Impact of a 10-year nation-wide alcohol campaign on knowledge of sensible drinking limits in Denmark

In Great Britain and in Denmark, strong efforts have been made to influence knowledge on upper threshold for hazardous drinking. In Denmark, a campaign has been repeated every week 40 from 1990 to 2000 with information on the sensible drinking limits of 21 drinks per week for men and 14 drinks per week for women. The aim of this study was to examine the effect of this ongoing campaign on the level of knowledge of sensible drinking limits for men and women. Random representative samples of 1030 adult Danes were telephone interviewed each year during 1994-1999. Our main finding was that the level of knowledge of sensible drinking limits for own sex increased in all subsets of the population throughout the period. However, at the end of the study period (1999) a total of 80% of highly educated young (18-25 years) men knew sensible drinking limits for own sex, while only 35% of uneducated older (more than 65 years) men had knowledge on sensible drinking limits. The proportions were similar among women. Subjects admitting an intake higher than sensible for own sex, i.e. 21 and 14 drinks per week, respectively, had the highest knowledge of these drinking limits. We conclude that public health campaigns, such as the sensible drinking limit campaign, certainly has an impact on level of awareness in the general population. Furthermore, those drinking more than 21 and 14 drinks per week, respectively, are reached by these campaigns.

Does the association between smoking status and selected healthy foods depend on gender? A population-based study of 54 417 middle-aged Danes

OBJECTIVE

Smoking serves different functions for men and women. Thus, we wanted to investigate the association between smoking behaviour and intakes of selected healthy foods in men and women with special focus on differences and similarities between the two genders.

DESIGN

In 1993-1997, a random sample of 80 996 men and 79 729 women aged 50-64 y was invited to participate in the study 'Diet, Cancer and Health'. In all, 27 179 men and 29 876 women attended a health examination and completed a 192-item food-frequency questionnaire (FFQ). The association between smoking status and low, median and high intakes of selected foods was examined among 25 821 men and 28 596 women.

SETTING

The greater Copenhagen and Aarhus area, Denmark.

RESULTS

For both men and women, smoking status group was associated with diet, such that increasing level of smoking status ranging from never smokers over ex-smokers to currently heavy smokers was associated with a lower intake of the healthy foods: fresh fruit, cooked vegetables, raw vegetables/salad, and olive oil. For wine, increasing level of smoking status category was associated with a higher fraction of abstainers and heavy drinkers. The difference between the extreme smoking status categories was larger than the difference between men and women within smoking status categories such that never smoking men in general had a higher intake of healthy foods than heavy smoking women. Correction for age, educational level, and body mass index (BMI) did not affect the results.

CONCLUSION

In this middle-aged population, intake of healthy foods were associated with smoking behaviour with a dose-response type of relationship. The overall pattern was similar for men and women.

Moderate alcohol consumption and waiting time to pregnancy

BACKGROUND

Recent research indicates that even a moderate consumption of alcohol in women trying to become pregnant is associated with longer waiting time to pregnancy. The findings, though, are based upon few observations.

METHODS

Self-reported data on alcohol intake and waiting time to pregnancy (0-2, 3-5, 6-12 and >12 months) was used for 39 612 pregnant women, recruited to the Danish National Birth Cohort within the first 24 weeks of pregnancy from 1997 to 2000. Main outcome measures were odds ratios (OR) for a prolonged waiting time to pregnancy according to alcohol intake.

RESULTS

In nulliparous women neither moderate nor high alcohol intake was related with longer waiting time to pregnancy compared with a low intake. In parous women, a modest association was seen only among those with an intake of >14 drinks per week (subfecundity OR 1.3; 95% confidence interval 1.0-1.7). Women who reported no alcohol intake had a slightly longer waiting time (subfecundity OR 1.2; 95% confidence interval 1.1-1.3) than women with a moderate intake of alcohol.

CONCLUSIONS

Our findings do not corroborate recent results suggesting a marked reduction in fecundity associated with a moderate intake of alcohol.

