Body mass index interacts with sex to predict readmission in in-patients with alcohol use disorder

Glucose intake reduces alcohol craving and amplifies habituation to cue-induced brain activation in male patients with alcohol use disorder: A randomized, placebo-controlled crossover study examining male and female patients with AUD

INTRODUCTION

Evidence suggests a role of appetite-regulating hormones in alcohol use disorder. Reductions in acylated ghrelin levels are associated with reductions in craving and cue-induced brain activity. Ghrelin levels can be physiologically decreased by glucose intake, which therefore could be a treatment reducing craving and cue-induced brain activity in patients with alcohol use disorder, potentially mediated by acylated ghrelin.

MATERIAL AND METHODS

80 males and females with alcohol use disorder participated in the randomized placebo-controlled crossover study, examining glucose intake as acute treatment to reduce craving. Changes in craving and ghrelin levels were assessed at eight time points. Of these, 43 participants attended fMRI measurements examining habituation to cue-induced brain activation over time. Craving and hormone levels over time were analyzed using linear mixed modeling, brain activation habituation over time using flexible factorial models.

RESULTS

Models revealed a significant interaction effect (F(1,474.607)= 13.563, p < .001) between sex and treatment on craving, with lower craving values in males (difference in means=-.540, p = .016, 95 %CI: -.976, -.103) and higher craving in females (difference in means=.815, p = .005, 95 %CI:.243, 1.387) in the glucose compared to the placebo condition. In males, we found a significant effect of treatment (F(1,313.602)= 7.811, p = .006) and a trend, but no significant effect of acylated ghrelin (F(1,301.568)= 3.574, p = .060) on craving as well as greater habituation to cue-induced brain activation after glucose compared to placebo intake in right putamen (T(1,35)= 4.77, p = .019). Individual habituation slopes significantly predicted the difference in craving before and after the alcohol task (F(2,36)= 5.234, p = .010; B= -36.018, p = .027) in males.

CONCLUSIONS

Glucose intake could be a short-term treatment for males with alcohol use disorder to reduce alcohol craving and cue-induced brain activation. Sex-specific differences should be considered to gain a better understanding of the underlying mechanisms and develop treatment options for females.

Blood phosphatidylethanol measurements indicate GLP-1 receptor stimulation causes delayed decreases in alcohol consumption

BACKGROUND

The investigation of glucagon-like peptide 1 (GLP-1) receptor agonists (GLP-1RA) as a potential treatment for individuals with alcohol use disorder (AUD) and obesity is currently underway. In this secondary analysis of a randomized placebo-controlled trial, we included AUD patients with comorbid obesity and assessed the effect of the GLP-1RA exenatide versus placebo on alcohol consumption as measured by the alcohol biomarker phosphatidylethanol (PEth).

METHODS

Thirty AUD patients (9 females, 21 males), with an average age of 53 years and a body mass index (BMI) of at least 30 kg/m2, were included in this secondary analysis. Blood samples for PEth were collected at baseline and at weeks 4, 12, 20, and 26. The effect of time and treatment on PEth levels was analyzed using a baseline-adjusted linear mixed model.

RESULTS

A significant interaction between time and treatment was observed at Week 26, with PEth levels reduced by -0.9 μmol/L in the exenatide group compared to placebo (95% CI [-1.6 to -0.1], p = 0.03). However, the difference in PEth blood levels between the exenatide and placebo groups was not significant at earlier time points.

CONCLUSION

This secondary analysis indicates that exenatide has a delayed yet significant impact on alcohol consumption in individuals with AUD and obesity, as assessed by PEth levels. These findings warrant further investigation, which is currently underway (NCT05895643).

An overlooked relationship in recovery from substance use disorders: Associations between body mass index and negative emotional states

Recovery from substance use disorders (SUD) is multifactorial. Being overweight could negatively impact physiological and psychological health-related parameters. Using model selection, we examined associations between body mass index (BMI) and negative emotional states (NES; e.g., stress, anxiety, depression) in 54 men with SUD and under treatment in five different therapeutic recovery centers. We found that BMI was positively associated with stress (p < .001), anxiety (p < .001), and depression (p = .002). Therefore, our findings suggest that decreasing the accumulation of body fat might contribute to improving mental health in individuals with SUD during recovery.

Meta-analytic evidence for a sex-diverging association between alcohol use and body mass index

Alcohol use is an important health issue and has been suggested to contribute to the burden produced by obesity. Both alcohol use and obesity are subject to sex differences. The available studies on the relationship between alcohol use and body mass index (BMI) report inconsistent results with positive, negative, and null findings which requests a meta-analytic approach. Therefore, we conducted a meta-analysis of case-control, cohort, and cross-sectional studies. The systematic literature search and data extraction was performed by 3 independent raters. We conducted sex-separated meta-analyses and -regressions to investigate how alcohol consumption associates with BMI. Our systematic literature search resulted in 36 studies with 48 data sets (Nmen = 172,254; kmen = 30; Nwomen = 24,164; kwomen = 18; Nunknown sex = 672,344; kunknown sex = 24). Alcohol use was associated with higher BMI in men (g = 0.08 [0.07; 0.09]) and lower BMI in women (g = - 0.26 [- 0.29; - 0.22]). Moreover, we found the amount of daily alcohol intake in men (β = 0.001 [0.0008; 0.0014]) and ethnicity in women (g[Caucasians] = - 0.45 versus g[Asians] = - 0.05; z = 11.5, p < 0.0001) to moderate these effects. We here identified sex-diverging relationships between alcohol use and BMI, found daily alcohol intake and ethnicity to sex-specifically moderate these effects, and argue that sex-specific choice of beverage type and higher amount of daily alcohol use in men than in women account for these observations. Future research is needed to provide empirical evidence for the underlying mechanisms.