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Sarich P, Gao S, Zhu Y, Canfell K, Weber MF. The association between alcohol consumption and all-cause mortality: An umbrella review of systematic reviews using lifetime abstainers or low-volume drinkers as a reference group. Addiction 2024; 119:998-1012. [PMID: 38465993 DOI: 10.1111/add.16446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 01/07/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND AND AIMS Systematic reviews of the relationship between alcohol consumption and all-cause mortality have reported different relative risk (RR) curves, possibly due to the choice of reference group. Results have varied from 'J-shaped' curves, where low-volume consumption is associated with reduced risk, to monotonically increased risk with increasing consumption. We summarised the evidence on alcohol consumption and all-cause mortality exclusively from systematic reviews using lifetime abstainers or low-volume/occasional drinkers as the reference group. METHODS We conducted a systematic umbrella review of systematic reviews of the relationship between alcohol consumption and all-cause mortality in prospective cohort studies using a reference group of lifetime abstainers or low-volume/occasional drinkers. Several databases (PubMed/Medline/Embase/PsycINFO/Cochrane Library) were searched to March 2022. Reviews were assessed for risk of bias, and those with reference groups containing former drinkers were excluded. RESULTS From 2149 articles retrieved, 25 systematic reviews were identified, and five did not include former drinkers in the reference group. Four of the five included reviews had high risk of bias. Three reviews reported a J-shaped relationship between alcohol consumption and all-cause mortality with significant decreased risk for low-volume drinking (RR range 0.84 to 0.95), while two reviews did not. The one review at low risk of bias reported monotonically increased risk with greater consumption (RRs = 1.02, 1.13, 1.33 and 1.52 for low-, medium-, high- and higher-volume drinking, respectively, compared with occasional drinking). All five reviews reported significantly increased risk with higher levels of alcohol consumption (RR range 1.28 to 3.70). Sub-group analyses were reported by sex and age; however, there were evidence gaps for many important factors. Conversely, 17 of 20 excluded systematic reviews reported decreased mortality risk for low-volume drinking. CONCLUSIONS Over 70% of systematic reviews and meta-analyses published to March 2022 of all-cause mortality risk associated with alcohol consumption did not exclude former drinkers from the reference group and may therefore be biased by the 'sick-quitter effect'.
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Affiliation(s)
- Peter Sarich
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, New South Wales, Australia
| | - Shuhan Gao
- Changzhou Center for Disease Control and Prevention, Changzhou, Jiangsu Province, China
| | - Yining Zhu
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Karen Canfell
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, New South Wales, Australia
| | - Marianne F Weber
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, New South Wales, Australia
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2
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Angus C, Henney M, Pryce R. Modelling the longer-term health and health inequality impacts of changes in alcohol consumption during the COVID-19 pandemic in England. J Public Health (Oxf) 2024; 46:286-293. [PMID: 38304989 DOI: 10.1093/pubmed/fdae010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/12/2023] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Alcohol consumption changed substantially during the COVID-19 pandemic for many people. This study quantified how these changes in drinking varied across the population and their potential longer-term impact on health and health inequalities. METHODS We analyzed data from the Alcohol Toolkit Study to estimate how alcohol consumption changed during the pandemic (April 2020-November 2021) and how these changes varied with age, sex, drinking level and socioeconomic position. We combined these estimates with a range of alternative scenarios of future alcohol consumption and used the Sheffield Alcohol Policy Model to assess the long-term health and health inequality impacts of these changes. RESULTS Alcohol consumption in 2020-21 increased in heavier drinkers but fell in moderate drinkers. If alcohol consumption returns to pre-pandemic levels in 2022, we estimate a total of 42 677 additional hospital admissions and 1830 deaths over 20 years because of these changes. If consumption remains at 2021 levels in the long-term these figures rise to 355 832 and 12 849, respectively. In all scenarios, the biggest increase in harm occurs in the most deprived 20% of the population. CONCLUSIONS Pandemic-era changes in alcohol consumption are likely to have a significant negative impact on public health and health inequalities, even under optimistic assumptions about future drinking.
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Affiliation(s)
- Colin Angus
- Sheffield Centre for Health and Related Research, University of Sheffield, Sheffield S1 4DA, UK
| | - Madeleine Henney
- Sheffield Centre for Health and Related Research, University of Sheffield, Sheffield S1 4DA, UK
| | - Robert Pryce
- Sheffield Centre for Health and Related Research, University of Sheffield, Sheffield S1 4DA, UK
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3
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McCambridge J, Golder S. Alcohol, cardiovascular disease and industry funding: A co-authorship network analysis of epidemiological studies. Addict Behav 2024; 151:107932. [PMID: 38103279 DOI: 10.1016/j.addbeh.2023.107932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 11/28/2023] [Accepted: 11/30/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION Alcohol's effects on cardiovascular disease (CVD) are controversial. Alcohol industry actors have shown particular interest in this subject, and been extensively involved through research funding, and in other ways, generating concerns about bias, particularly in reviews. MATERIAL & METHODS We conducted a co-authorship network analysis of the primary studies included within a previous co-authorship study of 60 systematic reviews on the impact of alcohol on CVD. Additionally, we examined the relationships between declared alcohol industry funding and network structure. RESULTS There were 713 unique primary studies with 2832 authors published between 1969 and 2019 located within 229 co-authorship subnetworks. There was industry funding across subnetworks and approximately 8% of all papers declared industry funding. The largest subnetwork dominated, comprising 43% of all authors, with sparse evidence of substantial industry funding. The second largest subnetwork contained approximately 4% of all authors, with largely different industry funders involved. Harvard affiliated authors who at the review level formed co-authorship subnetworks with industry funded authors were seen at the primary study level to belong to the largest epidemiological subnetwork. A small number of key authors make extensive alcohol industry funding declarations. CONCLUSIONS There was no straightforward relationship between co-authorship network formation and alcohol industry funding of epidemiological studies on alcohol and CVD. More fine-grained attention to patterns of alcohol industry funding and to key nodes may shed further light on how far industry funding may be responsible for conflicting findings on alcohol and CVD.
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Affiliation(s)
- Jim McCambridge
- Department of Health Sciences, Seebohm Rowntree Building, University of York, Heslington York YO10 5DD, United Kingdom.
| | - Su Golder
- Department of Health Sciences, Seebohm Rowntree Building, University of York, Heslington York YO10 5DD, United Kingdom
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Norström T, Landberg J. The association between population drinking and ischemic heart disease mortality in educational groups. Alcohol Alcohol 2023:7161016. [PMID: 37208001 DOI: 10.1093/alcalc/agad033] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 04/07/2023] [Accepted: 04/11/2023] [Indexed: 05/21/2023] Open
Abstract
A large number of observational studies have found a J-shaped relationship between alcohol intake and ischemic heart disease (IHD) risk. However, some studies suggest that the alleged cardio-protective effect may be an artifact in the way that the elevated risk for abstainers is due to self-selection on risk factors for IHD. The aim of this paper is to estimate the association between alcohol and IHD-mortality on the basis of aggregate time-series data, where the problem with selection effects is not present. In addition, we will analyze SES-specific mortality to investigate whether there is any socio-economic gradient in the relationship at issue. SES was measured by educational level. We used IHD-mortality in three educational groups as outcome. Per capita alcohol consumption was proxied by Systembolaget's alcohol sales (litres of alcohol 100% per capita 15+). Swedish quarterly data on mortality and alcohol consumption spanned the period 1991Q1-2020Q4. We applied SARIMA time-series analysis. Survey data were used to construct an indicator of heavy SES-specific episodic drinking. The estimated association between per capita consumption and IHD-mortality was positive and statistically significant in the two groups with primary and secondary education, but not in the group with postsecondary education. The association was significantly stronger the lower the educational group. Although the associations were generally stronger for males than for females, these differences were not statistically significant (P > 0.05). Our findings suggest that the detrimental impact of per capita consumption on IHD-mortality was stronger the lower the educational group.
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Affiliation(s)
- Thor Norström
- Swedish Institute for Social Research (SOFI), Stockholm University, Stockholm 109 91, Sweden
| | - Jonas Landberg
- Department of Public Health Sciences, Stockholm University, Stockholm 106 91, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm 171 77, Sweden
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Suter F, Pestoni G, Sych J, Rohrmann S, Braun J. Alcohol consumption: context and association with mortality in Switzerland. Eur J Nutr 2023; 62:1331-1344. [PMID: 36564527 PMCID: PMC10030531 DOI: 10.1007/s00394-022-03073-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 12/12/2022] [Indexed: 12/25/2022]
Abstract
PURPOSE Non-communicable diseases generate the largest number of avoidable deaths often caused by risk factors such as alcohol, smoking, and unhealthy diets. Our study investigates the association between amount and context of alcohol consumption and mortality from major non-communicable diseases in Switzerland. METHODS Generalized linear regression models were fitted on data of the cross-sectional population-based National Nutrition Survey menuCH (2014-2015, n = 2057). Mortality rates based on the Swiss mortality data (2015-2018) were modeled by the alcohol consumption group considering the amount and context (i.e., during or outside mealtime) of alcohol consumption and potential confounders. The models were checked for spatial autocorrelation using Moran's I statistic. Integrated nested Laplace approximation (INLA) models were fitted when evidence for missing spatial information was found. RESULTS Higher mortality rates were detected among drinkers compared to non-drinkers for all-cancer (rate ratio (RR) ranging from 1.01 to 1.07) and upper aero-digestive tract cancer (RR ranging from 1.15 to 1.20) mortality. Global Moran's I statistic revealed spatial autocorrelation at the Swiss district level for all-cancer mortality. An INLA model led to the identification of three districts with a significant decrease and four districts with a significant increase in all-cancer mortality. CONCLUSION Significant associations of alcohol consumption with all-cancer and upper aero-digestive tract cancer mortality were detected. Our study results indicate the need for further studies to improve the next alcohol-prevention scheme and to lower the number of avoidable deaths in Switzerland.
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Affiliation(s)
- Flurina Suter
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
| | - Giulia Pestoni
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
- Nutrition Group, Health Department, Swiss Distance University of Applied Sciences, Zurich, Switzerland
| | - Janice Sych
- Institute of Food and Beverage Innovation, ZHAW School of Life Sciences and Facility Management, Waedenswil, Switzerland
| | - Sabine Rohrmann
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland.
| | - Julia Braun
- Divisions of Epidemiology and Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
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Wang C, Zhang X, Li B, Mu D. A study of factors impacting disease based on the Charlson Comorbidity Index in UK Biobank. Front Public Health 2023; 10:1050129. [PMID: 36699869 PMCID: PMC9868818 DOI: 10.3389/fpubh.2022.1050129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 12/20/2022] [Indexed: 01/12/2023] Open
Abstract
Objective With advances in medical diagnosis, more people are diagnosed with more than one disease. The damage caused by different diseases varies, so relying solely on the number of diseases to represent multimorbidity is limited. The Charlson comorbidity index (CCI) is widely used to measure multimorbidity and has been validated in various studies. However, CCI's demographic and behavioral risk factors still need more exploration. Methods We conduct multivariate logistic regression analysis and restricted cubic splines to examine the influence factors of CCI and the relationship between covariates and risk of CCI, respectively. Our research employs the Multivariate Imputation by Chained Equations method to interpolate missing values. In addition, the CCI score for each participant is calculated based on the inpatient's condition using the International Classification of Diseases, edition 10 (ICD10). Considering the differences in the disease burden between males and females, the research was finally subgroup analyzed by sex. Results This study includes 5,02,411 participants (2,29,086 female) with CCI scores ranging from 0 to 98. All covariates differed between CCI groups. High waist-hip ratio (WHR) increases the risk of CCI in both males [OR = 19.439, 95% CI = (16.261, 23.241)] and females [OR = 12.575, 95% CI = (11.005, 14.370)], and the effect of WHR on CCI is more significant in males. Associations between age, Body Mass Index (BMI) and WHR, and CCI risk are J-shaped for all participants, males, and females. Concerning the association between Townsend deprivation index (TDI) and CCI risk, the U-shape was found in all participants and males and varied to a greater extent in males, but it is a J-shape in females. Conclusions Increased WHR, BMI, and TDI are significant predictors of poor health, and WHR showed a greater role. The impact of deprivation indices on health showed differences by sex. Socio-economic factors, such as income and TDI, are associated with CCI. The association of social status differences caused by these socioeconomic factors with health conditions should be considered. Factors might interact with each other; therefore, a comprehensive, rational, and robust intervention will be necessary for health.
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Affiliation(s)
- Changcong Wang
- Division of Clinical Research, The First Hospital of Jilin University, Changchun, China,Department of Medical Informatics, School of Public Health, Jilin University, Changchun, China
| | - Xinyue Zhang
- Division of Clinical Research, The First Hospital of Jilin University, Changchun, China,Department of Medical Informatics, School of Public Health, Jilin University, Changchun, China
| | - Bai Li
- Department of Colorectal and Anal Surgery, General Surgery Center, First Hospital of Jilin University, Changchun, China
| | - Dongmei Mu
- Division of Clinical Research, The First Hospital of Jilin University, Changchun, China,Department of Medical Informatics, School of Public Health, Jilin University, Changchun, China,*Correspondence: Dongmei Mu ✉
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Karavasiloglou N, Pestoni G, Kühn T, Rohrmann S. Adherence to cancer prevention recommendations and risk of breast cancer in situ in the United Kingdom Biobank. Int J Cancer 2022; 151:1674-1683. [PMID: 35723078 PMCID: PMC9796371 DOI: 10.1002/ijc.34183] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 04/28/2022] [Accepted: 05/23/2022] [Indexed: 01/01/2023]
Abstract
A health-conscious lifestyle may protect against breast cancer in situ. However, breast cancer in situ is mainly detected by screening, and many studies lack information on screening participation. Thus, we evaluated the association between prediagnostic lifestyle and risk of breast cancer in situ, accounting for screening participation at recruitment. A score reflecting the adherence to the World Cancer Research Fund/American Institute for Cancer Research cancer prevention recommendations was constructed, using the recommendations on healthy body weight, physical activity, consumption of plant-based foods, red and processed meat, alcohol and avoidance of sugar. Cox proportional hazards regression models were used to investigate the association between the lifestyle score and breast cancer in situ risk, while accounting for important confounders. The lifestyle score was not significantly associated with breast cancer in situ risk (HRcontinuous = 0.96, 95% CI = 0.91-1.03) in the overall cohort. In participants not reporting dietary changes in the past 5 years, the lifestyle score was inversely associated with breast cancer in situ risk (HRcontinuous = 0.92, 95% CI = 0.85-0.99). In those reporting dietary changes in the past 5 years due to illness or other reasons, the lifestyle score was not associated with breast cancer in situ risk (HRcontinuous = 1.04, 95% CI = 0.94-1.15). Lifestyle was inversely associated with breast cancer in situ risk in women not reporting recent changes in their dietary habits. This inverse association is consistent with inverse associations reported in previous studies. Our findings suggest that breast cancer in situ and invasive breast cancer share a similar risk factor profile.
