Alcohol and mortality in British men: explaining the U-shaped curve

Alcohol consumption, drinking patterns, and ischemic heart disease: a narrative review of meta-analyses and a systematic review and meta-analysis of the impact of heavy drinking occasions on risk for moderate drinkers

BACKGROUND

Alcohol consumption is a major global risk factor for mortality and morbidity. Much discussion has revolved around the diverse findings on the complex relationship between alcohol consumption and the leading cause of death and disability, ischemic heart disease (IHD).

METHODS

We conducted a systematic search of the literature up to August 2014 using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify meta-analyses and observational studies examining the relationship between alcohol drinking, drinking patterns, and IHD risk, in comparison to lifetime abstainers. In a narrative review we have summarized the many meta-analyses published in the last 10 years, discussing the role of confounding and experimental evidence. We also conducted meta-analyses examining episodic heavy drinking among on average moderate drinkers.

RESULTS

The narrative review showed that the use of current abstainers as the reference group leads to systematic bias. With regard to average alcohol consumption in relation to lifetime abstainers, the relationship is clearly J-shaped, supported by short-term experimental evidence and similar associations within strata of potential confounders, except among smokers. Women experience slightly stronger beneficial associations and also a quicker upturn to a detrimental effect at lower levels of average alcohol consumption compared to men. There was no evidence that chronic or episodic heavy drinking confers a beneficial effect on IHD risk. People with alcohol use disorder have an elevated risk of IHD (1.5- to 2-fold). Results from our quantitative meta-analysis showed that drinkers with average intake of <30 g/day and no episodic heavy drinking had the lowest IHD risk (relative risk = 0.64, 95% confidence interval 0.53 to 0.71). Drinkers with episodic heavy drinking occasions had a risk similar to lifetime abstainers (relative risk = 1.12, 95% confidence interval 0.91 to 1.37).

CONCLUSIONS

Epidemiological evidence for a beneficial effect of low alcohol consumption without heavy drinking episodes is strong, corroborated by experimental evidence. However, episodic and chronic heavy drinking do not provide any beneficial effect on IHD. Thus, average alcohol consumption is not sufficient to describe the risk relation between alcohol consumption and IHD. Alcohol policy should try to reduce heavy drinking patterns.

Drinking pattern, abstention and problem drinking as risk factors for depressive symptoms: evidence from three urban Eastern European populations

Purpose

To examine whether the frequency and amount of alcohol consumed in binge drinking sessions, total annual volume of alcohol consumed, problem drinking and abstaining from alcohol are associated with depressive symptoms in Eastern Europe.

Subjects and Methods

Cross-sectional data from a total of 24,381 participants from general population samples of the Czech Republic (N = 7,601), Russia (N = 6,908) and Poland (N = 9,872) aged 45–69 years in 2002–2005. Depressive symptoms were defined as ≥16 points on the Centre for Epidemiological Studies – Depression (CES-D) scale. Several alcohol related measures were derived using responses from the graduated frequency questionnaire. Binge drinking was defined at several sex-specific thresholds (ranging from 60+ to 140+ g of ethanol) and two frequencies (at least monthly or weekly). Total annual alcohol intake in grams was also extracted. Problem drinking was defined as ≥2 positive answers on the CAGE questionnaire.

Results

Problem drinking was consistently associated with approximately a 2-fold increase in odds of depressive symptoms across all countries and in both sexes. Abstaining from alcohol was typically associated with increased odds of depressive symptoms. Analyses separating lifelong abstainers and former drinkers in the Russian cohort revealed that this increased odds was driven by former drinkers. Amongst men, heavy frequent binge drinking was associated with increased odds of depressive symptoms in the Czech Republic and Poland. In women, heavy infrequent binge drinking was associated with increased odds of depressive symptoms in Russia and Poland. Only in Polish men was higher annual volume of alcohol intake associated with increased odds of depressive symptoms.

Conclusion

Abstaining from alcohol and problem drinking were associated with increased odds of depressive symptoms in these Eastern European populations. Annual volume of alcohol intake as well as frequency and amount of alcohol consumed in a binge drinking session were less consistently associated with depressive symptoms.

Methodological biases in estimating the relationship between alcohol consumption and breast cancer: the role of drinker misclassification errors in meta-analytic results

BACKGROUND

While alcohol consumption has been linked to breast cancer in women, few studies have controlled for possible biases created by including former or occasional drinkers in the abstainer reference group. We explored the potential for such misclassification errors as sources of bias in estimates of the alcohol-breast cancer relationship.

METHODS

Meta-analyses of population case-control, hospital case-control, and cohort studies to examine relationships between level of alcohol use and breast cancer morbidity and/or mortality in groups of studies with and without different misclassification errors.

RESULTS

Of 60 studies identified, only 6 were free of all misclassification errors. The abstainer reference group was biased by the inclusion of former drinkers in 49 studies, occasional drinkers (<10 g ethanol [EtOH] per week) in 22 and by both these groups in 18. Occasional drinkers were also mixed with light or hazardous-level drinkers in 22 studies. Unbiased estimates of the odds ratio (OR) for breast cancer were 1.011 (95% confidence interval [CI]: 0.891 to 1.148) among former drinkers (n = 11) and 1.034 (95% CI: 1.003 to 1.064) among occasional drinkers (n = 17). Hazardous-level drinking (>20 g < 41 g EtOH/d) was not significantly associated with breast cancer in studies with occasional drinker bias. However, in studies free from occasional drinker bias, the OR for breast cancer was 1.085 (95% CI: 1.015 to 1.160) for low-level (<21 g/d) drinkers (n = 17), 1.374 (95% CI: 1.319 to 1.431) for hazardous-level drinkers (n = 26), and 1.336 (95% CI: 1.228 to 1.454) for harmful-level (>40 g/d) drinkers (n = 9).

CONCLUSIONS

While the great majority of studies of the alcohol-breast cancer link include misclassification errors, only misclassification of occasional drinkers was found to bias risk estimates significantly. Estimates based on error-free studies confirmed that low, hazardous and harmful levels of alcohol use each significantly increase the risk of breast cancer.

Association between alcohol and cardiovascular disease: Mendelian randomisation analysis based on individual participant data

OBJECTIVE

To use the rs1229984 variant in the alcohol dehydrogenase 1B gene (ADH1B) as an instrument to investigate the causal role of alcohol in cardiovascular disease.

DESIGN

Mendelian randomisation meta-analysis of 56 epidemiological studies.

PARTICIPANTS

261 991 individuals of European descent, including 20 259 coronary heart disease cases and 10 164 stroke events. Data were available on ADH1B rs1229984 variant, alcohol phenotypes, and cardiovascular biomarkers.

MAIN OUTCOME MEASURES

Odds ratio for coronary heart disease and stroke associated with the ADH1B variant in all individuals and by categories of alcohol consumption.