Factors influencing the relation between alcohol and mortality--with focus on wine

The impact of alcohol intake on mortality has been described in a large number of prospective population studies from many countries. Most have shown a J-shaped relation between alcohol intake and subsequent mortality, indicating that there are both beneficial and harmful effects of ethanol on health. In exploring the French paradox, it has been suggested that wine may have beneficial effects additional to that of ethanol. Recently, several prospective population studies have supported this idea. However, it is also likely that the apparent additional beneficial effect of wine on health is confounding.

Leisure-time physical activity levels and changes in relation to risk of hip fracture in men and women

The authors prospectively studied the effect of leisure-time physical activity level on hip fracture risk along with the influence of within-subject changes in activity levels, while taking possible confounding by other health behaviors and poor health into account. Analyses were based on pooled data from three population studies conducted in Copenhagen, Denmark. Among 13,183 women and 17,045 men, 1,121 first hip fractures were identified during follow-up. In comparison with being sedentary, the relative risk (RR) of hip fracture associated with being moderately physically active 2-4 hours per week was 0.72 (95% confidence interval (CI): 0.59, 0.89) in women and 0.75 (95% CI: 0.55, 1.03) in men after adjustment for confounders. Being in the most active leisure activity category did not decrease the risk of hip fracture further. Adjustment for poor health affected the risk estimates only modestly. Subjects who, during follow-up, reduced their physical activity level from the highest or the intermediate activity level to a sedentary level had a higher risk of hip fracture than did those who remained moderately physically active at the intermediate level (multivariate adjusted RR = 2.19, 95% CI: 1.00, 4.84 and RR = 1.89, 95% CI: 1.21, 2.95, for reduction from the highest and intermediate levels, respectively). There was no evidence of a fracture-protective effect from increasing physical activity. In conclusion, moderate levels of physical activity appear to provide protection against later hip fracture. Decline in the physical activity level over time is an important risk factor for hip fracture.

Stroke incidence and case fatality in two populations: the Auckland Stroke Study and the Copenhagen City Heart Study

Comparison of stroke incidence and case fatality in different parts of the world provides information that may lead to a better understanding of the disease. In this report we have investigated these two aspects in two large populations, one in Auckland, New Zealand, and the other in Copenhagen, Denmark (the Copenhagen City Heart Study, CCHS). Incidence rates of stroke are higher for men than women in both studies. The stroke incidence rate ratios between Auckland men and CCHS men are significantly different in most age groups, whereas in women the incidence rates differ only in one age group. The age- and sex-adjusted incidence rates are higher in the CCHS for both men and women as compared to the Auckland Stroke Study. The age-adjusted incidence rate ratio is higher for men than women in both studies: 1.29 in the Auckland Stroke Study and 1.54 in the CCHS. The 28-day case fatality is also higher in the CCHS than in Auckland and is higher for women than men in both studies. The incidence rate of stroke and the 28-day case fatality is higher in the CCHS as compared to the Auckland Stroke Study in both men and women. A very high proportion of smokers in CCHS may explain some of the differences in incidence rates in the two populations.

Type of alcohol consumed and mortality from all causes, coronary heart disease, and cancer

BACKGROUND

Although the J-shaped relation between alcohol intake and mortality has been reproduced in many large cohort studies, the question of whether the effects of beer, wine, and spirits differ remains controversial.

OBJECTIVE

To examine the relation between intake of different types of alcohol and death from all causes, coronary heart disease, and cancer.

DESIGN

Pooled cohort studies in which intake of beer, wine, and spirits; smoking status; educational level; physical activity; and body mass index were assessed at baseline.

SETTING

Copenhagen, Denmark.

PARTICIPANTS

13 064 men and 11 459 women 20 to 98 years of age.

MEASUREMENTS

Number of deaths and time to death from all causes, coronary heart disease, and cancer during follow-up.

RESULTS

During 257 859 person-years of follow-up, 4833 participants died. J-shaped relations were found between total alcohol intake and mortality at various levels of wine intake. Compared with nondrinkers, light drinkers who avoided wine had a relative risk for death from all causes of 0.90 (95% CI, 0.82 to 0.99) and those who drank wine had a relative risk of 0.66 (CI, 0. 55 to 0.77). Heavy drinkers who avoided wine were at higher risk for death from all causes than were heavy drinkers who included wine in their alcohol intake. Wine drinkers had significantly lower mortality from both coronary heart disease and cancer than did non-wine drinkers (P = 0.007 and P = 0.004, respectively).

