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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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Skinner J, Shepstone L, Hickson M, Welch AA. Alcohol Consumption and Measures of Sarcopenic Muscle Risk: Cross-Sectional and Prospective Associations Within the UK Biobank Study. Calcif Tissue Int 2023; 113:143-156. [PMID: 37227465 PMCID: PMC10372115 DOI: 10.1007/s00223-023-01081-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 03/31/2023] [Indexed: 05/26/2023]
Abstract
Alcohol intake is a major modifiable risk factor for many diseases. Alcohol can also damage skeletal muscle health during ageing which in turn increases risk of sarcopenia, frailty and falls but this relationship is understudied. The aim of this study was to model the relationship between a full range of alcohol consumption and components of sarcopenic risk, skeletal muscle mass and function, in middle-aged and younger older-aged men and women. A cross-sectional analyses was undertaken of 196,561 white participants from the UK Biobank with longitudinal analysis also in 12,298 of these participants, with outcome measures for the latter repeated after around four years. For the cross-sectional analysis fractional polynomial curves were fitted in models of measures of skeletal muscle mass, appendicular lean mass/body mass index (ALM/BMI), fat-free mass as a percentage of body weight (FFM%) and grip strength, all predicted from alcohol consumption with models fitted for men and women separately. Alcohol consumption at baseline was based on the mean of up to five dietary recalls, typically over 16 months. Linear regression was used for longitudinal analyses to model the effects of alcohol consumption groups on these measures. All models were adjusted for covariates. In the cross-sectional analysis, modelled values of the muscle mass measures all showed a peak at medium levels of alcohol consumption and a steep decline with increasing alcohol consumption. Modelled differences in muscle mass from zero consumption of alcohol to 160 g/d ranged from 3.6 to 4.9% for ALM/BMI for men and women, respectively, and 3.6 to 6.1% for FFM%. Grip strength consistently increased with alcohol consumption. No association between alcohol consumption and muscle measures were seen in the longitudinal results. Our results suggest that higher levels of alcohol consumption could have detrimental effects on muscle mass in middle- and older-aged men and women.
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Affiliation(s)
- Jane Skinner
- Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK.
| | - Lee Shepstone
- Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Mary Hickson
- School of Health Professions, University of Plymouth, Plymouth, PL4 8AA, UK
| | - Ailsa A Welch
- Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK
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Ystrom E, Degerud E, Tesli M, Høye A, Reichborn-Kjennerud T, Næss Ø. Alcohol consumption and lower risk of cardiovascular and all-cause mortality: the impact of accounting for familial factors in twins. Psychol Med 2023; 53:4130-4138. [PMID: 35440344 PMCID: PMC10317821 DOI: 10.1017/s0033291722000812] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 12/17/2021] [Accepted: 03/08/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND A moderate to high alcohol consumption is associated with a lower risk of cardiovascular disease (CVD) mortality in comparison with low consumption. The mechanisms underlying this association are not clear and have been suggested to be caused by residual confounding. The main objective of this study was to separate the familial and individual risk for CVD mortality and all-cause mortality related to alcohol consumption. This will be done by estimating the risk for CVD mortality and all-cause mortality in twin pairs discordant for alcohol consumption. METHODS Alcohol consumption was assessed at two time points using self-report questionnaires in the Norwegian Twin Registry. Data on CVD mortality was obtained from the Norwegian Cause of Death Registry. Exposure-outcome associations for all-cause mortality and mortality due to other causes than CVD were estimated for comparison. RESULTS Coming from a family with moderate to high alcohol consumption was protective against cardiovascular death (HR = 0.54, 95% CI 0.65-0.83). Moderate and high alcohol consumption levels were associated with a slightly increased risk of CVD mortality at the individual level (HR = 1.33, 95% CI 1.02-1.73). There was no association between alcohol consumption and all-cause mortality both at the familial nor at the individual level. CONCLUSIONS The protective association of moderate to high alcohol consumption with a lower risk of CVD mortality was accounted for by familial factors in this study of twins. Early life genetic and environmental familial factors may mask an absence of health effect of moderate to high alcohol consumption on cardiovascular mortality.
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Affiliation(s)
- Eivind Ystrom
- Norwegian Institute of Public Health, P.O. box 222 Skøyen, 0213 Oslo, Norway
- PROMENTA Research Center, Department of Psychology, University of Oslo, P.O. box 1094 Blindern, 0317 Oslo, Norway
| | - Eirik Degerud
- Norwegian Institute of Public Health, P.O. box 222 Skøyen, 0213 Oslo, Norway
| | - Martin Tesli
- Norwegian Institute of Public Health, P.O. box 222 Skøyen, 0213 Oslo, Norway
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Anne Høye
- Department of Clinical Medicine, UiT – The Arctic University of Norway, Tromsø, Norway
- Division of Mental Health and Substance Abuse, University Hospital of North Norway, Tromsø, Norway
- Center for Clinical Documentation and Evaluation (SKDE), Tromsø, Norway
| | - Ted Reichborn-Kjennerud
- Norwegian Institute of Public Health, P.O. box 222 Skøyen, 0213 Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, P.O. box 1170, Blindern, 0318 Oslo, Norway
| | - Øyvind Næss
- Norwegian Institute of Public Health, P.O. box 222 Skøyen, 0213 Oslo, Norway
- Institute of Health and Society, University of Oslo, P.O. box 1130, Blindern, 0318 Oslo, Norway
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Zhao X, Yin Y, Fang W, Yang Z. What happens when fruit married with beer? Int J Gastron Food Sci 2023. [DOI: 10.1016/j.ijgfs.2023.100716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
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Stout K, Almerstani M, Adomako R, Shin D, Aroudaky A, Tandon H, Alziadin N, Schleifer JW, Payne J, Easley A, Khan F, Windle J, Goyal N, Tsai S, Anderson D, Peeraphatdit T, Naksuk N. Prevalence and Impact of Poorly Controlled Modifiable Risk Factors Among Patients Who Underwent Atrial Fibrillation Ablation. Am J Cardiol 2023; 198:38-46. [PMID: 37201229 DOI: 10.1016/j.amjcard.2023.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 03/30/2023] [Accepted: 04/15/2023] [Indexed: 05/20/2023]
Abstract
Managing atrial fibrillation (AF) risk factors (RFs) improves ablation outcomes in obese patients. However, real-world data, including nonobese patients, are limited. This study examined the modifiable RFs of consecutive patients who underwent AF ablation at a tertiary care hospital from 2012 to 2019. The prespecified RFs included body mass index (BMI) ≥30 kg/m2, >5% fluctuation in BMI, obstructive sleep apnea with continuous positive airway pressure noncompliance, uncontrolled hypertension, uncontrolled diabetes, uncontrolled hyperlipidemia, tobacco use, alcohol use higher than the standard recommendation, and a diagnosis-to-ablation time (DAT) >1.5 years. The primary outcome was a composite of arrhythmia recurrence, cardiovascular admissions, and cardiovascular death. In this study, a high prevalence of preablation modifiable RFs was observed. More than 50% of the 724 study patients had uncontrolled hyperlipidemia, a BMI ≥30 mg/m2, a fluctuating BMI >5%, or a delayed DAT. During a median follow-up of 2.6 (interquartile range 1.4 to 4.6) years, 467 patients (64.5%) met the primary outcome. Independent RFs were a fluctuation in BMI >5% (hazard ratio [HR] 1.31, p = 0.008), diabetes with A1c ≥6.5% (HR 1.50, p = 0.014), and uncontrolled hyperlipidemia (HR 1.30, p = 0.005). A total of 264 patients (36.46%) had at least 2 of these predictive RFs, which was associated with a higher incidence of the primary outcome. Delayed DAT over 1.5 years did not alter the ablation outcome. In conclusion, substantial portions of patients who underwent AF ablation have potentially modifiable RFs that were not well controlled. Fluctuating BMI, diabetes with hemoglobin A1c ≥6.5%, and uncontrolled hyperlipidemia portend an increased risk of recurrent arrhythmia, cardiovascular hospitalizations, and mortality after ablation.
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Affiliation(s)
| | | | | | | | | | - Hannah Tandon
- College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska
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Kimura Y, Yamamoto R, Shinzawa M, Aoki K, Tomi R, Ozaki S, Yoshimura R, Shimomura A, Iwatani H, Isaka Y, Iseki K, Tsuruya K, Fujimoto S, Narita I, Konta T, Kondo M, Kasahara M, Shibagaki Y, Asahi K, Watanabe T, Yamagata K, Moriyama T. Alcohol Consumption and a Decline in Glomerular Filtration Rate: The Japan Specific Health Checkups Study. Nutrients 2023; 15:nu15061540. [PMID: 36986270 PMCID: PMC10058733 DOI: 10.3390/nu15061540] [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: 02/08/2023] [Revised: 03/16/2023] [Accepted: 03/17/2023] [Indexed: 03/30/2023] Open
Abstract
Previous studies have reported conflicting results on the clinical impact of alcohol consumption on the glomerular filtration rate (GFR). This retrospective cohort study aimed to assess the dose-dependent association between alcohol consumption and the slope of the estimated GFR (eGFR) in 304,929 participants aged 40-74 years who underwent annual health checkups in Japan between April 2008 and March 2011. The association between the baseline alcohol consumption and eGFR slope during the median observational period of 1.9 years was assessed using linear mixed-effects models with the random intercept and random slope of time adjusting for clinically relevant factors. In men, rare drinkers and daily drinkers with alcohol consumptions of ≥60 g/day had a significantly larger decline in eGFR than occasional drinkers (difference in multivariable-adjusted eGFR slope with 95% confidence interval (mL/min/1.73 m2/year) of rare, occasional, and daily drinkers with ≤19, 20-39, 40-59, and ≥60 g/day: -0.33 [-0.57, -0.09], 0.00 [reference], -0.06 [-0.39, 0.26], -0.16 [-0.43, 0.12], -0.08 [-0.47, 0.30], and -0.79 [-1.40, -0.17], respectively). In women, only rare drinkers were associated with lower eGFR slopes than occasional drinkers. In conclusion, alcohol consumption was associated with the eGFR slope in an inverse U-shaped fashion in men but not in women.
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Affiliation(s)
- Yoshiki Kimura
- Department of Nephrology, Graduate School of Medicine, Osaka University, Suita 565-0871, Japan
- Department of Nephrology, National Hospital Organization Osaka National Hospital, Osaka 540-0006, Japan
| | - Ryohei Yamamoto
- Department of Nephrology, Graduate School of Medicine, Osaka University, Suita 565-0871, Japan
- Health and Counseling Center, Osaka University, Toyonaka 560-0043, Japan
| | - Maki Shinzawa
- Department of Nephrology, Graduate School of Medicine, Osaka University, Suita 565-0871, Japan
| | - Katsunori Aoki
- Department of Nephrology, Graduate School of Medicine, Osaka University, Suita 565-0871, Japan
| | - Ryohei Tomi
- Department of Nephrology, Graduate School of Medicine, Osaka University, Suita 565-0871, Japan
| | - Shingo Ozaki
- Department of Nephrology, Graduate School of Medicine, Osaka University, Suita 565-0871, Japan
| | - Ryuichi Yoshimura
- Health and Counseling Center, Osaka University, Toyonaka 560-0043, Japan
| | - Akihiro Shimomura
- Department of Nephrology, National Hospital Organization Osaka National Hospital, Osaka 540-0006, Japan
| | - Hirotsugu Iwatani
- Department of Nephrology, National Hospital Organization Osaka National Hospital, Osaka 540-0006, Japan
| | - Yoshitaka Isaka
- Department of Nephrology, Graduate School of Medicine, Osaka University, Suita 565-0871, Japan
| | - Kunitoshi Iseki
- The Japan Specific Health Checkups (J-SHC) Study Group, Fukushima, Japan
| | - Kazuhiko Tsuruya
- The Japan Specific Health Checkups (J-SHC) Study Group, Fukushima, Japan
| | - Shouichi Fujimoto
- The Japan Specific Health Checkups (J-SHC) Study Group, Fukushima, Japan
| | - Ichiei Narita
- The Japan Specific Health Checkups (J-SHC) Study Group, Fukushima, Japan
| | - Tsuneo Konta
- The Japan Specific Health Checkups (J-SHC) Study Group, Fukushima, Japan
| | - Masahide Kondo
- The Japan Specific Health Checkups (J-SHC) Study Group, Fukushima, Japan
| | - Masato Kasahara
- The Japan Specific Health Checkups (J-SHC) Study Group, Fukushima, Japan
| | - Yugo Shibagaki
- The Japan Specific Health Checkups (J-SHC) Study Group, Fukushima, Japan
| | - Koichi Asahi
- The Japan Specific Health Checkups (J-SHC) Study Group, Fukushima, Japan
| | - Tsuyoshi Watanabe
- The Japan Specific Health Checkups (J-SHC) Study Group, Fukushima, Japan
| | - Kunihiro Yamagata
- The Japan Specific Health Checkups (J-SHC) Study Group, Fukushima, Japan
| | - Toshiki Moriyama
- Department of Nephrology, Graduate School of Medicine, Osaka University, Suita 565-0871, Japan
- Health and Counseling Center, Osaka University, Toyonaka 560-0043, Japan
- The Japan Specific Health Checkups (J-SHC) Study Group, Fukushima, Japan
- Health Promotion and Regulation, Department of Health Promotion Medicine, Osaka University Graduate School of Medicine, Toyonaka 560-0043, Japan
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Yang D, Chen J, Zhang T, Lin Y, Yao X, Meng L, Guo F, Chen K, Dai H, Tang M. Influencing factors of wide pulse pressure in an elderly Chinese population: A cross-sectional study. J Clin Hypertens (Greenwich) 2022; 24:1482-1490. [PMID: 36259250 DOI: 10.1111/jch.14582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/01/2022] [Accepted: 09/06/2022] [Indexed: 11/30/2022]
Abstract
Blood pressure and pulse pressure (PP) had their own characteristics in the elderly population. This cross-sectional study including 5030 elderly participants was conducted to describe the distribution of blood pressure and wide PP in the elderly population and find influencing factors of wide PP. Wide PP was defined as PP equal to or more than 65 mmHg, and was classified three types as low systolic blood pressure (SBP) and low diastolic blood pressure (DBP) (LSLD), high SBP and low DBP (HSLD), and high SBP and high DBP (HSHD). Using multivariate logistic regression models to analyze the associations of demographic factors, health-related factors and lifestyle factors with different wide PP types. The associations of lifestyles with wide PP by gender were estimated by subgroup analyses. Among 5030 elderly participants, 2727 (54.2%) participants had wide PP. Logistic regression models showed older age (OR = 2.48, 95%CI: 2.14-2.88), female (OR = 1.31, 95%CI: 1.07-1.60), not married (OR = 1.26, 95%CI: 1.07-1.49), having chronic diseases (OR = 1.28, 95%CI: 1.09-1.50), current alcohol drinker (OR = 1.29, 95%CI: 1.11-1.50) were positively associated, and higher body height (OR = .78, 95%CI: .62-.99), higher education level (OR = .60, 95%CI: .43-.82), current smoker (OR = .79, 95%CI: .64-.97) were negatively associated with wide PP. Among three different types of wide PP including LSLD, HSLD, HSHD, these factors had different effects. Subgroup analyses found that only among male, current smoker was negatively associated and current alcohol drinker was positively associated with wide PP.