RESULTS

Carriers of the A-allele of ADH1B rs1229984 consumed 17.2% fewer units of alcohol per week (95% confidence interval 15.6% to 18.9%), had a lower prevalence of binge drinking (odds ratio 0.78 (95% CI 0.73 to 0.84)), and had higher abstention (odds ratio 1.27 (1.21 to 1.34)) than non-carriers. Rs1229984 A-allele carriers had lower systolic blood pressure (-0.88 (-1.19 to -0.56) mm Hg), interleukin-6 levels (-5.2% (-7.8 to -2.4%)), waist circumference (-0.3 (-0.6 to -0.1) cm), and body mass index (-0.17 (-0.24 to -0.10) kg/m(2)). Rs1229984 A-allele carriers had lower odds of coronary heart disease (odds ratio 0.90 (0.84 to 0.96)). The protective association of the ADH1B rs1229984 A-allele variant remained the same across all categories of alcohol consumption (P=0.83 for heterogeneity). Although no association of rs1229984 was identified with the combined subtypes of stroke, carriers of the A-allele had lower odds of ischaemic stroke (odds ratio 0.83 (0.72 to 0.95)).

CONCLUSIONS

Individuals with a genetic variant associated with non-drinking and lower alcohol consumption had a more favourable cardiovascular profile and a reduced risk of coronary heart disease than those without the genetic variant. This suggests that reduction of alcohol consumption, even for light to moderate drinkers, is beneficial for cardiovascular health.

An exploration of the dynamic longitudinal relationship between mental health and alcohol consumption: a prospective cohort study

BACKGROUND

Despite intense investigation, the temporal sequence between alcohol consumption and mental health remains unclear. This study explored the relationship between alcohol consumption and mental health over multiple occasions, and compared a series of competing theoretical models to determine which best reflected the association between the two.

METHODS

Data from phases 5 (1997 to 1999), 7 (2002 to 2004), and 9 (2007 to 2009) of the Whitehall II prospective cohort study were used, providing approximately 10 years of follow-up for 6,330 participants (73% men; mean ± SD age 55.8 ± 6.0 years). Mental health was assessed using the Short Form (SF)-36 mental health component score. Alcohol consumption was defined as the number of UK units of alcohol drunk per week. Four dynamic latent change score models were compared: 1) a baseline model in which alcohol consumption and mental health trajectories did not influence each other, 2) and model in which alcohol consumption influenced changes in mental health but mental health exerted no effect on changes in drinking and 3) vice versa, and (4) a reciprocal model in which both variables influenced changes in each other.

RESULTS

The third model, in which mental health influenced changes in alcohol consumption but not vice versa, was the best fit. In this model, the effect of previous mental health on upcoming change in alcohol consumption was negative (γ = -0.31, 95% CI -0.52 to -0.10), meaning that those with better mental health tended to make greater reductions (or shallower increases) in their drinking between occasions.

CONCLUSIONS

Mental health appears to be the leading indicator of change in the dynamic longitudinal relationship between mental health and weekly alcohol consumption in this sample of middle-aged adults. In addition to fuelling increases in alcohol consumption among low-level consumers, poor mental health may also be a maintaining factor for heavy alcohol consumption. Future work should seek to examine whether there are critical levels of alcohol intake at which different dynamic relationships begin to emerge between alcohol-related measures and mental health.

Alcohol consumption over time and risk of death: a systematic review and meta-analysis

The results from the few cohort studies that have measured usual alcohol consumption over time have not been summarized. We therefore conducted a systematic review and meta-analysis to quantify mortality risk. Pertinent studies were identified by searching the Medline, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL) Plus, and Scopus databases through August 2012 using broad search criteria. Studies reporting relative mortality risks for quantitatively defined categories of alcohol consumption over time were eligible. Nine cohort studies published during 1991-2010 (comprising 62,950 participants and 10,490 deaths) met the inclusion criteria. For men, there was weak evidence of lower mortality risk with low levels of alcohol intake over time but higher mortality risk for those with intakes over 40 g/day compared with abstainers using a random-effects model (P for nonlinearity = 0.02). The pooled relative risks were 0.90 (95% confidence interval: 0.81, 0.99) for 1-29 g/day, 1.19 (95% confidence interval: 0.89, 1.58) for 30-59 g/day, and 1.52 (95% confidence interval: 0.78, 2.98) for 60 or more g/day compared with abstention. There was moderate between-study heterogeneity but no evidence of publication bias. Studies including women were extremely scarce. Our findings include a curvilinear association between drinking over time and mortality risk for men overall and widespread disparity in methods used to capture exposure and report results.

Relationship between alcohol use categories and noninvasive markers of advanced hepatic fibrosis in HIV-infected, chronic hepatitis C virus-infected, and uninfected patients

BACKGROUND

It is unclear if the risk of liver disease associated with different levels of alcohol consumption is higher for patients infected with human immunodeficiency virus (HIV) or chronic hepatitis C virus (HCV). We evaluated associations between alcohol use categories and advanced hepatic fibrosis, by HIV and chronic HCV status.

METHODS

We performed a cross-sectional study among participants in the Veterans Aging Cohort Study who reported alcohol consumption at enrollment (701 HIV/HCV-coinfected; 1410 HIV-monoinfected; 296 HCV-monoinfected; 1158 HIV/HCV-uninfected). Alcohol use category was determined by the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) questionnaire and alcohol-related diagnoses and was classified as nonhazardous drinking, hazardous/binge drinking, or alcohol-related diagnosis. Advanced hepatic fibrosis was defined by FIB-4 index >3.25.

RESULTS

Within each HIV/HCV group, the prevalence of advanced hepatic fibrosis increased as alcohol use category increased. For each alcohol use category, advanced hepatic fibrosis was more common among HIV-infected than uninfected (nonhazardous: 6.7% vs 1.4%; hazardous/binge: 9.5% vs 3.0%; alcohol-related diagnosis: 19.0% vs 8.6%; P < .01) and chronic HCV-infected than uninfected (nonhazardous: 13.6% vs 2.5%; hazardous/binge: 18.2% vs 3.1%; alcohol-related diagnosis: 22.1% vs 6.5%; P < .01) participants. Strong associations with advanced hepatic fibrosis (adjusted odds ratio [95% confidence interval]) were observed among HIV/HCV-coinfected patients with nonhazardous drinking (14.2 [5.91-34.0]), hazardous/binge drinking (18.9 [7.98-44.8]), and alcohol-related diagnoses (25.2 [10.6-59.7]) compared with uninfected nonhazardous drinkers.

CONCLUSIONS

Advanced hepatic fibrosis was present at low levels of alcohol consumption, increased with higher alcohol use categories, and was more prevalent among HIV-infected and chronic HCV-infected patients than uninfected individuals. All alcohol use categories were strongly associated with advanced hepatic fibrosis in HIV/HCV-coinfected patients.

Alcohol consumption and health status of family members: health impacts without ingestion

BACKGROUND

Over several decades, many cohort studies from the medical epidemiology literature have observed that compared with abstainers, moderate drinkers experience lower risk for a range of diseases. It was very difficult to separate the hypothesised physiological protective effect of moderate drinking from its well-correlated confounders in observational study settings.

AIMS

To investigate the association between current alcohol consumption levels of randomly selected family members and the current self-reported health status of other members living within the same family, using a large-scale representative general population survey.

METHOD

Poisson regression models of the association between randomly selected key respondent alcohol consumption and health status of cohabiting family members using data from the 2008, 2009 and 2010 National Health Interview Surveys. Self-reported alcohol consumption of randomly selected key participants and self-reported health status of adult and child (parent reported) family members living in the same household were measured and compared.

RESULTS

After controlling for a large range of commonly reported confounders, inverse associations were evident between light and moderate alcohol consumption of key participants and the prevalence of adverse health status among their family members, including children.

