Sugar intake and craving during alcohol withdrawal in alcohol use disorder inpatients

Breadth of substance use is associated with the selection of a larger food portion size via elevated impulsivity

Substance use is associated with altered or elevated food consumption and disordered eating. In the present study we examined whether breadth (variety) of drug use was associated with elevated portion size in a general population sample as it was in persons in recovery from substance use disorder. Furthermore, measures of emotional eating, impulsivity, food misuse, food craving were taken as possible mediators and reward responsiveness was examined as a potential moderator of this association. 444 adults (48.6 % women, mean age of 47.8 years) completed an online study in which they were asked to make judgements of ideal portion size for 6 different foods using a validated online tool that allowed participants to adjust the portion size of images of foods. Ideal portion size has been identified as a strong predictor of actual consumption. Participants were also asked to report the number of substances used in the past and provide anthropometric information. The results confirmed that breadth of drug use was associated with selection of higher portion size. Reward responsiveness was not a moderator of this relationship. Of the tested mediators, only impulsivity mediated the association between breadth of drug use and portion size. The results show that impulsivity may underlie the association between eating and substance use.

Biochemical, Hematological, Inflammatory, and Gut Permeability Biomarkers in Patients with Alcohol Withdrawal Syndrome with and without Delirium Tremens

Background: Delirium Tremens (DT) is known to be a serious complication of alcohol withdrawal syndrome (AWS). Neurotransmitter abnormalities, inflammation, and increased permeability are associated with the pathogenesis of AWS and DT. However, the biomarkers of these conditions are still poorly understood. Methods: In this work, biochemical, hematologic, inflammatory, and gut permeability biomarkers were investigated in the following three groups: healthy controls (n = 75), severe AWS patients with DT (n = 28), and mild/moderate AWS without DT (n = 97). Blood sampling was performed after resolution of the acute condition (on 5 ± 1 day after admission) to collect clinical information from patients and to investigate associations with clinical scales. Biomarker analysis was performed using automated analyzers and ELISA. Inflammatory biomarkers included the erythrocyte sedimentation rate (ESR), high-sensitivity C-reactive protein (hsCRP), and platelet-to-lymphocyte ratio (PLR). Results: Among the biochemical biomarkers, only glucose, total cholesterol, and alanine aminotransferase (ALT) changed significantly in the analyzed groups. A multiple regression analysis showed that age and ALT were independent predictors of the CIWA-Ar score. Hematologic biomarker analysis showed an increased white blood cell count, and the elevated size and greater size variability of red blood cells and platelets (MCV, RDWc, and PDWc) in two groups of patients. Gut permeability biomarkers (FABP2, LBP, and zonulin) did not change, but were associated with comorbid pathologies (alcohol liver disease and pancreatitis). The increase in inflammatory biomarkers (ESR and PLR) was more evident in AWS patients with DT. Cluster analysis confirmed the existence of a subgroup of patients with evidence of high inflammation, and such a subgroup was more frequent in DT patients. Conclusions: These findings contribute to the understanding of biomarker variability in AWS patients with and without DT and support the heterogeneity of patients by the level of inflammation.

Nutritional status changes in the treatment of substance use disorder: Relationship with substance craving

Tailored nutrition counseling enhances the efficacy of routine treatment for substance (alcohol/drugs) use disorders (SUDs). For this purpose, it is important to understand the current nutritional status of addicts and the changes in their nutritional status during the treatment process. Furthermore, the consumption of sweets to manage substance cravings is common among people with SUDs, but the evidence for the effectiveness of this practice is limited and conflicting. We therefore hypothesized SUD treatment would be associated with increases in appetite, nutrient intake, and anthropometric measurements in addicts, and that these changes, including changes in sweet consumption, would not be associated with decreased substance craving. Data for this prospective observational study were collected from 38 adult male patients who completed 21 days of inpatient SUD treatment. During the treatment, the participants' levels of appetite (P < 1.0 × 10-4), the frequency of main meals (P < 1.0 × 10-4), intake of macro- and micronutrients (P < .05 for each), and anthropometric measurements (P ≤ 5.9 × 10-4), significantly increased. Furthermore, it was found that the patients had a significant increase in sweets craving (P < 1.0 × 10-4) and sweets consumption (P = 1.2 × 10-3) during treatment. However, there was no significant difference between the individuals whose craving decreased and those whose craving did not decrease at the end of the treatment (P > .05 for both). The findings suggest the need to offer dietary counseling to individuals undergoing inpatient SUD treatment, given the substantial changes in nutritional status, and that increased consumption of sweets is not an effective strategy to reduce substance craving.