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Affiliation(s)
- Dandan Yang
- Department of Public Health, Fourth Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jie Chen
- Fourth Affiliated Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - Tingting Zhang
- Fourth Affiliated Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - Yaoyao Lin
- Department of Public Health, Fourth Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xuecheng Yao
- Department of Public Health, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lin Meng
- Department of Public Health, Fourth Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Fanjia Guo
- Department of Public Health, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Kun Chen
- Department of Public Health, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Honglei Dai
- Fourth Affiliated Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - Mengling Tang
- Department of Public Health, Fourth Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Li Y, Zhu B, Song N, Shi Y, Fang Y, Ding X. Alcohol consumption and its association with chronic kidney disease: Evidence from a 12-year China health and Nutrition Survey. Nutr Metab Cardiovasc Dis 2022; 32:1392-1401. [PMID: 35304050 DOI: 10.1016/j.numecd.2022.02.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 02/18/2022] [Accepted: 02/18/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND AIMS Alcohol consumption is a major threat to global health. The aim of the present study was to explore the association between alcohol consumption and chronic kidney disease (CKD) in a Chinese population. METHODS AND RESULTS A total of 4664 participants, aged ≥18 years, who participated in a baseline alcohol survey in 1997 and were followed up in 2009 of the China Health and Nutrition Survey (CHNS), were recruited in the current study. Data on alcohol consumption was obtained using standardized questionnaires, with CKD (defined as eGFR <60 mL/min/1.73 m2) as the outcome. The results showed that 37.3% of the participants had consumed alcohol at the baseline. Current drinkers were mainly men, with at least senior high school education, and a history of smoking. In the 2009 survey, 14.5% of the participants had CKD. Association analyses revealed that alcohol drinkers had a lower likelihood of CKD than non-drinkers (11.0% vs. 16.6%, aOR: 0.76, 95%CI: 0.58-1.00), after adjusting potential covariates. Restricted cubic splines revealed that the relationship between alcohol consumption and CKD prevalence was U-shaped. The probability of CKD significantly increased when alcohol consumption exceeded 18 standard drinks per week (aOR: 1.66, 95%CI: 1.00-2.76). Approximately one-fourth of participants changed their drinking patterns during the 12-year follow-up, and male drinkers with persistent drinking patterns had the lowest prevalence of CKD (aOR: 0.48, 95% CI: 0.31-0.73). CONCLUSION Alcohol consumption showed a U-shaped association with CKD. Moderate drinkers exhibited a lower disease prevalence compared with non-drinkers and heavy drinkers. Further studies should be conducted to explore the mechanisms underlying this protective effect. However, non-drinkers should not start drinking alcohol even with this protective effect.
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Affiliation(s)
- Yang Li
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Medical Center of Kidney, Shanghai, China; Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, China
| | - Bowen Zhu
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Medical Center of Kidney, Shanghai, China; Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, China
| | - Nana Song
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Medical Center of Kidney, Shanghai, China; Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, China
| | - Yiqin Shi
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Medical Center of Kidney, Shanghai, China; Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, China
| | - Yi Fang
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Medical Center of Kidney, Shanghai, China; Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, China
| | - Xiaoqiang Ding
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Medical Center of Kidney, Shanghai, China; Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, China.
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Cho IY, Yoo JE, Han K, Kim D, Jeong SM, Hwang S, Lee H, Jeon KH, Shin DW. Frequent drinking is more predictive of ischemic stroke than binge drinking, but not of myocardial infarction. Atherosclerosis 2022; 350:65-72. [DOI: 10.1016/j.atherosclerosis.2022.04.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 03/27/2022] [Accepted: 04/21/2022] [Indexed: 12/28/2022]
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Abstract
The ALDH2*2 missense variant that commonly causes alcohol flushing reactions is the single genetic polymorphism associated with the largest number of traits in humans. The dysfunctional ALDH2 variant affects nearly 8% of the world population and is highly concentrated among East Asians. Carriers of the ALDH2*2 variant commonly present alterations in a number of blood biomarkers, clinical measurements, biometrics, drug prescriptions, dietary habits and lifestyle behaviors, and they are also more susceptible to aldehyde-associated diseases, such as cancer and cardiovascular disease. However, the interaction between alcohol and ALDH2-related pathology is not clearly delineated. Furthermore, genetic evidence indicates that the ALDH2*2 variant has been favorably selected for in the past 2000-3000 years. It is therefore necessary to consider the disease risk and mechanism associated with ALDH2 deficiency, and to understand the possible beneficial or protective effect conferred by ALDH2 deficiency and whether the pleiotropic effects of ALDH2 variance are all mediated by alcohol use.
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Affiliation(s)
- Che-Hong Chen
- Department of Chemical and Systems Biology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | | | - Daria Mochly-Rosen
- Department of Chemical and Systems Biology, Stanford University School of Medicine, Stanford, CA 94305, USA
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Tang S, Gong Y, Yao L, Xu Y, Liu M, Yang T, Ye C, Bai Y. Do medical treatment choices affect the health of chronic patients in middle and old age in China?-Evidence from CHARLS 2018. BMC Public Health 2022; 22:937. [PMID: 35538471 PMCID: PMC9088154 DOI: 10.1186/s12889-022-13309-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 04/26/2022] [Indexed: 12/21/2022] Open
Abstract
Different medical treatment choices may affect the health of patients with chronic diseases. This study aims to assess the relationship between treatment choices, including the use of traditional Chinese medicine (TCM), and the health levels of middle-aged and elderly patients with six chronic diseases. The sample data comes from China Health and Retirement Longitudinal Study (CHARLS 2018). Basic conditions, medical choices and health status of patients are incorporated. The ordered Logit and Logit regression models are used to analyze and compare the effects of six chronic disease patients’ medical options on their self-rated health (SRH) and depression. The overall average score of SRH is the highest in patients with heart disease (the worst in SRH), which is 3.433. Arthritis patients have the highest overall depression average score (depression) at 0.444. Under the premise of controlling a variety of socio-demographic factors, compared with the non-treatment group, taking TCM has a significant positive effect on SRH of patients with five diseases except hypertension. Both taking western medicine (WM) and taking integrated Chinese and Western medicine (IM) have a significant positive effect on SRH scores of patients with six chronic diseases in middle and old age. Taking TCM has effect on depression of patients with heart or stomach diseases, and taking WM and IM affects depression of middle-aged and elderly chronic patients except diabetes. Taking IM has a greater effect on SRH and depression of chronically ill patients, followed by taking WM, and the effect of taking TCM is relatively small, which is related to the development stage of the disease. Therefore, in the future, the control and treatment of chronic diseases in the middle and late stages can be discussed from the perspective of integrated traditional Chinese and western medicine, but attention should be paid to drug interactions. In order to improve the treatment rate and health level of patients with chronic diseases, their economic burden should be reduced, and they should be guided to choose more reasonable treatment methods.
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Affiliation(s)
| | - Ying Gong
- Nanjing University of Chinese Medicine, Nanjing, China.
| | - Ling Yao
- Nanjing University of Chinese Medicine, Nanjing, China
| | - Yun Xu
- Nanjing University of Chinese Medicine, Nanjing, China
| | - Meixian Liu
- Nanjing University of Chinese Medicine, Nanjing, China
| | - Tongling Yang
- Nanjing University of Chinese Medicine, Nanjing, China
| | - Chaoyu Ye
- Nanjing University of Chinese Medicine, Nanjing, China
| | - Yamei Bai
- Nanjing University of Chinese Medicine, Nanjing, China
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12
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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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13
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Alcohol's Impact on the Cardiovascular System. Nutrients 2021; 13:nu13103419. [PMID: 34684419 PMCID: PMC8540436 DOI: 10.3390/nu13103419] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/22/2021] [Accepted: 09/24/2021] [Indexed: 12/21/2022] Open
Abstract
Alcohol consumption has been shown to have complex, and sometimes paradoxical, associations with cardiovascular diseases (CVDs). Several hundred epidemiological studies on this topic have been published in recent decades. In this narrative review, the epidemiological evidence will be examined for the associations between alcohol consumption, including average alcohol consumption, drinking patterns, and alcohol use disorders, and CVDs, including ischaemic heart disease, stroke, hypertension, atrial fibrillation, cardiomyopathy, and heart failure. Methodological shortcomings, such as exposure classification and measurement, reference groups, and confounding variables (measured or unmeasured) are discussed. Based on systematic reviews and meta-analyses, the evidence seems to indicate non-linear relationships with many CVDs. Large-scale longitudinal epidemiological studies with multiple detailed exposure and outcome measurements, and the extensive assessment of genetic and confounding variables, are necessary to elucidate these associations further. Conflicting associations depending on the exposure measurement and CVD outcome are hard to reconcile, and make clinical and public health recommendations difficult. Furthermore, the impact of alcohol on other health outcomes needs to be taken into account. For people who drink alcohol, the less alcohol consumed the better.
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14
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Peake L, van Schalkwyk MCI, Maani N, Petticrew M. Analysis of the accuracy and completeness of cardiovascular health information on alcohol industry-funded websites. Eur J Public Health 2021; 31:1197-1204. [PMID: 34480167 DOI: 10.1093/eurpub/ckab135] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The Alcohol Industry (AI), and the Social Aspects/Public Relations Organisations (SAPRO) it funds, has been shown to mis-represent the risk of alcohol with respect to cancer and pregnancy. It is theorized that the AI would position alcohol as 'heart healthy' to further undermine public perceptions of risks from drinking. METHODS A comparative analysis (including content, thematic and context analyses) of cardiovascular health information published on the websites of AI-funded (n = 18, such as 'Drinkaware' and the 'Distilled Spirits Council of the US') and non-AI-funded (n = 18, such as 'NHS.uk') organizations based in multiple high-income jurisdictions. RESULTS Websites of non-industry-funded health organizations were more likely than AI/SAPRO websites to label alcohol as a risk factor for a range of important cardiovascular diseases (such as myocardial infarction, congestive cardiac failure, hypertension and stroke). Conversely, AI/SAPRO websites were more likely to suggest alcohol was protective in the development of some heart conditions. AI/SAPRO websites frequently referenced the J-shaped curve as proof of benefit from moderate alcohol consumption; suggested a balance between the benefits and harms from drinking; positioned alcohol as consistent with a 'healthy lifestyle'; and framed drinking as a social norm. CONCLUSIONS AI-funded health organizations mis-represent the evidence on cardiovascular effects of moderate alcohol consumption. Healthcare professionals should appreciate the role of funding source in biasing content, and exercise caution when directing patients to content funded by the AI. Tighter regulation of messaging that AI/SAPRO's provide to the public is required, to avoid the dissemination of harmful misinformation.
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Affiliation(s)
- Lewis Peake
- South West Public Health Training Programme, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
| | - May C I van Schalkwyk
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, LSHTM, London, UK
| | - Nason Maani
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, LSHTM, London, UK.,Department of Public Health Environments and Society, School of Public Health, Boston University, Boston, MA, USA
| | - Mark Petticrew
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, LSHTM, London, UK.,Department of Public Health Environments and Society, School of Public Health, Boston University, Boston, MA, USA
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15
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Kaigorodova TV, Kryukova IA. Тhe impact of alcohol abuse on the development of non-communicable diseases (analytical review). Public Health 2021. [DOI: 10.21045/2782-1676-2021-1-2-48-61] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The harmful use of alcohol is a risk factor for the development of non-communicable diseases (NCDs), such as cancer, cardiovascular disease, gastrointestinal diseases, diabetes and others. In addition to morbidity, alcohol abuse increases mortality, especially at young ages. An important characteristic is the frequency and amount of alcohol consumed by a person. The more often and more a person abuses alcohol, the higher the risk of developing NCDs and the mortality rate. Purpose of the study: analysis of publications of the World Health Organization and scientific publications of foreign researchers on the influence of alcohol on the development of non-communicable diseases.Materials and research methods. Content analysis of documents of the World Health Organization and foreign studies on the assessment of the impact of alcohol In total, 48 documents of international organizations were analyzed, including the World Health Organization (WHO), the United Nations (UN), the International Agency for Research on Cancer (IARC-IARC) and the World Bank, as well as 211 scientific publications. Of these, 19 documents were selected, which included materials from WHO, UN, IARC and the World Bank on the impact of alcohol abuse on health, and 63 scientific publications on this topic. Selection criterion: the content in the documents of materials that adequately describe the impact of alcohol abuse on health as a risk factor for the development of various diseases.Results. An analysis of the documents and publications presented revealed a large massif of evidence that the harmful use of alcohol is a causal factor in the development of a number of noncommunicable diseases, an increase in mortality and disability at earlier stages of life, and the development of a link between harmful use of alcohol and a number of mental and behavioral disorders.
