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Visontay R, Mewton L, Sunderland M, Chapman C, Slade T. Is low-level alcohol consumption really health-protective? A critical review of approaches to promote causal inference and recent applications. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2024; 48:771-780. [PMID: 38643426 DOI: 10.1111/acer.15299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 01/16/2024] [Accepted: 02/29/2024] [Indexed: 04/22/2024]
Abstract
Heavy and disordered alcohol consumption is a known risk factor for several health conditions and is associated with considerable disease burden. However, at low-to-moderate levels, evidence suggests that drinking is associated with reduced risk for certain health outcomes. Whether these findings represent genuine protective effects or mere methodological artifacts remains unclear, but has substantial consequences for policy and practice. This critical review introduces methodological advances capable of enhancing causal inference from observational research, focusing on the 'G-methods' and Mendelian Randomization. We also present and evaluate recent research applying these methods and compare findings to the existing evidence base. Future directions are proposed for improving our causal understanding of the relationships between alcohol and long-term health outcomes.
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Affiliation(s)
- Rachel Visontay
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, New South Wales, Australia
| | - Louise Mewton
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, New South Wales, Australia
| | - Matthew Sunderland
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, New South Wales, Australia
| | - Cath Chapman
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, New South Wales, Australia
| | - Tim Slade
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, New South Wales, Australia
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Jung JH, Kim SE, Suk KT, Kim DJ. Gut microbiota-modulating agents in alcoholic liver disease: Links between host metabolism and gut microbiota. Front Med (Lausanne) 2022; 9:913842. [PMID: 35935787 PMCID: PMC9354621 DOI: 10.3389/fmed.2022.913842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 07/04/2022] [Indexed: 11/13/2022] Open
Abstract
Alcoholic liver disease (ALD) involves a wide spectrum of diseases, including asymptomatic hepatic steatosis, alcoholic hepatitis, hepatic fibrosis, and cirrhosis, which leads to morbidity and mortality and is responsible for 0.9% of global deaths. Alcohol consumption induces bacterial translocation and alteration of the gut microbiota composition. These changes in gut microbiota aggravate hepatic inflammation and fibrosis. Alteration of the gut microbiota leads to a weakened gut barrier and changes host immunity and metabolic function, especially related to bile acid metabolism. Modulation and treatment for the gut microbiota in ALD has been studied using probiotics, prebiotics, synbiotics, and fecal microbial transplantation with meaningful results. In this review, we focused on the interaction between alcohol and gut dysbiosis in ALD. Additionally, treatment approaches for gut dysbiosis, such as abstinence, diet, pro-, pre-, and synbiotics, antibiotics, and fecal microbial transplantation, are covered here under ALD. However, further research through human clinical trials is warranted to evaluate the appropriate gut microbiota-modulating agents for each condition related to ALD.
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Affiliation(s)
- Jang Han Jung
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, South Korea
| | - Sung-Eun Kim
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, South Korea
- Institute for Liver and Digestive Diseases, Hallym University, Chuncheon, South Korea
| | - Ki Tae Suk
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, South Korea
- Institute for Liver and Digestive Diseases, Hallym University, Chuncheon, South Korea
| | - Dong Joon Kim
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, South Korea
- Institute for Liver and Digestive Diseases, Hallym University, Chuncheon, South Korea
- *Correspondence: Dong Joon Kim,
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Polyphenol-rich vinegar extract regulates intestinal microbiota and immunity and prevents alcohol-induced inflammation in mice. Food Res Int 2021; 140:110064. [DOI: 10.1016/j.foodres.2020.110064] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 12/13/2020] [Accepted: 12/21/2020] [Indexed: 02/06/2023]
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Lee S, Lee J, Lee H, Sung J. Relative protective activities of quercetin, quercetin-3-glucoside, and rutin in alcohol-induced liver injury. J Food Biochem 2019; 43:e13002. [PMID: 31378953 DOI: 10.1111/jfbc.13002] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 06/26/2019] [Accepted: 07/10/2019] [Indexed: 12/12/2022]