Food selection in a buffet scenario by persons in recovery from substance use disorder: Testing a parallel mediation model including impulsivity, food craving, and breadth of drug use

Elevated food cravings and higher food consumption and body weight have been reported in studies of people in recovery from substance use disorder (SUD). In a previous study, SUD recovery status predicted the energy from selected food images in a virtual buffet meal, most strongly in those with high reward responsiveness. The present study was conducted to determine which psychological variables might mediate the relationship between SUD recovery status and food selection and to replicate the finding that reward responsiveness moderated this relationship. In an online study, 216 women and men (109 in recovery from SUD) were asked to choose from among 16 food images in an all-you-can-eat buffet scenario. Food craving, impulsivity, "food addiction", irrational food beliefs, anhedonia, and breadth of drug use were examined as potential mediators while reward responsiveness was examined as a potential moderator. The amount of energy in the selected foods was the outcome variable. Results indicated that breadth of drug use was a mediator; being in SUD recovery predicted higher variety of drug use which predicted higher food selection. However, reward responsiveness did not moderate the relationship between SUD recovery status and energy from the selected foods. Exploratory analysis indicated that lack of premeditation, a measure of impulsivity, with food craving partially mediated the relationship between breadth of drug use and energy from selected foods and that lack of premeditation fully mediated it for sweet foods. The results confirm an association between substance use and food selection and suggest a mechanism via impulsivity.

Adapting the Dietary Fat and Free Sugar Short Questionnaire: A Comprehensive Polish Modification for Enhanced Precision in Nutritional Assessments

BACKGROUND

This study aimed to investigate whether The Dietary Fat and Free Sugar-Short Questionnaire (DFS) is a reliable and valid measure that can be used in Polish conditions. It involved 291 participants, aged 14 to 70 (M = 25.9, SD = 10.1), the majority of whom were women (75%).

METHODS

The questionnaire consisted of, among others, Polish DFS version, FFQ-6, TFEQ, and SCOFF. Test-retest reliability was established on the group of 26 students with a 2-week interval. Participants' percentage of energy intake from both free sugars and saturated fats based on FFQ was correlated with DFS total and subscales scores. To investigate convergent and divergent validity, DFS scores with TFEQ correlations were performed. Diagnostic validity was established based on difference analysis between groups with the risk of eating disorders and those without the risk of those based on SCOFF.

RESULTS

Test-retest reliability (rtr = 0.856) and internal consistency (α = 0.797) indicated excellent reliability. DFS correlated significantly with FFQ for both total scores (r = 0.82) and each subscale: sugar (0.79), fat (0.75), and fat-sugar (0.59). The correlations of DFS and TFEQ were statistically significant for cognitive restraint (r = 0.32) and uncontrolled eating (r = 0.19). There also have been found significant differences based on SCOFF regarding DFS.

CONCLUSIONS

The results suggest good reliability and validity of the Polish version of DFS.

Pupillary response to percutaneous auricular vagus nerve stimulation in alcohol withdrawal syndrome: A pilot trial

BACKGROUND

Autonomic symptoms in alcohol withdrawal syndrome (AWS) are associated with a sympathetic-driven imbalance of the autonomic nervous system. To restore autonomic balance in AWS, novel neuromodulatory approaches could be beneficial. We conducted a pilot trial with percutaneous auricular vagus nerve stimulation (pVNS) in AWS and hypothesized that pVNS will enhance the parasympathetic tone represented by a reduction of pupillary dilation in a parasympatholytic pharmacological challenge.

METHODS

Thirty patients suffering from alcohol use disorder, undergoing AWS, and stable on medication, were recruited in this open-label, single-arm pilot trial with repeated-measure design. Peripheral VNS (monophasic volt impulses of 1 msec, alternating polarity, frequency 1 Hz, amplitude 4 mV) was administered at the left cymba conchae for 72 h, followed by pupillometry under a tropicamide challenge. We assessed craving with a visual analog scale. We used pupillary mean as the dependent variable in a repeated-measures ANOVA (rmANOVA).

