Good practice principles low rik drinking EU RARHA

Annex 4
Country snapshots:
Development of national low risk drinking guidelines
Setting low risk drinking guidelines: the Italian experience
Andrea Ghiselli and Laura Rossi a
In Italy, the consumption of alcoholic beverages – almost exclusively wine up to some twenty years
ago – has been considered an integral part of culture and diet, to the extent that in the past alcohol
was seen as a way to supplement an energy-deficient diet. Over the past decades the perception of
the role of alcoholic beverages in Italian food culture has shifted from potential benefit to potential
harm, an evolution reflected in the nutrition recommendations of the Italian Society of Human
Nutrition (SINU) and in the guidelines for a healthy diet issued by the National Institute of
Nutrition (currently CREA).
Changes in alcohol intake guidelines from 1979 to 2014 are summarised in Table 1.
Focus on benefit for health
The first Italian policy document on nutrition intake, developed in 1979 by the National Institute of
Nutrition in collaboration with the Ministry of Health, set a daily ration of 500 ml of wine for men and
300 ml for women[ 1 ]. While a lesser amount was considered to suffice for older people, consumption of
300 ml wine was suggested even for pregnant and lactating women.
The nutrition recommendations (LARN) revised in 1987 highlighted risks of alcohol consumption
during pregnancy and breastfeeding as well as risk of harm for young people under 18 years[ 2 ].
Nevertheless, alcohol was still considered a nutrient with high energy value. The recommendation was
to limit the share of calories from alcohol to 10% of the total reference energy intake, which for men
amounted to around 42g pure alcohol per day, for women around 30g, and for older people under 30g.
Today alcohol is no longer considered a nutrient as the calories derived from alcohol are “empty”.
Instead, it is categorized as a non-nutrient substance with nutritional interest – like dietary fibres, it
could have an effect on health and wellbeing[ 3 ].
In 1986, the first Italian Guidelines for a healthy diet defined acceptable alcohol consumption as 1g
of pure alcohol per 1Kg of body weight, corresponding to 450-600 ml of wine per day for men and 250-
350 ml for women [ 4 ]. In the second edition of the Guidelines in 1997, daily consumption was lowered to
450 ml for men but maintained at 350 ml for women[ 5 ]. This was in line with the nutrition
recommendations revised in 1996, which set the limit of alcohol intake to 40g pure alcohol per day for
men and 30g for women[ 6 ].
Epidemiological studies of the time showed lower mortality in moderate drinkers compared to
heavy drinkers and to absainers (the J-shaped curve). Wine, especially red wine, was considered
beneficial because of the antioxidants contained in it. Scientific literature tended to support, and even
promote, moderate consumption of wine – and also beer – for protection against cardiovascular
disease. The public health message at that period was “alcoholic beverages: if yes, in moderation”.
The idea of wine as more beneficial compared with other alcoholic beverages was maintained in
the next version of the dietary Guidelines for a healthy diet in 2003, even though with reservations. The
risk of interaction of alcohol with medications was highlighted. The concept of alcohol unit was
introduced, defined as equivalent to 12 grams of pure alcohol. The guidelines regarding alcohol
consumption showed a downward trend and older people in particular were recommended to reduce
drinking because of changes in metabolism[ 7 ].
a
The national Food and Nutrition Research Center CREA
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Good practice principles for low risk drinking guidelines