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Affiliation(s)
- Nena Karavasiloglou
- Division of Chronic Disease Epidemiology, Institute for Epidemiology, Biostatistics and Prevention, University of Zurich, Zurich, Switzerland.,Cancer Registry Zurich, Zug, Schaffhausen, and Schwyz, University Hospital Zurich, Zurich, Switzerland
| | - Giulia Pestoni
- Division of Chronic Disease Epidemiology, Institute for Epidemiology, Biostatistics and Prevention, University of Zurich, Zurich, Switzerland.,Nutrition Group, Health Department, Swiss Distance University of Applied Sciences, Zurich, Switzerland
| | - Tilman Kühn
- Institute for Global Food Security, Queen's University Belfast, Belfast, UK.,Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - Sabine Rohrmann
- Division of Chronic Disease Epidemiology, Institute for Epidemiology, Biostatistics and Prevention, University of Zurich, Zurich, Switzerland.,Cancer Registry Zurich, Zug, Schaffhausen, and Schwyz, University Hospital Zurich, Zurich, Switzerland
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8
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Kim M, Kim H, Han K, Yoo J, Yang K, Jeon HJ. Changes in alcohol consumption and the risk of cardiovascular diseases in patients with depression who had not consumed alcohol: A nationwide cohort study. J Psychiatr Res 2022; 155:458-464. [PMID: 36183599 DOI: 10.1016/j.jpsychires.2022.09.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 08/01/2022] [Accepted: 09/16/2022] [Indexed: 11/30/2022]
Abstract
Although numerous studies have examined the association between alcohol consumption and cardiovascular diseases (CVDs) in the general population, such association in patients with depression has not been reported yet. Thus, the objective of this study was to examine the association between changes in alcohol consumption and CVDs in patients with depression who had not consumed alcohol. A national database of medical records in South Korea was used and 375,710 subjects newly diagnosed with depression who had not consumed alcohol within two years after the diagnosis of depression (1st point) were identified. Subjects were categorized into three groups (non-drinkers, mild-to-moderate drinkers, and heavy drinkers) based on the status of alcohol intake within two years after the 1st point (2nd point). Subjects were followed up for the occurrence of CVDs including myocardial infarction (MI), ischemic stroke, and all-cause mortality. Among eligible subjects, 329,802 non-drinkers, 43,659 mild-to-moderate drinkers, and 2,249 heavy drinkers were identified. Compared to non-drinkers, heavy drinkers showed increased risks for MI (aHR, 1.41; 95% CI, 1.08-1.83), ischemic stroke (aHR, 1.49; 95% CI, 1.12-1.99), composite CVDs (aHR, 1.48; 95% CI, 1.21-1.80), and all-cause mortality (aHR, 1.38; 95% CI, 1.13-1.68). Compared to those who maintained abstinence from alcohol, those who started heavy drinking after the diagnosis of depression had increased risks of CVDs and all-cause mortality. These data highlight the need for alcohol consumption limitations for people who are diagnosed with depression in clinical settings.
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Affiliation(s)
- Minsoo Kim
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hyewon Kim
- Department of Psychiatry, Hanyang University Hospital, Seoul, South Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, South Korea
| | - Juhwan Yoo
- Department of Biomedicine & Health Science, The Catholic University of Korea, Seoul, South Korea
| | - Kyojin Yang
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hong Jin Jeon
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Health Sciences & Technology, Department of Medical Device Management & Research, Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea.
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9
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Warner JB, Zirnheld KH, Hu H, Floyd A, Kong M, McClain CJ, Kirpich IA. Analysis of alcohol use, consumption of micronutrient and macronutrients, and liver health in the 2017-2018 National Health and Nutrition Examination Survey. Alcohol Clin Exp Res 2022; 46:2025-2040. [PMID: 36124871 PMCID: PMC9722540 DOI: 10.1111/acer.14944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Alcohol use is a major global healthcare burden that contributes to numerous adverse health outcomes, including liver disease. Many factors influence individual susceptibility to alcohol-associated diseases, including nutritional factors. The objective of the current study was to examine inter-relations among alcohol, dietary micronutrients and macronutrient consumption, and liver health by analyzing data from the 2017-2018 National Health and Nutrition Examination Survey (NHANES). METHODS Based on self-reported alcohol consumption, NHANES respondents were assigned to one of four categories: never drinkers (lifetime abstainers), non-drinkers (past-year abstainers), moderate drinkers (1/2 drinks per day for females/males, respectively), and heavy drinkers (>1/>2 drinks per day for females/males, respectively, and/or frequent binge drinking). Survey-weighted regression analyses (adjusted for gender, age, race, education, and body mass index) were performed to examine associations between alcohol intake, dietary, and liver health characteristics. RESULTS Individuals categorized as heavy drinkers were significantly younger, most often well-educated males with low incidences of diabetes and other comorbidities. They consumed the most overall calories and various micronutrients, indicating a diet that was not necessarily nutrient poor. Neither moderate nor heavy drinkers had liver steatosis or fibrosis as measured by liver elastography, although heavy drinkers had modestly elevated plasma biomarkers of liver injury, including ALT, AST, and GGT, compared with the other groups. CONCLUSIONS Our findings suggest that the category of heavy drinkers in the 2017-2018 NHANES consisted of generally healthy individuals with high-energy intake and no evidence of liver steatosis or fibrosis. However, slightly increased plasma liver markers may indicate a risk of future progression to more advanced stages of liver disease over time in some individuals. Several limitations should be considered when interpreting these data, including the potential misclassification of drinking categories and the lack of standardized cutoff scores for fatty liver as assessed by elastography, among others.
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Affiliation(s)
- Jeffrey B. Warner
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, School of Medicine, University of Louisville, 505 South Hancock Street, Louisville KY, 40202, United States
- Department of Pharmacology and Toxicology, School of Medicine, University of Louisville, 505 South Hancock Street, Louisville KY, 40202, United States
| | - Kara H. Zirnheld
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, School of Medicine, University of Louisville, 505 South Hancock Street, Louisville KY, 40202, United States
| | - Huirong Hu
- Department of Bioinformatics and Biostatistics, School of Public Health and Information Sciences, University of Louisville, 485 East Gray Street, Louisville, KY 40202, United States
| | - Alison Floyd
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, School of Medicine, University of Louisville, 505 South Hancock Street, Louisville KY, 40202, United States
| | - Maiying Kong
- Department of Bioinformatics and Biostatistics, School of Public Health and Information Sciences, University of Louisville, 485 East Gray Street, Louisville, KY 40202, United States
- Robley Rex Veterans Affairs Medical Center, 800 Zorn Avenue, Louisville, KY 40206, United States
| | - Craig J. McClain
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, School of Medicine, University of Louisville, 505 South Hancock Street, Louisville KY, 40202, United States
- Department of Pharmacology and Toxicology, School of Medicine, University of Louisville, 505 South Hancock Street, Louisville KY, 40202, United States
- Alcohol Research Center, School of Medicine, University of Louisville, 505 South Hancock Street, Louisville KY, 40202, United States
- Hepatobiology and Toxicology Center, School of Medicine, University of Louisville, 505 South Hancock Street, Louisville KY, 40202, United States
- Robley Rex Veterans Affairs Medical Center, 800 Zorn Avenue, Louisville, KY 40206, United States
| | - Irina A. Kirpich
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, School of Medicine, University of Louisville, 505 South Hancock Street, Louisville KY, 40202, United States
- Department of Pharmacology and Toxicology, School of Medicine, University of Louisville, 505 South Hancock Street, Louisville KY, 40202, United States
- Alcohol Research Center, School of Medicine, University of Louisville, 505 South Hancock Street, Louisville KY, 40202, United States
- Hepatobiology and Toxicology Center, School of Medicine, University of Louisville, 505 South Hancock Street, Louisville KY, 40202, United States
- Department of Microbiology and Immunology, School of Medicine, University of Louisville, 505 South Hancock Street, Louisville KY, 40202, United States
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Angus C. Harms of alcohol in different age groups. BMJ 2022; 378:o1979. [PMID: 35948355 DOI: 10.1136/bmj.o1979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Colin Angus
- Sheffield Alcohol Research Group, ScHARR, University of Sheffield, Sheffield, UK
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11
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Ding C, O'Neill D, Britton A. Trajectories of alcohol consumption in relation to all-cause mortality in patients with cardiovascular disease: a 35-year prospective cohort study. Addiction 2022; 117:1920-1930. [PMID: 35188300 PMCID: PMC9314067 DOI: 10.1111/add.15850] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 02/04/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND AIMS Research into alcohol consumption and cardiovascular disease (CVD) patients' prognosis has largely ignored the longitudinal dynamics in drinking behaviour. This study measured the association between alcohol consumption trajectories and mortality risk in CVD patients. DESIGN Prospective cohort study. SETTING UK-based Whitehall II Study. PARTICIPANTS A total of 1306 participants with incident non-fatal CVD (coronary heart disease/stroke) events. MEASUREMENTS Up to eight repeated measures of alcohol intake were available for each patient from the most recent assessment phase pre-incident CVD and all subsequent phases post-incident CVD, spanning up to three decades. Six trajectory groups of alcohol consumption were identified using group-based trajectory modelling and related to the risk of all-cause mortality, adjusting for demographics and changes in life-style and health status. FINDINGS Three hundred and eighty deaths were recorded during a median follow-up of 5 years after patients' last alcohol assessment. Compared with patients who consistently drank moderately (≤ 14 units/week), former drinkers had a greater risk of mortality (hazard ratio = 1.74, 95% confidence interval = 1.19-2.54) after adjustment for covariates. There was no significantly increased risk of mortality in long-term abstainers, reduced moderate drinkers, stable or unstable heavy drinkers. Cross-sectional analyses based only on drinking information at patients' last assessment found no significant differences in mortality risk for abstainers, former or heavy drinkers versus moderate drinkers. CONCLUSIONS Cardiovascular disease patients who consistently drink ≤ 14 units/week appear to have a similar risk of mortality to those who are long-term abstainers, which does not support a protective effect of moderate drinking on total mortality. Cardiovascular disease patients who stop drinking appear to have increased mortality risk compared with continuous moderate drinkers, but this may be linked to poor self-rated health before cardiovascular disease onset.
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Affiliation(s)
- Chengyi Ding
- Research Department of Epidemiology and Public HealthUniversity College LondonLondonUK
| | - Dara O'Neill
- CLOSER, UCL Social Research InstituteUniversity College LondonLondonUK
| | - Annie Britton
- Research Department of Epidemiology and Public HealthUniversity College LondonLondonUK
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12
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Rossow I. Normalization of non-drinking and implications for alcohol epidemiology. Addiction 2022; 117:1214-1215. [PMID: 34913213 DOI: 10.1111/add.15763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 11/25/2021] [Indexed: 01/15/2023]
Affiliation(s)
- Ingeborg Rossow
- Department of Alcohol, Tobacco, and Drugs, Norwegian Institute of Public Health, Oslo, Norway
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Hoek AG, van Oort S, Mukamal KJ, Beulens JWJ. Alcohol Consumption and Cardiovascular Disease Risk: Placing New Data in Context. Curr Atheroscler Rep 2022; 24:51-59. [PMID: 35129737 PMCID: PMC8924109 DOI: 10.1007/s11883-022-00992-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2021] [Indexed: 11/30/2022]
Abstract
Purpose of Review A clear link between excessive alcohol consumption and cardiovascular disease (CVD) has been established, but no consensus exists on the effects of moderate alcohol consumption on CVD. Recent Findings A lower risk of coronary heart disease and myocardial infarction among moderate drinkers compared to abstainers has been consistently observed in epidemiological studies and meta-analyses of these studies. However, ambiguity remains on the effect of alcohol on other CVDs and all-cause mortality. Short-term randomized controlled trials (RCT) have identified potentially beneficial effects of alcohol consumption on cardiovascular risk factors, but studies investigating genetic polymorphisms that influence alcohol consumption (i.e., Mendelian randomization) have yielded inconclusive results. To date, a long-term RCT providing causal evidence is lacking but urgently needed. Summary Triangulation of evidence from different study designs, including long-term RCTs, pragmatic trials and the evaluation of policy measures, combined will lead to the best available evidence.
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Affiliation(s)
- Anna G Hoek
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology & Data Science, Amsterdam Cardiovascular Sciences Research Institute, De Boelelaan 1117, Amsterdam, The Netherlands.
| | - Sabine van Oort
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology & Data Science, Amsterdam Cardiovascular Sciences Research Institute, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Kenneth J Mukamal
- Beth Israel Deaconess Medical Center, Harvard Medical School and Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Joline W J Beulens
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology & Data Science, Amsterdam Cardiovascular Sciences Research Institute, De Boelelaan 1117, Amsterdam, The Netherlands.,University Medical Centre Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht University, Utrecht, The Netherlands
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Ramos-Vera C, Serpa Barrientos A, Calizaya-Milla YE, Carvajal Guillen C, Saintila J. Consumption of Alcoholic Beverages Associated With Physical Health Status in Adults: Secondary Analysis of the Health Information National Trends Survey Data. J Prim Care Community Health 2022; 13:21501319211066205. [PMID: 34991399 PMCID: PMC8744155 DOI: 10.1177/21501319211066205] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/23/2021] [Accepted: 11/24/2021] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION Alcohol consumption constitutes one of the main modifiable risk factors that contribute to the increase in the global burden of non-communicable diseases (NCDs). The objective of this study was to determine the effects of the consumption of alcoholic beverages on the state of physical health and its equivalence according to gender. METHODS Cross-sectional data from the Health Information National Trends Survey (HINTS) of the National Cancer Institute (NCI) (n = 3865), collected during 2020 were used. Structural equation modeling was applied to assess the fit of the model, which included the prediction of measures of alcohol consumption in physical health and the equivalence of measurements of the proposed structural model in men and women. RESULTS The proposed structural model reported adequate goodness-of-fit indices (SBχ²/gl = 3.817, CFI = 0.984, TLI = 0.968, RMSEA [90% CI] = 0.027 [0.016-0.039]; SRMR = 0.016). Frequent alcohol consumption had a negative effect on physical health (b = -0.13, P < .01). Similarly, occasional alcohol consumption negatively predicted elevated BMI and chronic conditions such as, diabetes, hypertension, CVD, and cancer (b = -0.09, P < .01). In addition, drinking patterns of alcoholic beverages affect physical health in equal ways for men and women. CONCLUSION The findings highlight that frequent and occasional alcohol consumption significantly affected physical health in a negative way. Future interventions could address ways to encourage the adoption of a healthy lifestyle to reduce the risks of chronic conditions derived from excessive alcohol consumption.