CONCLUSIONS

The superior health status attributed to family members of light and moderate drinkers is highly likely to be spurious and due to residual confounding rather than physiologically protective effects of alcohol. Unaccounted for confounding is likely to underpin apparent 'protective effects' due to moderate drinking commonly reported from observational studies of all-cause mortality, heart disease, stroke and other chronic diseases.

Are psychosocial stressors associated with the relationship of alcohol consumption and all-cause mortality?

BACKGROUND

Several studies have shown a protective association of moderate alcohol intake with mortality. However, it remains unclear whether this relationship could be due to misclassification confounding. As psychosocial stressors are among those factors that have not been sufficiently controlled for, we assessed whether they may confound the relationship between alcohol consumption and all-cause mortality.

METHODS

Three cross-sectional MONICA surveys (conducted 1984-1995) including 11,282 subjects aged 25-74 years were followed up within the framework of KORA (Cooperative Health Research in the Region of Augsburg), a population-based cohort, until 2002. The prevalences of diseases as well as of lifestyle, clinical and psychosocial variables were compared in different alcohol consumption categories. To assess all-cause mortality risks, hazard ratios (HRs) were estimated by Cox proportional hazards models which included lifestyle, clinical and psychosocial variables.

RESULTS

Diseases were more prevalent among non-drinkers than among drinkers: Moreover, non-drinkers showed a higher percentage of an unfavourable lifestyle and were more affected with psychosocial stressors at baseline. Multivariable-adjusted HRs for moderate alcohol consumption versus no consumption were 0.74 (95% confidence interval (CI): 0.58-0.94) in men and 0.87 (95% CI: 0.66-1.16) in women. In men, moderate drinkers had a significantly lower all-cause mortality risk than non-drinkers or heavy drinkers (p=0.002) even after multivariable adjustment. In women, moderate alcohol consumption was not associated with lowered risk of death from all causes.

CONCLUSIONS

The present study confirmed the impact of sick quitters on mortality risk, but failed to show that the association between alcohol consumption and mortality is confounded by psychosocial stressors.

Relationship between obesity, metabolic syndrome, and nonalcoholic fatty liver disease in the elderly agricultural and fishing population of Taiwan

BACKGROUND

The purpose of this study was to explore the relationship between obesity, the metabolic syndrome, and nonalcoholic fatty liver disease (NAFLD) in the elderly agricultural and fishing population of Taipei, Taiwan.

METHODS

The study participants comprised 6,511 (3,971 male and 2,540 female) healthy elderly subjects voluntarily attending a teaching hospital for a physical check-up in 2010. Blood samples and real-time ultrasound-proven fatty liver sonography results were collected.

RESULTS

The prevalence of NAFLD in this elderly population was 27.2%, including mild NAFLD (16.0%), moderate NAFLD (10.3%), and severe NAFLD (0.9%). The prevalence of moderate or severe NAFLD for metabolic syndrome proved to be substantially greater (P<0.0001, χ(2) test) for one or two metabolic factors. Using multinomial logistic regression analysis, age, sex, metabolic syndrome, and higher body mass index had a statistically significant association with mild NAFLD. Age, sex, metabolic syndrome, higher body mass index, and higher alanine aminotransferase were significantly related to moderate NAFLD. In addition, higher body mass index, higher uric acid, and higher alanine aminotransferase levels were significantly related to severe NAFLD. The sensitivity and specificity of body mass index and waist circumference as markers of NAFLD were estimated to be 81% and 84%, respectively, and 77% and 69%, respectively.

CONCLUSION

The prevalence of mild or moderate NAFLD was related to obesity and metabolic syndrome. Higher body mass index was also related to severe NAFLD but not to metabolic syndrome. Targeting this population for control of obesity and improved metabolic function is important.

Alcohol use and early mortality in Swedish middle-aged women: Nine-year follow-up of the Women’s Health in Lund Area study

Aims: The majority of prospective studies on alcohol use and mortality risk indicate that non-drinkers are at increased risk of death compared to moderate drinkers. This article investigates the association between middle-aged women’s alcohol use and mortality, controlling for socio-demographic and health variables. An association between alcohol use and hospital in-patient care is also analysed. Methods: Baseline data were collected during 1995–2000 in a population-based cohort of 6917 women aged 50–59 years living in southern Sweden, the Women’s Health in Lund Area (WHILA). After 9 years, a register follow-up was performed from the National cause-of-death register and the Swedish hospital discharge register. Cox proportional hazards regression were used to analyse differences in survival. Results: During the observation period, 201 (2.9%) women died. In a crude model, non-drinkers had a significantly increased risk for death. When including socio-demographic predictors in the model, there was a strong indication that non-drinkers were at increased risk for death compared to moderate drinkers. Adding health predictors, not drinking alcohol was no longer a risk factor for death. Further, analyses of in-patient care indicate that non-drinkers had poorer health during their entire adult life. Conclusions: This study underlines the importance of including health status at base-line when prospectively studying the association between alcohol use and mortality, otherwise moderate alcohol consumption may appear more beneficial than is the case.

Prevalence and 1-year course of alcohol misuse and smoking in persons with lower extremity amputation as a result of peripheral arterial disease

OBJECTIVE

The aim of this study was to describe prevalence of alcohol misuse and smoking among individuals with amputations as a result of peripheral arterial disease before surgery and 12 mos after surgery, changes in these behaviors over time, and factors associated with change.

DESIGN

This is a prospective cohort study of 75 veterans experiencing their first major unilateral amputation. Measures included demographic and general health information, Alcohol Use Disorders Identification Test, smoking behaviors, and social support.

RESULTS

Sixteen percent of the participants reported engaging in alcohol misuse at presurgical baseline; and 13% at 12 mos after amputation. Thirty-seven percent of the participants were categorized as smokers at baseline; this number dropped to 29% at 12 mos after amputation. Among those who decreased drinking and quit smoking, there was a trend indicating greater social support.

CONCLUSIONS

The participants endorsed drinking and smoking behaviors at levels consistent with other types of disability and with veterans using the Veterans Health Administration for their health care. Even with a variety of health concerns, after amputation, most of the smokers and those engaging in alcohol misuse continued to smoke and drink at their preamputation rate. The presence of social support may encourage health behavior change and is an important area for future research and intervention.

Alcohol drinking does not affect postoperative surgical site infection or anastomotic leakage: a systematic review and meta-analysis

BACKGROUND

Alcohol abuse appears to increase postoperative complications, but clinical trials have reported conflicting results. The objective of this systematic review and meta-analysis is to clarify how alcohol drinking affects postoperative surgical site infection and anastomotic leakage and to determine the impact of perioperative alcohol intervention.

MATERIAL AND METHODS

The databases MEDLINE, EMBASE, and CENTRAL were searched. Observational studies assessing surgical site infection and anastomotic leakage for alcohol drinkers and randomized controlled trials (RCTs) studying perioperative alcohol interventions were included. Meta-analyses were performed with random effects models. Methodological quality was assessed by the Newcastle-Ottawa Scale and Cochrane methodology.

RESULTS

Fifteen observational studies and 2 RCTs were identified. Meta-analyses were performed for alcohol drinkers vs nondrinkers and moderate drinkers (≤ 2 U/day), respectively. No difference between alcohol drinkers and nondrinkers was found. When drinkers and moderate drinkers were compared, a significantly higher incidence of surgical site infection and anastomotic leakage was found in unadjusted studies. In the meta-analysis of studies adjusting for smoking and age, alcohol drinking did not significantly affect surgical site infection and anastomotic leakage. The RCTs did not show any effect of perioperative alcohol abstinence or pharmacological withdrawal treatment on outcome.

