Body composition in detoxified alcoholics

Basic Human Body Dimensions Relate to Alcohol Dependence and Predict Hospital Readmission

Alcohol dependence is a severe mental illness and there is a need for more effective preventive and therapeutic strategies. Translational research suggests that intrauterine sex hormone exposure modulates the risk and course of alcohol dependence during adulthood. During development, sex hormones permanently shape sexually dimorphic body dimensions. Thus, these dimensions may provide insight into sex hormone organization. Here, we compared body measurements (absolute, relative to, and residualized on height) between 200 alcohol-dependent in-patients and 240 age-matched healthy control subjects and investigated how these measurements associate with the patients' prospective 12- and 24-month outcome. The results show that alcohol dependence is related to lower absolute, relative, and residualized body measurements for height and weight, head circumference, bitragion head arc, lip-chin distance, hip, thigh, and calf circumference, and foot length and breadth. In male alcohol-dependent in-patients, higher risk, shorter latency, and more alcohol-related readmissions were predicted by higher absolute, relative, and residualized thigh and calf circumferences. The second-to-fourth finger length ratio, a putative proxy for prenatal sex hormone organization, was not convincingly correlated with the body dimensions, suggesting that the results represent pubertal (or later) effects. The study's findings have implications for further research. The body measurements' high accessibility may facilitate the future transition into clinical settings.

Role of parasympathetic (vagal) cardiac control in elevated heart rates of smokers

Smokers may develop chronic increases in cardiac rate and alterations in cardiovascular control. If the increased mean heart rate (HR) in cigarette smokers is due in part to a deficit in vagal cardiac rate control, this should be reflected in a decreased amplitude of respiratory sinus arrhythmia (RSA). To test this hypothesis we studied 36 smokers and 36 non-smokers, matched for age, race, gender and blood pressure. All subjects were studied in the supine and seated positions. Mean heart rate was determined from the ECG during 30 s of quiet breathing; RSA was determined for 10 consecutive deep (>50% vital capacity) slow (5-7/min) breaths. Mean HRs in smokers were significantly higher than in non-smokers, but the increases in mean HRs evoked by a shift from the supine to seated position were lower in smokers than in non-smokers, suggesting that chronic tobacco use may alter the relative contributions of sympathetic and parasympathetic control of cardiac rate. Because neither the RSAs nor the position-dependent increase in RSA were different between smokers and non-smokers, we conclude that the elevated mean HRs in smokers were not the result of decreased respiratory or vasomotor modulation of vagal cardiac control, but instead were the result primarily of sympathetic stimulation.

Alcoholic skeletal muscle myopathy: definitions, features, contribution of neuropathy, impact and diagnosis

Alcohol misusers frequently have difficulties in gait, and various muscle symptoms such as cramps, local pain and reduced muscle mass. These symptoms are common in alcoholic patients and have previously been ascribed as neuropathological in origin. However, biochemical lesions and/or the presence of a defined myopathy occur in alcoholics as a direct consequence of alcohol misuse. The myopathy occurs independently of peripheral neuropathy, malnutrition and overt liver disease. Chronic alcoholic myopathy is characterized by selective atrophy of Type II fibres and the entire muscle mass may be reduced by up to 30%. This myopathy is arguably the most prevalent skeletal muscle disorder in the Western Hemisphere and occurs in approximately 50% of alcohol misusers. Alcohol and acetaldehyde are potent inhibitors of muscle protein synthesis, and both contractile and non-contractile proteins are affected by acute and chronic alcohol dosage. Muscle RNA is also reduced by mechanisms involving increased RNase activities. In general, muscle protease activities are either reduced or unaltered, although markers of muscle membrane damage are increased which may be related to injury by reactive oxygen species. This supposition is supported by the observation that in the UK, alpha-tocopherol status is poor in myopathic alcoholics. Reduced alpha-tocopherol may pre-dispose the muscle to metabolic injury. However, experimental alpha-tocopherol supplementation is ineffective in preventing ethanol-induced lesions in muscle as defined by reduced rates of protein synthesis and in Spanish alcoholics with myopathy, there is no evidence of impaired alpha-tocopherol status. In conclusion, by a complex series of mechanisms, alcohol adversely affects skeletal muscle. In addition to the mechanical changes to muscle, there are important metabolic consequences, by virtue of the fact that skeletal muscle is 40% of body mass and an important contributor to whole-body protein turnover.