CONCLUSION

Wine intake may have a beneficial effect on all-cause mortality that is additive to that of alcohol. This effect may be attributable to a reduction in death from both coronary heart disease and cancer.

Smoking and alcohol intake as risk factors for bleeding and perforated peptic ulcers: a population-based cohort study

Both the incidence of and mortality from bleeding and perforated peptic ulcers are increasing. We assessed the association between smoking, intake of alcohol (including type of alcoholic beverage), and risk of a complicated peptic ulcer in a population-based study of 26,518 Danish subjects followed up for an average of 13.4 years. There were 214 cases of incident bleeding and 107 cases with perforated ulcers. We estimated relative risks (RRs) for incident bleeding and perforated peptic ulcers using Poisson regression analysis. Smoking more than 15 cigarettes per day compared with never smoking increased the risk of a perforated ulcer more than threefold [RR = 3.5; 95% confidence interval (CI) = 1.7-7.1)]. Drinking more than 42 drinks per week increased the risk of a bleeding ulcer fourfold (RR = 4.4; 95% CI = 2.3-8.3) compared with drinking less than one drink per week. Using the same comparison group, subjects who drank more than 21 drinks per week but no wine were at a higher risk of a bleeding ulcer (RR = 8.8; 95% CI = 2.2-35) than drinkers of the same amount of alcohol, but with more than 25% of their intake as wine (RR = 2.4; 95% CI = 1.0-6.0).

Tobacco smoking and risk of hip fracture in men and women

BACKGROUND

Previous findings suggest that tobacco smoking increases the risk of hip fracture in women. A similar adverse effect of smoking is suspected to be present in men, but bone mineral density studies have raised the concern that men may be more sensitive to the deleterious effect of smoking on bone than women. In this study we prospectively determined the influence of current, previous, and cumulative smoking history on risk of hip fracture in men and women and addressed the issue of possible gender difference in the susceptibility to tobacco smoking.

METHODS

Pooled data from three population studies conducted in Copenhagen with detailed information on smoking habit. A total of 13,393 women and 17,379 men, initially examined between 1964 and 1992, were followed until 1997 for first admission due to hip fracture. The relative risks (RR) of hip fracture associated with smoking were estimated by means of multiplicative Poisson regression models.

RESULTS

During follow-up, 722 hip fractures were identified in women, and 447 in men. After adjustment for potential confounders, including body mass index, female current smokers had an RR of hip fracture of 1.36 (95% CI: 1.12-1.65) and male smokers 1.59 (95% CI: 1.04-2.43) relative to never smokers. In both sexes, the RR of hip fracture gradually increased by current and accumulated tobacco consumption. The RR were consistently higher in men than in women, but the test for interaction between sex and tobacco smoking was insignificant. After 5 years, male ex-smokers had an adjusted RR of 0.73 (95% CI: 0.55-0.98) relative to current smokers, while no significant decrease in risk was observed in female ex-smokers (RR = 0.91; 95% CI: 0.72-1.17)). Approximately 19% of all hip fractures in the present study population were attributable to tobacco smoking.

CONCLUSION

Tobacco smoking is an independent risk factor for hip fracture in men and women, and there appears to be no gender differences in smoking related risk. Smoking cessation reduces the risk of hip fracture in men after 5 years, while the deleterious effect of smoking seems to be more long-lasting in female ex-smokers.

Type of alcohol and drinking pattern in 56, 970 Danish men and women

OBJECTIVE

To describe drinking patterns among individuals who prefer drinking wine, beer or spirits.

DESIGN

Cross-sectional study obtaining detailed information on intake of wine, beer and spirits and on frequency of alcohol intake. Adjustment for gender, age, smoking habits, educational attainment and body mass index.

SETTING

Denmark.

SUBJECTS

27, 151 men and 29, 819 women, randomly selected from Copenhagen and Aarhus, Denmark.

MAIN OUTCOME MEASURES

Drinking pattern-steady or binge drinking.