RESULTS

A repeated-measures ANOVA resulted in a significant difference for pupillary diameter across time and condition (F(2,116) = 27.97, p < .001, ηp2 > .14). Tukey-adjusted post hoc analysis revealed a significant reduction of pupillary diameter after pVNS. Alcohol craving was significantly reduced after pVNS (p < .05, Cohen's d = 1.27).

CONCLUSION

Our study suggests that pVNS activates the parasympathetic nervous system in patients with acute AWS, and that this activation is measurable by pupillometry. To this end, pVNS could be beneficial as a supportive therapy for AWS. Potential confounding effects of anti-craving treatment should be kept in mind.

Diabetes and Metabolic Disorders: Their Impact on Cardiovascular Events in Liver Transplant Patients

Cardiovascular diseases are currently one of the most important causes of morbidity and mortality in liver transplant patients over the long term. Therefore, evaluating prognostic factors for cardiovascular events (CVEs) in this population is essential for taking preventive measures. The aim of this study was to identify the impact of diabetes and other metabolic disorders on CVEs in liver transplant patients. Three hundred fifty-six liver transplant recipients who survived at least 6 months after surgery were enrolled. Patients were followed for a median time of 118 months (12-250 months). All cardiovascular events were carefully recorded and detailed in the patients' charts. Demographic data, diabetes, hypertension, dyslipidemia, weight changes, and a diagnosis of metabolic syndrome both before and after transplantation were noted to assess their possible relationship with CVE. The presence of a diagnosis of metabolic-associated fatty liver disease (MAFLD) was also evaluated. Immunosuppressive therapy was included in the analysis. Diabetes mellitus (DM), especially when present before transplantation, was strongly associated with CVEs (hazard risk HR 3.10; 95% confidence interval CI: 1.60-6.03). Metabolic syndrome was found to be associated with CVEs in univariate analysis (HR 3.24; 95% CI: 1.36-7.8), while pretransplantation and de novo MAFLD were not. Immunosuppressive therapy had no influence on predisposing transplanted patients to CVEs during follow-up. Further prospective studies may be useful in investigating the risk factors for CVEs after liver transplantation and improving the long-term survival of transplant patients.

Confusion of Alcohol Craving With Food Hunger in Alcohol-Dependent Individuals Entering In-Patient Drug Treatment

AIM

To identify the distinguishing characteristics of alcohol dependent patients who confuse alcohol cravings with pre-meal hunger.

METHODS

Data were collected at interview on sociodemographic status, clinical status and anthropometry in 179 patients (163 men and 16 women) undergoing in-patient treatment for alcohol dependence.

RESULTS

A comparison of the patient subgroups studied showed that patients who did not confuse, and those who did confuse, alcohol craving with pre-meal hunger differed significantly in terms of alcohol craving scale scores (9 vs. 4 points). Patients confusing alcohol cravings with pre-meal hunger were more likely to recognize that experiencing severe pre-meal hunger can cause relapse (67.9 vs. 22.8%) and that not being able to distinguish between the sensations under study also increases the risk of breaking abstinence (75.0% vs. 50.4%). This was independent of severity of dependence and intensity of recent alcohol consumption.

CONCLUSIONS

Alcohol-dependent persons who confuse alcohol craving with pre-meal hunger differ from those who do not confuse these hunger pangs in terms of feeling stronger alcohol craving and more frequent occurrence of symptoms accompanying the feeling of alcohol craving during pre-meal hunger. At the start of treatment for alcohol withdrawal, alcohol-dependent individuals who report confusing alcohol cravings with pre-meal hunger are less confident of maintaining abstinence. This is relevant to treatment. The role of possible confounders (depressive symptoms, cognitive and educational deficiency) could not be elucidated definitively.