Abstract
Alcoholic liver diseases has been known to be one of the major health risks worldwide. The purpose of this study was aimed to demonstrate the relative protective effect of quercetin, quercetin-3-glucoside, and rutin on alcohol-induced damage in hepatocytes. The hepatotoxicity, antioxidant enzymatic defense mechanisms, and pro-inflammatory mediators were examined for evaluating the hepatoprotective effects of quercetins in hepG2 cells. The results revealed that quercetin and its glucoside derivatives significantly prevented ethanol-induced hepatotoxicity by decreasing hepatic aminotransferase activities and inflammatory response in HepG2 cells. Moreover, the quercetins significantly induced detoxifying enzymes via the nuclear accumulation of the NF-E2-related factor 2 (Nrf2) and induction of antioxidant response element (ARE) gene. These hepatoprotective activities were observed to be more effective with quercetin aglycone than quercetin glucosides. From the above findings, the present study imply that quercetin aglycone may have a vital function in the therapeutic and preventive strategies of alcoholic liver diseases. PRACTICAL APPLICATIONS: Quercetin is commonly present in fruits and vegetables as aglycone and glucoside-derived forms. In the present study, quercetin and its glycosides was shown to alleviate oxidative stress, glutathione depletion, and pro-inflammatory cytokines in alcohol-induced HepG2 cells via the Nrf2/ARE antioxidant pathway. Moreover, quercetin aglycone had better protective effects against alcohol-induced liver damage in vitro, compared to its glycosylated form. The present study proposed that quercetin aglycone may be a more efficient hepatoprotective agent than its glucoside derivatives such as rutin in the amelioration of alcohol-induced liver diseases.
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Affiliation(s)
- Seyun Lee
- Division of Food and Animal Sciences, Chungbuk National University, Cheongju, Korea
| | - Junsoo Lee
- Division of Food and Animal Sciences, Chungbuk National University, Cheongju, Korea
| | - Hana Lee
- Division of Food and Animal Sciences, Chungbuk National University, Cheongju, Korea
| | - Jeehye Sung
- Division of Food and Animal Sciences, Chungbuk National University, Cheongju, Korea
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Association of Ambient Air Pollution with Increased Liver Enzymes in Korean Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16071213. [PMID: 30987355 PMCID: PMC6479611 DOI: 10.3390/ijerph16071213] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 03/22/2019] [Accepted: 03/28/2019] [Indexed: 12/14/2022]
Abstract
An association between exposure to air pollution and liver enzymes in certain areas or older people has been reported in the literature; however, it cannot be generalized to the general population. We investigated the association between air pollution, liver enzyme levels, and alcohol consumption using nationwide data of South Korean adults. Air pollutants included particulate matter with an aerodynamic diameter ≤10 µm (PM10), nitrogen dioxide (NO₂), sulfur dioxide (SO₂), and carbon monoxide (CO). Liver enzymes included alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Exposure to air pollutants were significantly associated with elevation of log ALT and log AST, especially increases from 0.0073 IU/L (95% confidence interval (CI) = 0.0042, 0.0104) to 0.0251 IU/L (95% CI = 0.0132, 0.0371) per interquartile range (IQR) increase of each pollutant (all pollutants: p < 0.001). Association of the liver enzymes with PM10 (β (95% CI) = 0.0285 IU/L (0.0201, 0.0368) for log ALT; β (95% CI) = 0.0139 IU/L (0.0079, 0.0198) for log AST) and CO (β (95% CI) = 0.0247 IU/L (0.0182, 0.0311) for log ALT; β (95% CI) = 0.0164 IU/L (0.0118, 0.0210) for log AST) were only significant among drinkers. Our findings suggest that chronic exposure to PM10 and CO is a risk factor for liver enzymes increases among the general adult population who admitted to drinking alcohol.
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Collier MG, Bhaurla SK, Cuevas-Mota J, Armenta RF, Teshale EH, Garfein RS. Awareness of HCV infection among persons who inject drugs in San Diego, California. Am J Public Health 2015; 105:302-3. [PMID: 25521877 DOI: 10.2105/ajph.2014.302245] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
We asked persons who inject drugs questions about HCV, including past testing and diagnosis followed by HCV testing. Of 540 participants, 145 (27%) were anti-HCV positive, but of those who were positive, only 46 (32%) knew about their infection. Asking about previous HCV testing results yielded better results than did asking about prior HCV diagnosis. Factors associated with knowing about HCV infection included older age, HIV testing, and drug treatment. Comprehensive approaches to educating and screening this population for HCV need implementation.