CONCLUSIONS

Alcohol drinking is not an independent risk factor for surgical site infection and anastomotic leakage. Interventions which aim to make patients quit alcohol or treat withdrawal symptoms do not seem to affect the surgical outcomes of interest.

Mediterranean alcohol-drinking pattern and mortality in the SUN (Seguimiento Universidad de Navarra) Project: a prospective cohort study

Moderate alcohol intake has been related to lower mortality. However, alcohol use includes other dimensions beyond the amount of alcohol consumed. These aspects have not been sufficiently studied as a comprehensive entity. We aimed to test the relationship between an overall alcohol-drinking pattern and all-cause mortality. In a Mediterranean cohort study, we followed 18 394 Spanish participants up to 12 years. A validated 136-item FFQ was used to assess baseline alcohol intake. We developed a score assessing simultaneously seven aspects of alcohol consumption to capture the conformity to a traditional Mediterranean alcohol-drinking pattern (MADP). It positively scored moderate alcohol intake, alcohol intake spread out over the week, low spirit consumption, wine preference, red wine consumption, wine consumed during meals and avoidance of binge drinking. During the follow-up, 206 deaths were identified. For each 2-point increment in a 0-9 score of adherence to the MADP, we observed a 25% relative risk reduction in mortality (95% CI 11, 38%). Within each category of alcohol intake, a higher adherence to the MADP was associated with lower mortality. Abstainers (excluded from the calculations of the MADP) exhibited higher mortality (hazard ratio 1·82, 95% CI 1·14, 2·90) than participants highly adherent to the MADP. In conclusion, better adherence to an overall healthy alcohol-drinking pattern was associated with reduced mortality when compared with abstention or departure from this pattern. This reduction goes beyond the inverse association usually observed for moderate alcohol drinking. Even moderate drinkers can benefit from the advice to follow a traditional MADP.

Sarcopenic obesity and risk of cardiovascular disease and mortality: a population-based cohort study of older men

Objectives

To examine associations between sarcopenia, obesity, and sarcopenic obesity and risk of cardiovascular disease (CVD) and all-cause mortality in older men.

Design

Prospective cohort study.

Setting

British Regional Heart Study.

Participants

Men aged 60–79 years (n = 4,252).

Measurements

Baseline waist circumference (WC) and midarm muscle circumference (MAMC) measurements were used to classify participants into four groups: sarcopenic, obese, sarcopenic obese, or optimal WC and MAMC. The cohort was followed for a mean of 11.3 years for CVD and all-cause mortality. Cox regression analyses assessed associations between sarcopenic obesity groups and all-cause mortality, CVD mortality, CVD events, and coronary heart disease (CHD) events.

Results

There were 1,314 deaths, 518 CVD deaths, 852 CVD events, and 458 CHD events during follow-up. All-cause mortality risk was significantly greater in sarcopenic (HR = 1.41, 95% CI = 1.22–1.63) and obese (HR = 1.21, 95% CI = 1.03–1.42) men than in the optimal reference group, with the highest risk in sarcopenic obese (HR = 1.72, 95% CI = 1.35–2.18), after adjustment for lifestyle characteristics. Risk of CVD mortality was significantly greater in sarcopenic and obese but not sarcopenic obese men. No association was seen between sarcopenic obesity groups and CHD or CVD events.

Conclusion

Sarcopenia and central adiposity were associated with greater cardiovascular mortality and all-cause mortality. Sarcopenic obese men had the highest risk of all-cause mortality but not CVD mortality. Efforts to promote healthy aging should focus on preventing obesity and maintaining muscle mass.

Clinical implications in the prevalence and associated cardiovascular factors of elevated serum alanine aminotransferase levels among elderly agricultural and fishing population in Taipei, Taiwan: experience at a teaching hospital

AIM

To discuss the prevalence and associated factors related to an elevated serum alanine aminotransferase (ALT) level among the elderly agricultural and fishing population.

METHODS

A total of 6542 (3989 males and 2553 females) healthy adults voluntarily admitted to a teaching hospital for a physical checkup in 2010 in Taipei, Taiwan. Fasting blood samples were drawn via venipuncture, and clinical nurses interviewed the study participants using a structured questionnaire from.

RESULTS

The overall prevalence of an elevated serum ALT level was 18.2% and revealed a statistically significant decrease with increasing age (P < 0.001). The men exhibited a higher prevalence than the women (19.7% vs 15.9%; P < 0.001). Male sex; younger age; and presence of obesity, hypertension, hyperuricemia, and hypoalbuminemia were significantly associated with an elevated serum ALT level. Sex-related differences were also revealed. For the men, type 2 diabetes (odds ratio [OR], 1.23; 95% confidence interval [CI], 1.02-1.57), hypercholesterolemia (OR, 1.78; 95% CI, 1.22-2.83), hypertriglyceridemia (OR, 1.32; 95% CI, 1.04-1.73), and low high-density lipoprotein (OR, 1.26; 95% CI, 1.05-1.51) were significantly related to an elevated serum ALT level, but this was not so for the women. The disparity of ALT in age groups was revealed.

CONCLUSION

Several sex-related differences were indicated pertaining to the prevalence of an elevated serum ALT level among elderly specific occupational population.

Persistent long-standing illness and non-drinking over time, implications for the use of lifetime abstainers as a control group

BACKGROUND

Non-drinkers are shown to have worse health than moderate drinkers in later life. We examine the preceding health status of non-drinkers in early adulthood, and secondly whether persistent poor health is associated with persistent non-drinking.

METHODS

Using two prospective British birth cohort studies established in 1958 (National Child Development Study (NCDS)) and in 1970 (British Cohort Study (BCS)), participants who reported 'never' or 'never had an alcoholic drink' to drinking status questions in successive waves from 23 to 26 years in the NCDS/BCS were derived as 'lifetime abstainers'. Logistic regression on the odds of being a lifetime abstainer was carried out on changes in limiting long-standing illness (LLSI) in the NCDS and long-standing illness (LSI) in the BCS, adjusting for sex, education, poor psychosocial health, marital and parental status.

RESULTS

Participants with an LLSI in consecutive waves since 23 years had 4.50 times the odds of someone who did not have an LLSI of being a lifetime abstainer at 33 years (95% CI 1.99 to 10.18) and 7.02 times the odds at 42 years (2.39 to 20.66) after adjusting for all factors. Similarly, in the BCS, having an LSI in consecutive waves resulted in higher odds of being a lifetime abstainer at 30 years (OR 2.80, 1.88 to 4.18) and 34 years (OR 3.33, 2.01 to 5.53).

CONCLUSIONS

Persistent LSI was associated with remaining a non-drinker across adulthood. Studies comparing the health outcomes of moderate drinkers to lifetime abstainers that do not account for pre-existing poor health may overestimate the better health outcomes from moderate alcohol consumption.

The relationship between alcohol consumption and vascular complications and mortality in individuals with type 2 diabetes

OBJECTIVE

Moderate alcohol consumption has been associated with a reduced risk of mortality and coronary artery disease. The relationship between cardiovascular health and alcohol use in type 2 diabetes is less clear. The current study assesses the effects of alcohol use among participants in the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified-Release Controlled Evaluation (ADVANCE) trial.