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15
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Golder S, McCambridge J. Alcohol, cardiovascular disease and industry funding: A co-authorship network analysis of systematic reviews. Soc Sci Med 2021; 289:114450. [PMID: 34607052 PMCID: PMC8586735 DOI: 10.1016/j.socscimed.2021.114450] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 09/14/2021] [Accepted: 09/29/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Alcohol's effects on heart health is the site of a major scientific controversy. We conducted a co-authorship network analysis of systematic reviews on the impacts on alcohol on cardiovascular disease (CVD) in order to investigate patterns of co-authorship in the literature, with particular attention given to industry funding. METHODS We used Epistemonikos to identify systematic reviews. Review characteristics, influential authors, co-authorship subnetworks, prior histories of alcohol industry funding, study outcomes and citations were investigated. RESULTS 60 systematic reviews with 231 unique authors met our inclusion criteria. 14 systematic reviews were undertaken by authors with histories of alcohol industry funding, including 5 that were funded directly by the alcohol industry itself. All 14 such reviews identified a cardioprotective effect of alcohol. These formed distinct co-authorship subnetworks within the literature. Of reviews by authors with no prior histories of alcohol industry funding, the findings were mixed, with 54% (25/46) concluding there was evidence of health protective effects. These two groups of reviews differed in other respects. Those with industry funding were more likely to study broader outcomes such as 'cardiovascular disease' or 'coronary heart disease' as opposed to specific CVD issues such as hypertension or stroke (93% [13/14] versus 41% [19/46]) (chi-squared 12.4, p < 0.001) and have more included studies (mean of 29 versus 20). They were also more widely cited by others. Over time the proportions of systematic reviews on CVD and alcohol undertaken by authors with no prior histories of alcohol industry funding has increased. CONCLUSIONS Systematic reviews undertaken by authors with histories of alcohol industry funding were more likely to study broader outcomes, and be cited more widely, and exclusively reported favorable conclusions.
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Affiliation(s)
- Su Golder
- Department of Health Sciences, University of York, York, United Kingdom.
| | - Jim McCambridge
- Department of Health Sciences, University of York, York, United Kingdom
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16
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John U, Rumpf HJ, Hanke M, Meyer C. Alcohol abstinence and mortality in a general population sample of adults in Germany: A cohort study. PLoS Med 2021; 18:e1003819. [PMID: 34727120 PMCID: PMC8562854 DOI: 10.1371/journal.pmed.1003819] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 09/17/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Evidence suggests that people who abstain from alcohol have a higher mortality rate than those who drink low to moderate amounts. However, little is known about factors that might be causal for this finding. The objective was to analyze former alcohol or drug use disorders, risky drinking, tobacco smoking, and fair to poor health among persons who reported abstinence from alcohol drinking in the last 12 months before baseline in relation to total, cardiovascular, and cancer mortality 20 years later. METHODS AND FINDINGS A sample of residents aged 18 to 64 years had been drawn at random among the general population in northern Germany and a standardized interview conducted in the years 1996 to 1997. The baseline assessment included 4,093 persons (70.2% of those who had been eligible). Vital status and death certificate data were retrieved in the years 2017 and 2018. We found that among the alcohol-abstinent study participants at baseline (447), there were 405 (90.60%) former alcohol consumers. Of the abstainers, 322 (72.04%) had met one or more criteria for former alcohol or drug dependence or abuse, alcohol risky drinking, or had tried to cut down or to stop drinking, were daily smokers, or self-rated their health as fair to poor. Among the abstainers with one or more of these risk factors, 114 (35.40%) had an alcohol use disorder or risky alcohol consumption in their history. Another 161 (50.00%) did not have such an alcohol-related risk but were daily smokers. The 322 alcohol-abstinent study participants with one or more of the risk factors had a shorter time to death than those with low to moderate alcohol consumption. The Cox proportional hazard ratio (HR) was 2.44 (95% confidence interval (CI), 1.68 to 3.56) for persons who had one or more criteria for an alcohol or drug use disorder fulfilled in their history and after adjustment for age and sex. The 125 alcohol-abstinent persons without these risk factors (27.96% of the abstainers) did not show a statistically significant difference from low to moderate alcohol consumers in total, cardiovascular, and cancer mortality. Those who had stayed alcohol abstinent throughout their life before (42; 9.40% of the alcohol-abstinent study participants at baseline) had an HR 1.64 (CI 0.72 to 3.77) compared to low to moderate alcohol consumers after adjustment for age, sex, and tobacco smoking. Main limitations of this study include its reliance on self-reported data at baseline and the fact that only tobacco smoking was analyzed as a risky behavior alongside alcohol consumption. CONCLUSIONS The majority of the alcohol abstainers at baseline were former alcohol consumers and had risk factors that increased the likelihood of early death. Former alcohol use disorders, risky alcohol drinking, ever having smoked tobacco daily, and fair to poor health were associated with early death among alcohol abstainers. Those without an obvious history of these risk factors had a life expectancy similar to that of low to moderate alcohol consumers. The findings speak against recommendations to drink alcohol for health reasons.
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Affiliation(s)
- Ulrich John
- University Medicine Greifswald, Prevention Research and Social Medicine, Institute of Community Medicine, Greifswald, Germany
- German Center for Cardiovascular Research, partner site Greifswald, Greifswald, Germany
- * E-mail:
| | - Hans-Juergen Rumpf
- University of Luebeck, Department of Psychiatry and Psychotherapy, Research Group S:TEP, Luebeck, Germany
| | - Monika Hanke
- University Medicine Greifswald, Prevention Research and Social Medicine, Institute of Community Medicine, Greifswald, Germany
| | - Christian Meyer
- University Medicine Greifswald, Prevention Research and Social Medicine, Institute of Community Medicine, Greifswald, Germany
- German Center for Cardiovascular Research, partner site Greifswald, Greifswald, Germany
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Moissl AP, Delgado GE, Krämer BK, Dawczynski C, Stojakovic T, März W, Kleber ME, Lorkowski S. Alcohol consumption and mortality: The Ludwigshafen Risk and Cardiovascular Health (LURIC) study. Atherosclerosis 2021; 335:119-125. [PMID: 34454737 DOI: 10.1016/j.atherosclerosis.2021.08.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 07/04/2021] [Accepted: 08/10/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS One of the most important risk factors for morbidity and mortality is the consumption of alcohol. The aim of our study was to examine the effect of alcohol consumption on all-cause mortality and cardiovascular mortality. METHODS The Ludwigshafen Risk and Cardiovascular Health (LURIC) study includes 3316 patients hospitalized for coronary angiography at a tertiary care centre in Southwest Germany. Patients were followed-up for a median of 9.9 (range 0.1-11.9 years) years. Total mortality number in the follow-up period was 995, and the number of incident cases, i.e. cardiovascular death, was 622. Information on alcohol consumption assessed by self-report questionnaires was used to calculate intake in grams of ethanol per day. Associations of alcohol consumption with morbidity and mortality were analysed using Cox proportional hazards regression. RESULTS We found significantly increased mortality for patients in the highest alcohol intake group age- and sex-adjusted (hazard ratio of 1.59 (95%CI, 0.93-2.72)) and a reduced risk for the group of low-volume drinkers (hazard ratio of 0.75 (95%CI, 0.65-0.86)). After adjustment for cardiovascular risk factors, the risk difference between abstainers and low-volume drinkers was not significant anymore. CONCLUSIONS In the LURIC study, the risk of overall mortality and cardiovascular mortality is significantly increased in study participants with very high alcohol consumption and slightly increased in total abstainers as compared to participants with low consumption in unadjusted analysis, replicating the well-known J-curve. Adjusting for cardiovascular risk factors rendered the risk decrease observed for low-volume drinkers insignificant. Therefore, our results do not show a significant health benefit of low-volume alcohol consumption in a cohort of patients at medium-to-high cardiovascular risk.
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Affiliation(s)
- Angela P Moissl
- Institute of Nutritional Sciences, Friedrich Schiller University Jena, Jena, Germany; Vth Department of Medicine (Nephrology, Hypertensiology, Rheumatology, Endocrinology, Diabetology), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; Competence Cluster for Nutrition and Cardiovascular Health (nutriCARD) Halle-Jena-Leipzig, Germany.
| | - Graciela E Delgado
- Vth Department of Medicine (Nephrology, Hypertensiology, Rheumatology, Endocrinology, Diabetology), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; Center for Preventive Medicine and Digital Health Baden-Württemberg (CPDBW), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Bernhard K Krämer
- Vth Department of Medicine (Nephrology, Hypertensiology, Rheumatology, Endocrinology, Diabetology), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; Center for Preventive Medicine and Digital Health Baden-Württemberg (CPDBW), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; European Center for Angioscience (ECAS), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Christine Dawczynski
- Institute of Nutritional Sciences, Friedrich Schiller University Jena, Jena, Germany; Competence Cluster for Nutrition and Cardiovascular Health (nutriCARD) Halle-Jena-Leipzig, Germany
| | - Tatjana Stojakovic
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, University Hospital Graz, Graz, Austria
| | - Winfried März
- Vth Department of Medicine (Nephrology, Hypertensiology, Rheumatology, Endocrinology, Diabetology), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; Competence Cluster for Nutrition and Cardiovascular Health (nutriCARD) Halle-Jena-Leipzig, Germany; Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University Graz, Graz, Austria; SYNLAB Academy, SYNLAB Holding Deutschland GmbH, Augsburg and Mannheim, Germany
| | - Marcus E Kleber
- Vth Department of Medicine (Nephrology, Hypertensiology, Rheumatology, Endocrinology, Diabetology), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; SYNLAB MVZ für Humangenetik Mannheim GmbH, Mannheim, Germany
| | - Stefan Lorkowski
- Institute of Nutritional Sciences, Friedrich Schiller University Jena, Jena, Germany; Competence Cluster for Nutrition and Cardiovascular Health (nutriCARD) Halle-Jena-Leipzig, Germany.
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18
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Rehm J, Rovira P, Llamosas-Falcón L, Shield KD. Dose-Response Relationships between Levels of Alcohol Use and Risks of Mortality or Disease, for All People, by Age, Sex, and Specific Risk Factors. Nutrients 2021; 13:2652. [PMID: 34444809 PMCID: PMC8401096 DOI: 10.3390/nu13082652] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 07/26/2021] [Accepted: 07/28/2021] [Indexed: 11/17/2022] Open
Abstract
Alcohol use has been causally linked to more than 200 disease and injury conditions, as defined by three-digit ICD-10 codes. The understanding of how alcohol use is related to these conditions is essential to public health and policy research. Accordingly, this study presents a narrative review of different dose-response relationships for alcohol use. Relative-risk (RR) functions were obtained from various comparative risk assessments. Two main dimensions of alcohol consumption are used to assess disease and injury risk: (1) volume of consumption, and (2) patterns of drinking, operationalized via frequency of heavy drinking occasions. Lifetime abstention was used as the reference group. Most dose-response relationships between alcohol and outcomes are monotonic, but for diabetes type 2 and ischemic diseases, there are indications of a curvilinear relationship, where light to moderate drinking is associated with lower risk compared with not drinking (i.e., RR < 1). In general, women experience a greater increase in RR per gram of alcohol consumed than men. The RR per gram of alcohol consumed was lower for people of older ages. RRs indicated that alcohol use may interact synergistically with other risk factors, in particular with socioeconomic status and other behavioural risk factors, such as smoking, obesity, or physical inactivity. The literature on the impact of genetic constitution on dose-response curves is underdeveloped, but certain genetic variants are linked to an increased RR per gram of alcohol consumed for some diseases. When developing alcohol policy measures, including low-risk drinking guidelines, dose-response relationships must be taken into consideration.
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Affiliation(s)
- Jürgen Rehm
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, 33 Ursula Franklin Street, Toronto, ON M5S 2S1, Canada; (L.L.-F.); (K.D.S.)
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246 Hamburg, Germany
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON M5T 1P8, Canada
- Faculty of Medicine, Institute of Medical Science, University of Toronto, Medical Sciences Building, 1 King’s College Circle, Room 2374, Toronto, ON M5S 1A8, Canada
- Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, 33 Ursula Franklin Street, Toronto, ON M5S 3M1, Canada
- Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, ON M5T 1R8, Canada
- Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Street 8, b. 2, 119991 Moscow, Russia
- Program on Substance Abuse, Public Health Agency of Catalonia, 08005 Barcelona, Spain;
| | - Pol Rovira
- Program on Substance Abuse, Public Health Agency of Catalonia, 08005 Barcelona, Spain;
| | - Laura Llamosas-Falcón
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, 33 Ursula Franklin Street, Toronto, ON M5S 2S1, Canada; (L.L.-F.); (K.D.S.)
- Hospital Universitario 12 de Octubre, Av. de Córdoba, s/n, 28041 Madrid, Spain
| | - Kevin D. Shield
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, 33 Ursula Franklin Street, Toronto, ON M5S 2S1, Canada; (L.L.-F.); (K.D.S.)
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON M5T 1P8, Canada
- Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, 33 Ursula Franklin Street, Toronto, ON M5S 3M1, Canada
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Golder S, Garry J, McCambridge J. Declared funding and authorship by alcohol industry actors in the scientific literature: a bibliometric study. Eur J Public Health 2021; 30:1193-1200. [PMID: 32939544 PMCID: PMC7733050 DOI: 10.1093/eurpub/ckaa172] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Alcohol industry actors are known to be involved in scientific research. Despite concerns regarding bias, the extent of involvement and coverage of this research are unknown. Methods We aimed to investigate the extent and type of scientific research 1918–2019 which was supported by the alcohol industry, including alcohol companies themselves and other organizations, such as trade associations. We identified bibliographic records from the Web of Science suite of databases which have named alcohol companies or organizations in the fields relating to author affiliations and support declarations. We then ascertained trends in publications over time, type of support, funding, outlets (such as journal titles), subject areas covered (such as health) and named companies (such as Carlsberg) and organizations (such as Drinkaware). Results The analysis included 13 481 unique records, 11 014 (82%) were authored or funded by alcohol companies and 2488 (18%) were authored or funded by other organizations. The majority of the records (90%, 12 157/13 481) were journal publications. The most common subject areas covered by the publications were biology (5415/13 481, 40%), chemistry (3937/13 481, 29%) and health (3707/13 481, 27%). In line with general publishing trends, there has been an overall increase in research funded or supported by alcohol companies and organizations since records began. The main exception is the steady decline in company author affiliations, particularly in health-related topics since the mid-1990s. Conclusions Alcohol companies and related organizations are extensively involved in or supporting scientific research according to data in Web of Science. This does not, however, necessarily reflect the totality of scientific research produced by alcohol companies and related organizations.