Psychosocial Experiences Related to Dietary Behavior of Japanese Lactating Women: A Qualitative Study

Adequate dietary intake during the lactation period is important for breast milk components, postpartum recovery, and physical and mental health. This study aimed to clarify the psychosocial experiences related to dietary behavior around one month postpartum among Japanese lactating women. Semi-structured interviews were conducted with 18 women between February and June 2022 in Osaka, Japan. The data were analyzed using qualitative descriptive approaches. Four core categories were identified. All participants had a [desire to have healthy meals for themselves or their families] to improve their postpartum health, regain their pre-pregnancy body shape, produce sufficient and good-quality breast milk, and keep their families healthy. Some participants, who had [subjective difficulties in getting information on diet and preparing meals] due to insufficient or complicated information and viewing meal preparation as a burden, used [services and support regarding their postpartum diet] to alleviate these difficulties. They had [postpartum-specific appetite and dietary views], including an increased appetite triggered by breastfeeding and postpartum stress and the effects of the dietary changes during pregnancy. Some of these psychosocial experiences were influenced by Japanese traditional customs in the postpartum period and familiar food preferences in the Japanese. Healthcare professionals should consider these experiences when providing tailored dietary guidance.

Prevalence of Overweight and Associated Factors in a Male Prison Population in the Extreme South of Brazil: A Cross-Sectional Study

Background: This cross-sectional study serves as a first Brazilian inventory about overweight as a marker for metabolic health and risk factor to develop noncommunicable chronic diseases in prison populations. The prevalence of overweight, and its associated factors in prisoners of the Fifth Regional State Penitentiary of Rio Grande do Sul (5th DPR) in the extreme South of Brazil were investigated using a precoded questionnaire with sociodemographic, behavioral, and health questions, applied to proportional stratified random sampled prisoners. Methods: Five hundred eighty male prisoners (70%) in the closed regime agreed to answer the questionnaire and allowed anthropomorphic body measurement, carried out by trained scientists. We used bivariate Pearson's chi-squared test and adjusted multinomial logistic regression for analyses. Results: Considering that the studied incarcerated population is young (mean age 33 years) it is concerning that already 43.6% of them are overweight, report regular sweets and sugary soft drink consumption (77.7%, and 81.4%, respectively), 60.2% are smokers, and 19.4% are at elevated risk to develop cardiovascular diseases. Further, 13.8% of the respondents reported a diagnosis of hypertension, 4.9% hypercholesterolemia, and 2.7% diabetes mellitus type 2. Among those who reported not smoking, excess weight was almost four times higher (prevalence ratio: 3.79; 95% confidence interval: 2.61-5.50). Conclusions: Our study suggests that the prison environment promotes modifiable risk factors for chronic diseases. These data deserve attention and intervention, aiming to prevent and reduce the current levels of excess weight.

Association of ALDH2 Genotypes and Alcohol Intake with Dietary Patterns: The Bunkyo Health Study

Dietary habits are associated with various diseases and assessed by dietary patterns (DPs). Since the ALDH2 genotype is correlated with alcohol and several food preferences, this genotype is probably associated with DPs. In this cross-sectional study of 1612 elderly adults, we investigated the effects of the ALDH2 genotype on DPs and the mediating role of alcohol intake. We identified the ALDH2 genotype and conducted a dietary history survey, then used principal component analysis to determine DPs for each gender. We performed multiple regression analysis to determine the independent contribution of the ALDH2 genotype and alcohol intake to DP scores. We identified three DPs: the "Japanese side dish type" (DP1), the "Japanese dish with alcohol type" (DP2), and the "Western dish with alcohol type" (DP3). In men, the single nucleotide polymorphism ALDH2 rs671 was significantly associated with all DP scores. When alcohol intake was added as a covariate, ALDH2 rs671 was still significantly correlated with the DP2 score but not with the DP1 or DP3 score, and alcohol intake was significantly correlated with all DP scores. In women, ALDH2 rs671 was significantly associated with the DP2 and DP3 scores; however, after adding alcohol intake as a covariate, these associations disappeared, and alcohol intake significantly correlated with all DP scores. In conclusion, the ALDH2 genotype was associated with several DPs in elderly adults, but most associations were mediated by alcohol intake.

G-CuP: the effect of a forced oral glucose intake on alcohol craving and mesolimbic cue reactivity in alcohol dependence-study protocol of a randomized, double-blind, placebo-controlled crossover study

BACKGROUND

Multiple studies indicate that a lower plasma level of the acetylated form of the appetite-regulating hormone ghrelin and higher plasma levels of insulin lead to a reduction in subjective alcohol craving and a reduced mesolimbic cue reactivity in functional magnetic resonance imaging (fMRI) when being exposed to alcohol-associated stimuli. The ghrelin level can physiologically be reduced by the induction of stomach distension and the ingestion of glucose or lipids.