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Affiliation(s)
- T. V. Kaigorodova
- Federal Research Institute for Health Organization and Informatics of Ministry of Health of the Russian Federation
| | - I. A. Kryukova
- Federal Research Institute for Health Organization and Informatics of Ministry of Health of the Russian Federation
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16
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Degerud E, Høiseth G, Mørland J, Ariansen I, Graff-Iversen S, Ystrom E, Zuccolo L, Tell GS, Næss Ø. Associations of Binge Drinking With the Risks of Ischemic Heart Disease and Stroke: A Study of Pooled Norwegian Health Surveys. Am J Epidemiol 2021; 190:1592-1603. [PMID: 33720294 PMCID: PMC8489425 DOI: 10.1093/aje/kwab063] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 03/04/2021] [Accepted: 03/10/2021] [Indexed: 11/14/2022] Open
Abstract
Norwegian health survey data (1987-2003) were analyzed to determine if binge drinking increases the risk of incident major events from ischemic heart disease (IHD) and stroke. Among current drinkers reporting average alcohol intakes of 2.00-59.99 g/day (n = 44,476), frequent binge drinking (≥5 units at least once per month) was not associated with a greater risk of IHD (adjusted hazard ratio (HR) = 0.91, 95% confidence interval (CI): 0.76, 1.09) or stroke (adjusted HR = 0.98, 95% CI: 0.81, 1.19), in comparison with participants who reported that they never or only infrequently (less than once per month) had episodes of binge drinking. Participants with an average alcohol intake of 2.00-59.99 g/day had a lower risk of IHD in comparison with participants with very low intakes (<2.00 g/day), both among frequent binge drinkers (adjusted HR = 0.67, 95% CI: 0.56, 0.80) and among never/infrequent binge drinkers (adjusted HR = 0.75, 95% CI: 0.67, 0.84). The findings suggest that frequent binge drinking, independent of average alcohol intake, does not increase the risk of incident IHD or stroke events. However, the findings should be interpreted in light of the limitations of the study design.
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Affiliation(s)
- Eirik Degerud
- Correspondence to Dr Eirik Degerud, Department of Chronic Diseases and Ageing, Division of Mental and Physical Health, Norwegian Institute of Public Health, PO Box 222, Skøyen, N-0213 Oslo, Norway (e-mail: )
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17
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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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18
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Gulayin PE, Irazola V, Gutierrez L, Elorriaga N, Lanas F, Mores N, Ponzo J, Calandrelli M, Poggio R, Rubinstein A, Bardach A. Association between drinking patterns and cardiovascular risk: a population-based study in the Southern Cone of Latin America. J Public Health (Oxf) 2021; 42:107-117. [PMID: 30649400 DOI: 10.1093/pubmed/fdy226] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 12/11/2018] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Using data from general adult population, this study aims to describe epidemiology of alcohol consumption patterns and their association with cardiovascular risk. METHODS CESCAS I is a population-based study from four mid-sized cities in Argentina, Chile and Uruguay. Associations between diabetes, hypertension, dyslipidemia, cardiovascular disease (CVD) risk and history of CVD and drinking patterns were assessed using crude prevalence odds ratios (ORs) and adjusted OR. RESULTS A total of 37.2% of the studied population never drank and 18.3% reported to be former drinkers. Among current drinkers, moderate drinking was the most frequent pattern (24.2%). For women with light and moderate consumption, the odds of having >20% CVD risk was ~40% lower than that of never drinkers. The odds of having a history of CVD was 50% lower in those with moderate consumption. For men with heavy consumption, the odds of having >20% CVD risk was about twice as high as for never drinkers. CONCLUSIONS A harmful association was observed between heavy drinking and having >20% CVD risk for men. However, for women, an apparently protective association was observed between light and moderate drinking and having >20% CVD risk and between moderate drinking and having a history of CVD.
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Affiliation(s)
- Pablo Elías Gulayin
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina.,Facultad de Ciencias Médicas, Universidad Nacional de La Plata, Buenos Aires, Argentina
| | - Vilma Irazola
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - Laura Gutierrez
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - Natalia Elorriaga
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | | | - Nora Mores
- Municipalidad de Marcos Paz, Buenos Aires, Argentina
| | - Jaqueline Ponzo
- Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | | | - Rosana Poggio
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina.,Comisión Nacional de Investigaciones Científico Tecnológicas, Argentina
| | | | - Ariel Bardach
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina.,Comisión Nacional de Investigaciones Científico Tecnológicas, Argentina
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19
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Chinese Guideline on the Primary Prevention of Cardiovascular Diseases. CARDIOLOGY DISCOVERY 2021; 1:70-104. [DOI: 10.1097/cd9.0000000000000025] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
Abstract
Cardiovascular disease is the leading cause of mortality in China. Primary prevention of cardiovascular disease with a focus on lifestyle intervention and risk factor control has been shown to effectively delay or prevent the occurrence of cardiovascular events. To promote a healthy lifestyle and enhance the detection, diagnosis, and treatment of cardiovascular risk factors such as hypertension, dyslipidemia, and diabetes, and to improve the overall capacity of primary prevention of cardiovascular disease, the Chinese Society of Cardiology of Chinese Medical Association has collaborated with multiple societies to summarize and evaluate the latest evidence with reference to relevant guidelines and subsequently to develop recommendations for primary cardiovascular disease prevention in Chinese adults. The guideline consists of 10 sections: introduction, methodology for developing the guideline, epidemiology of cardiovascular disease in China and challenges in primary prevention, general recommendations for primary prevention, assessment of cardiovascular risk, lifestyle intervention, blood pressure control, lipid management, management of type 2 diabetes, and use of aspirin. The promulgation and implementation of this guideline will play a key role in promoting the practice of primary prevention for cardiovascular disease in China.
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20
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Jalali Z, Khademalhosseini M, Soltani N, Esmaeili Nadimi A. Smoking, alcohol and opioids effect on coronary microcirculation: an update overview. BMC Cardiovasc Disord 2021; 21:185. [PMID: 33858347 PMCID: PMC8051045 DOI: 10.1186/s12872-021-01990-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 04/07/2021] [Indexed: 02/07/2023] Open
Abstract
Smoking, heavy alcohol drinking and drug abuse are detrimental lifestyle factors leading to loss of million years of healthy life annually. One of the major health complications caused by these substances is the development of cardiovascular diseases (CVD), which accounts for a significant proportion of substance-induced death. Smoking and excessive alcohol consumption are related to the higher risk of acute myocardial infarction. Similarly, opioid addiction, as one of the most commonly used substances worldwide, is associated with cardiac events such as ischemia and myocardial infarction (MI). As supported by many studies, coronary artery disease (CAD) is considered as a major cause for substance-induced cardiac events. Nonetheless, over the last three decades, a growing body of evidence indicates that a significant proportion of substance-induced cardiac ischemia or MI cases, do not manifest any signs of CAD. In the absence of CAD, the coronary microvascular dysfunction is believed to be the main underlying reason for CVD. To date, comprehensive literature reviews have been published on the clinicopathology of CAD caused by smoking and opioids, as well as macrovascular pathological features of the alcoholic cardiomyopathy. However, to the best of our knowledge there is no review article about the impact of these substances on the coronary microvascular network. Therefore, the present review will focus on the current understanding of the pathophysiological alterations in the coronary microcirculation triggered by smoking, alcohol and opioids.
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Affiliation(s)
- Zahra Jalali
- Non-Communicable Diseases Research Center, Rafsanjan University of Medical Sciences, Building Number 1, Emam Ali Boulevard, P.O. Box: 77175-835, 7719617996, Rafsanjan, Iran
- Department of Clinical Biochemistry, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Morteza Khademalhosseini
- Non-Communicable Diseases Research Center, Rafsanjan University of Medical Sciences, Building Number 1, Emam Ali Boulevard, P.O. Box: 77175-835, 7719617996, Rafsanjan, Iran
- Department of Pathology, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Narjes Soltani
- Non-Communicable Diseases Research Center, Rafsanjan University of Medical Sciences, Building Number 1, Emam Ali Boulevard, P.O. Box: 77175-835, 7719617996, Rafsanjan, Iran
| | - Ali Esmaeili Nadimi
- Non-Communicable Diseases Research Center, Rafsanjan University of Medical Sciences, Building Number 1, Emam Ali Boulevard, P.O. Box: 77175-835, 7719617996, Rafsanjan, Iran.
- Department of Cardiology, School of Medicine, Rafsanjani University of Medical Sciences, Rafsanjan, Iran.
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21
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Trefan L, Akbari A, Morgan JS, Farewell DM, Fone D, Lyons RA, Jones Hywel M, Moore SC. Visualisation and optimisation of alcohol-related hospital admissions ICD-10 codes in Welsh e-cohort data. Int J Popul Data Sci 2021; 6:1373. [PMID: 34007894 PMCID: PMC8103565 DOI: 10.23889/ijpds.v6i1.1373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Introduction The excessive consumption of alcohol is detrimental to long term health and increases the likelihood of hospital admission. However, definitions of alcohol-related hospital admission vary, giving rise to uncertainty in the effect of alcohol on alcohol-related health care utilization. Objectives To compare diagnostic codes on hospital admission and discharge and to determine the ideal combination of codes necessary for an accurate determination of alcohol-related hospital admission. Methods Routine population-linked e-cohort data were extracted from the Secure Anonymised Information Linkage (SAIL) Databank containing all alcohol-related hospital admissions (n,= 92,553) from 2006 to 2011 in Wales, United Kingdom. The distributions of the diagnostic codes recorded at admission and discharge were compared. By calculating a misclassification rate (sensitivity-like measure) the appropriate number of coding fields to examine for alcohol-codes was established. Results There was agreement between admission and discharge codes. When more than ten coding fields were used the misclassification rate was less than 1%. Conclusion With the data at present and alcohol-related codes used, codes recorded at admission and discharge can be used equivalently to identify alcohol-related admissions. The appropriate number of coding fields to examine was established: fewer than ten is likely to lead to under-reporting of alcohol-related admissions. The methods developed here can be applied to other medical conditions that can be described using a certain set of diagnostic codes, each of which can be a known sole cause of the condition and recorded in multiple positions in e-cohort data.
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Affiliation(s)
- Laszl Trefan
- Honorary Research Associate, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff CF14 4YS
| | - Ashley Akbari
- Senior Research Manager and Data Scientist, Health Data Research UK Wales and Northern Ireland, Swansea University Medical School, Institute of Life Science 2, Sketty, Swansea SA2 8QA
| | - Jennifer Siân Morgan
- Performance Analysis Manager, NHS Wales Delivery Unit, Pencoed, Bridgend CF35 5LJ
| | - Daniel Mark Farewell
- Senior Lecturer, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff CF14 4YS
| | - David Fone
- Retired professor, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff CF14 4YS
| | - Ronan A Lyons
- Professor, Health Data Research UK Wales and Northern Ireland, Swansea University Medical School, Institute of Life Science 2, Sketty, Swansea SA2 8QA
| | - Merfyn Jones Hywel
- Research Associate / Statistician, Division of Population Medicine, Cardiff University, Cardiff CF14 4YS
| | - Simon C Moore
- Professor of Public Health Research, Crime and Security Research Institute and School of Dentistry, Cardiff University, Cardiff CF14 4XY
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Moderate Consumption of Beer and Its Effects on Cardiovascular and Metabolic Health: An Updated Review of Recent Scientific Evidence. Nutrients 2021; 13:nu13030879. [PMID: 33803089 PMCID: PMC8001413 DOI: 10.3390/nu13030879] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/01/2021] [Accepted: 03/03/2021] [Indexed: 12/21/2022] Open
Abstract
There is growing interest in the potential health-related effects of moderate alcohol consumption and, specifically, of beer. This review provides an assessment of beer-associated effects on cardiovascular and metabolic risk factors to identify a consumption level that can be considered “moderate”. We identified all prospective clinical studies and systematic reviews that evaluated the health effects of beer published between January 2007 and April 2020. Five of six selected studies found a protective effect of moderate alcohol drinking on cardiovascular disease (beer up to 385 g/week) vs. abstainers or occasional drinkers. Four out of five papers showed an association between moderate alcohol consumption (beer intake of 84 g alcohol/week) and decreased mortality risk. We concluded that moderate beer consumption of up to 16 g alcohol/day (1 drink/day) for women and 28 g/day (1–2 drinks/day) for men is associated with decreased incidence of cardiovascular disease and overall mortality, among other metabolic health benefits.
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23
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Brennan A, Angus C, Pryce R, Buykx P, Henney M, Gillespie D, Holmes J, Meier PS. Potential effects of minimum unit pricing at local authority level on alcohol-attributed harms in North West and North East England: a modelling study. PUBLIC HEALTH RESEARCH 2021. [DOI: 10.3310/phr09040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
In 2018, Scotland implemented a 50p-per-unit minimum unit price for alcohol. Previous modelling estimated the impact of minimum unit pricing for England, Scotland, Wales and Northern Ireland. Decision-makers want to know the potential effects of minimum unit pricing for local authorities in England; the premise of this study is that estimated effects of minimum unit pricing would vary by locality.
Objective
The objective was to estimate the potential effects on mortality, hospitalisations and crime of the implementation of minimum unit pricing for alcohol at local authority level in England.
Design
This was an evidence synthesis, and used computer modelling using the Sheffield Alcohol Policy Model (local authority version 4.0). This study gathered evidence on local consumption of alcohol from the Health Survey for England, and gathered data on local prices paid from the Living Costs and Food Survey and from market research companies’ actual sales data. These data were linked with local harms in terms of both alcohol-attributable mortality (from the Office for National Statistics) and alcohol-attributable hospitalisations (from Hospital Episode Statistics) for 45 conditions defined by the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision. These data were examined for eight age–sex groups split by five Index of Multiple Deprivation quintiles. Alcohol-attributable crime data (Office for National Statistics police-recorded crimes and uplifts for unrecorded offences) were also analysed.
Setting
This study was set in 23 upper-tier local authorities in North West England, 12 upper-tier local authorities in the North East region and nine government office regions, and a national summary was conducted.
Participants
The participants were the population of England aged ≥ 18 years.
Intervention
The intervention was setting a local minimum unit price. The base case is 50p per unit of alcohol. Sensitivity analyses were undertaken using minimum unit prices of 30p, 40p, 60p and 70p per unit of alcohol.
