Screening and intervention for alcohol-related disease in middle-aged men: the Malmö Preventive Programme

In the Malmö Preventive Programme the tracing and prevention of alcohol-related disease was attempted by means of the enzyme serum gamma-glutamyltransferase (GGT) in a large unselected population of middle-aged men. Alcohol was considered to be the underlying factor in 70% of subjects with raised GGT values. In a prospective analysis, alcohol-related death turned out to be a major contributor to death in men who died within five years of the screening. GGT was the variable that was most predictive for premature death in this population. There were also statistically significant correlations between alcohol-related death and a questionnaire, the Mm-MAST, positively, and serum creatinine and serum cholesterol, negatively. In the randomized intervention programme, reductions in sickness benefit days, hospital admissions and mortality were seen in the intervention group in comparison with the control group, after four years of follow-up. The intervention programme was therefore effective in preventing the consequences of heavy drinking, and a risk factor approach to alcohol-related diseases seems feasible. This approach, however, encounters several problems, such as the recruitment of the non-participants in the screening, the investigation of the GGT-high/non-alcoholic subjects, and the identification of the GGT-normal/alcoholic subjects.