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Affiliation(s)
- Melissa G Collier
- Melissa G. Collier and Eyasu H. Teshale are with the Division of Viral Hepatitis, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Sandeep K. Bhaurla, Jazmine Cuevas-Mota, Richard F. Armenta, and Richard S. Garfein are with the Division of Global Public Health, School of Medicine, University of California, San Diego
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Finch ML, Marquardt JU, Yeoh GC, Callus BA. Regulation of microRNAs and their role in liver development, regeneration and disease. Int J Biochem Cell Biol 2014; 54:288-303. [PMID: 24731940 DOI: 10.1016/j.biocel.2014.04.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Revised: 03/25/2014] [Accepted: 04/03/2014] [Indexed: 12/12/2022]
Abstract
Since their discovery more than a decade ago microRNAs have been demonstrated to have profound effects on almost every aspect of biology. Numerous studies in recent years have shown that microRNAs have important roles in development and in the etiology and progression of disease. This review is focused on microRNAs and the roles they play in liver development, regeneration and liver disease; particularly chronic liver diseases such as alcoholic liver disease, non-alcoholic fatty liver disease, non-alcoholic steatohepatitis, viral hepatitis and primary liver cancer. The key microRNAs identified in liver development and chronic liver disease will be discussed together with, where possible, the target messenger RNAs that these microRNAs regulate to profoundly alter these processes. This article is part of a Directed Issue entitled: The Non-coding RNA Revolution.
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Affiliation(s)
- Megan L Finch
- School of Chemistry and Biochemistry, University of Western Australia, Crawley 6009, WA, Australia.
| | - Jens U Marquardt
- Department of Medicine I, Johannes Gutenberg University, Mainz, Germany.
| | - George C Yeoh
- School of Chemistry and Biochemistry, University of Western Australia, Crawley 6009, WA, Australia; Harry Perkins Institute of Medical Research, Nedlands 6000, WA, Australia.
| | - Bernard A Callus
- School of Chemistry and Biochemistry, University of Western Australia, Crawley 6009, WA, Australia.
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Hu TM, Subeq YM, Yang FL, Hsu BG, Lin NT, Lee RP. The use of a selective serotonin reuptake inhibitor decreases heavy alcohol exposure-induced inflammatory response and tissue damage in rats. J Psychopharmacol 2013; 27:940-6. [PMID: 23828825 DOI: 10.1177/0269881113494938] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Alcohol intoxication and psychiatric medication overdoses, including antidepressants, are common emergency room events. Heavy alcohol and antidepressant exposure are able to induce changes in cytokines disturbing normal physiology. We examined the inflammatory and physiological effects of selective serotonin reuptake inhibitor (SSRI) medication after heavy alcohol exposure. Rats were randomly divided into Alc (EtOH 5g/kg, intravenous infusion for 3 h), SSRI (paroxetine oral intake) and Alc+SSRI groups. Serum samples were collected to measure blood ethanol, aspartate transferase, alanine transferase, creatine phosphokinase, lactate dehydrogenase, amylase, tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) levels. Lactate dehydrogenase levels in bronchoalveolar lavage fluid were also examined. Liver, pancreas and lungs were removed after sacrifice and any pathological changes were catalogued. Ethanol infusion resulted in blood levels of ethanol of >100 mg/dL after ethanol infusion. Serum levels of aspartate transferase, alanine transferase, creatine phosphokinase, lactate dehydrogenase, amylase, TNF-α and IL-6 in the Alc+SSRI group were lower than in the Alc group. Moreover, pathological damages to the liver, pancreas and lungs were slightly lower in the Alc+SSRI group than in the Alc group. These findings suggested that SSRI is able to decrease the release of pro-inflammatory cytokines and thereby reduce liver and pancreas damage after heavy alcohol exposure.