Main outcome measures
The main outcome measures were changes in alcohol-attributable deaths, hospitalisations and crime. Savings in NHS costs, changes in alcohol purchasing and consumption, changes in revenue to off-trade and on-trade retailers and changes in the slope index of inequality between most and least deprived areas were also examined.
Results
The modelling has proved feasible at the upper-tier local authority level. The resulting estimates suggest that minimum unit pricing for alcohol at local authority level could be effective in reducing alcohol-attributable deaths, hospitalisations, NHS costs and crime. A 50p minimum unit price for alcohol at local authority level is estimated to reduce annual alcohol-related deaths in the North West region by 205, hospitalisations by 5956 (–5.5%) and crimes by 8528 (–2.5%). These estimated reductions are mostly due to the 5% of people drinking at high-risk levels (e.g. men drinking > 25 pints of beer or five bottles of wine per week, women drinking > 17 pints of beer or 3.5 bottles of wine per week, and who spend around £2500 per year currently on alcohol). Model estimates of impact are bigger in the North West and North East regions than nationally because, currently, more cheap alcohol is consumed in these regions and because there are more alcohol-related deaths and hospitalisations in these areas. A 30p minimum unit price has estimated effects that are ≈ 90% lower than those of a 50p minimum unit price, and a 40p minimum unit price has estimated effects that are ≈ 50% lower. Health inequalities are estimated to reduce with greater health gains in the deprived areas, where more cheap alcohol is purchased and where there are higher baseline harms.
Limitations
The approach requires synthesis of evidence from multiple sources on alcohol consumption; prices paid; and incidence of diseases, mortality and crime. Price elasticities used are from previous UK analysis of price responsiveness rather than specific to local areas. The study has not estimated ‘cross-border effects’, namely travelling to shops outside the region.
Conclusions
The modelling estimates suggest that minimum unit pricing for alcohol at local authority level would be an effective and well-targeted policy, reducing inequalities.
Future work
The Sheffield Alcohol Policy Model for Local Authorities framework could be further utilised to examine the local impact of national policies (e.g. tax changes) or local policies (e.g. licensing or identification and brief advice). As evidence emerges from the Scottish minimum unit price implementation, this will further inform estimates of impact in English localities. The methods used to estimate drinking and purchasing patterns in each local authority could also be used for other topics involving unhealthy products affecting public health, for example to estimate local smoking or high-fat, high-salt food consumption patterns.
Funding
This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 9, No. 4. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Alan Brennan
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Colin Angus
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Robert Pryce
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Penny Buykx
- School of Health and Related Research, University of Sheffield, Sheffield, UK
- School of Humanities and Social Science, University of Newcastle, Newcastle, NSW, Australia
| | - Madeleine Henney
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Duncan Gillespie
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - John Holmes
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Petra S Meier
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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Cook WK, Tam CC, Luczak SE, Kerr WC, Mulia N, Lui C, Li L. Alcohol Consumption, Cardiovascular-Related Conditions, and ALDH2*2 Ethnic Group Prevalence in Asian Americans. Alcohol Clin Exp Res 2020; 45:418-428. [PMID: 33349921 DOI: 10.1111/acer.14539] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 12/14/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Little is known about the relationships between alcohol consumption and cardiovascular disease (CVD) and related chronic conditions in Asian Americans and how such risk relationships vary among their subgroups. We examine these relationships in Asian Americans and their moderation by ethnic prevalence of a variant the aldehyde dehydrogenase gene: ALDH2*2. METHODS Multiple logistic regression modeling was performed using a nationally representative sample of Asian-American adults aged 30 to 70 (n = 1,720) from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) Waves 2 (2004 to 2005) and 3 (2012 to 2013). Outcomes considered were diabetes, hypertension, high cholesterol, CVD, any of the 3 conditions (i.e., diabetes, high cholesterol, and CVD) documented to have a J-shaped relationship with drinking (CVDRC3), and any of the CVD-related conditions (ANYCVD). Demographic and socioeconomic characteristics, health insurance coverage, and other lifestyle risk factors (smoking and obesity/overweight) were adjusted. Analyses were stratified by gender. RESULTS Alcohol consumption level was positively associated only with hypertension in Asian males, with consuming 7 to 14 drinks per week associated with more than double the risk of lifetime abstinence. For females, alcohol consumption had a dose-response relationship with high cholesterol and CVDRC3. Membership in the higher ALDH2*2 ethnic group overall was associated with lower risk of CVD-related conditions. However, compared to abstainers in lower ALDH2*2 group, females in the higher ALDH2*2 group who consumed more than 7 drinks per week had a higher risk of diabetes, hypertension, CVDRC3, and ANYCVD. CONCLUSIONS Asian Americans may have increased risk of CVD-related conditions at relatively low alcohol consumption levels. Among Asian-American females, in particular, any amount of drinking may increase risk for high cholesterol or any of the CVD-related conditions previously documented to have a curvilinear relationship with drinking. These risks may be particularly elevated for those in ethnic groups with a high prevalence of ALDH2*2.
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Affiliation(s)
- Won Kim Cook
- Alcohol Research Group, Public Health Institute, Emeryville, CA, USA
| | - Christina C Tam
- Alcohol Research Group, Public Health Institute, Emeryville, CA, USA
| | | | - William C Kerr
- Alcohol Research Group, Public Health Institute, Emeryville, CA, USA
| | - Nina Mulia
- Alcohol Research Group, Public Health Institute, Emeryville, CA, USA
| | - Camillia Lui
- Alcohol Research Group, Public Health Institute, Emeryville, CA, USA
| | - Libo Li
- Alcohol Research Group, Public Health Institute, Emeryville, CA, USA
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25
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Holmes J, Beard E, Brown J, Brennan A, Kersbergen I, Meier PS, Michie S, Stevely AK, Buykx P. The impact of promoting revised UK low-risk drinking guidelines on alcohol consumption: interrupted time series analysis. PUBLIC HEALTH RESEARCH 2020. [DOI: 10.3310/phr08140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
The UK’s Chief Medical Officers revised the UK alcohol drinking guidelines in 2016 to ≤ 14 units per week (1 unit = 10 ml/8 g ethanol) for men and women. Previously, the guideline stated that men should not regularly consume more than 3–4 units per day and women should not regularly consume more than 2–3 units per day.
Objective
To evaluate the impact of promoting revised UK drinking guidelines on alcohol consumption.
Design
Interrupted time series analysis of observational data.
Setting
England, March 2014 to October 2017.
Participants
A total of 74,388 adults aged ≥ 16 years living in private households in England.
Interventions
Promotion of revised UK low-risk drinking guidelines.
Main outcome measures
Primary outcome – alcohol consumption measured by the Alcohol Use Disorders Identification Test – Consumption score. Secondary outcomes – average weekly consumption measured using graduated frequency, monthly alcohol consumption per capita adult (aged ≥ 16 years) derived from taxation data, monthly number of hospitalisations for alcohol poisoning (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision: T51.0, T51.1 and T51.9) and assault (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision: X85–Y09), and further measures of influences on behaviour change.
Data sources
The Alcohol Toolkit Study, a monthly cross-sectional survey and NHS Digital’s Hospital Episode Statistics.
Results
The revised drinking guidelines were not subject to large-scale promotion after the initial January 2016 announcement. An analysis of news reports found that mentions of the guidelines were mostly factual, and spiked during January 2016. In December 2015, the modelled average Alcohol Use Disorders Identification Test – Consumption score was 2.719 out of 12.000 and was decreasing by 0.003 each month. After the January 2016 announcement, Alcohol Use Disorders Identification Test – Consumption scores did not decrease significantly (β = 0.001, 95% confidence interval –0.079 to 0.099). However, the trend did change significantly such that scores subsequently increased by 0.005 each month (β = 0.008, 95% confidence interval 0.001 to 0.015). This change is equivalent to 0.5% of the population moving each month from drinking two or three times per week to drinking four or more times per week. Secondary analyses indicated that the change in trend began 6 months before the guideline announcement. The secondary outcome measures showed conflicting results, with no significant changes in consumption measures and no substantial changes in influences on behaviour change, but immediate reductions in hospitalisations of 7.3% for assaults and 15.4% for alcohol poisonings.
Limitations
The pre-intervention data collection period was only 2 months for influences on behaviour change and the graduated frequency measure. Our conclusions may be generalisable only to scenarios in which guidelines are announced but not promoted.
Conclusions
The announcement of revised UK low-risk drinking guidelines was not associated with clearly detectable changes in drinking behaviour. Observed reductions in alcohol-related hospitalisations are unlikely to be attributable to the revised guidelines. Promotion of the guidelines may have been prevented by opposition to the revised guidelines from the government's alcohol industry partners or because reduction in alcohol consumption was not a government priority or because practical obstacles prevented independent public health organisations from promoting the guidelines. Additional barriers to the effectiveness of guidelines may include low public understanding and a need for guidelines to engage more with how drinkers respond to and use them in practice.
Trial registration
Current Controlled Trials ISRCTN15189062.
Funding
This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 8, No. 14. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- John Holmes
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Emma Beard
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Cancer Research UK Health Behaviour Research Centre, University College London, London, UK
| | - Jamie Brown
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Cancer Research UK Health Behaviour Research Centre, University College London, London, UK
| | - Alan Brennan
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Inge Kersbergen
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Petra S Meier
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Susan Michie
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Abigail K Stevely
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Penny Buykx
- School of Health and Related Research, University of Sheffield, Sheffield, UK
- School of Humanities and Social Science, University of Newcastle, Newcastle, NSW, Australia
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26
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Meeting the Global NCD Target of at Least 10% Relative Reduction in the Harmful Use of Alcohol: Is the WHO European Region on Track? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103423. [PMID: 32423032 PMCID: PMC7277362 DOI: 10.3390/ijerph17103423] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/08/2020] [Accepted: 05/09/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND The Global Action Plan for the Prevention and Control of Noncommunicable Diseases set the target of an "at least 10% relative reduction in the harmful use of alcohol, as appropriate, within the national context". This study investigated progress in the World Health Organization (WHO) European Region towards this target based on two indicators: (a) alcohol per capita consumption (APC) and (b) the age-standardized prevalence of heavy episodic drinking (HED). METHODS Alcohol exposure data for the years 2010-2017 were based on country-validated data and statistical models. RESULTS Between 2010 and 2017, the reduction target for APC has been met with a decline by -12.4% (95% confidence interval (CI) -17.2, -7.0%) in the region. This progress differed greatly across the region with no decline for the EU-28 grouping (-2.4%; 95% CI -12.0, 7.8%) but large declines for the Eastern WHO EUR grouping (-26.2%; 95% CI -42.2, -8.1%). Little to no progress was made concerning HED, with an overall change of -1.7% (-13.7% to 10.2%) in the WHO European Region. CONCLUSIONS The findings indicate a divergence in alcohol consumption reduction in Europe, with substantial progress in the Eastern part of the region and very modest or no progress in EU countries.
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De Sio S, Tittarelli R, Di Martino G, Buomprisco G, Perri R, Bruno G, Pantano F, Mannocchi G, Marinelli E, Cedrone F. Alcohol consumption and employment: a cross-sectional study of office workers and unemployed people. PeerJ 2020; 8:e8774. [PMID: 32231881 PMCID: PMC7100587 DOI: 10.7717/peerj.8774] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 02/21/2020] [Indexed: 12/24/2022] Open
Abstract
Background Alcohol is a psychoactive substance with toxic and addictive properties. Biomarkers like GGT, AST, ALT and MCV are influenced by excessive ethanol consumption. Alcohol consumption represents a health risk and it has been linked to unemployment. The aim of this study how working status predict alcohol consumption through a cross sectional study comparing alcohol-related biomarkers levels in office workers and unemployed people. Methods This study includes 157 office workers and 157 unemployed people, who were recruited from January to December 2018. A propensity score matching procedure was applied to obtain two homogenous groups in terms of age and gender. A non-parametric analysis was performed on serum biomarkers that are generally altered by alcohol consumption. Logistic regression models were designed to evaluate how working status predict abnormal biomarker levels related with alcohol consumption. Results No differences in median biomarker values were found between groups. Logistic regression analysis showed that office work is a negative predictor of pathological biomarker levels. Office workers had a significant relation with the levels of GGT (OR 0.48; 95% CI [0.28–0.84]), AST (OR 0.42; 95% CI [0.22–0.78]), ALT (OR 0.39; 95% CI [0.23–0.66]), and MCV (OR 0.37; 95% CI [0.19–0.70]). Conclusion Office workers had lower absolute frequencies of pathological values of alcohol consumption biomarkers, after matching for age and gender compared with unemployed people. In addition, a significant negative association between office work is a negative predictor of biomarker levels of alcohol consumption. These results showed that work is an important determinant of health and that can represent a benefit for workers in terms of reducing the risk of consuming alcohol.