Application of bioelectric impedance methodology and prediction equations to determine the volume of distribution for ethanol

In large-scale epidemiologic studies of drinking behavior there is a need for simple and reliable estimates of the body water compartment of subjects. This, in turn, provides an estimate of the volume of distribution of ingested ethanol and a better estimate of tissue exposure levels than the use of total body weight as the volume of distribution for alcohol. The volume of distribution for ethanol (total body water, TBW) was estimated in a racially mixed group of 276 alcoholics and 166 nonalcoholics (aged 20-59 years) by means of bioelectric impedance methodology (BIA) and by means of prediction equations based upon age, body weight, and height. Estimations of mean TBW from BIA were found to be only slightly higher (1-4%) than those provided by the prediction equations. TBW values generated from both prediction equations were also highly correlated with TBW values obtained by impedance methodology, with the highest correlations observed in females (particularly black) and in alcoholics (particularly female).

Drinking patterns and health status in smoking and nonsmoking alcoholics

Alcoholics who smoked also reported that they drank more frequently and consumed more alcohol on drinking occasions than alcoholics who did not smoke, a practice that resulted in a substantially greater lifetime alcohol consumption in the smokers. Smoking alcoholics also consumed more cigarettes and reported more smoking-related physical symptoms than social drinkers who smoked. The heart rates (HRs) of smoking and nonsmoking alcoholics were similar and both exceeded the HRs for the smoking social drinkers by approximately 13 beats/min (bpm) in males and by approximately 7 bpm in females. Surprisingly, correlations between HR and lifetime alcohol consumption were higher and slopes were steeper in controls than in alcoholics. HRs in a subset of the male alcoholics fell only approximately 3 bpm after 24 weeks of abstinence, but changed no further over an additional 24-week period. Taken together, the findings suggest that HRs may have been higher in this group of alcoholics before the onset of alcohol abuse and that alcohol intake contributed only slightly to the high HR.

Hand movement speed and accuracy in detoxified alcoholics

Detoxified alcoholics (n = 192) were found to be 9.3% slower than age-matched controls (n = 112) with regard to the composite speed (movement time, MT) with which they were able to strike targets of various sizes and distances with a hand-held stylus at onset of a light stimulus (Fitts's Task). Females (n = 102) were 8% slower than males (n = 202), and blacks (n = 103) about 15.6% slower than whites (n = 201). Gender was the only significant factor with regard to errors (target misses), with women committing 28% fewer errors than men. Women, in contrast to men, appear to trade speed for accuracy in this task. Favorable socioeconomic/medical status and target misses were directly related to movement speed. Thus, when the MT data were corrected for lifestyle variables, the significance of the alcohol effects on MT disappeared, but gender differences persisted. The alcohol effect became statistically significant, the ethnic group differences remained statistically significant, and the gender effect became insignificant when MT scores were corrected for accuracy of performance (target misses). The slope of the linear function relating MT to target difficulty was similar for all subgroups. Prior knowledge of the direction of movement was found to affect MT performance more in white than in black subjects. With regard to reaction times, ethnic group and alcohol use effects remained statistically significant after corrections for lifestyle and errors were made, with values for blacks about 5% slower than values for whites, and values for alcoholics about 4.6% slower than those for controls. Prior knowledge of the direction of movement significantly improved (shortened) reaction time in all subgroups (14%-19%).

A survey of muscle function in detoxified alcoholics

Selected characteristics of arm and leg muscle contraction were examined in a racially mixed group of male detoxified alcoholics (N = 45, ages 20-49) and age-matched controls (N = 75). Lifetime drinking histories estimated the mean lifetime consumption of ethanol to be 8.96, 12.1 and 20.4 kg ethanol/kg body weight for alcoholic subjects aged 20-29, 30-39 and 40-49, respectively. The severity of the alcohol dependence syndrome (ADS scale) was marked in alcoholics, but was not age-dependent. Alcoholics did not differ significantly from controls on health status or physical activity scales. The performance of alcoholic subjects was impaired on all muscle function measures, with relatively more impairment found in older alcoholics. Maximal knee extension force generated at 3 muscle lengths (hip, angle, 45 degrees, 90 degrees, 180 degrees) was impaired only in alcoholics 30-49 years of age. Forearm (handgrip) muscle strength was impaired in all age groups of alcoholics. Maximal muscle (biceps) contraction speed at 3 levels of resistance was impaired only in alcoholics in their fifth decade of life. The greatest deficit in alcoholics (all age groups) was observed in the anaerobic power (bicycle ergometer) test. Thus, the magnitude of dysfunction and the extent of age-relatedness was found to be a function of the muscle test employed.