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Affiliation(s)
- Su Golder
- Department of Health Sciences, University of York, York, UK
- Correspondence: Su Golder, Department of Health Sciences, University of York, York YO10 5DD, UK, Tel: +44 (0) 1904 321904, Fax: 01904 321383, e-mail:
| | - Jack Garry
- Department of Health Sciences, University of York, York, UK
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Coelho JS, Martinez OGE, Siqueira JH, Campos GC, Viana MC, Griep RH, Alvim RO, Mill JG, Molina MCB. Alcoholic beverage consumption, changes in blood pressure, and incidence of hypertension in the Longitudinal Adult Health Study (ELSA-Brasil). Nutrition 2021; 91-92:111387. [PMID: 34303960 DOI: 10.1016/j.nut.2021.111387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 05/11/2021] [Accepted: 05/31/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Alcohol consumption is generally associated with increased risk of hypertension. We aimed to investigate, prospectively, the effect of alcoholic-beverage consumption on blood pressure (BP) and incidence of hypertension, after a 4-y follow-up, in participants of the Longitudinal Adult Health Study (ELSA-Brasil). METHODS We analyzed information from 3,990 participants (ages 35-74 y), men and women, from educational and research institutions, at baseline (2008-2010) and follow-up (2012-2014). Socioeconomic, hemodynamic, anthropometric, and health data were collected. Hypertension was defined as systolic BP ≥ 140 mm Hg and/or diastolic BP ≥ 90 mm Hg and/or use of antihypertensive medication. Change in alcohol consumption (g/d) was estimated by subtracting total consumed at follow-up from total consumed at baseline, and was categorized in tertiles. RESULTS The consumption of alcoholic beverages was associated with changes in BP and hypertension only in men. Individuals who reduced total consumption of alcohol showed a smaller increase in systolic BP (1.1 versus 2.3 mm Hg; P = 0.03) and diastolic BP (1.3 versus 2.2 mm Hg; P = 0.008) compared to individuals who increased consumption. In addition, individuals in the highest tertiles of total consumption of alcohol (odds ratio [OR], 1.62; 95% confidence interval [CI], 1.14-2.29) and consumption of beer (OR, 1.51; 95% CI, 1.07-12.13), wine (OR, 1.71; 95% CI, 1.01-2.86), and spirits (OR, 2.01; 95% CI, 1.21-3.32) showed higher odds ratios for hypertension compared to the lowest tertile. CONCLUSIONS Increased consumption of alcoholic beverages was positively associated with increased BP levels and higher chances of developing hypertension in men.
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Affiliation(s)
- Juliana S Coelho
- Post Graduate Program in Public Health, Federal University of Espírito Santo, Espírito Santo, Brazil
| | - Oscar G E Martinez
- Post Graduate Program in Public Health, Federal University of Espírito Santo, Espírito Santo, Brazil
| | - Jordana H Siqueira
- Post Graduate Program in Public Health, Federal University of Espírito Santo, Espírito Santo, Brazil
| | - Gláucia C Campos
- Post Graduate Program in Public Health, Federal University of Espírito Santo, Espírito Santo, Brazil
| | - Maria C Viana
- Post Graduate Program in Public Health, Federal University of Espírito Santo, Espírito Santo, Brazil
| | - Rosane H Griep
- Laboratory of Health and Environment Education, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Rafael O Alvim
- Department of Physiological Sciences, Federal University of Amazonas, Manaus, Brazil
| | - José G Mill
- Post Graduate Program in Public Health, Federal University of Espírito Santo, Espírito Santo, Brazil
| | - Maria C B Molina
- Post Graduate Program in Public Health, Federal University of Espírito Santo, Espírito Santo, Brazil.
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21
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Stefanovics EA, Gavriel-Fried B, Potenza MN, Pietrzak RH. Current drinking patterns in US veterans with a lifetime history of alcohol use disorder: Results from the National Health and Resilience in Veterans Study. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2020; 46:784-794. [PMID: 32975444 DOI: 10.1080/00952990.2020.1803893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Background: Although more than 40% of US military veterans have lifetime histories of alcohol use disorder (AUD), little is known about the prevalence and correlates of current drinking patterns (i.e., abstinent, subthreshold, hazardous drinking) in this population. Objectives: To characterize the prevalence and key correlates of abstinence, subthreshold drinking, and hazardous drinking in a nationally representative sample of US veterans with lifetime AUD. Methods: Data from 1,282 veterans with lifetime AUD who participated in the National Health and Resilience in Veterans Study were analyzed using analyses of variance, chi-square analyses, and multinomial regression models. Results: Of the 1,282 veterans with lifetime AUD (of which 94.7% were males), 674 (48.2%) were past-year subthreshold drinkers, 317 (28.0%) were abstinent and 291 (23.8%) were hazardous drinkers. Abstinent veterans were older, less educated, less socially engaged, and had higher levels of religiosity than subthreshold and hazardous drinkers. They were also more likely to smoke, screen positive for PTSD, reported greater somatic symptoms than subthreshold drinkers, and had more physical difficulties and lifetime trauma than hazardous drinkers. Subthreshold drinkers were more likely than hazardous drinkers to be female and report physical health problems and less likely to smoke and be depressed. Conclusion: More than three-quarters of US veterans with lifetime AUD are currently abstinent or subthreshold drinkers. Factors associated with abstinence included older age, health problems, religiosity and social engagement. Results suggest a "J-shaped" relationship between current drinking patterns and health and psychosocial factors in veterans, with subthreshold drinkers generally having better health than abstinent and hazardous drinkers.
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Affiliation(s)
- Elina A Stefanovics
- Department of Psychiatry, Yale School of Medicine , New Haven, CT, USA.,U.S. Department of Veterans Affairs (VA) New England Mental Illness Research and Education, Clinical Center (MIRECC), VA Connecticut Healthcare System , West Haven, CT, USA
| | - Belle Gavriel-Fried
- The Bob Shapell School of Social Work, Tel Aviv University , Tel Aviv, Israel
| | - Marc N Potenza
- Department of Psychiatry, Yale School of Medicine , New Haven, CT, USA.,The Connecticut Council on Problem Gambling , Wethersfield, CT, USA.,The Connecticut Mental Health Center , New Haven, CT, USA.,Department of Neuroscience and Child Study Center, Yale School of Medicine , New Haven, CT, USA
| | - Robert H Pietrzak
- Department of Psychiatry, Yale School of Medicine , New Haven, CT, USA.,U.S. Department of Veterans Affairs (VA) National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System , West Haven, CT, USA
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Lee K, Kim J. The Effect of Smoking on the Association between Long-Term Alcohol Consumption and Dyslipidemia in a Middle-Aged and Older Population. Alcohol Alcohol 2020; 55:531-539. [PMID: 32588881 DOI: 10.1093/alcalc/agaa051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 05/10/2020] [Accepted: 05/10/2020] [Indexed: 12/23/2022] Open
Abstract
AIMS The joint effects of chronic alcohol consumption and smoking on dyslipidemia remain unclear in a prospective design. This study examined the effect of smoking on the association between long-term alcohol consumption and risk of incident dyslipidemia. METHODS A total of 4467 participants (1866 men and 2601women) aged 40-69 years without dyslipidemia were recruited at baseline. Alcohol consumption was assessed biennially using a questionnaire and classified as light, moderate or heavy drinker. Smoking status was examined at baseline and categorized into non-smokers and current smokers. Dyslipidemia was defined as the presence of one or more of following: hypertriglyceridemia (triglyceride ≥200 mg/dL), hypercholesterolemia (total cholesterol ≥240 mg/dL), low high-density lipoprotein-cholesterol (HDL-C) < 40 mg/dL, or high low-density lipoprotein cholesterol ≥160 mg/dL. RESULTS During a follow-up period of 12 years, 2872 (64.3%) participants developed dyslipidemia. In non-smoking men, light or moderate alcohol consumption was associated with a lower risk of incident dyslipidemia such as hypertriglyceridemia and hypercholesterolemia, whereas this association was not observed in current smoking men. Unlike non-smokers, the duration of alcohol drinking > 10 years was associated with a higher risk of hypertriglyceridemia in current smoking men (hazard ratio = 1.57, 95% confidence interval: 1.07-2.30, P = 0.020). In addition, alcohol consumption was inversely associated with low HDL-C regardless of smoking status. In women, alcohol consumption was inversely associated with dyslipidemia hypercholesterolemia and low HDL-C regardless of alcohol amount. CONCLUSION Smoking crucially confounds the association between long-term alcohol consumption and dyslipidemia, particularly in hypertriglyceridemia and hypercholesterolemia.
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Affiliation(s)
- Kyueun Lee
- Department of Medical Nutrition, Graduate School of East-West Medical Science, Kyung Hee University, Yongin 17104, Republic of Korea
| | - Jihye Kim
- Department of Medical Nutrition, Graduate School of East-West Medical Science, Kyung Hee University, Yongin 17104, Republic of Korea
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Abstract
PURPOSE OF REVIEW To provide an overview of the risk relationships between alcohol use and cancer and of the alcohol-attributable cancer burden; to highlight areas of controversy in the alcohol-cancer relationship; to examine the reasons why these risk relationships have not received greater public attention. RECENT FINDINGS In 2016, alcohol caused an estimated 376,200 cancer deaths, 10.0 million cancer years of life lost (YLLs), 236,600 cancer years lived with disability (YLDs), and 10.3 million cancer disability-adjusted years of life (DALYs), representing 4.2%, 4.2%, 4.6%, and 4.2% of all deaths, YLLs, YLDs, and DALYs lost due to cancer, respectively, proportionally highest in high- and upper-middle-income countries. Alcohol use is a major contributor to cancer and is linked to the most prevalent types of cancer. No threshold for the effects of alcohol on cancer has yet been identified, and thus, abstinence is best for cancer prevention. Greater public awareness of the relationship between alcohol use and cancer is advisable.
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Affiliation(s)
- Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Room T420, 33 Russell Street, Toronto, ON, M5S 2S1, Canada.
- Institute of Medical Science (IMS), University of Toronto, Room 2374, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada.
- Dalla Lana School of Public Health, University of Toronto, 6th Floor, 155 College Street, Toronto, ON, M5T 3M7, Canada.
- WHO Collaboration Centre, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON, M5S 2S1, Canada.
- Department of Psychiatry, University of Toronto, 8th Floor, 250 College Street, Toronto, ON, M5T 1R8, Canada.
- Campbell Family Mental Health Research Institute, CAMH, 250 College Street, Toronto, ON, M5T 1R8, Canada.
- Institute for Clinical Psychology and Psychotherapy, TU Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany.
| | - Isabelle Soerjomataram
- Section of Cancer Surveillance, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372, Lyon Cedex, France
| | - Carina Ferreira-Borges
- World Health Organization, WHO European Office for the Prevention and Control of Noncommunicable Diseases (NCD Office), 9 Leontyevsky Pereulok, Moscow, Russian Federation, 125009
| | - Kevin D Shield
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Room T420, 33 Russell Street, Toronto, ON, M5S 2S1, Canada
- Dalla Lana School of Public Health, University of Toronto, 6th Floor, 155 College Street, Toronto, ON, M5T 3M7, Canada
- WHO Collaboration Centre, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON, M5S 2S1, Canada
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Matloff WJ, Zhao L, Ning K, Conti DV, Toga AW. Interaction effect of alcohol consumption and Alzheimer disease polygenic risk score on the brain cortical thickness of cognitively normal subjects. Alcohol 2020; 85:1-12. [PMID: 31734309 PMCID: PMC7220836 DOI: 10.1016/j.alcohol.2019.11.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 10/31/2019] [Accepted: 11/11/2019] [Indexed: 01/01/2023]
Abstract
Alcohol consumption and genetic risk for Alzheimer disease (AD) are among many factors known to be associated with brain structure in cognitively healthy adults. It is unclear, however, whether the effect of alcohol consumption on brain structure varies depending on a person's level of genetic risk for AD. We hypothesized that there is an interaction effect of alcohol consumption and a 33-SNP AD polygenic risk score (PRS) on the cortical thickness of brain regions known to be affected early in the course of AD. Studying 6,213 cognitively healthy subjects from the UK Biobank, we found a significant interaction effect of the 33-SNP AD PRS and alcohol consumption on this AD Cortical Thickness Signature. Stratified, among those who consume 12-24 g/day of alcohol, the 33-SNP AD PRS had a significant, positive association with AD Cortical Thickness Signature, with high-risk subjects having the greatest AD Cortical Thickness Signature. There were no significant associations of the 33-SNP AD PRS with AD Cortical Thickness Signature among the nondrinker or <1, 1-6, 6-12, 24-48, or >48 g/day groups. It is unclear whether this interaction is due to a detrimental or beneficial effect of moderate alcohol consumption in those with the highest genetic risk for AD.
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Affiliation(s)
- William J Matloff
- Laboratory of Neuro Imaging, USC Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90033, United States
| | - Lu Zhao
- Laboratory of Neuro Imaging, USC Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90033, United States
| | - Kaida Ning
- Laboratory of Neuro Imaging, USC Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90033, United States
| | - David V Conti
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90032, United States
| | - Arthur W Toga
- Laboratory of Neuro Imaging, USC Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90033, United States.
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Gioia C, Lucchino B, Tarsitano MG, Iannuccelli C, Di Franco M. Dietary Habits and Nutrition in Rheumatoid Arthritis: Can Diet Influence Disease Development and Clinical Manifestations? Nutrients 2020; 12:nu12051456. [PMID: 32443535 PMCID: PMC7284442 DOI: 10.3390/nu12051456] [Citation(s) in RCA: 117] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/14/2020] [Accepted: 05/14/2020] [Indexed: 12/14/2022] Open
Abstract
Rheumatoid arthritis (RA) is a systemic, autoimmune disease characterized by joint involvement, with progressive cartilage and bone destruction. Genetic and environmental factors determine RA susceptibility. In recent years, an increasing number of studies suggested that diet has a central role in disease risk and progression. Several nutrients, such as polyunsaturated fatty acids, present anti-inflammatory and antioxidant properties, featuring a protective role for RA development, while others such as red meat and salt have a harmful effect. Gut microbiota alteration and body composition modifications are indirect mechanisms of how diet influences RA onset and progression. Possible protective effects of some dietary patterns and supplements, such as the Mediterranean Diet (MD), vitamin D and probiotics, could be a possible future adjunctive therapy to standard RA treatment. Therefore, a healthy lifestyle and nutrition have to be encouraged in patients with RA.
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Affiliation(s)
- Chiara Gioia
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari-Reumatologia, Sapienza University of Rome, 00161 Roma, Italy; (C.G.); (C.I.); (M.D.F.)
| | - Bruno Lucchino
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari-Reumatologia, Sapienza University of Rome, 00161 Roma, Italy; (C.G.); (C.I.); (M.D.F.)
- Correspondence: ; Tel.: +39-06-4997-4635
| | | | - Cristina Iannuccelli
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari-Reumatologia, Sapienza University of Rome, 00161 Roma, Italy; (C.G.); (C.I.); (M.D.F.)
| | - Manuela Di Franco
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari-Reumatologia, Sapienza University of Rome, 00161 Roma, Italy; (C.G.); (C.I.); (M.D.F.)