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Affiliation(s)
- Simone De Sio
- School of Occupational Medicine-U.R. Occupational Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Roberta Tittarelli
- Unit of Forensic Toxicology, Department of Anatomical, Histological, Forensic and Orthopedic Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Giuseppe Di Martino
- School of Hygiene and Preventive Medicine, University "G.d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Giuseppe Buomprisco
- School of Occupational Medicine-U.R. Occupational Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Roberto Perri
- School of Occupational Medicine-U.R. Occupational Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Guglielmo Bruno
- School of Occupational Medicine-U.R. Occupational Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Flaminia Pantano
- Unit of Forensic Toxicology-Department of Anatomical, Histological, Forensic and Orthopedic Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Giulio Mannocchi
- Bioethics and Legal Medicine Centre, School of Law, University of Camerino, Camerino, Italy
| | - Enrico Marinelli
- Unit of Forensic Toxicology-Department of Anatomical, Histological, Forensic and Orthopedic Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Fabrizio Cedrone
- School of Hygiene and Preventive Medicine, University "G.d'Annunzio" of Chieti-Pescara, Chieti, Italy
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28
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Barnett SBL, Coe NB, Harris JR, Basu A. Washington's privatization of liquor: effects on household alcohol purchases from Initiative 1183. Addiction 2020; 115:681-689. [PMID: 31670853 PMCID: PMC8509083 DOI: 10.1111/add.14875] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 03/05/2018] [Accepted: 10/23/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Washington Initiative 1183 (I-1183), a 2012 law that privatized liquor retail sales and distribution in Washington State, USA, has had two opposing effects on liquor purchases: it has increased access to liquor and imposed new fees on retailers and distributors. This study aimed to estimate the effect of I-1183 on monthly alcohol purchases during the post-I-1183 period (June 2012-December 2014) compared with the pre-I-1183 period (January 2010-May 2012). DESIGN DIFFERENCES-IN-DIFFERENCES STUDY: Setting and participants The study included households participating in the Nielsen Consumer Panel Dataset living in metropolitan and surrounding areas in Washington State and 10 control states. Measurements Outcomes were alcohol purchases by type (ounces of liquor, wine, beer and total alcohol or ethanol). Findings I-1183 was associated with a 6.34-ounce (P < 0.001) and a 2.01-ounce (P < 0.001) increase in monthly liquor and ethanol purchases, respectively, per household in the post-policy period spanning 31 months compared with monthly purchases in control states. In a longitudinal subgroup analysis, low and moderate alcohol purchasers increased monthly purchases of ethanol and high purchasers decreased purchases of ethanol. Conclusions Enacting 'Washington Initiative 1183', a law that privatized sale and distribution of liquor and imposed new fees on retailers and distributors, appears to have been associated with an approximate 82% increase in monthly liquor purchases and 26% increase in monthly ethanol purchases by households in metropolitan and surrounding areas in Washington State, USA.
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Affiliation(s)
- Sarah Beth L. Barnett
- Alcohol Research Group, 6001 Shellmound St. Ste 450, Emeryville, CA 94608,School of Public Health, UC Berkeley, 50 University Hall #7360, Berkeley, CA 94720,Corresponding author
| | - Norma B. Coe
- Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd Building 421, Philadelphia, PA 19104,National Bureau of Economic Research (NBER), 1050 Massachusetts Ave, Cambridge, MA 02138
| | - Jeffrey R. Harris
- School of Public Health, Department of Health Services, University of Washington, 1959 NE Pacific St, Seattle, WA 98195
| | - Anirban Basu
- National Bureau of Economic Research (NBER), 1050 Massachusetts Ave, Cambridge, MA 02138,School of Public Health, Department of Health Services, University of Washington, 1959 NE Pacific St, Seattle, WA 98195,School of Pharmacy, University of Washington, 1959 NE Pacific St, Seattle, WA 98195
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29
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Rehm J, Shield K. Alcohol Use and Cancers of the Gastrointestinal Tract. Epidemiology and Preventive Implications. Front Oncol 2020; 10:403. [PMID: 32269967 PMCID: PMC7109294 DOI: 10.3389/fonc.2020.00403] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 03/06/2020] [Indexed: 12/15/2022] Open
Abstract
Introduction: Alcohol is a carcinogen for human cancer. This contribution summarizes the relationships between alcohol use and gastrointestinal cancers, and implications for prevention. Methods: Comparative risk assessment and narrative literature review. Results: The following gastrointestinal cancer sites were found to be causally impacted by alcohol use: lip and oral cavity, pharynx other than nasopharynx, esophagus, colon and rectum, and liver. Globally, 368,000 deaths (304,000 men and 64,000 women) and more than 10 million disability-adjusted life years (DALYs) lost (10.1 million; 8.4 million men and 1.6 million women) in 2016 were attributable to alcohol use, making up about 10% of all deaths and DALYs lost due to these cancers, respectively. There are effective and cost-effective alcohol control policies available to reduce this burden, namely the best buys of increasing taxation, reducing availability, and banning advertisement. In addition, public knowledge about the alcohol-cancer link should be increased. Discussion: There are a number of assumptions underlying these estimates, but overall all of them seem to be conservative.
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Affiliation(s)
- Jürgen Rehm
- Centre for Addiction and Mental Health (CAMH), Institute for Mental Health Policy Research, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Institute of Clinical Psychology and Psychotherapy, Faculty of Psychology, School of Science, Technische Universität Dresden, Dresden, Germany
- Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Kevin Shield
- Centre for Addiction and Mental Health (CAMH), Institute for Mental Health Policy Research, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, Toronto, ON, Canada
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30
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Wallach JD, Serghiou S, Chu L, Egilman AC, Vasiliou V, Ross JS, Ioannidis JPA. Evaluation of confounding in epidemiologic studies assessing alcohol consumption on the risk of ischemic heart disease. BMC Med Res Methodol 2020; 20:64. [PMID: 32171256 PMCID: PMC7071725 DOI: 10.1186/s12874-020-0914-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 01/27/2020] [Indexed: 01/22/2023] Open
Abstract
Background Among different investigators studying the same exposures and outcomes, there may be a lack of consensus about potential confounders that should be considered as matching, adjustment, or stratification variables in observational studies. Concerns have been raised that confounding factors may affect the results obtained for the alcohol-ischemic heart disease relationship, as well as their consistency and reproducibility across different studies. Therefore, we assessed how confounders are defined, operationalized, and discussed across individual studies evaluating the impact of alcohol on ischemic heart disease risk. Methods For observational studies included in a recent alcohol-ischemic heart disease meta-analysis, we identified all variables adjusted, matched, or stratified for in the largest reported multivariate model (i.e. potential confounders). We recorded how the variables were measured and grouped them into higher-level confounder domains. Abstracts and Discussion sections were then assessed to determine whether authors considered confounding when interpreting their study findings. Results 85 of 87 (97.7%) studies reported multivariate analyses for an alcohol-ischemic heart disease relationship. The most common higher-level confounder domains included were smoking (79, 92.9%), age (74, 87.1%), and BMI, height, and/or weight (57, 67.1%). However, no two models adjusted, matched, or stratified for the same higher-level confounder domains. Most (74/87, 85.1%) articles mentioned or alluded to “confounding” in their Abstract or Discussion sections, but only one stated that their main findings were likely to be affected by residual confounding. There were five (5/87, 5.7%) authors that explicitly asked for caution when interpreting results. Conclusion There is large variation in the confounders considered across observational studies evaluating the impact of alcohol on ischemic heart disease risk and almost all studies spuriously ignore or eventually dismiss confounding in their conclusions. Given that study results and interpretations may be affected by the mix of potential confounders included within multivariate models, efforts are necessary to standardize approaches for selecting and accounting for confounders in observational studies.
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Affiliation(s)
- Joshua D Wallach
- Department of Environmental Health Sciences, Yale School of Public Health, 60 College Street, 4th Floor, Room 411, New Haven, CT, 06510, USA. .,Collaboration for Research Integrity and Transparency (CRIT), Yale School of Medicine, New Haven, CT, 06510, USA. .,Center for Outcomes Research and Evaluation, Yale-New Haven Health System, New Haven, CT, 06510, USA.
| | - Stylianos Serghiou
- Meta-Research Innovation Center at Stanford (METRICS), Stanford School of Medicine, 1265 Welch Rd, MSOB X306, Stanford, CA, 94305, USA.,Department of Epidemiology & Population Health, Stanford School of Medicine, 150 Governor's Lane, Stanford, CA, 94305, USA
| | - Lingzhi Chu
- Department of Environmental Health Sciences, Yale School of Public Health, 60 College Street, 4th Floor, Room 411, New Haven, CT, 06510, USA
| | - Alexander C Egilman
- Collaboration for Research Integrity and Transparency (CRIT), Yale School of Medicine, New Haven, CT, 06510, USA.,Center for Outcomes Research and Evaluation, Yale-New Haven Health System, New Haven, CT, 06510, USA
| | - Vasilis Vasiliou
- Department of Environmental Health Sciences, Yale School of Public Health, 60 College Street, 4th Floor, Room 411, New Haven, CT, 06510, USA
| | - Joseph S Ross
- Center for Outcomes Research and Evaluation, Yale-New Haven Health System, New Haven, CT, 06510, USA.,Section of General Medicine, Department of Internal Medicine, Yale School of Medicine, 367 Cedar Street, Ste 405B, New Haven, CT, 06510, USA.,National Clinician Scholars Program, Yale School of Medicine, 367 Cedar Street, Ste 405B, New Haven, CT, 06510, USA.,Department of Health Policy and Management, Yale School of Public Health, 60 College Street, New Haven, CT, 06510, USA
| | - John P A Ioannidis
- Meta-Research Innovation Center at Stanford (METRICS), Stanford School of Medicine, 1265 Welch Rd, MSOB X306, Stanford, CA, 94305, USA.,Department of Epidemiology & Population Health, Stanford School of Medicine, 150 Governor's Lane, Stanford, CA, 94305, USA.,Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, 1265 Welch Rd, MSOB X306, Stanford, CA, 94305, USA.,Department of Statistics, Stanford University School of Humanities and Sciences, Stanford, CA, 94305, USA
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31
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Lui CK, Kerr WC, Li L, Mulia N, Ye Y, Williams E, Greenfield TK, Lown EA. Lifecourse Drinking Patterns, Hypertension, and Heart Problems Among U.S. Adults. Am J Prev Med 2020; 58:386-395. [PMID: 31928761 PMCID: PMC7176748 DOI: 10.1016/j.amepre.2019.10.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 10/22/2019] [Accepted: 10/23/2019] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Understanding the role of alcohol in hypertension and heart problems requires a lifecourse perspective accounting for drinking patterns before onset of health problems that distinguishes between lifetime abstinence and former drinking, prior versus current drinking, and overall alcohol consumption in conjunction with heavy episodic drinking. Using prospective data among U.S. adults aged 21-55 years, this study accounts for these lifecourse factors to investigate the effect of alcohol on hypertension and heart problems. METHODS Data from the U.S. National Longitudinal Survey of Youth, aged 14-21 years in 1979 and followed through 2012 (n=8,289), were analyzed in 2017-18 to estimate hypertension and heart problems onset from lifecourse drinking patterns. Discrete-time survival models stratified by sex and race/ethnicity, controlling for demographics and time-varying factors of employment, smoking, and obesity. RESULTS Elevated risks for hypertension were found for women drinking >14 drinks/week regardless of any heavy drinking (AOR=1.57, p=0.023) and for men engaged in risky drinking (15-28 drinks/week) together with monthly heavy drinking (AOR=1.64, p=0.016). Having a history of weekly heavy drinking elevated the risk for women but not for men. No significant relationship was evident for alcohol and heart problems onset. CONCLUSIONS This study confirms previous findings of increased hypertension risk from higher volume and heavier drinking patterns among women and men but did not find any support for increased heart problems risk, which may be due to the younger age profile of the sample. Further research that incorporates lifecourse drinking patterns is needed to better understand the alcohol-health relationship.
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Affiliation(s)
- Camillia K Lui
- Alcohol Research Group, Public Health Institute, Emeryville, California.
| | - William C Kerr
- Alcohol Research Group, Public Health Institute, Emeryville, California
| | - Libo Li
- Alcohol Research Group, Public Health Institute, Emeryville, California
| | - Nina Mulia
- Alcohol Research Group, Public Health Institute, Emeryville, California
| | - Yu Ye
- Alcohol Research Group, Public Health Institute, Emeryville, California
| | - Edwina Williams
- Alcohol Research Group, Public Health Institute, Emeryville, California
| | | | - E Anne Lown
- Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, San Francisco, California
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32
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Association of coincident self-reported mental health problems and alcohol intake with all-cause and cardiovascular disease mortality: A Norwegian pooled population analysis. PLoS Med 2020; 17:e1003030. [PMID: 32012170 PMCID: PMC6996806 DOI: 10.1371/journal.pmed.1003030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 01/06/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The disease burden attributable to mental health problems and to excess or harmful alcohol use is considerable. Despite a strong relationship between these 2 important factors in population health, there are few studies quantifying the mortality risk associated with their co-occurrence in the general population. The aim of this study was therefore to investigate cardiovascular disease (CVD) and all-cause mortality according to self-reported mental health problems and alcohol intake in the general population. METHODS AND FINDINGS We followed 243,372 participants in Norwegian health surveys (1994-2002) through 2014 for all-cause and CVD mortality by data linkage to national registries. The mean (SD) age at the time of participation in the survey was 43.9 (10.6) years, and 47.8% were men. During a mean (SD) follow-up period of 16.7 (3.2) years, 6,587 participants died from CVD, and 21,376 died from all causes. Cox models estimated hazard ratios (HRs) with 95% CIs according to a mental health index (low, 1.00-1.50; high, 2.01-4.00; low score is favourable) based on the General Health Questionnaire and the Hopkins Symptom Checklist, and according to self-reported alcohol intake (low, <2; light, 2-11.99; moderate, 12-23.99; high, ≥24 grams/day). HRs were adjusted for age, sex, educational level, marital status, and CVD risk factors. Compared to a reference group with low mental health index score and low alcohol intake, HRs (95% CIs) for all-cause mortality were 0.93 (0.89, 0.97; p = 0.001), 1.00 (0.92, 1.09; p = 0.926), and 1.14 (0.96, 1.35; p = 0.119) for low index score combined with light, moderate, and high alcohol intake, respectively. HRs (95% CIs) were 1.22 (1.14, 1.31; p < 0.001), 1.24 (1.15, 1.33; p < 0.001), 1.43 (1.23, 1.66; p < 0.001), and 2.29 (1.87, 2.80; p < 0.001) for high index score combined with low, light, moderate, and high alcohol intake, respectively. For CVD mortality, HRs (95% CIs) were 0.93 (0.86, 1.00; p = 0.058), 0.90 (0.76, 1.07; p = 0.225), and 0.95 (0.67, 1.33; p = 0.760) for a low index score combined with light, moderate, and high alcohol intake, respectively, and 1.11 (0.98, 1.25; p = 0.102), 0.97 (0.83, 1.13; p = 0.689), 1.01 (0.71, 1.44; p = 0.956), and 1.78 (1.14, 2.78; p = 0.011) for high index score combined with low, light, moderate, and high alcohol intake, respectively. HRs for the combination of a high index score and high alcohol intake (HRs: 2.29 for all-cause and 1.78 for CVD mortality) were 64% (95% CI 53%, 74%; p < 0.001) and 69% (95% CI 42%, 97%; p < 0.001) higher than expected for all-cause mortality and CVD mortality, respectively, under the assumption of a multiplicative interaction structure. A limitation of our study is that the findings were based on average reported intake of alcohol without accounting for the drinking pattern. CONCLUSIONS In the general population, the mortality rates associated with more mental health problems and a high alcohol intake were increased when the risk factors occurred together.