RESEARCH DESIGN AND METHODS

The effects of alcohol use were explored using Cox regression models, adjusted for potential confounders. The study end points were cardiovascular events (cardiovascular death, myocardial infarction, and stroke), microvascular complications (new or worsening nephropathy or retinopathy), and all-cause mortality.

RESULTS

During a median of 5 years of follow-up, 1,031 (9%) patients died, 1,147 (10%) experienced a cardiovascular event, and 1,136 (10%) experienced a microvascular complication. Compared with patients who reported no alcohol consumption, those who reported moderate consumption had fewer cardiovascular events (adjusted hazard ratio [aHR] 0.83; 95% CI 0.72-0.95; P = 0.008), less microvascular complications (aHR 0.85; 95% CI 0.73-0.99; P = 0.03), and lower all-cause mortality (aHR 0.87; 96% CI 0.75-1.00; P = 0.05). The benefits were particularly evident in participants who drank predominantly wine (cardiovascular events aHR 0.78, 95% CI 0.63-0.95, P = 0.01; all-cause mortality aHR 0.77, 95% CI 0.62-0.95, P = 0.02). Compared with patients who reported no alcohol consumption, those who reported heavy consumption had dose-dependent higher risks of cardiovascular events and all-cause mortality.

CONCLUSIONS

In patients with type 2 diabetes, moderate alcohol use, particularly wine consumption, is associated with reduced risks of cardiovascular events and all-cause mortality.

Clinical epidemiology of reduced kidney function among elderly male fishing and agricultural population in Taipei, Taiwan

PURPOSE

To quantify the prevalence of and associated factors for chronic kidney disease (CKD) among male elderly fishing and agricultural population in Taipei, Taiwan.

METHODS

Subjects (n = 2,766) aged 65 years and over voluntarily admitted to a teaching hospital for a physical checkup were collected in 2010. CKD was defined as an estimated glomerular filtration rate <60 mL/min/1.73 m².

RESULTS

Among these subjects, the over prevalence of chronic kidney disease was 13.6% (95% CI: 12.3-14.9%). The age-specific prevalence of CKD in 65-74 years, 75-84 years, and ≥85 years was 8.2%, 19.1%, and 27.0%, respectively. From the multiple logistic regression, age (OR = 1.05, 95% CI: 1.02-1.09), hyperuricemia (OR = 2.94, 95% CI: 1.90-3.78), central obesity (OR = 1.17, 95% CI: 1.02-1.56), hyperglycemia (OR = 1.23, 95% CI: 1.11-1.67), hypertriglyceridemia (OR = 1.25, 95% CI: 1.08-1.66), and lower HDL-C (OR = 1.61, 95% CI: 1.23-1.92) were statistically significantly related to CKD. The presence of metabolic components (one or two versus none, OR = 1.10, 95% CI: 1.04-1.25; three or more versus none, OR = 2.12, 95% CI: 1.86-2.78) also appeared to be statistically significantly related to CKD after adjustment for other independent factors.

CONCLUSION

Several clinical factors independently affect the development of CKD in the elderly male fishing and agricultural population.

Association of alcohol consumption with incident hypertension among middle-aged and older Japanese population: the Ibarakai Prefectural Health Study (IPHS)

The objective of this study was to examine the effect of age on the relationship between alcohol consumption and incident hypertension in a general Japanese population. A cohort of Japanese men (n=37 310) and women (n=78 426) aged 40 to 79 years who underwent community-based health checkups from 1993 to 2004 and were free of hypertension were followed up with annual examinations, including the measurement of blood pressure, until the end of 2010. Incident hypertension was defined as systolic blood pressure of ≥140 mm Hg, diastolic blood pressure of ≥90 mm Hg, or the initiation of treatment for hypertension. Hazard ratios for incident hypertension according to alcohol consumption were estimated using a Cox proportional hazards model adjusted for possible confounding variables. A total of 45 428 participants (39.3%) developed hypertension (16 155 men and 29 273 women) for a mean follow-up time of 3.9 (1-18) years. Significant associations between alcohol consumption and incident hypertension were found in both sexes and age groups (P for trend was <0.001 for men aged 40-59 years and aged 60-79 years; 0.004 for women aged 40-59 years and 0.026 for women aged 60-79 years). No significant interaction with age on the association of alcohol consumption with incident hypertension was found in either sex (P for interaction, >0.05). Our results suggest that alcohol consumption is a similar risk factor for incident hypertension in both the middle-aged and the older populations.

Probability and predictors of patients converting from negative to positive screens for alcohol misuse

BACKGROUND

Medicare reimburses providers for annual alcohol screening. However, the benefit of rescreening patients a year after a negative screen for alcohol misuse is unknown. We hypothesized that some subgroups of patients who screen negative would have a very low probability of converting to a positive subsequent screen (e.g., <0.1%), calling into question the value of annual alcohol screening for some patient subgroups.

METHODS

This retrospective cohort study estimated the probability of converting to a positive screen for alcohol misuse a year after a negative screen among outpatients from 30 Veterans Health Administration (VA) medical centers. Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) alcohol screening scores (range 0 to 12 points) from 2004 to 2008 were obtained from electronic health record data. Eligible patients screened negative on their initial screen (AUDIT-C scores 0 to 3 for men; 0 to 2 for women). The main outcome was a positive subsequent screen (AUDIT-C scores ≥4 men; ≥3 women).

RESULTS

Among 21,081 women and 323,913 men who screened negative on an initial screen, 5.4% and 6.0%, respectively, screened positive a year later. The adjusted probability of converting to a positive subsequent screen varied from 2.1 to 38.9% depending on age, gender, and initial negative screen score. Women, older patients, and those with initial AUDIT-C scores of 0 were least likely to a convert to a positive subsequent screen, while younger men with AUDIT-C scores of 3 were most likely to a convert to a positive subsequent screen.

CONCLUSIONS

The probability of a positive subsequent screen varied depending on age, gender, and initial negative screen score but exceeded 2% in all patient subgroups. Annual rescreening appears reasonable for all VA patients who had a negative screen the year prior.

Observational research on alcohol use and chronic disease outcome: new approaches to counter biases

BACKGROUND

The frequently reported protective effects of moderate alcohol consumption in observational studies may be due to unadjusted bias.

AIM

To examine two new approaches that account for unknown confounding factors and allow the application of intention-to-treat analysis.

METHOD

This study used data from the 2008, 2009, and 2010 National Health Interview Surveys conducted in the United States. Unknown confounding effects were estimated through the association between parental alcohol use and health outcomes for children, because the presence of hypothetical physiological effects of alcohol can be ruled out for this association. In order to apply intention-to-treat analysis, previous alcohol use of former drinkers was obtained by using multiple imputations. Estimates with new adjustment approaches were compared with the traditional approach.

RESULTS

The traditional analytical approach; appears to be consistent with findings from previous observational studies; when two further adjustment approaches were used, the "protective" effects of moderate drinking almost disappeared.

CONCLUSION

Use of a proxy outcome to estimate and control residual confounding effects of alcohol use and application of the intention-to-treat principle could provide a more realistic estimation of the true effects of alcohol use on health outcomes in observational epidemiological studies.

