daily and mostly at home. To explore possible regional differences, researchers used interview data from 2919 bai jiu drinkers in rural areas in Hebei, Anhui, and Hubei provinces in China. Results confirmed that patterns varied by province. The sample in Hubei preferred unrecorded bai jiu with a more stable preference to alcohol type, tended to drink less frequently, and reported experiencing less drinking pressure, suggesting lower-risk drinking patterns in this region. The Hebei and Anhui sample reported higher frequency and greater amount of alcohol consumption, were more likely to experience drinking pressure, indicating higher-risk patterns in alcohol use in these two regions. The results provide needed details about regional differences in unrecorded bai jiu drinking patterns that are not evident in aggregated data and suggest variations in drinking patterns that may reflect local geography, local values, traditions, and ethnic differences.

Dielectric spectroscopy of Baijiu over 2-20 GHz using an open-ended coaxial probe

The complex electric permittivity of Baijiu (one of the most consumed beverages) is measured over a frequency range of 2 to 20 GHz using a low-cost open-ended coaxial probe and a portable microwave analyzer. The Cole-Cole equation is used to fit the permittivity data, and the parameter values related are extracted using the particle swarm optimization. A linear relationship is obtained between these parameters and the alcohol by volume. A strong dependence of the permittivity on the alcohol content is also observed for other alcoholic drinks, including brandy and whisky. The study demonstrates that the microwave technique provides an efficient solution in the effort to determine the alcohol content and the principal component analysis is a powerful tool for the quick estimation of the dielectric properties. The sensor presented can contribute to efficient on-site quality control of alcoholic drinks. PRACTICAL APPLICATION: The microwave approach presented could offer an economical approach for the characterization of Baijiu and a general solution to the alcohol content determination for the alcoholic drinks industry.

Heavy metal contamination in recorded and unrecorded spirits. Should we worry?

Heavy metals can be released into all alcoholic beverages during production and storage. However, there is at least a theoretical risk that they could be present in higher, and potentially toxic, concentrations in those produced in the household and small-scale stills common in Central and Eastern Europe, which lack quality control and whose products are unrecorded by authorities. Yet, so far, few studies comparing concentrations of heavy metals in recorded and unrecorded spirits have been published. In this study we ask whether there is any difference between heavy metal concentrations in recorded and unrecorded spirits and, thus, the related health risk. The levels of heavy metals were determined in recorded (n = 97) and unrecorded (n = 100) spirits using inductively coupled plasma optical emission spectrometric analysis and applied to population-based risk assessments, considering average, regular and chronic heavy drinkers. Concentrations of Cu, Zn, and Sn were significantly higher in unrecorded spirits than those in their recorded counterparts and recorded spirits contained significantly higher levels of Fe, Mn, and Ni than unrecorded spirits. Combined exposure to heavy metals posed a potential health risk in chronic heavy drinkers consuming recorded spirits. However, when compared to the health risk arising from drinking large volumes of ethanol, the risk is negligible. Consequently, there are no grounds to worry about the adverse effects of heavy metals from spirits.

Methanol content in homemade alcohol from a province in North Vietnam

INTRODUCTION AND AIMS

Methanol poisonings pose a major risk especially where illegal alcohol is consumed. The source of the methanol in the drinks are debated. We aimed to evaluate whether home distillation of alcohol made from rice was capable of producing toxic amounts of methanol.

DESIGN AND METHODS

Twenty households with homemade alcohol production in Phu Tho province in Vietnam were included in this pilot study. We followed the whole production process and an alcohol sample from each household was analysed for methanol content.

RESULTS

17 (85%) of the samples contained detectable levels of methanol. The median concentration was 9 mg/L (range 2-37 mg/L). To develop clinical symptoms of methanol poisoning from the sample with the highest concentration would require drinking more than 424 L.

DISCUSSION AND CONCLUSIONS

Homemade alcohol from rice did not contain sufficient amount of methanol to cause toxicity in our study. This supports the theory of methanol being added to ethanol post production for economical purposes as the main source of mass poisonings.

Growing burden of alcoholic liver disease in China: A review

Explosive economic growth and increasing social openness in China over the last 30 years have significantly boosted alcohol consumption, and consequently, the incidence of alcoholic liver disease (ALD) in China has increased. Because the epidemiologic and clinical features of ALD in the Chinese population may differ from those of the Caucasian population, this review describes the epidemiology, pathogenesis, genetic polymorphisms, diagnosis, and treatment of ALD in the Chinese population. This updated knowledge of ALD in China provides information needed for a global understanding of ALD and may help in the development of useful strategies for reducing the global ALD burden.

Chemical Composition and Safety of Unrecorded Grain Alcohol (Bai Jiu) Samples from Three Provinces in China

About 20% of spirits consumed in China are “unrecorded”, where these spirits are produced in small-scale distilleries and sold outside the systems of taxation and quality control. Researchers visited small distilleries in rural Yunnan, Hubei and Anhui and purchased 56 samples of unrecorded bai jiu. Seven samples of the recorded bai jiu were purchased as reference samples. An independent laboratory conducted a blind analysis of the samples. Results were compared to the standards for unrecorded alcohol adopted by the European Commission’s Alcohol Measures for Public Health Research Alliance (AMPHORA). No samples exceeded the AMPHORA guidelines for methanol, ethyl acetate, lead and cadmium; one sample exceeded 1000 g/hL of combined higher alcohols; one sample exceeded 100 mg/L of arsenic; and three samples exceeded 50g/hL of acetaldehyde, but only by relatively small amounts. Low-priced unrecorded bai jiu averaged 9.8 RMB/jin (500 mL), compared to 10.7 RMB/jin for inexpensive recorded bai jiu. The low-priced unrecorded bai jiu samples had a mean alcohol-by-volume of 51.8%, compared to 50.1% for the recorded bai jiu samples. The results did not raise any critical safety issues with unrecorded bai jiu, but there may be long-term health risks related to ethanol, acetaldehyde and arsenic. The social ties between the bai jiu makers and the people who consume their product are a deterrent to adulteration; but when bai jiu is sold outside of the social circle, the deterrent disappears.

Comparison of Patterns of Use of Unrecorded and Recorded Spirits: Survey of Adult Drinkers in Rural Central China

About 70% of the beverage alcohol consumed in China annually is spirits. Recorded spirits make up most spirit consumption, but about 25% of total alcohol consumption (1.7 L pure alcohol per capita annually) is unrecorded spirits (bai jiu), either homemade or made in unregulated distilleries. In some parts of China, the consumption of unrecorded spirits is higher than average. This paper compares the patterns of use of unrecorded distilled spirits and recorded distilled spirits among rural residents in Central China. Interviews were conducted with 3298 individuals in 21 towns/villages in 10 counties in the Hubei, Anhui, and Hebei provinces in the People's Republic of China. Unrecorded bai jiu drinkers chose it because of its taste and its low price. It was consumed mostly by older men, mostly at home with family, more regularly and at higher alcohol by volume (ABV) compared to recorded alcohol. Recorded bai jiu drinkers were more likely to drink away from their homes, consumed more bai jiu at memorable drinking occasions, and reported feeling sick after drinking more often than unrecorded bai jiu drinkers. This comparison of patterns of use of unrecorded bai jiu and recorded bai jiu does not suggest that unrecorded bai jiu is more problematic for drinkers.