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Marees AT, Smit DJA, Ong JS, MacGregor S, An J, Denys D, Vorspan F, van den Brink W, Derks EM. Potential influence of socioeconomic status on genetic correlations between alcohol consumption measures and mental health. Psychol Med 2020; 50:484-498. [PMID: 30874500 PMCID: PMC7083578 DOI: 10.1017/s0033291719000357] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 02/01/2019] [Accepted: 02/12/2019] [Indexed: 11/06/2022]
Abstract
BACKGROUND Frequency and quantity of alcohol consumption are metrics commonly used to measure alcohol consumption behaviors. Epidemiological studies indicate that these alcohol consumption measures are differentially associated with (mental) health outcomes and socioeconomic status (SES). The current study aims to elucidate to what extent genetic risk factors are shared between frequency and quantity of alcohol consumption, and how these alcohol consumption measures are genetically associated with four broad phenotypic categories: (i) SES; (ii) substance use disorders; (iii) other psychiatric disorders; and (iv) psychological/personality traits. METHODS Genome-Wide Association analyses were conducted to test genetic associations with alcohol consumption frequency (N = 438 308) and alcohol consumption quantity (N = 307 098 regular alcohol drinkers) within UK Biobank. For the other phenotypes, we used genome-wide association studies summary statistics. Genetic correlations (rg) between the alcohol measures and other phenotypes were estimated using LD score regression. RESULTS We found a substantial genetic correlation between the frequency and quantity of alcohol consumption (rg = 0.52). Nevertheless, both measures consistently showed opposite genetic correlations with SES traits, and many substance use, psychiatric, and psychological/personality traits. High alcohol consumption frequency was genetically associated with high SES and low risk of substance use disorders and other psychiatric disorders, whereas the opposite applies for high alcohol consumption quantity. CONCLUSIONS Although the frequency and quantity of alcohol consumption show substantial genetic overlap, they consistently show opposite patterns of genetic associations with SES-related phenotypes. Future studies should carefully consider the potential influence of SES on the shared genetic etiology between alcohol and adverse (mental) health outcomes.
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Affiliation(s)
- Andries T. Marees
- Department of Psychiatry, Amsterdam UMC, Amsterdam Neuroscience, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Translational Neurogenomics Group, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Dirk J. A. Smit
- Department of Psychiatry, Amsterdam UMC, Amsterdam Neuroscience, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Jue-Sheng Ong
- Statistical Genetics, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Stuart MacGregor
- Statistical Genetics, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Jiyuan An
- Statistical Genetics, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Damiaan Denys
- Department of Psychiatry, Amsterdam UMC, Amsterdam Neuroscience, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Florence Vorspan
- Assistance Publique – Hôpitaux de Paris, Hôpital Fernand Widal, Département de Psychiatrie et de Médecine Addictologique, 200 rue du Faubourg Saint Denis, 75010Paris, France
- Inserm umr-s 1144, Université Paris Descartes, Université Paris Diderot, 4 avenue de l'Observatoire, 75006Paris, France
| | - Wim van den Brink
- Department of Psychiatry, Amsterdam UMC, Amsterdam Neuroscience, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Eske M. Derks
- Department of Psychiatry, Amsterdam UMC, Amsterdam Neuroscience, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Translational Neurogenomics Group, QIMR Berghofer Medical Research Institute, Brisbane, Australia
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Hu EA, Lazo M, Rosenberg SD, Grams ME, Steffen LM, Coresh J, Rebholz CM. Alcohol Consumption and Incident Kidney Disease: Results From the Atherosclerosis Risk in Communities Study. J Ren Nutr 2020; 30:22-30. [PMID: 30850190 PMCID: PMC6728235 DOI: 10.1053/j.jrn.2019.01.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 01/16/2019] [Accepted: 01/21/2019] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE(S) Moderate alcohol consumption has been found to be associated with lower risk of coronary heart disease and myocardial infarction, which share similar risk factors and pathophysiology with chronic kidney disease (CKD). However, there is inconsistent evidence on the association between alcohol consumption and CKD. DESIGN AND METHODS We conducted a prospective analysis of 12,692 participants aged 45-64 years from the Atherosclerosis Risk in Communities (ARIC) study. We categorized participants into 6 alcohol consumption categories: never drinkers, former drinkers, ≤1 drink per week, 2 to 7 drinks per week, 8 to 14 drinks per week, and ≥15 drinks per week based on food frequency questionnaire responses at visit 1 (1987-1989). Incident CKD was defined as estimated glomerular filtration rate <60 mL/minute/1.73 m2 accompanied by ≥25% estimated glomerular filtration rate decline, a kidney disease-related hospitalization or death or end-stage renal disease. RESULTS During a median follow-up of 24 years, there were 3,664 cases of incident CKD. Current drinkers were more likely to be men, whites, and to have a higher income level and education level. After adjusting for total energy intake, age, sex, race-center, income, education level, health insurance, smoking, and physical activity, there was no significant association between being a former drinker and risk of incident CKD. Participants who drank ≤1 drink per week, 2 to 7 drinks per week, 8 to 14 drinks per week, and ≥15 drinks per week had, respectively, a 12% (hazard ratio [HR]: 0.88, 95% confidence interval [CI]: 0.79-0.97), 20% (HR: 0.80, 95% CI: 0.72-0.89), 29% (HR: 0.71, 95% CI: 0.62-0.83), and 23% (HR: 0.77, 95% CI: 0.65-0.91) lower risk of CKD compared with never drinkers. CONCLUSION(S) Consuming a low or moderate amount of alcohol may lower the risk of developing CKD. Therefore, moderate consumption of alcohol may not likely be harmful to the kidneys.
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Affiliation(s)
- Emily A Hu
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Mariana Lazo
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Sarah D Rosenberg
- Department of Medicine, University of California San Diego, San Diego, California
| | - Morgan E Grams
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland; Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lyn M Steffen
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - Josef Coresh
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Casey M Rebholz
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
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Sherk A, Gilmore W, Churchill S, Lensvelt E, Stockwell T, Chikritzhs T. Implications of Cardioprotective Assumptions for National Drinking Guidelines and Alcohol Harm Monitoring Systems. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E4956. [PMID: 31817638 PMCID: PMC6950575 DOI: 10.3390/ijerph16244956] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 11/29/2019] [Accepted: 12/01/2019] [Indexed: 01/16/2023]
Abstract
The existence and potential level of cardioprotection from alcohol use is contested in alcohol studies. Assumptions regarding the risk relationship between alcohol use and ischaemic heart disease (IHD) are critical when providing advice for national drinking guidelines and for designing alcohol harm monitoring systems. We use three meta-analyses regarding alcohol use and IHD risk to investigate how varying assumptions lead to differential estimates of alcohol-attributable (AA) deaths and weighted relative risk (RR) functions, in Australia and Canada. Alcohol exposure and mortality data were acquired from administrative sources and AA fractions were calculated using the International Model of Alcohol Harms and Policies. We then customized a recent Global Burden of Disease (GBD) analysis to inform drinking guidelines internationally. Australians drink slightly more than Canadians, per person, but are also more likely to identify as lifetime abstainers. Cardioprotective scenarios resulted in substantial differences in estimates of net AA deaths in Australia (between 2933 and 4570) and Canada (between 5179 and 8024), using GBD risk functions for all other alcohol-related conditions. Country-specific weighted RR functions were analyzed to provide advice toward drinking guidelines: Minimum risk was achieved at or below alcohol use levels of 10 g/day ethanol, depending on scenario. Consumption levels resulting in 'no added' risk from drinking were found to be between 10 and 15 g/day, by country, gender, and scenario. These recommendations are lower than current guidelines in Australia, Canada, and some other high-income countries: These guidelines may be in need of downward revision.
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Affiliation(s)
- Adam Sherk
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC V8P 5C2, Canada; (S.C.); (T.S.)
| | - William Gilmore
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, WA 6845, Australia; (W.G.); (E.L.); (T.C.)
| | - Samuel Churchill
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC V8P 5C2, Canada; (S.C.); (T.S.)
| | - Eveline Lensvelt
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, WA 6845, Australia; (W.G.); (E.L.); (T.C.)
| | - Tim Stockwell
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC V8P 5C2, Canada; (S.C.); (T.S.)
| | - Tanya Chikritzhs
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, WA 6845, Australia; (W.G.); (E.L.); (T.C.)
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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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Cuesta A, Haseeb S, Aquistapache F, Grosso P, Alexander B, Hopman W, Santi RL, Baranchuk A. Alcohol consumption and cardiovascular health: A nationwide survey of Uruguayan cardiologists. Alcohol 2019; 79:163-169. [PMID: 30769023 DOI: 10.1016/j.alcohol.2019.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 01/20/2019] [Accepted: 02/05/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Heavy alcohol use is a risk factor for disease and mortality; however, epidemiological findings have demonstrated protective effects of a light-to-moderate intake of alcohol on cardiovascular health. There are many misconceptions regarding appropriate levels of alcohol intake and the risks and benefits of consumption. We sought to examine physician attitudes and recommendations regarding alcohol intake in a cohort of Uruguayan cardiologists. METHODS A cross-sectional survey of 25 questions was distributed through the Uruguayan Society of Cardiology to attending cardiologists and advanced cardiology trainees. RESULTS There were 298 respondents; 237 were attending cardiologists and 61 were advanced cardiology trainees. In total, 34% of cardiologists viewed moderate alcohol intake to be beneficial for cardiovascular health, 27% believed only wine offered such benefits, 36% viewed any intake to be harmful, and 3% had other opinions. More than half (57%) self-reported their perceived knowledge to come from academic sources. Regarding knowledge of guidelines, only 42% were aware of the concept of 'standard drink' (SD). Cardiologists were not comfortable (on a Likert scale) converting SD into other metric units (1.92 ± 2.77). Cardiologists were not satisfied with their knowledge of drinking guidelines (2.42 ± 2.63); however, men were more comfortable than women (p = 0.003). Cardiologists were generally comfortable in counseling patients regarding safe limits of consumption (5.46 ± 3.08, on a 0-10 scale). CONCLUSIONS Uruguayan cardiologists were not satisfied with their knowledge of drinking guidelines or understanding of the alcohol metric units. This study suggests a necessity to optimize educational resources for physicians.
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The Consumption of Alcoholic Beverages and the Prevalence of Cardiovascular Diseases in Men and Women: A Cross-Sectional Study. Nutrients 2019; 11:nu11061318. [PMID: 31212846 PMCID: PMC6628509 DOI: 10.3390/nu11061318] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 06/08/2019] [Accepted: 06/11/2019] [Indexed: 12/11/2022] Open
Abstract
Associations between alcohol consumption and the prevalence of cardiovascular diseases have been the subject of several studies for a long time; however, the presence and nature of any associations still remain unclear. The aim of the study was to analyze the associations between the consumption of alcoholic beverages and the prevalence of cardiovascular diseases in men and women. The data of 12,285 individuals aged 37-66 were used in the analysis. Multiple logistic regression models were utilized to estimate odds ratios and confidence intervals. The multivariable models included several potential confounders including age, education, marital status, body mass index (BMI), physical activity, smoking, coffee consumption, and statin use. The analyses were performed separately for men and women. In the model adjusted for confounders, the consumption from 0.1 to 10.0 g of alcohol/day was related to a lower risk of coronary disease and stroke (p < 0.05), and the consumption from 0.1 to 15.0 g/day was related to a lower risk of hypertension in women (p < 0.05). In men, in the adjusted model, there were no associations between alcohol consumption and the occurrence of hypertension or stroke. The risk of circulatory failure was significantly lower in the group in which participants drank more than 20.0 g of alcohol/day (p < 0.05) compared to nondrinkers. The risk of coronary disease was lower in drinkers at every level of alcohol consumption (p < 0.05) compared to nondrinkers. Alcohol consumption was related to a lower prevalence of cardiovascular diseases (CVD), both in men and women.