METHODS

A total of 108 alcohol-dependent patients aged between 18 and 65 years are examined in the randomized, double-blind, placebo-controlled crossover study. After collecting demographic and psychometric data, participants take part in an alcohol exposure session. Afterwards, the participants go through the intervention condition (oral glucose intake) and the control condition (placebo intake) in a randomized order on two examination days. Blood samples are taken repeatedly (every 10 min) during the study course on both measuring days to determine changes in acetylated and total ghrelin and insulin plasma levels. In parallel, subjective alcohol craving after the glucose or placebo intake as the primary outcome is assessed using the Alcohol Urge Questionnaire (AUQ) and a visual analog scale (VAS). To examine the mesolimbic cue reactivity as the secondary outcome, a fMRI measurement is conducted while being exposed to alcohol-related stimuli. Appropriate statistical analysis will be used for the evaluation of the outcomes.

DISCUSSION

If successful, the results of this study could offer alcohol-dependent patients a new potential option for acute short-term reduction of alcohol craving and thus prevent relapses and prolong periods of abstinence in the long term.

TRIAL REGISTRATION

German Clinical Trials Register DRKS00022419 (UTN: U1111-1278-9428). Retrospectively registered on September 15, 2020.

Restoring an adequate dietary fiber intake by inulin supplementation: a pilot study showing an impact on gut microbiota and sociability in alcohol use disorder patients

Alcohol use disorder (AUD) is a chronic relapsing disease associated with malnutrition, metabolic disturbances, and gut microbiota alterations that are correlated with the severity of psychological symptoms. This study aims at supplementing AUD patients with prebiotic fiber during alcohol withdrawal, in order to modulate the gut microbiota composition and to evaluate its effect on gastrointestinal tolerance, metabolism, and patient's behavior. A randomized, double-blind, placebo-controlled study included 50 AUD patients assigned to inulin versus maltodextrin daily supplementation for 17 days. Biological measurements (fecal microbial 16S rDNA sequencing, serum biology), dietary intake, validated psychological questionnaires, and gastrointestinal tolerance assessment were performed before and after the intervention. Inulin significantly decreased the richness and evenness and induced changes of 8 genera (q < 0.1) including Bifidobacterium and Bacteroides. Prebiotic had minor effects on gastrointestinal symptoms and nutritional intakes compared to placebo. All patients showed an improvement in depression, anxiety, and craving scores during alcohol withdrawal regardless of the intervention group. Interestingly, only patients treated with inulin significantly improved the sociability score and had an increased serum level of brain-derived neurotrophic factor. This pilot study shows that inulin is well tolerated and modulates the gut microbiota and the social behavior in AUD patients, without further improving other psychological and biological parameters as compared to placebo. Gut2Brain study, clinicaltrial.gov: NCT03803709, https://clinicaltrials.gov/ct2/show/NCT03803709.

Lower Emotion Regulation Competencies Mediate the Association between Impulsivity and Craving during Alcohol Withdrawal Treatment

There is evidence that craving mediates the relationship between Impulsive Personality Traits (IPTs) and relapse during the treatment of an Alcohol Use Disorder (AUD). To provide tailored interventions, a deeper understanding of the relation between IPTs and craving, namely mediating processes, is important. Based on previous literature, we proposed that lower emotion regulation competencies mediate the relation between attentional as well as non-planning IPTs and craving. To investigate these interrelations, we used data from the baseline assessment (n = 320) of the SmartAssistEntz project (pre-registered in the German Clinical Trials Register [DRKS00017700]). Inpatients with a primary AUD diagnosis were interviewed using standardized self-report measures (IPTs: BIS-15, emotion regulation competencies: ERSQ, craving: OCDS-G short version) during their withdrawal treatment. Indirect effects were calculated using the SPSS macro PROCESS v3.5. Attentional as well as non-planning, but not motor, IPTs were associated with craving. Emotion regulation competencies mediated the relationship between attentional as well as non-planning IPTs and craving. Given their mediating role in the present study, it is interesting to investigate if addressing emotion regulation competencies can mitigate the negative influences of attentional and non-planning IPTs. The direct effect of attentional IPTs implicates alternate mediating processes, which should also be investigated in future research.