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OPPENHEIMER GERALDM, BAYER RONALD. Is Moderate Drinking Protective Against Heart Disease? The Science, Politics and History of a Public Health Conundrum. Milbank Q 2020; 98:39-56. [PMID: 31803980 PMCID: PMC7077768 DOI: 10.1111/1468-0009.12437] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Policy Points For more than 40 years, most research by epidemiologists, social scientists, and alcohol policy experts found that moderate alcohol consumption was cardioprotective. In the early 2000s, that consensus was shaken by new critics who subjected the previous research to vigorous methodological and empirical analysis, precipitating a bitter controversy, seemingly unresolvable despite numerous observational epidemiological studies. The effort to finally put that debate to rest through a large, multiyear randomized controlled trial under the aegis of the National Institute on Alcohol Abuse and Alcoholism, generated external criticism and adverse newspaper coverage, particularly because the trial was largely funded by the alcohol industry, forcing National Institutes of Health leadership to abruptly terminate the study shortly after it started. In the absence of definitive evidence and given the contentious debate over the risks and benefits of moderate alcohol consumption, those who formulate health policy have a responsibility to clearly acknowledge to the public the existence of evidentiary uncertainty when making recommendations.
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Affiliation(s)
- GERALD M. OPPENHEIMER
- Mailman School of Public HealthColumbia University
- CUNY School of Public Health and ManagementCity University of New York
| | - RONALD BAYER
- Mailman School of Public HealthColumbia University
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27
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Karavasiloglou N, Hüsing A, Masala G, van Gils CH, Turzanski Fortner R, Chang-Claude J, Huybrechts I, Weiderpass E, Gunter M, Arveux P, Fournier A, Kvaskoff M, Tjønneland A, Kyrø C, Dahm CC, Vistisen HT, Bakker MF, Sánchez MJ, Chirlaque López MD, Santiuste C, Ardanaz E, Menéndez V, Agudo A, Trichopoulou A, Karakatsani A, La Vecchia C, Peppa E, Palli D, Agnoli C, Panico S, Tumino R, Sacerdote C, Butt ST, Borgquist S, Skeie G, Schulze M, Key T, Khaw KT, Tsilidis KK, Ellingjord-Dale M, Riboli E, Kaaks R, Dossus L, Rohrmann S, Kühn T. Adherence to the World Cancer Research Fund/American Institute for Cancer Research cancer prevention recommendations and risk of in situ breast cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. BMC Med 2019; 17:221. [PMID: 31787099 PMCID: PMC6886197 DOI: 10.1186/s12916-019-1444-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 10/08/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Even though in situ breast cancer (BCIS) accounts for a large proportion of the breast cancers diagnosed, few studies have investigated potential risk factors for BCIS. Their results suggest that some established risk factors for invasive breast cancer have a similar impact on BCIS risk, but large population-based studies on lifestyle factors and BCIS risk are lacking. Thus, we investigated the association between lifestyle and BCIS risk within the European Prospective Investigation into Cancer and Nutrition cohort. METHODS Lifestyle was operationalized by a score reflecting the adherence to the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) cancer prevention recommendations. The recommendations utilized in these analyses were the ones pertinent to healthy body weight, physical activity, consumption of plant-based foods, energy-dense foods, red and processed meat, and sugary drinks and alcohol, as well as the recommendation on breastfeeding. Cox proportional hazards regression was used to assess the association between lifestyle score and BCIS risk. The results were presented as hazard ratios (HR) and corresponding 95% confidence intervals (CI). RESULTS After an overall median follow-up time of 14.9 years, 1277 BCIS cases were diagnosed. Greater adherence to the WCRF/AICR cancer prevention recommendations was not associated with BCIS risk (HR = 0.98, 95% CI 0.93-1.03; per one unit of increase; multivariable model). An inverse association between the lifestyle score and BCIS risk was observed in study centers, where participants were recruited mainly via mammographic screening and attended additional screening throughout follow-up (HR = 0.85, 95% CI 0.73-0.99), but not in the remaining ones (HR = 0.99, 95% CI 0.94-1.05). CONCLUSIONS While we did not observe an overall association between lifestyle and BCIS risk, our results indicate that lifestyle is associated with BCIS risk among women recruited via screening programs and with regular screening participation. This suggests that a true inverse association between lifestyle habits and BCIS risk in the overall cohort may have been masked by a lack of information on screening attendance. The potential inverse association between lifestyle and BCIS risk in our analyses is consistent with the inverse associations between lifestyle scores and breast cancer risk reported from previous studies.
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Affiliation(s)
- Nena Karavasiloglou
- Division of Chronic Disease Epidemiology, Institute for Epidemiology, Biostatistics and Prevention, University of Zurich, Zurich, Switzerland.
- Cancer Registry Zurich and Zug, University Hospital Zurich, Zurich, Switzerland.
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - Anika Hüsing
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Giovanna Masala
- Cancer Risk Factors and Life-Style Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network - ISPRO, Florence, Italy
| | - Carla H van Gils
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | - Jenny Chang-Claude
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Elisabete Weiderpass
- International Agency for Research on Cancer, Lyon, France
- Department of Community Medicine, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
| | - Marc Gunter
- International Agency for Research on Cancer, Lyon, France
| | - Patrick Arveux
- CESP, Fac. de médecine - Univ. Paris-Sud, Fac. de médecine - UVSQ, INSERM, Université Paris-Saclay, 94805, Villejuif, France
- Gustave Roussy, F-94805, Villejuif, France
- Breast and Gynaecologic Cancer Registry of Côte d'Or, Georges-François Leclerc Cancer Centre, UNICANCER, Dijon, France
| | - Agnès Fournier
- CESP, Fac. de médecine - Univ. Paris-Sud, Fac. de médecine - UVSQ, INSERM, Université Paris-Saclay, 94805, Villejuif, France
- Gustave Roussy, F-94805, Villejuif, France
| | - Marina Kvaskoff
- CESP, Fac. de médecine - Univ. Paris-Sud, Fac. de médecine - UVSQ, INSERM, Université Paris-Saclay, 94805, Villejuif, France
- Gustave Roussy, F-94805, Villejuif, France
| | - Anne Tjønneland
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Cecilie Kyrø
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | | | | | - Marije F Bakker
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Maria-Jose Sánchez
- Andalusian School of Public Health (EASP), Granada, Spain
- Instituto de Investigación Biosanitaria de Granada (ibs. GRANADA), Granada, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Universidad de Granada, Granada, Spain
| | - María Dolores Chirlaque López
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain
- Department of Health and Social Sciences, Murcia University, Murcia, Spain
| | - Carmen Santiuste
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain
| | - Eva Ardanaz
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Navarra Public Health Institute, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | | | - Antonio Agudo
- Unit of Nutrition and Cancer, Catalan Institute of Oncology - ICO, Nutrition and Cancer Group, Bellvitge Biomedical Research Institute - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Anna Karakatsani
- Hellenic Health Foundation, Athens, Greece
- 2nd Pulmonary Medicine Department, School of Medicine, "ATTIKON" University Hospital, National and Kapodistrian University of Athens, Haidari, Greece
| | - Carlo La Vecchia
- Hellenic Health Foundation, Athens, Greece
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | | | - Domenico Palli
- Cancer Risk Factors and Life-Style Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network - ISPRO, Florence, Italy
| | - Claudia Agnoli
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Salvatore Panico
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Rosario Tumino
- Cancer Registry and Histopathology Department, Azienda Sanitaria Provinciale (ASP), Ragusa, Italy
| | - Carlotta Sacerdote
- Unit of Cancer Epidemiology, Città della Salute e della Scienza University-Hospital and Center for Cancer Prevention (CPO), Turin, Italy
| | - Salma Tunå Butt
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Surgery, Skåne University Hospital, Malmö, Sweden
| | - Signe Borgquist
- Department of Oncology, Aarhus University Hospital, Aarhus University, Aarhus, Denmark
- Division of Oncology and Pathology, Clinical Sciences, Lund University, Lund, Sweden
| | - Guri Skeie
- Department of Community Medicine, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - Matthias Schulze
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke (DIfE), Nuthetal, Germany
| | - Timothy Key
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Kay-Tee Khaw
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Kostantinos K Tsilidis
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | - Merete Ellingjord-Dale
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Elio Riboli
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Laure Dossus
- International Agency for Research on Cancer, Lyon, France
| | - Sabine Rohrmann
- Division of Chronic Disease Epidemiology, Institute for Epidemiology, Biostatistics and Prevention, University of Zurich, Zurich, Switzerland
- Cancer Registry Zurich and Zug, University Hospital Zurich, Zurich, Switzerland
| | - Tilman Kühn
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
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Nixon SJ, Lewis B. Clarifying the neurobehavioral sequelae of moderate drinking lifestyles and acute alcohol effects with aging. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2019; 148:39-78. [PMID: 31733667 DOI: 10.1016/bs.irn.2019.10.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Epidemiological estimates indicate not only an increase in the proportion of older adults, but also an increase in those who continue moderate alcohol consumption. Substantial literatures have attempted to characterize health benefits/risks of moderate drinking lifestyles. Not uncommonly, reports address outcomes in a single outcome, such as cardiovascular function or cognitive decline, rather than providing a broader overview of systems. In this narrative review, retaining focus on neurobiological considerations, we summarize key findings regarding moderate drinking and three health domains, cardiovascular health, Type 2 diabetes (T2D), and cognition. Interestingly, few investigators have studied bouts of low/moderate doses of alcohol consumption, a pattern consistent with moderate drinking lifestyles. Here, we address both moderate drinking as a lifestyle and as an acute event. Review of health-related correlates illustrates continuing inconsistencies. Although substantive reductions in risk for cardiovascular and T2D events are reported, robust conclusions remain elusive. Similarly, whereas moderate drinking is often associated with enhanced cognition and lower dementia risk, few benefits are noted in rates of decline or alterations in brain structure. The effect of sex/gender varies across health domains and by consumption levels. For example, women appear to differentially benefit from alcohol use in terms of T2D, but experience greater risk when considering aspects of cardiovascular function. Finally, we observe that socially relevant alcohol doses do not consistently impair performance in older adults. Rather, older drinkers demonstrate divergent, but not necessarily detrimental, patterns in neural activation and some behavioral measures relative to younger drinkers. Taken together, the epidemiological and laboratory studies reinforce the need for greater attention to key individual differences and for the conduct of systematic studies sensitive to age-related shifts in neurobiological systems.
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Affiliation(s)
- Sara Jo Nixon
- University of Florida, Department of Psychiatry, Gainesville, FL, United States; University of Florida Center for Addiction Research & Education, Gainesville, FL, United States.
| | - Ben Lewis
- University of Florida, Department of Psychiatry, Gainesville, FL, United States; University of Florida Center for Addiction Research & Education, Gainesville, FL, United States
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What is the effect of alcohol consumption on the risk of chronic widespread pain? A Mendelian randomisation study using UK Biobank. Pain 2019; 160:501-507. [PMID: 30371560 DOI: 10.1097/j.pain.0000000000001426] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Studies have shown that moderate alcohol consumption is strongly associated with reduced reporting of chronic widespread pain (CWP). The study designs used, however, are prone to confounding and are not able to establish the direction of causality. The current study overcomes these problems using the Mendelian randomisation design to determine the effect of alcohol consumption on the likelihood of reporting CWP. The UK Biobank recruited 500,000 participants aged between 40 and 69 years. Data collected included questions on chronic pain and alcohol consumption, and biological samples providing genotypic information. Alcohol consumption was categorised as "weekly consumption" or "nonfrequent or infrequent." Participants were classified by genotype according to alleles of the rs1229984 single-nucleotide polymorphism, either "GG" or "AA/AG." Chronic widespread pain was defined as pain all over the body for more than 3 months that interfered with activities. Associations between genotype, CWP, and alcohol consumption were tested by logistic regression. Instrumental variable analysis was used to calculate the causal effect of weekly alcohol consumption on CWP. Persons with "GG" genotype had an increased risk of CWP (odds ratio [OR] 1.17, 99% confidence interval 1.01-1.35) and were more likely to consume alcohol weekly (OR 1.76, 1.70-1.81) compared to those with "AA/AG" genotype. Weekly consumption of alcohol was associated with reduced risk of CWP (OR 0.33, 0.31-0.35), but instrumental variable analysis did not show a causal effect of alcohol consumption on reducing CWP (OR 1.29, 0.96-1.74). An interpretation of observational population studies as showing a protective effect of alcohol on CWP is not supported.
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Sarich P, Canfell K, Banks E, Paige E, Egger S, Joshy G, Korda R, Weber M. A Prospective Study of Health Conditions Related to Alcohol Consumption Cessation Among 97,852 Drinkers Aged 45 and Over in Australia. Alcohol Clin Exp Res 2019; 43:710-721. [PMID: 30758044 DOI: 10.1111/acer.13981] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 02/08/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Evidence suggests that people who develop serious health conditions are likely to cease drinking alcohol (sometimes known as "sick-quitters"). We quantified the likelihood of quitting drinking in relation to the onset of a variety of health conditions. METHODS Odds ratios (ORs) and 95% confidence intervals (CIs) of ceasing alcohol consumption after diagnosis of 28 health conditions and 4 general indicators of health were derived from logistic regression among 97,852 drinkers aged ≥ 45 years between baseline (2006 to 2009) and median 5.3 years of follow-up in the New South Wales 45 and Up Study. Incident health conditions at follow-up were self-reported. RESULTS At follow-up, 9.6% (n = 9,438) of drinkers had ceased drinking. Drinking cessation was significantly associated with 24 of 32 health conditions examined: 15.4% of participants with newly diagnosed diabetes quit drinking (OR for quitting vs. continuing 1.77, 95% CI: 1.60 to 1.96), 16.4% with Parkinson's disease (1.71, 1.35 to 2.17), 17.8% with poor memory (1.68, 1.43 to 1.97), 19.2% with hip fracture (1.64, 1.30 to 2.06), 14.7% with stroke (1.45, 1.27 to 1.66), 12.5% with depression (1.40, 1.26 to 1.55), 15.0% with breast cancer (1.38, 1.18 to 1.61), 12.3% with heart disease (1.34, 1.25 to 1.44), and 13.3% with osteoarthritis (1.22, 1.12 to 1.33). Strong associations with quitting were observed in those with a decline in self-rated overall health (2.93, 2.53 to 3.40) and quality of life (2.68, 2.24 to 3.21). Some health conditions not significantly associated with quitting were prostate cancer, melanoma, nonmelanoma skin cancer, hay fever, and hearing loss. Findings were generally consistent for men and women, by age group and by smoking status. CONCLUSIONS Diagnosis with a variety of health conditions appears to prompt drinking cessation in older adults.