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Affiliation(s)
- Tsung M Hu
- 1Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan, ROC
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Abstract
OBJECTIVES AND METHODS Most definitions of nonalcoholic fatty liver disease (NAFLD) allow some intake of alcohol but little attention has been paid to the possible contribution of alcohol-derived calories in the overall daily intake. The aim of the present study was to determine whether, in a group of 144 patients referred to liver outpatients with NAFLD, a more structured questioning of dietary habits and alcohol consumption would provide better information on alcohol-derived and dietary-derived calorie intake and the relationship with the BMI. RESULTS Both food intake and calories resulting from alcohol ingestion were frequently underestimated as was the percentage of patients who were drinking excessively (>30 U a week), which was surprisingly high at 40%. The substantial calorie intake resulting from alcohol consumption in this group was associated with a reduction in dietary calorie intake, so that the total daily calorie intake remained similar to those with low-to-moderate or no alcohol consumption. The findings also showed that the BMI, although still elevated, was significantly reduced in those drinking heavily compared with low and nondrinkers. CONCLUSION Patients with NAFLD can have substantially higher levels of alcohol consumption than usually recognized. The additional calorie intake resulting from this is to some extent balanced by a reduction in dietary calorie intake with less elevation in BMI, and a clear distinction from an alcohol-induced steatosis may be difficult.
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Jeong HG, Kim TH, Lee JJ, Lee SB, Park JH, Huh Y, Chin HJ, Jhoo JH, Lee DY, Woo JI, Kim KW. Impact of alcohol use on mortality in the elderly: results from the Korean Longitudinal Study on Health and Aging. Drug Alcohol Depend 2012; 121:133-9. [PMID: 21908108 DOI: 10.1016/j.drugalcdep.2011.08.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Revised: 08/09/2011] [Accepted: 08/19/2011] [Indexed: 12/22/2022]
Abstract
BACKGROUND To examine the effects of problematic drinking, amount of alcohol use and binge drinking on all-cause mortality in the elderly. METHODS We investigated 45-month all-cause mortality of 997 randomly sampled community-dwelling elderly Koreans aged 65 years or older who participated in the Korean Longitudinal Study on Health and Aging. Problematic drinking was defined as having alcohol use disorders according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition criteria or having 8 or higher of the Alcohol Use Disorders Identification Test. Light drinking was defined as drinking 7 alcoholic drinks or less, and heavy drinking as having 14 alcoholic drinks more per week during past 12 months. Binge drinking was defined as having 6 or more drinks on a single occasion at least monthly. RESULTS One hundred and thirteen participants (11.3%) died during the 45-month follow-up period. Heavy drinking (>14 alcoholic drinks per week) increased the all-cause mortality risk when in association with problematic drinking (hazard ratio [HR]=2.604, 95% confidence interval [CI]=1.221-5.553, p=0.012) or binge drinking (HR=2.823, 95% CI=1.259-6.328, p=0.013). Light drinking (≤ 7 alcoholic drinks per week) was associated with decreased all-cause mortality (HR=0.114, 95% CI=0.015-0.833, p=0.032). CONCLUSIONS Problematic drinking is associated with increased all-cause mortality in elderly Koreas, particularly when it is heavy and/or combined with binge drinking.
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Affiliation(s)
- Hyun-Ghang Jeong
- Department of Psychiatry, Korea University Guro Hospital, Korea University College of Medicine, Republic of Korea
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Oser M, Cucciare M, McKellar J, Weingardt K. Correlates of hazardous drinking among Veterans with and without hepatitis C. J Behav Med 2012; 35:634-41. [PMID: 22234384 DOI: 10.1007/s10865-011-9394-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Accepted: 12/23/2011] [Indexed: 02/06/2023]
Abstract
Hazardous drinking is a major barrier to antiviral treatment eligibility among hepatitis C (HCV) patients. We evaluated differences in substance-related coping, drinking-related consequences, and importance and confidence in ability to change alcohol use among hazardous drinkers with and without HCV (N = 554; 93.5% male). We examined group differences between HCV+ patients (n = 43) and their negative HCV counterparts (n = 511). Results indicate a higher percentage of HCV+ patients report using substances to cope with possible symptoms of PTSD (P < .05) and depression (P < .01), and endorse more lifetime drinking-related negative consequences than HCV patients (P < .01). Furthermore, HCV+ patients place greater importance on changing alcohol use (P < .01) but report less confidence in their ability to change (P < .01). Use of brief assessment and feedback with skills-based interventions to decrease alcohol use may be well-received by HCV+ patients.