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Millwood IY, Walters RG, Mei XW, Guo Y, Yang L, Bian Z, Bennett DA, Chen Y, Dong C, Hu R, Zhou G, Yu B, Jia W, Parish S, Clarke R, Davey Smith G, Collins R, Holmes MV, Li L, Peto R, Chen Z. Conventional and genetic evidence on alcohol and vascular disease aetiology: a prospective study of 500 000 men and women in China. Lancet 2019; 393:1831-1842. [PMID: 30955975 PMCID: PMC6497989 DOI: 10.1016/s0140-6736(18)31772-0] [Citation(s) in RCA: 279] [Impact Index Per Article: 55.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 07/21/2018] [Accepted: 07/24/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Moderate alcohol intake has been associated with reduced cardiovascular risk in many studies, in comparison with abstinence or with heavier drinking. Studies in east Asia can help determine whether these associations are causal, since two common genetic variants greatly affect alcohol drinking patterns. We used these two variants to assess the relationships between cardiovascular risk and genotype-predicted mean alcohol intake in men, contrasting the findings in men with those in women (few of whom drink). METHODS The prospective China Kadoorie Biobank enrolled 512 715 adults between June 25, 2004, and July 15, 2008, from ten areas of China, recording alcohol use and other characteristics. It followed them for about 10 years (until Jan 1, 2017), monitoring cardiovascular disease (including ischaemic stroke, intracerebral haemorrhage, and myocardial infarction) by linkage with morbidity and mortality registries and electronic hospital records. 161 498 participants were genotyped for two variants that alter alcohol metabolism, ALDH2-rs671 and ADH1B-rs1229984. Adjusted Cox regression was used to obtain the relative risks associating disease incidence with self-reported drinking patterns (conventional epidemiology) or with genotype-predicted mean male alcohol intake (genetic epidemiology-ie, Mendelian randomisation), with stratification by study area to control for variation between areas in disease rates and in genotype-predicted intake. FINDINGS 33% (69 897/210 205) of men reported drinking alcohol in most weeks, mainly as spirits, compared with only 2% (6245/302 510) of women. Among men, conventional epidemiology showed that self-reported alcohol intake had U-shaped associations with the incidence of ischaemic stroke (n=14 930), intracerebral haemorrhage (n=3496), and acute myocardial infarction (n=2958); men who reported drinking about 100 g of alcohol per week (one to two drinks per day) had lower risks of all three diseases than non-drinkers or heavier drinkers. In contrast, although genotype-predicted mean male alcohol intake varied widely (from 4 to 256 g per week-ie, near zero to about four drinks per day), it did not have any U-shaped associations with risk. For stroke, genotype-predicted mean alcohol intake had a continuously positive log-linear association with risk, which was stronger for intracerebral haemorrhage (relative risk [RR] per 280 g per week 1·58, 95% CI 1·36-1·84, p<0·0001) than for ischaemic stroke (1·27, 1·13-1·43, p=0·0001). For myocardial infarction, however, genotype-predicted mean alcohol intake was not significantly associated with risk (RR per 280 g per week 0·96, 95% CI 0·78-1·18, p=0·69). Usual alcohol intake in current drinkers and genotype-predicted alcohol intake in all men had similarly strong positive associations with systolic blood pressure (each p<0·0001). Among women, few drank and the studied genotypes did not predict high mean alcohol intake and were not positively associated with blood pressure, stroke, or myocardial infarction. INTERPRETATION Genetic epidemiology shows that the apparently protective effects of moderate alcohol intake against stroke are largely non-causal. Alcohol consumption uniformly increases blood pressure and stroke risk, and appears in this one study to have little net effect on the risk of myocardial infarction. FUNDING Chinese Ministry of Science and Technology, Kadoorie Charitable Foundation, National Natural Science Foundation of China, British Heart Foundation, Cancer Research UK, GlaxoSmithKline, Medical Research Council, and Wellcome Trust.
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Affiliation(s)
- Iona Y Millwood
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Robin G Walters
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Xue W Mei
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Yu Guo
- Chinese Academy of Medical Sciences, Beijing, China
| | - Ling Yang
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Zheng Bian
- Chinese Academy of Medical Sciences, Beijing, China
| | - Derrick A Bennett
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Yiping Chen
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Caixia Dong
- Gansu Provincial Center for Disease Control and Prevention, Lanzhou, China
| | - Ruying Hu
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Gang Zhou
- Henan Center for Disease Control and Prevention, Zhengzhou, China
| | - Bo Yu
- Nangang Center for Disease Control and Prevention, Harbin, China
| | - Weifang Jia
- Liuyang Center for Disease Control and Prevention, Changsha, China
| | - Sarah Parish
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Robert Clarke
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - George Davey Smith
- Medical Research Council Integrative Epidemiology Unit, Population Health Sciences, University of Bristol, Bristol, UK
| | - Rory Collins
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Michael V Holmes
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Liming Li
- Department of Epidemiology and Biostatistics, Peking University Health Science Center, Peking University, Beijing, China.
| | - Richard Peto
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Zhengming Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
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Zapata PJ, Martínez-Esplá A, Gironés-Vilaplana A, Santos-Lax D, Noguera-Artiaga L, Carbonell-Barrachina ÁA. Phenolic, volatile, and sensory profiles of beer enriched by macerating quince fruits. Lebensm Wiss Technol 2019. [DOI: 10.1016/j.lwt.2019.01.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
AbstractObjectiveThe aim of the present study was to clarify the global relationship between Mediterranean diet score (MDS) and the incidence of IHD by country using international statistics.DesignThe incidence of IHD by country was derived from the Global Burden of Disease (GBD) database. Average supplies of food (g/d per capita) and energy (kcal/d per capita) by country, excluding loss between production and household, were obtained from the FAOSTAT database. MDS was evaluated based on the total score of nine food items that characterize the Mediterranean diet. The association between MDS and the incidence of IHD was examined in countries with a population of 1 million or greater using a general linear model controlled for socio-economic and lifestyle variables.SettingPopulation data from global international databases.ParticipantsOne hundred and thirty-two countries with a population of over 1 million.ResultsMDS was inversely correlated with obesity rate, ageing rate, years of education and IHD incidence; however, no associations were found with gross domestic product, life expectancy, smoking rate, energy supply or health expenditure. In the general linear model of IHD incidence by MDS controlled for socio-economic and lifestyle variables, the β of the MDS was –26·4 (se 8·6; P<0·01).ConclusionsThe results of this global international comparative study confirmed that the Mediterranean diet is inversely associated with the incidence of IHD.
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Fan AZ, Ruan WJ, Chou SP. Re-examining the relationship between alcohol consumption and coronary heart disease with a new lens. Prev Med 2019; 118:336-343. [PMID: 30508551 PMCID: PMC7571539 DOI: 10.1016/j.ypmed.2018.11.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 11/27/2018] [Accepted: 11/30/2018] [Indexed: 10/27/2022]
Abstract
Moderate alcohol consumption has been related to lower risk of coronary heart disease (CHD) in the literature. To examine whether alcohol drinking during the past 12 months and heaviest drinking period were differentially associated with the risk of CHD, we designed a case-control study using a population-based health survey of U.S. adults conducted from 2012 to 2013. Respondents who reported to have doctor-ascertained CHD served as cases (n = 1671), and those free of CHD and other alcohol-related health conditions served as controls (n = 17,629) in logistic regressions. Sex-specific quartiles of average daily ethanol intake were ascertained and calculated for the past 12 months and during the period of heaviest lifetime drinking. We further split current drinkers into reducers and non-reducers (past 12 months relative to the heaviest drinking period) to examine CHD risk profiles in association with the 12-month drinking level. Current-drinker reducers (AOR, 95% CI = 1.57 [1.10-2.27] for men; AOR, 95% CI = 1.33 [1.02-1.72] for women) and former drinkers (AOR, 95% CI = 2.06 [1.43-2.97] for men; AOR, 95% CI = 1.51 [1.19-1.92] for women) more often had CHD than lifetime abstainers. Male heavy drinkers during the heaviest drinking period (AOR, 95% CI = 2.25 [1.52-3.32]) were more likely to manifest CHD than lifetime abstainers. In addition, individuals with diagnosed CHD were significantly more likely to have reduced drinking in the past. A change in alcohol consumption over the life course among former and current drinkers may distort the true alcohol-CHD relationship.
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Affiliation(s)
- Amy Z Fan
- Epidemiology and Biometry Branch, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, United States.
| | - W June Ruan
- Epidemiology and Biometry Branch, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, United States
| | - S Patricia Chou
- Epidemiology and Biometry Branch, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, United States
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Stockwell T, Sherk A, Norström T, Angus C, Ramstedt M, Andréasson S, Chikritzhs T, Gripenberg J, Holder H, Holmes J, Mäkelä P. Estimating the public health impact of disbanding a government alcohol monopoly: application of new methods to the case of Sweden. BMC Public Health 2018; 18:1400. [PMID: 30577827 PMCID: PMC6303908 DOI: 10.1186/s12889-018-6312-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 12/07/2018] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Government alcohol monopolies were created in North America and Scandinavia to limit health and social problems. The Swedish monopoly, Systembolaget, reports to a health ministry and controls the sale of all alcoholic beverages with > 3.5% alcohol/volume for off-premise consumption, within a public health mandate. Elsewhere, alcohol monopolies are being dismantled with evidence of increased consumption and harms. We describe innovative modelling techniques to estimate health outcomes in scenarios involving Systembolaget being replaced by 1) privately owned liquor stores, or 2) alcohol sales in grocery stores. The methods employed can be applied in other jurisdictions and for other policy changes. METHODS Impacts of the privatisation scenarios on pricing, outlet density, trading hours, advertising and marketing were estimated based on Swedish expert opinion and published evidence. Systematic reviews were conducted to estimate impacts on alcohol consumption in each scenario. Two methods were applied to estimate harm impacts: (i) alcohol attributable morbidity and mortality were estimated utilising the International Model of Alcohol Harms and Policies (InterMAHP); (ii) ARIMA methods to estimate the relationship between per capita alcohol consumption and specific types of alcohol-related mortality and crime. RESULTS Replacing government stores with private liquor stores (Scenario 1) led to a 20.0% (95% CI, 15.3-24.7) increase in per capita consumption. Replacement with grocery stores (Scenario 2) led to a 31.2% (25.1-37.3%) increase. With InterMAHP there were 763 or + 47% (35-59%) and 1234 or + 76% (60-92%) more deaths per year, for Scenarios 1 and 2 respectively. With ARIMA, there were 850 (334-1444) more deaths per year in Scenario 1 and 1418 more in Scenario 2 (543-2505). InterMAHP also estimated 10,859 or + 29% (22-34%) and 16,118 or + 42% (35-49%) additional hospital stays per year respectively. CONCLUSIONS There would be substantial adverse consequences for public health and safety were Systembolaget to be privatised. We demonstrate a new combined approach for estimating the impact of alcohol policies on consumption and, using two alternative methods, alcohol-attributable harm. This approach could be readily adapted to other policies and settings. We note the limitation that some significant sources of uncertainty in the estimates of harm impacts were not modelled.
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Affiliation(s)
- Tim Stockwell
- Canadian Institute for Substance Use Research (CISUR), Department of Psychology, University of Victoria, PO Box 1700 STN CSC, Victoria, BC V8W 2Y2 Canada
| | - Adam Sherk
- Canadian Institute for Substance Use Research (CISUR), Social Dimensions of Health Program, University of Victoria, Victoria, BC Canada
| | - Thor Norström
- Swedish Institute for Social Research, Stockholm University, Stockholm, Sweden
| | | | - Mats Ramstedt
- The Swedish Council for Information on Alcohol and Other Drugs (CAN), Stockholm, Sweden
| | - Sven Andréasson
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Tanya Chikritzhs
- Health Sciences, National Drug Research Institute, Curtin University, Perth, Australia
| | - Johanna Gripenberg
- Department of Clinical Neuroscience, Stockholm Prevents Alcohol and Drug Problems (STAD), Karolinska Institutet, Stockholm, Sweden
| | - Harold Holder
- Prevention Research Center, Pacific Institute for Research and Evaluation, Berkeley, CA USA
| | | | - Pia Mäkelä
- National Institute for Health and Welfare, Helsinki, Finland
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Yun KE, Chang Y, Yun SC, Davey Smith G, Ryu S, Cho SI, Chung EC, Shin H, Khang YH. Alcohol and coronary artery calcification: an investigation using alcohol flushing as an instrumental variable. Int J Epidemiol 2018; 46:950-962. [PMID: 28073952 DOI: 10.1093/ije/dyw237] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2016] [Indexed: 01/21/2023] Open
Abstract
Background We examined whether alcohol flushing could be used as an instrumental variable (IV) and investigated the effect of alcohol consumption on coronary calcification using alcohol flushing status as an IV. Methods We analysed cross-sectional data from 24 681 Korean adults (20 696 men and 3985 women) who had been administered a questionnaire assessing alcohol consumption and alcohol flushing, as well as a coronary artery calcium (CAC) measurement. The associations of alcohol flushing status with potential confounders and alcohol consumption were examined. We employed two-stage predictor substitution methodology for the IV analysis. Results The prevalence of alcohol flushing did not differ depending on gender, education, household income, cigarette smoking or physical activity. Balanced levels of confounders were observed between alcohol flushers and non-flushers. Alcohol flushing was closely related to alcohol consumption and levels of liver enzymes. In men, a doubling in alcohol consumption was associated with increased odds of coronary calcification in both the IV analysis [odds ratio (OR) of CAC scores of 1 or over = 1.11; 95% confidence interval (CI) = 1.03-1.20) and the multivariable regression analysis (OR = 1.04; 95% CI = 1.01-1.07). For cardiovascular risk factors, the IV analysis showed a positive association between alcohol consumption and blood pressure and high-density lipoprotein-cholesterol. Conclusions Alcohol flushing can be used as an IV in studies evaluating the health impact of alcohol consumption, especially in East Asian countries. Through such an analysis, we found that increased alcohol consumption was associated with an increased risk of subclinical coronary atherosclerosis.
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Affiliation(s)
| | - Yoosoo Chang
- Center for Cohort Studies, Total Healthcare Center.,Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sung-Cheol Yun
- Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - George Davey Smith
- MRC Integrative Epidemiology Unit.,School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Seungho Ryu
- Center for Cohort Studies, Total Healthcare Center.,Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sung-Il Cho
- Department of Epidemiology, Graduate School of Public Health and Institute of Health and Environment, Seoul National University, Seoul, South Korea
| | | | - Hocheol Shin
- Department of Family Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Young-Ho Khang
- Department of Health Policy and Management, Seoul National University College of Medicine, and Institute of Health Policy and Management, Seoul National University Medical Research Center, Seoul, South Korea
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Stockwell T, Zhao J, Sherk A, Rehm J, Shield K, Naimi T. Underestimation of alcohol consumption in cohort studies and implications for alcohol's contribution to the global burden of disease. Addiction 2018; 113:2245-2249. [PMID: 30014539 DOI: 10.1111/add.14392] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 05/18/2018] [Accepted: 07/06/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIMS Estimated alcohol consumption from national self-report surveys is often only 30-40% of official estimates based on sales or taxation data. Global burden of disease (GBD) estimates for alcohol adjust survey estimates up to 80% of total per capita consumption. This assumes that cohort studies needed to estimate relative risks for disease suffer less from under-reporting than typical national surveys. However, there is limited evidence on which to base that assumption. This paper aims to assess the extent of underestimation of alcohol consumption in cohort studies concerning alcohol and mortality compared with official total consumption estimates. DESIGN Comparisons of estimated per capita consumption from a comprehensive sample of cohort studies against official estimates by country and year. PARTICIPANTS A total of 1 876 046 participants in 40 cohort studies from 18 countries on alcohol use and all-cause mortality identified by systematic review. MEASUREMENTS Alcohol consumption data from the cohort studies were converted into usual grams of ethanol per day and then to total age 15+ per capita consumption. Matched estimates were sourced from the World Health Organization (WHO) Global Health Observatory. FINDINGS The cohort studies had mean coverages of age 15+ per capita alcohol consumption of 61.71% (ranging from 29.19% for Russia to 96.53% for Japan), after weighting estimates by sample size for within-country estimates and by number of studies per country for the overall estimate. Regional estimates were higher for the United States (66.22%) and lower for western European countries (55.35%). CONCLUSIONS Underestimation of alcohol consumption in cohort studies is less than in typical population surveys. Because some under-coverage is caused by under-sampling heavier drinkers, the current practice of uplifting survey estimates to 80% of total population consumption in global burden of disease studies appears to be appropriate.