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Affiliation(s)
- Peter Sarich
- Cancer Research Division , Cancer Council New South Wales, Kings Cross, New South Wales, Australia.,Sydney School of Public Health , The University of Sydney, Sydney, New South Wales, Australia
| | - Karen Canfell
- Cancer Research Division , Cancer Council New South Wales, Kings Cross, New South Wales, Australia.,Sydney School of Public Health , The University of Sydney, Sydney, New South Wales, Australia.,Prince of Wales Clinical School , University of New South Wales, Sydney, New South Wales, Australia
| | - Emily Banks
- National Centre for Epidemiology and Population Health , Australian National University, Canberra, Australian Capital Territory, Australia.,Sax Institute , Haymarket, New South Wales, Australia
| | - Ellie Paige
- National Centre for Epidemiology and Population Health , Australian National University, Canberra, Australian Capital Territory, Australia
| | - Sam Egger
- Cancer Research Division , Cancer Council New South Wales, Kings Cross, New South Wales, Australia
| | - Grace Joshy
- National Centre for Epidemiology and Population Health , Australian National University, Canberra, Australian Capital Territory, Australia
| | - Rosemary Korda
- National Centre for Epidemiology and Population Health , Australian National University, Canberra, Australian Capital Territory, Australia
| | - Marianne Weber
- Cancer Research Division , Cancer Council New South Wales, Kings Cross, New South Wales, Australia.,Sydney School of Public Health , The University of Sydney, Sydney, New South Wales, Australia
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Larsson I, Andersson MLE. Reasons to stop drinking alcohol among patients with rheumatoid arthritis in Sweden: a mixed-methods study. BMJ Open 2018; 8:e024367. [PMID: 30552279 PMCID: PMC6303608 DOI: 10.1136/bmjopen-2018-024367] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES The aims were to identify patients with rheumatoid arthritis (RA) who had stopped drinking alcohol and compare them with patients drinking alcohol, and to explore reasons for stopping drinking alcohol. DESIGN A sequential explanatory mixed methods design was used. SETTING Six rheumatology clinics in Southern Sweden Better Anti-Rheumatic FarmacOTherapy cohort. PARTICIPANTS A total of 1509 patients completed the questions about alcohol and were included in the study. 86 of these had stopped drinking alcohol and 72 responded to the open question and their answers were analysed with qualitative content analysis. OUTCOME MEASURES The quantitative data were from a cross-sectional survey assessing disease severity, physical function (Health Assessment Questionnaire, HAQ) and health-related quality of life (EuroQol five dimensions, EQ5D), pain, fatigue, patient global assessment (PatGA) and lifestyle factors, for example, alcohol. The questions assessing alcohol included an open question 'Why have you stopped drinking alcohol?' RESULTS The patients who stopped drinking alcohol were older (median (min-max) 69 (36-90) vs 66 (23-95), p=0.011), had worse HAQ (1.00 (0-2.75) vs 0.50 (0-3.00), p<0.001), worse EQ5D (0.69 (-0.02-1.00) vs 0.76 (-0.58-1.00), p<0.001) worse PatGA (5 (0-10) vs 3 (0-10), p<0.001), more pain (5 (0-10) vs 3 (0-10), p<0.001) and more fatigue (6 (0-10) vs 4 (0-10), p<0.001 compared with patients drinking alcohol. The qualitative content analysis revealed five categories describing reasons for patients with RA to stop drinking alcohol: illness and treatment; health and well-being; work and family; faith and belief; and dependences and abuse. CONCLUSIONS The patients who had stopped drinking had worse physical functioning and higher levels in pain-related variables. Most stopped drinking due to their illness or a desire to improve health.
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Affiliation(s)
- Ingrid Larsson
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
- Spenshult Research and Development Center, Spenshult, Halmstad, Sweden
| | - Maria L E Andersson
- Spenshult Research and Development Center, Spenshult, Halmstad, Sweden
- Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden
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Kojima G, Jivraj S, Iliffe S, Falcaro M, Liljas A, Walters K. Alcohol Consumption and Risk of Incident Frailty: The English Longitudinal Study of Aging. J Am Med Dir Assoc 2018; 20:725-729. [PMID: 30503591 DOI: 10.1016/j.jamda.2018.10.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 09/27/2018] [Accepted: 10/01/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Alcohol consumption is a common modifiable lifestyle factor. Alcohol may be a risk factor for frailty, however, there is limited evidence in the literature. OBJECTIVE The objectives of this study were to examine the association of alcohol consumption with the risk of incident frailty. METHODS This is a prospective panel study of 2544 community-dwelling people aged 60 years and older in England. Frailty status defined by frailty phenotype criteria was measured at baseline and 4 years later. Participants free of frailty at baseline were divided into 5 groups based on quantity of self-reported alcohol consumption per week with cut-points at 0, 7, 14, and 21 UK units per week. Adjusted odds ratios (OR) were calculated for incident frailty according to the alcohol consumption using logistic regression models. RESULTS Compared with the low consumption group (>0 and ≤7 units per week), incident frailty risk over 4 years was significantly higher among nondrinkers [OR 1.71, 95% confidence interval (CI) 1.12‒2.60, P value = .01], after controlling for sociodemographic confounders. In a supplementary analysis this became nonsignificant after further adjustment for baseline health status. Heavy drinkers (>21 units per week) had a significantly lower incident frailty risk (unadjusted OR 0.45, 95% CI 0.27‒0.75, P < .01), which became nonsignificant on adjustment for sociodemographic factors (OR 0.64, 95% CI 0.37‒1.13, P = .12). CONCLUSIONS/IMPLICATIONS We found that nondrinkers were more likely than those with low alcohol consumption to develop frailty, but this appeared to be explained by poorer baseline health status. No evidence was found for an association between high levels of alcohol consumption and becoming frail. Future studies with information on life-course history of alcohol use, especially for those classified as nondrinkers in old age, are warranted.
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Affiliation(s)
- Gotaro Kojima
- Department of Primary Care and Population Health, University College London, London, United Kingdom.
| | - Stephen Jivraj
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Steve Iliffe
- Department of Primary Care and Population Health, University College London, London, United Kingdom
| | - Milena Falcaro
- Department of Primary Care and Population Health, University College London, London, United Kingdom
| | - Ann Liljas
- Department of Primary Care and Population Health, University College London, London, United Kingdom
| | - Kate Walters
- Department of Primary Care and Population Health, University College London, London, United Kingdom
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Staudt A, Freyer-Adam J, Meyer C, John U, Baumann S. Short-term stability of different drinking patterns over the course of four weeks among adults. A latent transition analysis. Drug Alcohol Depend 2018; 191:181-186. [PMID: 30125760 DOI: 10.1016/j.drugalcdep.2018.06.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 06/27/2018] [Accepted: 06/28/2018] [Indexed: 01/28/2023]
Abstract
OBJECTIVE The purpose of the present study was to identify drinking patterns and determine their intraindividual stability over the course of four weeks among a sample of adults from the general population. METHODS The sample comprised 288 adults who reported drinking alcohol at least once per month (49% female; mean age = 33.1 years, SD = 12.8 years). Participants were recruited in the waiting area of a local registration office in northeastern Germany. Data were collected four times over four consecutive weeks by interview (once in the registration office and thrice by telephone). To assess alcohol consumption in the past seven days, timeline follow-back questions were administered each time. For data analysis, latent profile and latent transition analyses were applied. Indicators for latent classes were total number of drinks per seven days, number of drinking days, and number of days with heavy episodic drinking. RESULTS Three classes of seven-day drinking patterns were identified at baseline: (a) light drinkers (77%), (b) moderate drinkers (18%), and (c) heavy drinkers (5%). Approximately one-fifth (21%) of baseline light drinkers and 94% of baseline moderate drinkers changed their drinking pattern at least once during the four weeks. The majority (81%) of baseline moderate drinkers also reported light drinking in at least one of the three subsequent weeks. CONCLUSIONS Our findings suggest intraindividual changes in drinking patterns even during a short period of time. Instability of drinking patterns may potentially impair the assessment of light to moderate alcohol consumption when a quantity-frequency approach is applied.
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Affiliation(s)
- Andreas Staudt
- Institute of Social Medicine and Prevention, University Medicine Greifswald, Walther-Rathenau-Str. 48, D-17475 Greifswald, Germany; German Centre for Cardiovascular Research, Partner Site Greifswald, Fleischmannstr. 42-44, D-17475 Greifswald, Germany.
| | - Jennis Freyer-Adam
- German Centre for Cardiovascular Research, Partner Site Greifswald, Fleischmannstr. 42-44, D-17475 Greifswald, Germany; Institute for Medical Psychology, University Medicine Greifswald, Walther-Rathenau-Str. 48, D-17475 Greifswald, Germany.
| | - Christian Meyer
- Institute of Social Medicine and Prevention, University Medicine Greifswald, Walther-Rathenau-Str. 48, D-17475 Greifswald, Germany; German Centre for Cardiovascular Research, Partner Site Greifswald, Fleischmannstr. 42-44, D-17475 Greifswald, Germany.
| | - Ulrich John
- Institute of Social Medicine and Prevention, University Medicine Greifswald, Walther-Rathenau-Str. 48, D-17475 Greifswald, Germany; German Centre for Cardiovascular Research, Partner Site Greifswald, Fleischmannstr. 42-44, D-17475 Greifswald, Germany.
| | - Sophie Baumann
- Institute of Social Medicine and Prevention, University Medicine Greifswald, Walther-Rathenau-Str. 48, D-17475 Greifswald, Germany; German Centre for Cardiovascular Research, Partner Site Greifswald, Fleischmannstr. 42-44, D-17475 Greifswald, Germany; Institute and Policlinic for Occupational and Social Medicine, Medical Faculty, TU Dresden, Fetscherstr. 74, D-01307 Dresden, Germany.
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Alcohol use and burden for 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2018; 392:1015-1035. [PMID: 30146330 PMCID: PMC6148333 DOI: 10.1016/s0140-6736(18)31310-2] [Citation(s) in RCA: 1760] [Impact Index Per Article: 293.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 05/22/2018] [Accepted: 05/30/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Alcohol use is a leading risk factor for death and disability, but its overall association with health remains complex given the possible protective effects of moderate alcohol consumption on some conditions. With our comprehensive approach to health accounting within the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we generated improved estimates of alcohol use and alcohol-attributable deaths and disability-adjusted life-years (DALYs) for 195 locations from 1990 to 2016, for both sexes and for 5-year age groups between the ages of 15 years and 95 years and older. METHODS Using 694 data sources of individual and population-level alcohol consumption, along with 592 prospective and retrospective studies on the risk of alcohol use, we produced estimates of the prevalence of current drinking, abstention, the distribution of alcohol consumption among current drinkers in standard drinks daily (defined as 10 g of pure ethyl alcohol), and alcohol-attributable deaths and DALYs. We made several methodological improvements compared with previous estimates: first, we adjusted alcohol sales estimates to take into account tourist and unrecorded consumption; second, we did a new meta-analysis of relative risks for 23 health outcomes associated with alcohol use; and third, we developed a new method to quantify the level of alcohol consumption that minimises the overall risk to individual health. FINDINGS Globally, alcohol use was the seventh leading risk factor for both deaths and DALYs in 2016, accounting for 2·2% (95% uncertainty interval [UI] 1·5-3·0) of age-standardised female deaths and 6·8% (5·8-8·0) of age-standardised male deaths. Among the population aged 15-49 years, alcohol use was the leading risk factor globally in 2016, with 3·8% (95% UI 3·2-4·3) of female deaths and 12·2% (10·8-13·6) of male deaths attributable to alcohol use. For the population aged 15-49 years, female attributable DALYs were 2·3% (95% UI 2·0-2·6) and male attributable DALYs were 8·9% (7·8-9·9). The three leading causes of attributable deaths in this age group were tuberculosis (1·4% [95% UI 1·0-1·7] of total deaths), road injuries (1·2% [0·7-1·9]), and self-harm (1·1% [0·6-1·5]). For populations aged 50 years and older, cancers accounted for a large proportion of total alcohol-attributable deaths in 2016, constituting 27·1% (95% UI 21·2-33·3) of total alcohol-attributable female deaths and 18·9% (15·3-22·6) of male deaths. The level of alcohol consumption that minimised harm across health outcomes was zero (95% UI 0·0-0·8) standard drinks per week. INTERPRETATION Alcohol use is a leading risk factor for global disease burden and causes substantial health loss. We found that the risk of all-cause mortality, and of cancers specifically, rises with increasing levels of consumption, and the level of consumption that minimises health loss is zero. These results suggest that alcohol control policies might need to be revised worldwide, refocusing on efforts to lower overall population-level consumption. FUNDING Bill & Melinda Gates Foundation.
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Yamaguchi M, Yang Y, Ando M, Kumrungsee T, Kato N, Okazaki Y. Increased intestinal ethanol following consumption of fructooligosaccharides in rats. Biomed Rep 2018; 9:427-432. [PMID: 30402226 DOI: 10.3892/br.2018.1150] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 09/10/2018] [Indexed: 12/20/2022] Open
Abstract
Previous studies have suggested that ethanol is a fermentation product of microflora. However, it is unknown whether this ethanol production is elevated by intake of prebiotics. Prebiotics are considered to enhance the production of short-chain fatty acids (SCFAs) as a fermentation product of beneficial bacteria. In the present study, the effect of fructooligosaccharides (FOS) consumption on intestinal ethanol levels was investigated. Rats were fed a diet with or without 10% FOS for two weeks. Consequently, FOS intake significantly increased ethanol levels per gram of ileum and cecum digesta of the rats (3.5-fold and 1.9-fold, respectively, P<0.01). The numbers of cecum Bifidobacterium (producer of ethanol and lactate) were significantly increased by FOS intake (P<0.05) and correlated with the cecum ethanol levels per gram of cecum (r=0.626, P<0.05). FOS intake also led to a significant increase in the cecum levels of SCFAs, namely lactate, propionate and n-butyrate (P<0.05). Furthermore, ethanol levels were significantly correlated with lactate levels (r=0.691, P<0.01), but not with propionate or n-butyrate levels (r=0.449 and 0.493, respectively, P>0.05). The current study, to the best of our knowledge, is the first to indicate that FOS intake significantly increases the level of intestinal ethanol. Therefore, dietary FOS may affect the intestinal health status of animals by elevating their ethanol levels, without direct ethanol consumption.