RESULTS

A vast majority (71%) of both men and women preferred wine or beer. At all levels of total alcohol intake, beer drinkers were most likely to be frequent drinkers. Thus, light drinkers of beer had an odds ratio for being frequent drinkers of 1.97 (95% confidence limits 1.50-2.58) as compared to light drinkers of wine (total alcohol intake 3-30 drinks per month), while people who preferred beer had an odds ratio of 1. 29 (1.19-1.40) compared with wine drinkers in the moderate drinking category (31-134 drinks per month). There were no significant differences in total alcohol intake between individuals preferring different alcoholic beverages.

CONCLUSION

If binge drinking is less healthy than steady drinking, the relation between wine intake and coronary heart disease mortality could be subject to negative confounding, since beer drinkers seem to have the most sensible drinking pattern.

SPONSORSHIP

Danish Cancer Society and the Danish National Board of Health. European Journal of Clinical Nutrition (2000) 54, 174-176

Hormone replacement therapy and hip fracture risk: effect modification by tobacco smoking, alcohol intake, physical activity, and body mass index

The authors prospectively studied the overall effect of hormone replacement therapy (HRT) on hip fracture risk and the effect modification by behavioral habits and body mass index. A total of 6,159 postmenopausal women from the Copenhagen Center for Prospective Population Studies, Copenhagen, Denmark, with initial examination in 1976-1978 were followed until 1993. During follow-up 363 hip fractures were identified. Women who reported current use of HRT had a lower risk of hip fracture as compared with women who were nonusers (relative risk (RR) = 0.71; 95 percent confidence interval (CI): 0.50, 1.01). Use of HRT was associated with a lower risk of hip fracture in former (RR = 0.55; 95 percent CI: 0.22, 1.37) and current (RR = 0.61; 95 percent CI: 0.38, 0.99) smokers but not in never smokers (RR = 1.10; 95 percent CI: 0.60, 2.03). HRT was also associated with lower risk of hip fracture among alcohol drinkers (RR = 0.36; 95 percent CI: 0.14, 0.90) and among sedentary women (RR = 0.42; 95 percent CI: 0.18, 0.98) but not among nondrinkers (RR = 0.99; 95 percent CI: 0.61, 1.61) and physically active women (RR = 0.92; 95 percent CI: 0.42, 2.04). There was no evidence of interaction between use of HRT and body mass index. In conclusion, the protective effect of HRT on hip fracture appears to be strongest in women who ever smoked, in women who drink alcohol, and in women who are sedentary. The results suggest that history of behavioral habits offers important information concerning the probable degree of protection against hip fracture afforded by HRT.

Beer, wine, spirits and subjective health

STUDY OBJECTIVE

To examine the association between intake of different types of alcoholic beverages and self reported subjective health.

DESIGN

Cross sectional health survey with assessment of intake of beer, wine and spirits (at last non-weekend day), smoking habits, social networks, physical activity, body mass index, educational level, presence of chronic disease, and self reported health.

SETTING

WHO Copenhagen Healthy City Survey, Denmark.

PARTICIPANTS

4113 men and 7926 women aged 18 to 100 years.

MAIN RESULTS

Of the 12,039 subjects, 8680 reported their health as optimal, and 3359 reported a suboptimal health. After controlling for the covariates, the relation between total alcohol intake and the proportion reporting suboptimal health was J shaped. Heavy drinkers of any of the three types of alcoholic beverages had a higher prevalence of suboptimal health than non-drinkers. However, only light (1-2 glasses of wine yesterday) and moderate (3-5) wine drinkers had significantly lower odds ratios for suboptimal health--0.72 (95% confidence limits; 0.56 to 0.92) and 0.65 (0.49 to 0.87), respectively--when compared with non-wine drinkers. Moderate beer or spirits drinkers did not differ significantly from non-drinkers of these beverages with regard to prevalence of suboptimal health. Consistently, beer preference drinkers had an odds ratio of 1.50 (1.25 to 1.80) for suboptimal health compared with wine preference drinkers.

CONCLUSIONS

A light to moderate wine intake is related to good self perceived health, whereas this is not the case for beer and spirits. The causal relations creating this association are unknown and should be considered when interpreting the relation between different types of alcoholic beverages and subsequent morbidity and mortality.