Habitual alcohol consumption is associated with lower cardiovascular stress responses--a novel explanation for the known cardiovascular benefits of alcohol?

In contrast to heavy alcohol consumption, which is harmful, light to moderate drinking has been linked to reduced cardiovascular morbidity and mortality. Effects on lipid status or clotting do not fully explain these benefits. Exaggerated cardiovascular responses to mental stress are detrimental to cardiovascular health. We hypothesized that habitual alcohol consumption might reduce these responses, with potential benefits. Advanced magnetic resonance techniques were used to accurately measure cardiovascular responses to an acute mental stressor (Montreal Imaging Stress Task) in 88 healthy adults (∼1:1 male:female). Salivary cortisol and task performance measures were used to assess endocrine and cognitive responses. Habitual alcohol consumption and confounding factors were assessed by questionnaire. Alcohol consumption was inversely related to responses of heart rate (HR) (r = -0.31, p = 0.01), cardiac output (CO) (r = -0.32, p = 0.01), vascular resistance (r = 0.25, p = 0.04) and mean blood pressure (r = -0.31, p = 0.01) provoked by stress, but not to stroke volume (SV), or arterial compliance changes. However, high alcohol consumers had greater cortisol stress responses, compared to moderate consumers (3.5 versus 0.7 nmol/L, p = 0.04). Cognitive measures did not differ. Findings were not explained by variations in age, sex, social class, ethnicity, physical activity, adrenocortical activity, adiposity, smoking, menstrual phase and chronic stress. Habitual alcohol consumption is associated with reduced cardiac responsiveness during mental stress, which has been linked to lower risk of hypertension and vascular disease. Consistent with established evidence, our findings suggest a mechanism by which moderate alcohol consumption might reduce cardiovascular disease, but not high consumption, where effects such as greater cortisol stress responses may negate any benefits.

Time characteristics of the effect of alcohol cessation on the risk of stomach cancer--a meta-analysis

BACKGROUND

In the Bagnardi et al. (2001) meta-analysis, it was found that alcohol consumption increases the risk of stomach cancer (OR = 1.32 for heavy drinkers). However, it is unknown if drinking cessation reverses this alcohol-elevated risk.

METHODS

A systematic literature review was performed to provide the information for a meta-analysis where the dose-risk trend was estimated for years since drinking cessation and the risk of stomach cancer. A random effect generalised least squares model for trend estimation was used, employing study characteristics to control for heterogeneity.

RESULTS

Nineteen observational studies were identified in the literature review, of which five studies quantified duration of cessation and risk of stomach cancer, giving a total of 1947 cancer cases. No significant effect of drinking cessation on the risk of stomach cancer could be found (OR = 0.99 CI: 0.97-1.02).

CONCLUSIONS

This result should be interpreted with caution due to the limited number of studies in this area. Recent findings suggest a link between heavy drinking and stomach cancer, especially gastric noncardia, but not for moderate drinking. Since all but one of the included studies in this meta-analysis failed to control for consumption level, the current study could not test if the risk decline following drinking cessation differs between moderate and high consumers.

NONDRINKER MORTALITY RISK IN THE UNITED STATES

The literature has shown that people who do not drink alcohol are at greater risk for death than light to moderate drinkers, yet the reasons for this remain largely unexplained. We examine whether variation in people's reasons for nondrinking explains the increased mortality. Our data come from the 1988-2006 National Health Interview Survey Linked Mortality File (N= 41,076 individuals age 21 and above, of whom 10,421 died over the follow-up period). The results indicate that nondrinkers include several different groups that have unique mortality risks. Among abstainers and light drinkers the risk of mortality is the same as light drinkers for a subgroup who report that they do not drink because of their family upbringing, and moral/religious reasons. In contrast, the risk of mortality is higher than light drinkers for former drinkers who cite health problems or who report problematic drinking behaviors. Our findings address a notable gap in the literature and may inform social policies to reduce or prevent alcohol abuse, increase health, and lengthen life.

Prospective correlates of drinking cessation: variation across the life-course

AIMS

To assess age variation in correlates of drinking cessation.

DESIGN

Prospective study of a US general population sample.

SETTING

Face-to-face household interviews.

PARTICIPANTS

Past-year ≥ monthly drinkers interviewed at baseline and 3-year follow-up (n = 14 885).

MEASUREMENTS

Baseline values and selected changes over follow-up in alcohol consumption, alcohol use disorder (AUD), socio-demographic and health characteristics, other substance use and psychiatric comorbidity were used to predict drinking cessation in three age groups.

FINDINGS

Correlates of drinking cessation varied over the life-course, with pregnancy/presence of an infant, nicotine or drug use disorder, incident AUD, cluster A personality disorder, liver disease and incident retirement being important at younger ages and high-school graduation, family income ≥ $70 000, volume of ethanol intake, Asian race/ethnicity, mood disorder and incident cardiovascular disease being significant at older ages. Age-invariant correlates included smoking cessation over follow-up, odds ratio (OR) = 2.82 [95% confidence interval (CI): 1.62-4.92] to 3.45 (2.20-5.39); college education, OR = 0.42 (0.27-0.65) to 0.54 (0.36-0.83); black and Hispanic race/ethnicity, OR = 1.74 (1.18-2.29) to 1.88 (1.21-2.93) and 1.58 (1.11-1.25) to 1.73 (0.83-3.63), respectively, and months since last drink, OR = 1.24 (1.13-1.36) to 1.29 (1.19-1.39).

CONCLUSIONS

Factors associated with ceasing alcohol use in US adults appear to differ over the life-course, reflecting age variation in both their prevalence and impact and supporting the importance of role transitions and health problems (the 'sick quitter' effect). The most consistent correlates of drinking cessation included factors reflecting ability/inability to give up potentially addictive substances and factors associated with perceived acceptability of drinking and subgroup-specific drinking contexts that might facilitate/impede continued drinking.

Consumo de álcool e risco para doença coronariana na região metropolitana de São Paulo: uma análise do Projeto GENACIS

OBJETIVOS: Examinar a associação entre consumo de álcool e risco para doença coronariana em amostra populacional. MÉTODOS: Estudo transversal, de base populacional, conduzido de janeiro/2006 a junho/2007, na região metropolitana de São Paulo, como parte do estudo internacional (Gender, Alcohol, and Culture: an International Study). Os sujeitos (1.501, sendo 609 homens e 892 mulheres) eram residentes da região metropolitana de São Paulo, tinham 30 anos ou mais de idade e foram selecionados aleatoriamente, a partir de amostragem complexa por conglomerados. Todos os indivíduos consentiram em participar da pesquisa. A variável dependente foi risco cardíaco avaliado através do WHO Rose Angina Questionnaire. A análise multivariada consistiu em regressão logística, tendo sido realizado ajuste para uso de tabaco e índice de massa corpórea. RESULTADOS: A taxa de resposta foi 75%. Ser mulher, ter mais idade, ser negro, fumante e ter um índice de massa corpórea elevado, foram associados a maior risco para doença coronariana. Indivíduos que nunca beberam na vida (OR = 2,22) e ex-bebedores (OR = 2,42) tiveram maior risco de doença cardíaca do que aqueles que informaram beber até 19 g de álcool por dia, sem episódios de beber excessivo. Entre os que tiveram episódios de embriaguês observou-se uma tendência a maior risco (OR = 3,95, p = 0,09). CONCLUSÕES: Nossos achados sugerem um menor risco para doença coronariana entre os bebedores moderados. Destaca-se que os estudos que avaliam o impacto do álcool sobre doença cardíaca precisam identificar o padrão de uso de álcool dos sujeitos, visto que este aspecto pode modificar o risco. Políticas públicas são necessárias para reduzir o uso nocivo de álcool e a morbidade a ele relacionada no país.