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Affiliation(s)
- Masahiro Yamaguchi
- Department of Biofunctional Science and Technology, Graduate School of Biosphere Science, Hiroshima University, Higashi-Hiroshima, Hiroshima 739-8528, Japan
| | - Yongshou Yang
- Department of Biofunctional Science and Technology, Graduate School of Biosphere Science, Hiroshima University, Higashi-Hiroshima, Hiroshima 739-8528, Japan
| | - Misaki Ando
- Department of Biofunctional Science and Technology, Graduate School of Biosphere Science, Hiroshima University, Higashi-Hiroshima, Hiroshima 739-8528, Japan
| | - Thanutchaporn Kumrungsee
- Department of Biofunctional Science and Technology, Graduate School of Biosphere Science, Hiroshima University, Higashi-Hiroshima, Hiroshima 739-8528, Japan
| | - Norihisa Kato
- Department of Biofunctional Science and Technology, Graduate School of Biosphere Science, Hiroshima University, Higashi-Hiroshima, Hiroshima 739-8528, Japan
| | - Yukako Okazaki
- Faculty of Human Life Sciences, Fuji Women's University, Ishikari, Hokkaido 061-3204, Japan
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Cunningham SA, Mosher A, Judd SE, Matz LM, Kabagambe EK, Moy CS, Howard VJ. Alcohol Consumption and Incident Stroke Among Older Adults. J Gerontol B Psychol Sci Soc Sci 2018; 73:636-648. [PMID: 28184880 PMCID: PMC6018946 DOI: 10.1093/geronb/gbw153] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 11/13/2016] [Indexed: 02/07/2023] Open
Abstract
Objectives This study examines the relationship between alcohol consumption and incident stroke among older adults and tests whether alcohol consumption contributes to observed race and sex differences in stroke. Method Data are from a U.S. national cohort of black and white adults aged 45 and older, the REasons for Geographic And Racial Differences in Stroke (REGARDS) study. Current and past drinking levels were reported at baseline (2003-2007). Participants who had never had a stroke were followed for adjudicated stroke events through September 2015 (n = 27,265). We calculated Cox proportional hazard models for stroke, adjusting for demographic, socioeconomic, behavioral, and health characteristics. Results Participants, mean age 64.7 years, consumed on average 2.2 drinks/week and experienced 1,140 first-time stroke events over median 9.1 years follow-up. Nondrinkers had a 12% higher risk of stroke than current drinkers; the risk of stroke among nondrinkers largely reflected high risks among past drinkers; these differences were explained by socioeconomic characteristics. Among current drinkers, light drinkers had significantly lower stroke risks than moderate drinkers after accounting for demographic, socioeconomic, behavioral, and health characteristics. Implications of alcohol did not differ between blacks and whites but did differ by sex: Especially among women, nondrinkers, and specifically past drinkers, had higher risks; these differences were largely explained by health characteristics and behaviors. Alcohol did not explain race and sex differences in stroke incidence. Discussion Among older adults, those who used to, but no longer, drink had higher risks of stroke, especially among women; current light drinkers had the lowest risk of stroke.
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Affiliation(s)
- Solveig A Cunningham
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Aleena Mosher
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham
| | - Suzanne E Judd
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham
| | - Lisa M Matz
- London School of Hygiene and Tropical Medicine, UK
| | - Edmond K Kabagambe
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Claudia S Moy
- National Institute of Neurological Disorders and Stroke, Bethesda, Maryland
| | - Virginia J Howard
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham
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Towers A, Philipp M, Dulin P, Allen J. The "Health Benefits" of Moderate Drinking in Older Adults may be Better Explained by Socioeconomic Status. J Gerontol B Psychol Sci Soc Sci 2018; 73:649-654. [PMID: 27927745 DOI: 10.1093/geronb/gbw152] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 11/10/2016] [Indexed: 12/29/2022] Open
Abstract
Objectives To assess whether a relationship between alcohol use and health exists for older adults before and after controlling for proxy and full indicators of socioeconomic status (SES). Method Secondary analysis of data from 2,908 participants in the New Zealand Longitudinal Study of Ageing (2012) completing measures of alcohol use, health, SES proxies (income, education) and SES. Sample mean age was 65, 52% were female, more than 80% were drinkers, and more than 75% had educational qualifications. Results Moderate drinkers had better health and SES than heavier or nondrinkers. The positive influence of moderate alcohol consumption on health was observed for men and women when controlling for SES proxies, but was substantially reduced in women and completely disappeared for men when controlling for full SES. Discussion SES plays a key role in presumed "heath benefits" of moderate alcohol consumption for older adults. It accounts for any alcohol-health relationship in a sample of men of whom 45% consume at least one drink daily, and substantially attenuates the association between alcohol and health in a sample of women who are not frequent drinkers. Prior research may have missed the influence of SES on this alcohol-health relationship due to the use of incomplete SES measures.
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Affiliation(s)
- Andy Towers
- School of Public Health, Massey University, Palmerston North, New Zealand
| | - Michael Philipp
- School of Psychology, Massey University, Palmerston North, New Zealand
| | - Patrick Dulin
- Department of Psychology, University of Alaska, Anchorage
| | - Joanne Allen
- School of Psychology, Massey University, Palmerston North, New Zealand
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Hassing LB. Light Alcohol Consumption Does Not Protect Cognitive Function: A Longitudinal Prospective Study. Front Aging Neurosci 2018; 10:81. [PMID: 29632484 PMCID: PMC5879951 DOI: 10.3389/fnagi.2018.00081] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 03/12/2018] [Indexed: 12/15/2022] Open
Abstract
Studies show that light to moderate alcohol consumption is related to better health and higher cognitive performance. However, it has been suggested that this association is caused by a systematic bias in the control group as many people abstain from drinking or quit because of health issues. Therefore, the group of non-drinkers is biased towards poor health and may not be suitable as a control group. The present study examined the effect of alcohol on cognitive performance while addressing this bias by excluding the non-drinkers. Thus, instead of comparing different levels of alcohol consumption to a non-drinking control group, a dose-response association was calculated between all levels of alcohol intake and cognitive performance. The study used information from a sample of people in the Swedish Twin Registry, who in their midlife (1967) participated in a survey on alcohol intake and 25 years later participated in a longitudinal study on cognitive aging (N = 486). The cognitive aging study took place on five occasions, at 2-year intervals, and included the Mini Mental State Examination (MMSE), tests of episodic memory, semantic memory and spatial ability. The association between midlife alcohol consumption and later cognitive performance was analyzed using growth curve models, adjusting for background variables. The findings showed that there was a significant negative dose-response association between alcohol intake in midlife and the MMSE, and the tests of episodic memory, such that higher intake in midlife was related to lower performance in old age. The associations between alcohol and semantic memory, and spatial ability respectively, were not significant. In contrast to findings from other studies, which show that low to moderate alcohol intake promotes cognitive function, the current study showed that alcohol intake was related to lower cognitive performance in a dose-response manner, even at low levels. The results from this study indicate that the observed benefits of moderate alcohol intake for cognitive function reported by others might be solely due to comparisons to an inappropriate control group, a group that is biased towards poor health. Hence, it is concluded that light alcohol intake may not protect cognitive function.
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Affiliation(s)
- Linda B Hassing
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
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Abstract
PURPOSE OF REVIEW This review aims to discuss the effect of alcohol consumption on various cardiovascular (CV) diseases and CV mortality. RECENT FINDINGS Alcohol intake has consistently shown a J- or U-shaped relationship with several cardiovascular diseases. Light to moderate alcohol intake has been associated with lower risk of coronary artery disease, heart failure (HF), as well as CV mortality. On the other hand, heavy consumption has been associated with deleterious CV outcomes including increased mortality. However, the evidence is based from observational and population-based studies where risk of confounding cannot be excluded even after meticulous methodological approaches. This is compounded by conflicting data such as higher risk of certain CV diseases like HF in former drinkers compared to abstainers. Further, Mendelian randomization studies using genetic polymorphisms in enzymes have recently questioned the beneficial association of low-moderate drinking with CV system. There has been substantial and consistent evidence that light to moderate alcohol consumption have beneficial effect on overall cardiovascular profile and mortality. However, there are considerable limitations in the reported literature to determine a strong causality of a protective effect of moderate alcohol consumption by itself. Further robust studies or possibly a well-structured randomized controlled could bring an end to this debate.
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Affiliation(s)
- Sunny Goel
- Division of Cardiovascular Medicine, Maimonides Medical Center, Brooklyn, NY, USA
| | - Abhishek Sharma
- Division of Cardiovascular Medicine, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
- Institute of Cardiovascular Research and Technology, Brooklyn, NY, USA.
| | - Aakash Garg
- Rutgers Robert Wood Johnson Medical School, 69 Duke Street, New Brunswick, NJ, USA
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Parder ML. What about just saying “no”? Situational abstinence from alcohol at parties among 13–15 year olds. DRUGS: EDUCATION, PREVENTION AND POLICY 2018. [DOI: 10.1080/09687637.2016.1223601] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Hawkins B, Holden C, Eckhardt J, Lee K. Reassessing policy paradigms: A comparison of the global tobacco and alcohol industries. Glob Public Health 2018; 13:1-19. [PMID: 26998944 PMCID: PMC6620754 DOI: 10.1080/17441692.2016.1161815] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Tobacco is widely considered to be a uniquely harmful product for human health. Since the mid-1990s, the strategies of transnational tobacco corporations to undermine effective tobacco control policy has been extensively documented through internal industry documents. Consequently, the sale, use and marketing of tobacco products are subject to extensive regulation and formal measures to exclude the industry from policy-making have been adopted in the Framework Convention on Tobacco Control. In contrast to tobacco, alcohol is subject to less stringent forms of regulation, and the alcohol industry continues to play a central role in policy-making in many countries and at the global level. This article examines whether there is a sufficient rationale for such different regulatory approaches, through a comparative analysis of the political economy of the tobacco and alcohol industries including the structure of the industries, and the market and political strategies they pursue. Despite some important differences, the extensive similarities which exist between the tobacco and alcohol industries in terms of market structure and strategy, and political strategy, call into question the rationale for both the relatively weak regulatory approach taken towards alcohol, and the continued participation of alcohol corporations in policy-making processes.
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Affiliation(s)
- Benjamin Hawkins
- a Department of Global Health and Development , London School of Hygiene and Tropical Medicine , London , UK
| | - Chris Holden
- b Department of Social Policy & Social Work , University of York , Heslington , UK
| | - Jappe Eckhardt
- c Department of Politics , University of York , Heslington , UK
| | - Kelley Lee
- d Faculty of Health Sciences , Simon Fraser University , Burnaby , Canada
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Brenner DR, Haig TR, Poirier AE, Akawung A, Friedenreich CM, Robson PJ. Alcohol consumption and low-risk drinking guidelines among adults: a cross-sectional analysis from Alberta's Tomorrow Project. Health Promot Chronic Dis Prev Can 2017; 37:413-424. [PMID: 29236379 PMCID: PMC5765818 DOI: 10.24095/hpcdp.37.12.03] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Moderate to heavy alcohol consumption is a risk factor for all-cause mortality and cancer incidence. Although cross-sectional data are available through national surveys, data on alcohol consumption in Alberta from a large prospective cohort were not previously available. The goal of these analyses was to characterize the levels of alcohol consumption among adults from the Alberta's Tomorrow Project in the context of cancer prevention guidelines. Furthermore, we conducted analyses to examine the relationships between alcohol consumption and other high-risk or risk-related behaviours. METHODS Between 2001 and 2009, 31 072 men and women aged 35 to 69 years were enrolled into Alberta's Tomorrow Project, a large provincial cohort study. Data concerning alcohol consumption in the past 12 months were obtained from 26 842 participants who completed self-administered health and lifestyle questionnaires. We conducted cross-sectional analyses on daily alcohol consumption and cancer prevention guidelines for alcohol use in relation to sociodemographic factors. We also examined the combined prevalence of alcohol consumption and tobacco use, obesity and comorbidities. RESULTS Approximately 14% of men and 12% of women reported alcohol consumption exceeding recommendations for cancer prevention. Higher alcohol consumption was reported in younger age groups, urban dwellers, those with higher incomes and those who consumed more red meat. Moreover, volume of daily alcohol consumption was positively associated with current tobacco use in both men and women. Overall, men were more likely to fall in the moderate and high-risk behavioural profiles and show higher daily alcohol consumption patterns compared to women. CONCLUSION Despite public health messages concerning the adverse impact of alcohol consumption, a sizeable proportion of Alberta's Tomorrow Project participants consumed alcohol in excess of cancer prevention recommendations. Continued strategies to promote low-risk drinking among those who choose to drink could impact future chronic disease risk in this population.
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Affiliation(s)
- Darren R Brenner
- Department of Cancer Epidemiology and Prevention Research, CancerControl Alberta, Alberta Health Services, Calgary, Alberta, Canada
- Department of Oncology and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Tiffany R Haig
- Cancer Measurement, Outcomes, Research and Evaluation, CancerControl Alberta, Alberta Health Services, Alberta, Canada
| | - Abbey E Poirier
- Department of Cancer Epidemiology and Prevention Research, CancerControl Alberta, Alberta Health Services, Calgary, Alberta, Canada
| | - Alianu Akawung
- Cancer Measurement, Outcomes, Research and Evaluation, CancerControl Alberta, Alberta Health Services, Alberta, Canada
| | - Christine M Friedenreich
- Department of Cancer Epidemiology and Prevention Research, CancerControl Alberta, Alberta Health Services, Calgary, Alberta, Canada
- Department of Oncology and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Paula J Robson
- Cancer Measurement, Outcomes, Research and Evaluation, CancerControl Alberta, Alberta Health Services, Alberta, Canada
- Department of Agricultural, Food and Nutritional Science, Faculty of Agricultural, Life and Environmental Sciences, University of Alberta, Calgary, Alberta, Canada
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Zhao J, Stockwell T, Roemer A, Naimi T, Chikritzhs T. Alcohol Consumption and Mortality From Coronary Heart Disease: An Updated Meta-Analysis of Cohort Studies. J Stud Alcohol Drugs 2017; 78:375-386. [PMID: 28499102 DOI: 10.15288/jsad.2017.78.375] [Citation(s) in RCA: 112] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Previous meta-analyses estimate that low-volume alcohol consumption protects against coronary heart disease (CHD). Potential errors in studies include systematic misclassification of drinkers as abstainers, inadequate measurement, and selection bias across the life course. METHOD Prospective studies of alcohol consumption and CHD mortality were identified in scholarly databases and reference lists. Studies were coded for potential abstainer biases and other study characteristics. The alcohol-CHD risk relationship was estimated in mixed models with controls for potential biases. Stratified analyses were performed based on variables identified as potential effect modifiers. RESULTS Fully adjusted meta-analysis of all 45 studies found significantly reduced CHD mortality for current low-volume drinkers (relative risk [RR] = 0.80, 95% CI [0.69, 0.93]) and all current drinkers (RR = 0.88, 95% CI [0.78, 0.99]). There was evidence of effect modification by cohort age, gender, ethnicity, and heart health at baseline. In stratified analyses, low-volume consumption was not significantly protective for cohorts ages 55 years or younger at baseline (RR = 0.95, 95% CI [0.75, 1.21]), for studies controlling for heart health (RR = 0.87, 95% CI [0.71, 1.06]), or for higher quality studies (RR = 0.86, 95% CI [0.68, 1.09]). In studies in which the mean age was 55 years or younger at baseline, there were significantly increased RRs for both former (RR = 1.45, 95% CI [1.08, 1.95]) and occasional drinkers (RR = 1.44, 95% CI [1.09, 1.89]) compared with abstainers. CONCLUSIONS Pooled analysis of all identified studies suggested an association between alcohol use and reduced CHD risk. However, this association was not observed in studies of those age 55 years or younger at baseline, in higher quality studies, or in studies that controlled for heart health. The appearance of cardio-protection among older people may reflect systematic selection biases that accumulate over the life course.