Type of alcohol and mortality from cardiovascular disease

Many epidemiological studies have described a U-shaped relation between alcohol intake and all-cause mortality (Boffetta and Garfinkel, 1990; Fuchs et al., 1995; Gronbaek et al., 1994; Marmot et al., 1981). Most researchers attribute the 'U' to a combination of beneficial and harmful effects of ethanol itself. It has, on the other hand, been explained as an artefact due to misclassification or confounding (Shaper et al., 1998). Most of the studies of the effect of total alcohol intake have found that the descending leg of the curve mainly is attributable to death from cardiovascular disease (Rimm et al., 1991; Stampfer et al., 1988). Until recently, most studies addressed the effect of the three beverages taken together as ethanol. Studies of the correlation between wine intake per capita in different countries and incidence of ischaemic heart disease gave rise to the hypothesis that there is a a more beneficial effect of wine than of beer and spirits. Leger et al., Renaud and de Lorgeril and later Criqui and Rigel found an inverse relation between incidence rates of ischemic heart disease and wine consumption in different countries, but no such relation for the other types of beverages (Criqui and Rigel, 1994; Leger et al., 1979; Renaud and de Logeril, 1992).

Fish consumption and coronary heart disease mortality. A systematic review of prospective cohort studies

OBJECTIVES

To review all prospective cohort studies examining the relationship between fish intake and coronary heart disease mortality, and to assess the strength and consistency of their findings.

DESIGN

Systematic review of studies based on individual records of fish or n-3 polyunsaturated fatty acid consumption and coronary heart disease death. Studies were given scientific quality scores and divided into categories of high, intermediate, or insufficient quality.

MAIN OUTCOME MEASURE

Coronary heart disease mortality.

RESULTS

Eleven studies were identified. The cohorts counted a total of 116764 individuals. Of four studies judged to be of high quality, the two largest (n = 44895 and 20051) were performed in populations at low risk of coronary heart disease. They found no protective effect of fish consumption. The other two high-quality studies were relatively small (n = 852 and 1822) and included individuals at higher risk. They both found an inverse relationship between fish consumption and coronary heart disease death, suggesting that 40-60 g fish per day is optimal and associated with a risk reduction of 40-60%. Results of four studies of intermediate quality support that fish consumption is inversely associated with coronary heart disease mortality in high-risk populations only. Three studies were judged to be of insufficient quality to be used for drawing conclusions.

CONCLUSIONS

Fish consumption is not associated with reduced coronary heart disease mortality in low-risk populations. However, fish consumption at 40-60 g daily is associated with markedly reduced coronary heart disease mortality in high-risk populations. The underlying biochemical mechanism is not known and causal inference premature.

Alcohol intake, beverage preference, and risk of hip fracture in men and women. Copenhagen Centre for Prospective Population Studies

The authors prospectively studied the association between quantity and type of alcohol intake and risk of hip fracture among 17,868 men and 13,917 women. Analyses were based on pooled data from three population studies conducted in 1964-1992 in Copenhagen, Denmark. During follow-up, 500 first hip fractures were identified in women and 307 in men. A low to moderate weekly alcohol intake (1-27 drinks for men and 1-13 drinks for women) was not associated with hip fracture. Among men, the relative risk of hip fracture gradually increased for those who drank 28 drinks or more per week (relative risk (RR) = 1.75, 95% confidence interval (CI) 1.06-2.89 for 28-41 drinks; RR = 5.28, 95% CI 2.60-10.70 for 70 or more drinks) as compared with abstainers. Women who drank 14-27 drinks per week had an age-adjusted relative risk of hip fracture of 1.44 (95% CI 1.03-2.03), but the association weakened after adjustment for confounders (RR = 1.32, 95% CI 0.92-1.87). The risk of hip fracture differed according to the type of alcohol preferred: preferrers of beer had a higher risk of hip fracture (RR = 1.46, 95% CI 1.11-1.91) than preferrers of other types of alcoholic beverages. The corresponding relative risks for preferrers of wine and spirits were 0.77 (95% CI 0.58-1.03) and 0.82 (95% CI 0.58-1.14), respectively. In conclusion, an alcohol intake within the current European drinking limits does not influence the risk of hip fracture, whereas an alcohol intake of more than 27 drinks per week is a major risk factor for men.