Role of alcohol drinking pattern in type 2 diabetes in Japanese men: the Toranomon Hospital Health Management Center Study 11 (TOPICS 11)

BACKGROUND

Findings of past studies on the effect of drinking patterns on diabetes risk have been inconsistent.

OBJECTIVE

We aimed to investigate the role of drinking frequency and usual quantity consumed in the development of type 2 diabetes.

DESIGN

Enrolled were 1650 Japanese men without diabetes (diabetes: fasting plasma glucose ≥7.0 mmol/L, glycated hemoglobin ≥6.5%, or self-reported clinician-diagnosed diabetes). Average alcohol consumption and 12 combinations of frequency and usual quantity per drinking occasion were assessed at the baseline examination. The absolute risk and HR for the development of diabetes were calculated.

RESULTS

During a mean follow-up period of 10.2 y, 216 individuals developed diabetes. Lifetime abstainers (n = 153) had a relatively low incidence of diabetes (9.1/1000 person-years), similar to moderate consumers (99-160 g ethanol/wk; 9.0/1000 person-years). Increasingly higher quantities of alcohol usually consumed per occasion increased the risk of diabetes regardless of drinking frequency. The lowest incidence rate of diabetes (8.5/1000 person-years) was associated with the consumption of <1 drink (<23 g ethanol) per occasion over ≥6 times/wk. Binge drinking (≥3 drinks per occasion) significantly increased the risk of future diabetes regardless of frequency (HR: 1.79; 95% CI: 1.17, 2.74) compared with <1 drink per occasion.

CONCLUSIONS

Among current drinkers, a drinking pattern of <1 drink per occasion regularly over 6 times within a week was associated with the lowest risk of developing diabetes. Usual quantity per drinking occasion was a more important determinant than was weekly drinking frequency in the association between alcohol consumption and risk of diabetes in Japanese men.

The effects of capping the alcohol consumption distribution and relative risk functions on the estimated number of deaths attributable to alcohol consumption in the European Union in 2004

BACKGROUND

When calculating the number of deaths attributable to alcohol consumption (i.e., the number of deaths that would not have occurred if everyone was a lifetime abstainer), alcohol consumption is most often modelled using a capped exposure distribution so that the maximum average daily consumption is 150 grams of pure alcohol. However, the effect of capping the exposure distribution on the estimated number of alcohol-attributable deaths has yet to be systematically evaluated. Thus, the aim of this article is to estimate the number of alcohol-attributable deaths by means of a capped and an uncapped gamma distribution and capped and uncapped relative risk functions using data from the European Union (EU) for 2004.

METHODS

Sex- and disease-specific alcohol relative risks were obtained from the ongoing Global Burden of Disease, Comparative Risk Assessment Study. Adult per capita consumption estimates were obtained from the Global Information System on Alcohol and Health. Data on the prevalence of current drinkers, former drinkers, and lifetime abstainers by sex and age were obtained from various population surveys. Alcohol-attributable deaths were calculated using Alcohol-Attributable Fractions that were calculated using capped (at 150 grams of alcohol) and uncapped alcohol consumption distributions and capped and uncapped relative risk functions.

RESULTS

Alcohol-attributable mortality in the EU may have been underestimated by 25.5% for men and 8.0% for women when using the capped alcohol consumption distribution and relative risk functions, amounting to the potential underestimation of over 23,000 and 1,100 deaths in 2004 in men and women respectively. Capping of the relative risk functions leads to an estimated 9,994 and 468 fewer deaths for men and for women respectively when using an uncapped gamma distribution to model alcohol consumption, accounting for slightly less than half of the potential underestimation.

CONCLUSIONS

Although the distribution of drinkers in the population and the exact shape of the relative risk functions at large average daily alcohol consumption levels are not known, the findings of our study stress the importance of conducting further research to focus on exposure and risk in very heavy drinkers.

Average volume of alcohol consumed, drinking patterns, and metabolic syndrome in older Korean adults

BACKGROUND

Controversial results have been reported on the relationship between alcohol intake and metabolic syndrome (MetS). We examined the association of average volume of alcohol consumed and drinking patterns with MetS and its components.

METHODS

This study was conducted as a baseline survey for the Dong-gu Study of adults aged 50 years or older. Drinking patterns were assessed using a structured interview, and average volume of alcohol consumed was calculated. MetS was defined according to the updated version of the National Cholesterol Education Program.

RESULTS

Compared with individuals who never drank, the adjusted odds ratio (OR) for the prevalence of MetS was significantly higher in men who consumed 2.1 to 4.0 drinks/day (OR, 1.53; 95% CI, 1.17-2.00) and greater than 4.0 drinks/day (OR, 1.63; 95% CI, 1.23-2.14), whereas no significant association was observed in women. Significant dose-response relationships between average volume of alcohol consumed and all metabolic components were observed in men. A usual quantity of 5 to 6 drinks/drinking day (OR, 1.57; 95% CI, 1.19-2.09), 7 or more drinks/drinking day (OR, 1.88; 95% CI, 1.45-2.44), and binge drinking on at least 1 occasion/week (OR, 1.33; 95% CI, 1.01-1.76) were associated with a significantly higher OR for prevalence of MetS in men; however, none of these drinking patterns were associated with MetS in women.

CONCLUSIONS

Unhealthy drinking patterns such as high usual quantity and binge drinking were significantly associated with MetS, suggesting that the effect of alcohol consumption on MetS should be considered in the context of drinking pattern, particularly in men.

Evaluating epidemiological evidence: a simple test

Epidemiological studies that investigate the relationships between health behaviors and diseases may be affected by both known and unknown confounding factors. Alcohol use is one of these behaviors that have been intensively investigated in epidemiological studies. This manuscript introduced a simple test that can identify confounded epidemiological studies. This approach is sensitive to both known and unknown confounders. It provides a new perspective to develop measures for evidence selection in the future.

Influence of life-related factors and participation in health examination on mortality in a 4.5-year follow-up of a rural cohort

To identify life-related factors causing increased mortality, 2,769 rural residents aged 29-77 were investigated through a self-administered questionnaire in 1990. Death certificates and migration information were inspected during the 4.5-year follow-up period. Age, obesity, life attitude, job, marital status, drinking and smoking habits, previous or current illness, and frequency of participation in health examinations were checked during the baseline survey. The person-year mortality rate was higher among irregular participants in health examinations than among regular participants both among males and females. From Cox's multiple regression analysis, factors with a significantly high hazard ratio (HR) for mortality were irregular participation (HR=2.05), increase of age (HR=1.54, for 10 years), previous or current illness (HR=2.44), unemployment (HR=1.95), and living without a spouse (HR=2.61) for males; and for females they were having previous or current illness (HR=15.21) and living without a spouse (HR=2.94). Thus, irregular participation in health examinations, unemployment and aging showed a relationship with a higher mortality only in males. A previous or current illness and living without a spouse were related in both sexes.