Associations of Binge Drinking and Heavy Alcohol Use on Sugar and Fat Intake in a Cohort of Southern People Living with HIV

AIMS

To assess whether binge drinking and heavy alcohol use are associated with increased sugar and fat consumption among a Southern cohort of people living with HIV (PWH).

METHODS

This was a cross-sectional analysis of PWH enrolled in the New Orleans Alcohol use in HIV (NOAH) Study (n = 215). Binge and heavy drinking were identified through a 30-day Alcohol Timeline-Followback and dietary intake was assessed through a 24-hour dietary recall.

RESULTS

Participants were 65.4% male, 83.3% Black, with a mean age of 49.2 ± 9.9. Heavy drinkers consumed more total calories than abstainers (P = 0.035) and low-to-moderate drinkers (P = 0.024), and binge drinkers consumed more calories than non-binge drinkers (P = 0.025). Binge and heavy drinkers had significantly higher intake of total and saturated fat in grams. However, substantially increased caloric intake among these participants led to non-significant associations for alcohol use with high total and saturated fat intake as a percent of total energy intake (%TEI). Binge drinkers had lower odds of consuming high sugar as a %TEI (odds ratio: 0.31 [0.14, 0.68]). Additionally, sugar intake predicted total and saturated fat intake, and this association was slightly higher among binge drinkers (total fat P-value: 0.12).

CONCLUSIONS

In this population of PWH, while binge and heavy drinking predicted higher caloric and fat intake in grams, binge drinkers were less likely to consume a high-sugar diet. This analysis suggests that interventions focused on reduced alcohol use may be especially beneficial in reducing metabolic disease burden in PWH if supplemented with information on incorporating lower energy-dense foods with reduced fat.

Prospective Associations between Attitudes toward Sweet Foods, Sugar Consumption, and Cravings for Alcohol and Sweets in Early Recovery from Alcohol Use Disorders

Sweet liking (heightened preference for highly-sweet solutions) is linked to Alcohol Use Disorder (AUD) and relapse, as well as attitudes towards sweet foods - use of sugar to cope with negative affect (sweet-cope), and impaired control over sweets consumption (sweet-control). This prospective analysis of individuals with AUD (N=26) participating in an Alcohol and Drug partial hospitalization program observed increases in self-reported sugar consumption and sweet craving from Time 1 (T1) to Time 2 (T2; 4 weeks later). Sweet-cope (T1) predicted T2 sweet craving. In an exploratory cross-lagged panel model, sweet-cope predicted sugar consumption and sweet craving at T1 and T2, and alcohol craving at T2. This pattern of results suggests the hypothesis that use of sugar to regulate negative affect may prove a novel, modifiable risk mechanism of the association between sweet liking and relapse. Sweet-cope may also prove an intervention target for improving nutrition and weight-related factors in early recovery. Future research in larger sample sizes is needed.

A systematic review of addiction substitution in recovery: Clinical lore or empirically-based?

This systematic review synthesized the literature examining addiction substitution during recovery from substance use or behavioral addictions. A total of 96 studies were included with sample sizes ranging from 6 to 14,885. The most common recovery addictions were opioids (30.21%), followed by cannabis (20.83%), unspecified use (17.71%), nicotine (12.50%), alcohol (12.50%), cocaine (4.17%), and gambling (2.08%). Statistical results were provided by 70.83% of the studies. Of these, 17.65% found support for addiction substitution, whereas 52.94% found support for concurrent recovery. A total of 19.12% found no statistical changes and 10.29% found both significant increases and decreases. The remaining 29.17% of studies provided descriptive data, without statistical tests. Predictors of addiction substitution were provided by 22.92% of the studies and 11.46% included information on impact of addiction substitution on treatment outcomes. Overall, male gender, younger age, greater substance use severity, and presence of mental health disorders were associated with addiction substitution. Addiction substitution was associated with poorer treatment outcomes. A limitation of the present systematic review is the use of significance counting for the quantitative synthesis. More research examining changes in addiction during recovery would aid in the development of more effective treatments for addictive disorders and prevent addiction substitution.