Alcohol intake and the risk of lung cancer: influence of type of alcoholic beverage

Alcohol consumption has been associated with an increased risk of lung cancer, but the antioxidants in wine may, in theory, provide protection. This association was studied in 28,160 men and women subjects from three prospective studies conducted in 1964-1992 in Copenhagen, Denmark. After adjustment for age, smoking, and education, a low to moderate alcohol intake (1-20 drinks per week) was not associated with an increased risk of lung cancer. Men who consumed 21-41 and more than 41 drinks per week had relative risks of 1.23 (95% confidence interval (CI) 0.88-1.74) and 1.57 (95% CI 1.06-2.33), respectively. The risk of lung cancer differed according to the type of alcohol consumed: After abstainers were excluded, drinkers of 1-13 and more than 13 glasses of wine per week had relative risks of 0.78 (95% CI 0.63-0.97) and 0.44 (95% CI 0.22-0.86), respectively, as compared with nondrinkers of wine (p for trend = 0.002). Corresponding relative risks for beer intake were 1.09 (95% CI 0.83-1.43) and 1.36 (95% CI 1.02-1.82), respectively (p for trend = 0.01); for spirits, they were 1.21 (95% CI 0.97-1.50) and 1.46 (95% CI 0.99-2.14), respectively (p for trend = 0.02). In women, the ability to detect associations with high alcohol intake and type of beverage was limited because of a limited range of alcohol intake. The authors concluded that in men, a high consumption of beer and spirits is associated with an increased risk of lung cancer, whereas wine intake may protect against the development of lung cancer.

Wine intake and diet in a random sample of 48763 Danish men and women

BACKGROUND

Variation in diet associated with drinking patterns may explain why wine seems to reduce ischemic heart disease mortality.

OBJECTIVE

Our objective was to study the association between intake of different alcoholic beverages and selected indicators of a healthy diet.

DESIGN

This was a cross-sectional study conducted in Copenhagen and Aarhus, Denmark, from 1995 to 1997, and included 23 284 men and 25 479 women aged 50-64 y. The main outcome measures were groups of selected foods that were indicators of a healthy dietary pattern.

RESULTS

Wine, as compared with other alcoholic drinks, was associated with a higher intake of fruit, fish, cooked vegetables, salad, and the use of olive oil for cooking in both men and women. Men who preferred beer and spirits had odds ratios of 0.42 (95% CI: 0.39, 0.45) and 0.51 (95% CI: 0.43, 0.60), respectively, for a high intake of salad compared with those who preferred wine. Higher wine intake was associated with a higher intake of healthy food items compared with intake of < or = 2.5 glasses of wine/mo; odds ratios for drinkers of between 30 and 135 glasses of wine/mo for all the chosen indicators of healthy diet varied between 1.23 and 4.20, and were all strongly significant.

CONCLUSION

Wine drinking is associated with an intake of a healthy diet. This finding may have implications for the interpretation of previous reports of the relation between type of alcoholic beverage and mortality.

Alcohol and mortality: is there a U-shaped relation in elderly people?

OBJECTIVE

to assess the relation between alcohol intake and mortality among seven cohorts of middle-aged and elderly Danes.

DESIGN

Prospective population study with baseline assessment of alcohol- and tobacco consumption, educational level and body mass index, and a mean of 11.5 years follow-up of mortality.

SUBJECTS

16304 men and women aged 50 years or more.

MAIN OUTCOME MEASURE

number and time of deaths from 1974 to 1995 as ascertained by the national central person register.

RESULTS

the effect of alcohol intake on mortality did not differ between middle-aged (50-64 years, mean = 56.6 years) and elderly subjects (>64 years old, mean = 69.9 years). There was a U-shaped risk function in both age groups, which persisted also when adjusting for age, sex, smoking habits, level of education and body mass index. Abstaining women had a relative risk of 1.29 (95% confidence limits 1.17-1.42) as compared with light drinkers (1-6 (drinks per week), while the relative risk for abstaining men was 1.22 (95% confidence limits; 1.08 to 1.37) as compared with light drinkers. Heavy drinking women (>28 drinks per week) had a relative risk of 1.23 (95% confidence limits; 0.85 to 1.78) and heavy drinking men (more than 69 drinks per week) had a relative risk of 2.11 (95% confidence limits 1.66-2.69), both compared with light drinkers.