Associations between self-reported illness and non-drinking in young adults

AIMS

This study investigated associations between self-reported illness, social factors and health behaviours and non-drinking among young people aged 18-34 years.

DESIGN

Logistic regression analysis of cross-sectional national survey data, collected from the Health Survey for England 2006 and 2008. Data were collected through face-to-face interviews and are self-reported.

PARTICIPANTS AND SETTINGS

A total of 2826 male and 3618 females aged 18-34 years drawn from a nationally representative multi-stage stratified probability sampling design across England.

MEASUREMENTS

Non-drinkers were based on those who reported 'no' to drinking alcohol currently. Exposure measures included self-reports of having a limiting long-standing illness, long-standing illness or self-reported poor health. We adjusted for ethnicity, income, education, general physical activity and other factors.

FINDINGS

Having a limiting long-standing illness during early adulthood increased the odds of being a non-drinker 1.74 times for men (P < 0.01) and 1.45 times for women (P < 0.01). In both men and women belonging to the lowest income quintile or having no qualifications was associated with increased odds of being a non-drinker (P < 0.001), indicating that the social gradient in non-drinking begins at an early age. Men and women aged 18-34 years with the lowest activity levels were also more likely to be non-drinkers (P < 0.01).

CONCLUSION

Young adults who have a limiting long-standing illness are more likely not to drink alcohol even after adjusting for a range of social and demographic measures. Studies on the putative health benefits of moderate alcohol consumption later in life need to take account of early life history.

20/20--Alcohol and age-related macular degeneration: the Melbourne Collaborative Cohort Study

Little evidence exists regarding associations between age-related macular degeneration (AMD) and moderate alcohol consumption, patterns of consumption, or different types of alcoholic beverage. The authors examined associations between AMD prevalence and alcohol intake using 20,963 participants from the Melbourne Collaborative Cohort Study aged 40-69 years at baseline (1990-1994). Participants' alcohol consumption was determined from a structured interview at baseline. At follow-up from 2003 to 2007, digital macula photographs of both eyes were taken and evaluated for early and late AMD signs. Drinking more than 20 g of alcohol per day was associated with an approximate 20% increase in the odds of early AMD (odds ratio = 1.21, 95% confidence interval: 1.06, 1.38; P = 0.004) when compared with those who reported no alcohol intake at baseline, having adjusted for sex, age, smoking, country of birth, education, physical activity, and energy from food. This positive association was apparent for wine, beer, and spirits. The estimates were similar for both sexes. The odds ratio for those drinking more than 20 g of alcohol per day for late AMD was 1.44 (95% confidence interval: 0.85, 2.45; P = 0.17). These results show a modest association between alcohol consumption and increased AMD risk.

The cardioprotective association of average alcohol consumption and ischaemic heart disease: a systematic review and meta-analysis

AIMS

  Most, but not all, epidemiological studies suggest a cardioprotective association for low to moderate average alcohol consumption. The objective was to quantify the dose-response relationship between average alcohol consumption and ischaemic heart disease (IHD) stratified by sex and IHD end-point (mortality versus morbidity).

METHODS

  A systematic search of published studies using electronic databases (1980-2010) identified 44 observational studies (case-control or cohort) reporting a relative risk measure for average alcohol intake in relation to IHD risk. Generalized least-squares trend models were used to derive the best-fitting dose-response curves in stratified continuous meta-analyses. Categorical meta-analyses were used to verify uncertainty for low to moderate levels of consumption in comparison to long-term abstainers.

RESULTS

  The analyses used 38,627 IHD events (mortality or morbidity) among 957,684 participants. Differential risk curves were found by sex and end-point. Although some form of a cardioprotective association was confirmed in all strata, substantial heterogeneity across studies remained unexplained and confidence intervals were relatively wide, in particular for average consumption of one to two drinks/day.

CONCLUSIONS

  A cardioprotective association between alcohol use and ischaemic heart disease cannot be assumed for all drinkers, even at low levels of intake. More evidence on the overall benefit-risk ratio of average alcohol consumption in relation to ischaemic heart disease and other diseases is needed in order to inform the general public or physicians about safe or low-risk drinking levels.

Time pattern of reduction in risk of oesophageal cancer following alcohol cessation--a meta-analysis

AIM

  To establish the current level of knowledge of the effect of drinking cessation on the risk of developing oesophageal cancer.

METHOD

  A meta-analysis was conducted based on relevant studies identified through a systematic literature review. A generalized least squares model for trend estimation of summarized dose-response data were utilized in order to estimate the effect of years since drinking cessation on risk of oesophageal cancer.

RESULT

  Seventeen studies that estimate the risk reduction after quantified drinking cessation were identified in the systematic literature review. Nine of these were appropriate for inclusion in the meta-analysis. A large degree of heterogeneity existed between the studies, but this was explainable and the increased risk of oesophageal cancer caused by alcohol consumption was found to be reversible, with a common trend between studies. A required time-period of 16.5 years (95% confidence interval 12.7-23.7) was estimated until no risk from former drinking remained, although this might have been an overestimation due to sample characteristics. The dose-response relationship was found to have an exponential decay. This means that about half the reduction in alcohol-related risk occurred after just a third of the time-period required to eliminate the additional risk.

CONCLUSION

  The alcohol-related increased risk of oesophageal cancer is reversible following drinking cessation. It is most likely that about 16 years are required until all elevated risk has disappeared. Due to lack of research and data, more research is urgently required to increase the robustness of the estimates and to approach study limitations.

The Estimated Risk of Atrial Fibrillation Related to Alcohol Consumption

The risk of acute heavy alcohol intake on the development of atrial fibrillation (AF), aka ?holiday heart syndrome?, has been well-described. However, whether chronic alcohol intake is also associated with increased risk of AF, or might even be protective as has been observed with other cardiac conditions, is more uncertain. A number of studies, from basic science to large cohort studies have been performed to analyze the association between alcohol and AF. Basic-level studies have found that alcohol causes changes in tissue electrophysiology, ion channels, and circulating hormones, which might promote development and maintenance of AF. Clinical studies have generally shown groups with the highest regular intake of alcohol to be at increased risk, with no association with more moderate use. However, these studies have not always accounted for other AF risk factors, been inconsistent in the assessment and validation of the quantity of alcohol consumed across populations, and been unable to completely separate drinking patterns from overall health of participants. As a result, solid conclusions about a threshold level for ?safe? chronic alcohol intake cannot be made with regard to AF risk, but it appears to be safe within currently recommended limits of 1 drink daily for women and 2 for men. In this review, we discuss these findings, limitations, and conclusions.

Relationships of Alcohol Use and Alcohol Problems to Probable Anxiety and Mood Disorder

We examine the effects of alcohol consumption and problem drinking on probable anxiety and mood disorder (AMD). Data were taken from the 2000–2006 CAMH Monitor (N = 15,653) general population survey of Ontario adults. Scoring 4+ on the 12-item General Health Questionnaire defined probable AMD, as suggested by recent research. Logistic regression showed that respondents with alcohol problems had significantly increased odds of probable AMD, but those reporting moderate daily alcohol consumption (up to 2 drinks) had decreased odds of probable AMD compared to abstainers. These data replicate other recent research in suggesting that the relationship between alcohol and adverse psychological states, such as psychological distress and probable anxiety and mood disorder, may not be monotonic. Several ways in which selection bias could account for these findings are discussed, as well as other possible causative mechanisms.