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Affiliation(s)
- Jinhui Zhao
- Centre for Addictions Research of BC, University of Victoria, Victoria, British Columbia, Canada
| | - Tim Stockwell
- Centre for Addictions Research of BC, University of Victoria, Victoria, British Columbia, Canada.,Department of Psychology, University of Victoria, British Columbia, Canada.,National Drug Research Institute, Curtin University, Perth, Australia
| | - Audra Roemer
- Centre for Addictions Research of BC, University of Victoria, Victoria, British Columbia, Canada.,Department of Psychology, University of Victoria, British Columbia, Canada
| | - Timothy Naimi
- Boston University Schools of Medicine and Public Health, Boston, Massachusetts
| | - Tanya Chikritzhs
- National Drug Research Institute, Curtin University, Perth, Australia.,Institute for Scientific Analysis, San Francisco, California
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Nehlin C, Arinell H, Dyster-Aas J, Jess K. Alcohol Habits and Health Care Use in Patients with Psychiatric Disorders. J Dual Diagn 2017; 13:247-253. [PMID: 28665254 DOI: 10.1080/15504263.2017.1347307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE It is common for persons with psychiatric disorders to also have alcohol problems. Studies in the general population as well as in clinical samples have found hazardous or harmful alcohol habits to be particularly prevalent in the presence of psychiatric disorders. This study sought to explore the relationships between drinking habits and health care utilization (psychiatric as well as general medical) in persons seeking psychiatric treatment and to investigate the associations among age, sex, and type or number of diagnoses and health care use and costs. For the planning of targeted interventions, we also sought to identify subgroups with a high prevalence of hazardous drinking habits. METHODS From a psychiatric clinic for affective disorders at a university hospital in Sweden, patients who had been screened for hazardous drinking (N = 609) were selected. Patients with primary psychosis or substance use disorder receive treatment at other clinics and did not participate. Medical records data were grouped and compared. The International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) was used for diagnoses and the Alcohol Use Disorders Identification Test for screening. Patients were grouped by drinking habits and sex, age, and diagnosis group, and their psychiatric as well as general medical health care use was compared. RESULTS Abstainers used psychiatric care more than all other drinking groups (p < .001). Psychiatric health care costs were higher in abstainers and low-risk drinkers (1.64 to 1). No differences in general medical care could be identified between drinking groups. Specific subgroups with higher rates of hazardous drinking could not be identified (44% of all males and 34% of all females reported such habits). Inconclusive results from previous research are most likely due to different methods used to classify drinking problems. CONCLUSIONS Abstainers and low-risk drinkers used psychiatric health care to a higher cost than the other drinking groups. Possible explanations are discussed from a clinical and scientific perspective. This study clarifies the need for uniform measures when classifying alcohol use in studies of relationships between alcohol use and health care use. There is also a need to separate former drinkers from abstainers in future studies.
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Affiliation(s)
- Christina Nehlin
- a Department of Neuroscience, Psychiatry , Uppsala University , Uppsala , Sweden.,b Division of Psychiatry , Uppsala University Hospital , Uppsala , Sweden
| | - Hans Arinell
- a Department of Neuroscience, Psychiatry , Uppsala University , Uppsala , Sweden
| | - Johan Dyster-Aas
- a Department of Neuroscience, Psychiatry , Uppsala University , Uppsala , Sweden.,b Division of Psychiatry , Uppsala University Hospital , Uppsala , Sweden
| | - Kari Jess
- c School of Education, Health & Social Studies , Dalarna University , Falun , Sweden
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45
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Staff J, Maggs J. Alcohol and Cigarette Use From Ages 23 to 55: Links With Health and Well-Being in the Long-Term National Child Development Study. J Stud Alcohol Drugs 2017; 78:394-403. [PMID: 28499106 PMCID: PMC5440364 DOI: 10.15288/jsad.2017.78.394] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 12/01/2016] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE Using longitudinal data from the National Child Development Study, an ongoing study of a nationally representative British cohort born in 1958 (n = 9,137; 51% female), we examined how patterns of alcohol and cigarette use from young adulthood (age 23) to midlife (age 55) are associated with health and well-being. METHOD We first used a nonparametric multilevel latent class specification to identify eight unique paths of alcohol and cigarette use from ages 23 to 55, and then assessed how these long-term latent paths related to overall health, heart problems, chronic illness, and quality of life at midlife. RESULTS Results show that adults who consistently drank within current U.K. low-risk guidelines (i.e., not exceeding 14 units of alcohol per week) and abstained from smoking from young adulthood to midlife reported the best overall health and well-being compared with latent paths involving steady, light to moderate drinking and both current and prior smoking, increasing drinking and smoking, and infrequent drinking/abstention. CONCLUSIONS British adults who consistently drank within new lower risk guidelines and abstained from smoking from young adulthood to midlife reported the best overall health and well-being across numerous indicators. However, apparent observed health benefits of stable low-dose alcohol use (vs. abstention) are weakened by the fact that by age 55 almost all alcohol "abstainers" in the National Child Development Study sample were former drinkers, and that respondents who followed infrequent drinking/abstention paths were the mostly likely to report poor health, psychological distress, and low educational qualifications in early adulthood.
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Affiliation(s)
- Jeremy Staff
- Department of Sociology, The Pennsylvania State University, University Park, Pennsylvania
| | - Jennifer Maggs
- Human Development & Family Studies, The Pennsylvania State University, University Park, Pennsylvania
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46
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Jeong H, Baek SY, Kim SW, Eun YH, Kim IY, Kim H, Lee J, Koh EM, Cha HS. Comorbidities of rheumatoid arthritis: Results from the Korean National Health and Nutrition Examination Survey. PLoS One 2017; 12:e0176260. [PMID: 28423031 PMCID: PMC5397042 DOI: 10.1371/journal.pone.0176260] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 04/07/2017] [Indexed: 01/05/2023] Open
Abstract
This study aimed to evaluate the prevalence of comorbidities in patients with rheumatoid arthritis (RA) compared with the non-RA population. The 2010-2012 Korea National Health and Nutrition Examination Survey (KNHANES), which assesses the general health status of populations in South Korea using interviews and basic health assessment, was analyzed retrospectively. Weighted prevalence and odds ratio (OR) of comorbidities were analyzed in patients with RA compared with the non-RA population. The overall weighted (n = 37,453,158) prevalence of RA was 1.5%. Patients with RA were older and more female predominant than subjects without RA. The prevalence of living in an urban area, college graduation, alcohol consumption and smoking was lower in patients with RA than non-RA. Patients with RA had more comorbidities including hypertension, dyslipidemia, myocardial infarction (MI) or angina, stoke, osteoarthritis, lung cancer, colon cancer, pulmonary tuberculosis, asthma, diabetes, depression, thyroid disease and chronic kidney disease. After adjusting socioeconomic and lifestyle characteristics, RA was associated with an increased prevalence of MI or angina (OR 1.86, 95% CI 1.17-2.96, p = 0.009), pulmonary TB (OR 1.95, 95% CI 1.24-3.09, p = 0.004), asthma (OR 1.97, 95% CI 1.05-3.71, p = 0.036), thyroid disease (OR 1.71, 95% CI 1.05-2.77), depression (OR 2.38, 95% CI 1.47-3.85, p < 0.001) and hepatitis B (OR 2.34, 95% CI 1.15-4.80, p = 0.020) compared with the non-RA population. Prevalence of solid cancer was not significantly associated with RA after adjustment.
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Affiliation(s)
- Hyemin Jeong
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sun Young Baek
- Biostatic and clinical epidemiology Center, Samsung Medical Center, Seoul, South Korea
| | - Seon Woo Kim
- Biostatic and clinical epidemiology Center, Samsung Medical Center, Seoul, South Korea
| | - Yeong Hee Eun
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - In Young Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hyungjin Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jaejoon Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Eun-Mi Koh
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hoon-Suk Cha
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- * E-mail:
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Bell S, Daskalopoulou M, Rapsomaniki E, George J, Britton A, Bobak M, Casas JP, Dale CE, Denaxas S, Shah AD, Hemingway H. Association between clinically recorded alcohol consumption and initial presentation of 12 cardiovascular diseases: population based cohort study using linked health records. BMJ 2017; 356:j909. [PMID: 28331015 PMCID: PMC5594422 DOI: 10.1136/bmj.j909] [Citation(s) in RCA: 200] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Objectives To investigate the association between alcohol consumption and cardiovascular disease at higher resolution by examining the initial lifetime presentation of 12 cardiac, cerebrovascular, abdominal, or peripheral vascular diseases among five categories of consumption.Design Population based cohort study of linked electronic health records covering primary care, hospital admissions, and mortality in 1997-2010 (median follow-up six years).Setting CALIBER (ClinicAl research using LInked Bespoke studies and Electronic health Records).Participants 1 937 360 adults (51% women), aged ≥30 who were free from cardiovascular disease at baseline.Main outcome measures 12 common symptomatic manifestations of cardiovascular disease, including chronic stable angina, unstable angina, acute myocardial infarction, unheralded coronary heart disease death, heart failure, sudden coronary death/cardiac arrest, transient ischaemic attack, ischaemic stroke, intracerebral and subarachnoid haemorrhage, peripheral arterial disease, and abdominal aortic aneurysm.Results 114 859 individuals received an incident cardiovascular diagnosis during follow-up. Non-drinking was associated with an increased risk of unstable angina (hazard ratio 1.33, 95% confidence interval 1.21 to 1.45), myocardial infarction (1.32, 1.24 to1.41), unheralded coronary death (1.56, 1.38 to 1.76), heart failure (1.24, 1.11 to 1.38), ischaemic stroke (1.12, 1.01 to 1.24), peripheral arterial disease (1.22, 1.13 to 1.32), and abdominal aortic aneurysm (1.32, 1.17 to 1.49) compared with moderate drinking (consumption within contemporaneous UK weekly/daily guidelines of 21/3 and 14/2 units for men and women, respectively). Heavy drinking (exceeding guidelines) conferred an increased risk of presenting with unheralded coronary death (1.21, 1.08 to 1.35), heart failure (1.22, 1.08 to 1.37), cardiac arrest (1.50, 1.26 to 1.77), transient ischaemic attack (1.11, 1.02 to 1.37), ischaemic stroke (1.33, 1.09 to 1.63), intracerebral haemorrhage (1.37, 1.16 to 1.62), and peripheral arterial disease (1.35; 1.23 to 1.48), but a lower risk of myocardial infarction (0.88, 0.79 to 1.00) or stable angina (0.93, 0.86 to 1.00).Conclusions Heterogeneous associations exist between level of alcohol consumption and the initial presentation of cardiovascular diseases. This has implications for counselling patients, public health communication, and clinical research, suggesting a more nuanced approach to the role of alcohol in prevention of cardiovascular disease is necessary.Registration clinicaltrails.gov (NCT01864031).
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Affiliation(s)
- Steven Bell
- Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Cambridge CB1 8RN, UK
- Research Department of Epidemiology and Public Health, University College London, London WC1E 7HB, UK
| | - Marina Daskalopoulou
- Department of Infection and Population Health, University College London, Royal Free Hospital, London NW3 2PF, UK
| | - Eleni Rapsomaniki
- Farr Institute of Health Informatics Research (London), University College London, London NW1 2DA, UK
| | - Julie George
- Farr Institute of Health Informatics Research (London), University College London, London NW1 2DA, UK
| | - Annie Britton
- Research Department of Epidemiology and Public Health, University College London, London WC1E 7HB, UK
| | - Martin Bobak
- Research Department of Epidemiology and Public Health, University College London, London WC1E 7HB, UK
| | - Juan P Casas
- Farr Institute of Health Informatics Research (London), University College London, London NW1 2DA, UK
| | - Caroline E Dale
- Farr Institute of Health Informatics Research (London), University College London, London NW1 2DA, UK
| | - Spiros Denaxas
- Farr Institute of Health Informatics Research (London), University College London, London NW1 2DA, UK
| | - Anoop D Shah
- Farr Institute of Health Informatics Research (London), University College London, London NW1 2DA, UK
| | - Harry Hemingway
- Farr Institute of Health Informatics Research (London), University College London, London NW1 2DA, UK
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48
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Ng Fat L. Commentary on Kerr and Colleagues (): More Evidence that Social and Health Limitations in Childhood Increase the Risk of Lifetime Abstention from Alcohol. Alcohol Clin Exp Res 2017; 41:876-879. [PMID: 28222224 DOI: 10.1111/acer.13360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 02/16/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Linda Ng Fat
- Department of Epidemiology & Public Health (LNF), Institute of Epidemiology & Health Care, University College London, London, United Kingdom
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49
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Parder ML, Vihalemm T. ”… if there's a party, then there's definitely alcohol”. Construction of partying practices and abstinence in Estonian youth forums. NORDIC STUDIES ON ALCOHOL AND DRUGS 2017. [DOI: 10.1515/nsad-2015-0054] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Aims Adolescents' abstinence from alcohol has not been much researched in terms of providing suggestions for prevention strategies. This study aims to fill that gap by offering a practice theory-inspired analysis of how the unwritten rules of partying practices are communicated between posters of Estonian youth forums. Data –These forums are novel objects of analysis in research on teenagers' alcohol use, and the article shares some topical experiences. Results The findings of the analysis show that non-drinking at teenagers' alcohol-related social gatherings is generally communicated as a non-tolerated individual performance that is seen to erode the whole collective partying practice. Young people therefore suggest in forums various mimicry strategies to justify non-drinking. Conclusions The article casts doubts about the efficiency of risk awareness raising and teaching individual skills in this context because they provide little help for those youngsters who have already been recruited into partying practices and who need peer legitimation to leave these practices. The authors pose suggestions for gradually making the current alcohol-related partying practices more tolerant of non-drinkers, thus opening “sub-culturally supported roads” to personal autonomy.
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50
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Stockwell T, Zhao J. Alcohol's contribution to cancer is underestimated for exactly the same reason that its contribution to cardioprotection is overestimated. Addiction 2017; 112:230-232. [PMID: 27891690 DOI: 10.1111/add.13627] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 09/23/2016] [Indexed: 12/26/2022]
Affiliation(s)
- Tim Stockwell
- University of Victoria Ringgold Standard Institution, Centre for Addictions Research of BC Victoria, BC, Canada
| | - Jinhui Zhao
- University of Victoria Ringgold Standard Institution, Centre for Addictions Research of BC Victoria, BC, Canada
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