CONCLUSION

among the middle-aged and elderly women and men, a light alcohol intake is associated with lower mortality than abstention or heavy drinking.

Population based cohort study of the association between alcohol intake and cancer of the upper digestive tract

OBJECTIVE

To examine the relation between different types of alcoholic drinks and upper digestive tract cancers (oropharyngeal and oesophageal).

DESIGN

Population based study with baseline assessment of intake of beer, wine, and spirits, smoking habits, educational level, and 2-19 years' follow up on risk of upper digestive tract cancer.

SETTING

Denmark.

SUBJECTS

15 117 men and 13 063 women aged 20 to 98 years.

MAIN OUTCOME MEASURE

Number and time of identification of incident upper digestive tract cancer during follow up.

RESULTS

During a mean follow up of 13.5 years, 156 subjects developed upper digestive tract cancer. Compared with non-drinkers (drinkers of <1 drink/week), subjects who drank 7-21 beers or spirits a week but no wine were at a risk of 3.0 (95% confidence interval 1.5 to 6.1), whereas those who had the same total alcohol intake but with wine as >=30% of their intake had a risk of 0.5 (0.2 to 1.4). Drinkers of >21 beers and spirits but no wine had a relative risk of 5.2 (2.7 to 10.2) compared with non-drinkers, whereas those who drank the same amount, but included wine in their alcohol intake, had a relative risk of 1.7 (0.6 to 4. 4).

CONCLUSION

A moderate intake of wine probably does not increase the risk of upper digestive tract cancer, whereas a moderate intake of beer or spirits increases the risk considerably.

[Positive effects of alcohol drinking?]

Findings in more than 30 population studies have suggested the relationship between alcohol consumption and mortality rates to be described by a U-shaped or J-shaped curve. The downstroke of the U is probably to be explained by a beneficial effect of moderate alcohol consumption on the risk of ischaemic heart disease. Various sources of bias in our interpretation of the downstroke of the curve have been reviewed and to some extent excluded. In all likelihood, however, both the drinking pattern and the type of alcohol used are determinants of the shape of the curve. One study has shown steady drinking to be more protective than binge drinking against heart disease, and a couple of studies have suggested wine-drinkers to enjoy greater protection than beer and spirits drinkers. Moreover, it is emphasised that the effect of alcohol on the risk of cardiovascular and other diseases is highly dependent on the distribution of other risk factors in the population under study. The pultative beneficial effects of moderate alcohol consumption should therefore be considered to apply only to individuals at risk of cardiovascular disease. Finally, it is stressed that available evidence of the efficacy of alcohol as a "heart medicine" is insufficient.

Trends in stroke incidence. The Copenhagen City Heart Study

BACKGROUND AND PURPOSE

Stroke incidence has increased in some countries and decreased in others. After 20 years of intensive antihypertensive treatment the latter could be expected, and we have evaluated the sex-specific temporal trends in stroke incidence using 17 years of follow-up in the Copenhagen City Heart Study.

SUBJECTS AND METHODS

Our cohort comprised 19,698 subjects living in Copenhagen, Denmark. They were invited for health examinations in the following time periods: 1976 through 1978, 1981 through 1983, and 1992 through 1994. Trends are presented for all persons who attended at least one of the two first examinations as well as the total cohort including nonresponders. Subjects between 45 and 84 years of age were followed from March 1, 1976 until March 1, 1993. Changes in age-specific stroke incidence were calculated by means of Poisson regression analysis.

RESULTS

For subjects aged 45 to 64 years, no significant trends were observed, with an annual incidence rate ratio of 1.00 (95% confidence interval [CI], 0.97 to 1.03) and 1.04 (95% CI, 0.99 to 1.08) for men and women, respectively. In subjects aged 65 to 84 years a significant decrease in stroke incidence was found in men, whose annual rate ratio was 0.97 (95% CI, 0.95 to 0.99), but not in women, whose annual rate ratio was 0.98 (95% CI, 0.95 to 1.00). Throughout four observed periods the stroke incidence among men remained significantly higher than that for women.

CONCLUSIONS

During the period from 1976 to 1993 there has been a decline in incidence of stroke in men and women aged 65 to 84 years that was significant only in men, whereas no changes were found for persons aged 45 to 64 years.