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Affiliation(s)
- Megan Oser
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Avenue, 4th Floor, Boston, MA, 02115, USA,
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Zule WA, Costenbader EC, Coomes CM, Wechsberg WM. Effects of a hepatitis C virus educational intervention or a motivational intervention on alcohol use, injection drug use, and sexual risk behaviors among injection drug users. Am J Public Health 2009; 99 Suppl 1:S180-6. [PMID: 19218179 DOI: 10.2105/ajph.2007.126854] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVES We compared the effects of 2 interventions on alcohol use, use of a new syringe at last injection, and condom use at last sexual encounter in a community sample of injection drug users. METHODS Between 2003 and 2006, 851 out-of-treatment injection drug users were recruited in Raleigh, NC, and Durham, NC, through street outreach and were randomly assigned to either a 6-session educational intervention or a 6-session motivational intervention. Intervention effects were examined at 6 and 12 months after enrollment. RESULTS In multiple logistic regression analyses adjusted for baseline alcohol use and HCV status, participants assigned to the motivational intervention were significantly less likely than were participants in the educational intervention to be drinking at the 6-month follow-up (odds ratio = 0.67; 95% confidence interval = 0.46, 0.97). There were no significant between-group differences in use of a new syringe at last injection or condom use at last sexual encounter at either follow-up. CONCLUSIONS Reducing alcohol use among persons with HCV may slow disease progression and provide important health benefits. Additional strategies are needed for slowing HCV disease progression until more effective HCV treatments are available.
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Affiliation(s)
- William A Zule
- Behavioral Health Criminal Justice Research Division, RTI International, P.O. Box 12194, Research Triangle Park, NC 27709-2194, USA.
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Alcohol Consumption by Aging Adults in the United States: Health Benefits and Detriments. ACTA ACUST UNITED AC 2008; 108:1668-76. [DOI: 10.1016/j.jada.2008.07.011] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2007] [Accepted: 02/15/2008] [Indexed: 02/05/2023]
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Ferreira MP, Willoughby D. Alcohol consumption: the good, the bad, and the indifferent. Appl Physiol Nutr Metab 2008; 33:12-20. [DOI: 10.1139/h07-175] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Dietary ethanol (alcohol) is the most widely consumed drug worldwide. High levels of mortality, morbidity, and social malaise are associated with abuse of alcohol, and increasing numbers of women and youth are abusing alcohol. However, strong epidemiological data demonstrate a U- or J-shaped relationship between volume of alcohol consumed and all-cause mortality or disease burden. Moderate alcohol consumption is associated with a lower risk of all-cause mortality and disease burden than are abstinence and immoderate drinking. A brief review of the absorption, distribution, metabolism, and excretion of ethanol is provided with a discussion of the impact of gender differences. Potential mechanisms by which ethanol, ethanol metabolites, and (or) phytochemicals, as associated with different types of ethanol-containing beverages, are discussed in regards to the beneficial and detrimental impacts they may have on physiological system functioning and mortality or disease burden. Per capita consumption of ethanol-containing beverages varies across geo-political regions worldwide. A more recent research focus is the impact of consumption patterns on consumption volumes as they relate to disease and mortality. Certain drinking patterns moderate overall volume of ethanol consumption. Thus, an emerging approach to the study of alcohol consumption in populations is to consider both the volume and pattern of consumption as they relate to mortality and disease burden. Alcohol consumption patterns among athletes are discussed; physiological implications of alcohol abuse in this population are outlined. Current guidelines for the consumption of alcohol are reviewed. Alcohol consumption guidelines reflect the current scientific understanding of both the benefits of moderate alcohol consumption and the detriments of immoderate alcohol consumption.
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Affiliation(s)
| | - Darryn Willoughby
- Baylor University, 1312 S. 5th St., One Bear Place No. 97313, Waco, TX 76798, USA
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