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Affiliation(s)
- Tim Stockwell
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC, Canada
| | - Jinhui Zhao
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC, Canada
| | - Adam Sherk
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC, Canada
| | - Jürgen Rehm
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Kevin Shield
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Tim Naimi
- School of Medicine, Clinical Addiction Research and Education Unit, Boston University, Boston, MA, USA
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Xu H, Vorderstrasse AA, McConnell ES, Dupre ME, Østbye T, Wu B. Migration and cognitive function: a conceptual framework for Global Health Research. Glob Health Res Policy 2018; 3:34. [PMID: 30519639 PMCID: PMC6267896 DOI: 10.1186/s41256-018-0088-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 11/01/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Migration is a fundamental demographic process that has been observed globally. It is suggested that migration is an issue of global health importance that can have an immediate and lasting impact on an individual's health and well-being. There is now an increasing body of evidence linking migration with cognitive function in older adults. In this paper, we synthesized the current evidence to develop a general conceptual framework to understand the factors contributing to the association between migration and cognitive function. METHODS A comprehensive review of the literature was conducted on the associations between migration and cognition among middle-aged and older adults. RESULTS Five potential mechanisms were identified from the literature: 1) socioeconomic status-including education, occupation, and income; 2) psychosocial factors-including social networks, social support, social stressors, and discrimination; 3) behavioral factors-including smoking, drinking, and health service utilization; 4) physical and psychological health status-including chronic conditions, physical function, and depression; and 5) environmental factors-including both physical and social environment. Several underlying factors were also identified-including early-life conditions, gender, and genetic factors. CONCLUSIONS The factors linking migration and cognitive function are multidimensional and complex. This conceptual framework highlights potential implications for global health policies and planning on healthy aging and migrant health. Additional studies are needed to further examine these mechanisms to extend and refine our general conceptual framework.
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Affiliation(s)
- Hanzhang Xu
- 1School of Nursing, Duke University, Durham, NC USA
- 2Department of Community and Family Medicine, Duke University, Durham, NC USA
| | | | - Eleanor S McConnell
- 1School of Nursing, Duke University, Durham, NC USA
- 4Geriatric Research, Education and Clinical Center, Durham Department of Veterans Affairs Healthcare System, Durham, NC USA
| | - Matthew E Dupre
- 5Department of Population Health Sciences, Duke University, Durham, NC USA
- 6Duke Clinical Research Institute, Duke University, Durham, NC USA
- 7Department of Sociology, Duke University, Durham, NC USA
| | - Truls Østbye
- 1School of Nursing, Duke University, Durham, NC USA
- 2Department of Community and Family Medicine, Duke University, Durham, NC USA
- 6Duke Clinical Research Institute, Duke University, Durham, NC USA
- 8Duke Global Health Institute, Duke University, Durham, NC USA
| | - Bei Wu
- 3New York University Rory Meyers College of Nursing, New York, NY USA
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Attitudes and Recommendations of Physicians towards Alcohol Consumption and Cardiovascular Health: A Perspective from Argentina. DISEASES (BASEL, SWITZERLAND) 2018; 6:diseases6030077. [PMID: 30200449 PMCID: PMC6165240 DOI: 10.3390/diseases6030077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 08/16/2018] [Accepted: 08/31/2018] [Indexed: 12/31/2022]
Abstract
Despite epidemiological findings of improvements in cardiovascular risk factors with a light-to-moderate intake of alcohol, many misconceptions remain regarding alcohol intake and the risks and benefits of consumption. We sought to examine physician attitudes and recommendations regarding alcohol intake in a cohort of Argentine physicians and to establish their sources of knowledge. An online national survey was distributed through the Argentine Federation of Cardiology (FAC) to cardiologists, internal medicine specialists, general and other subspecialty physicians in Argentina. The survey was completed by 745 physicians, of whom 671 (90%) were cardiologists. In total, 35% of physicians viewed moderate alcohol intake to be beneficial for cardiovascular health, 36% believed only wine offered such benefits, 24% viewed any intake to be harmful, and 5% had other opinions. More than half (57%) self-reported their knowledge came from academic sources. Regarding knowledge of drinking guidelines, only 41% of physicians were aware of the concept of “standard drink”. Physicians were generally not comfortable converting standard drinks into other metric units, however men tended to be more comfortable than women (p = 0.052). Physicians were not satisfied with their knowledge of drinking guidelines (3.01 ± 2.73, on a 0–10 scale). Physicians were generally comfortable in counselling patients regarding safe limits of consumption (6.22 ± 3.20, on a 0–10 scale). Argentine physicians were not satisfied with their knowledge of alcohol consumption guidelines or their understanding of the reported metrics. Only one-third of study participants viewed moderate alcohol intake as beneficial for cardiovascular health. This study shows the necessity to optimize the sources of knowledge.
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Degerud E, Ystrom E, Tambs K, Ariansen I, Mørland J, Magnus P, Davey Smith G, Næss Ø. The interplay between cognitive ability, alcohol consumption, and health characteristics. Psychol Med 2018; 48:2011-2022. [PMID: 29239293 DOI: 10.1017/s0033291717003543] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Higher cognitive ability is associated with favourable health characteristics. The relation between ability and alcohol consumption, and their interplay with other health characteristics, is unclear. We aimed to assess the relationship between cognitive ability and alcohol consumption and to assess whether alcohol consumption relates differently to health characteristics across strata of ability. METHODS For 63 120 Norwegian males, data on cognitive ability in early adulthood were linked to midlife data on alcohol consumption frequency (times per month, 0-30) and other health characteristics, including cardiovascular risk factors and mental distress. Relations were assessed using linear regression and reported as unstandardised beta coefficients [95% confidence interval (CI)]. RESULTS The mean ± s.d. frequency of total alcohol consumption in the sample was 4.0 ± 3.8 times per month. In the low, medium, and high group of ability, the frequencies were 3.0 ± 3.3, 3.7 ± 3.5, and 4.7 ± 4.1, respectively. In the full sample, alcohol consumption was associated with physical activity, heart rate, fat mass, smoking, and mental distress. Most notably, each additional day of consumption was associated with a 0.54% (0.44-0.64) and 0.14% (0.09-0.18) increase in the probability of current smoking and mental distress, respectively. In each strata of ability (low, medium, high), estimates were 0.87% (0.57-1.17), 0.48% (0.31-0.66) and 0.49% (0.36-0.62) for current smoking, and 0.44% (0.28-0.60), 0.10% (0.02-0.18), and 0.09% (0.03-0.15) for mental distress, respectively. CONCLUSIONS Participants with low cognitive ability drink less frequently, but in this group, more frequent alcohol consumption is more strongly associated with adverse health characteristics.
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Affiliation(s)
- E Degerud
- Norwegian Institute of Public Health,P.O Box 4404,N-0403 Oslo,Norway
| | - E Ystrom
- Norwegian Institute of Public Health,P.O Box 4404,N-0403 Oslo,Norway
| | - K Tambs
- Norwegian Institute of Public Health,P.O Box 4404,N-0403 Oslo,Norway
| | - I Ariansen
- Norwegian Institute of Public Health,P.O Box 4404,N-0403 Oslo,Norway
| | - J Mørland
- Norwegian Institute of Public Health,P.O Box 4404,N-0403 Oslo,Norway
| | - P Magnus
- Norwegian Institute of Public Health,P.O Box 4404,N-0403 Oslo,Norway
| | - G Davey Smith
- MRC Integrative Epidemiology Unit,School of Social and Community Medicine,University of Bristol,Senate House,Tyndall Avenue,Bristol BS8 1TH,UK
| | - Ø Næss
- Norwegian Institute of Public Health,P.O Box 4404,N-0403 Oslo,Norway
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O'Neill D, Britton A, Hannah MK, Goldberg M, Kuh D, Khaw KT, Bell S. Association of longitudinal alcohol consumption trajectories with coronary heart disease: a meta-analysis of six cohort studies using individual participant data. BMC Med 2018; 16:124. [PMID: 30131059 PMCID: PMC6103865 DOI: 10.1186/s12916-018-1123-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 07/10/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Studies have shown that alcohol intake trajectories differ in their associations with biomarkers of cardiovascular functioning, but it remains unclear if they also differ in their relationship to actual coronary heart disease (CHD) incidence. Using multiple longitudinal cohort studies, we evaluated the association between long-term alcohol consumption trajectories and CHD. METHODS Data were drawn from six cohorts (five British and one French). The combined analytic sample comprised 35,132 individuals (62.1% male; individual cohorts ranging from 869 to 14,247 participants) of whom 4.9% experienced an incident (fatal or non-fatal) CHD event. Alcohol intake across three assessment periods of each cohort was used to determine participants' intake trajectories over approximately 10 years. Time to onset for (i) incident CHD and (ii) fatal CHD was established using surveys and linked medical record data. A meta-analysis of individual participant data was employed to estimate the intake trajectories' association with CHD onset, adjusting for demographic and clinical characteristics. RESULTS Compared to consistently moderate drinkers (males: 1-168 g ethanol/week; females: 1-112 g ethanol/week), inconsistently moderate drinkers had a significantly greater risk of incident CHD [hazard ratio (HR) = 1.18, 95% confidence interval (CI) = 1.02-1.37]. An elevated risk of incident CHD was also found for former drinkers (HR = 1.31, 95% CI = 1.13-1.52) and consistent non-drinkers (HR = 1.47, 95% CI = 1.21-1.78), although, after sex stratification, the latter effect was only evident for females. When examining fatal CHD outcomes alone, only former drinkers had a significantly elevated risk, though hazard ratios for consistent non-drinkers were near identical. No evidence of elevated CHD risk was found for consistently heavy drinkers, and a weak association with fatal CHD for inconsistently heavy drinkers was attenuated following adjustment for confounding factors. CONCLUSIONS Using prospectively recorded alcohol data, this study has shown how instability in drinking behaviours over time is associated with risk of CHD. As well as individuals who abstain from drinking (long term or more recently), those who are inconsistently moderate in their alcohol intake have a higher risk of experiencing CHD. This finding suggests that policies and interventions specifically encouraging consistency in adherence to lower-risk drinking guidelines could have public health benefits in reducing the population burden of CHD. The absence of an effect amongst heavy drinkers should be interpreted with caution given the known wider health risks associated with such intake. TRIAL REGISTRATION ClinicalTrials.gov, NCT03133689 .
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Affiliation(s)
- Dara O'Neill
- CLOSER, Department of Social Science, Institute of Education, University College London, London, UK.
| | - Annie Britton
- Research Department of Epidemiology and Public Health, University College London, London, UK
| | - Mary K Hannah
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Marcel Goldberg
- Inserm UMS 011, Villejuif, France and Paris Descartes University, Villejuif, France
| | - Diana Kuh
- Research Department of Epidemiology and Public Health, University College London, London, UK
- UK MRC Unit for Lifelong Health & Ageing at UCL, London, UK
| | - Kay Tee Khaw
- Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Steven Bell
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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Luben R, Hayat S, Mulligan A, Lentjes M, Wareham N, Pharoah P, Khaw KT. Alcohol consumption and future hospital usage: The EPIC-Norfolk prospective population study. PLoS One 2018; 13:e0200747. [PMID: 30020973 PMCID: PMC6051641 DOI: 10.1371/journal.pone.0200747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 07/01/2018] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Heavy drinkers of alcohol are reported to use hospitals more than non-drinkers, but it is unclear whether light-to-moderate drinkers use hospitals more than non-drinkers. OBJECTIVE We examined the relationship between alcohol consumption in 10,883 men and 12,857 women aged 40-79 years in the general population and subsequent admissions to hospital and time spent in hospital. METHODS Participants from the EPIC-Norfolk prospective population-based study were followed for ten years (1999-2009) using record linkage. RESULTS Compared to current non-drinkers, men who reported any alcohol drinking had a lower risk of spending more than twenty days in hospital multivariable adjusted OR 0.80 (95%CI 0.68-0.94) after adjusting for age, smoking status, education, social class, body mass index and prevalent diseases. Women who were current drinkers were less likely to have any hospital admissions multivariable adjusted OR 0.84 (95%CI 0.74-0.95), seven or more admissions OR 0.77 (95% CI 0.66-0.88) or more than twenty hospital days OR 0.70 (95%CI 0.62-0.80). However, compared to lifelong abstainers, men who were former drinkers had higher risk of any hospital admissions multivariable adjusted OR 2.22 (95%CI 1.51-3.28) and women former drinkers had higher risk of seven or more admissions OR 1.30 (95%CI 1.01-1.67). CONCLUSION Current alcohol consumption was associated with lower risk of future hospital usage compared with non-drinkers in this middle aged and older population. In men, this association may in part be due to whether former drinkers are included in the non-drinker reference group but in women, the association was consistent irrespective of the choice of reference group. In addition, there were few participants in this cohort with very high current alcohol intake. The measurement of past drinking, the separation of non-drinkers into former drinkers and lifelong abstainers and the choice of reference group are all influential in interpreting the risk of alcohol consumption on future hospitalisation.
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Affiliation(s)
- Robert Luben
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
| | - Shabina Hayat
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
| | - Angela Mulligan
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
| | - Marleen Lentjes
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
| | - Nicholas Wareham
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge United Kingdom
| | - Paul Pharoah
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
| | - Kay-Tee Khaw
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
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