Does physical activity moderate the association between alcohol drinking and all-cause, cancer and cardiovascular diseases mortality? A pooled analysis of eight British population cohorts

China Trends in Physical Inactivity from 2013 to 2019: An Analysis of 4.23 Million Participants

INTRODUCTION

This study aimed to evaluate recent trends in physical inactivity prevalence by sociodemographic characteristics and the province of China's residence between 2013 and 2019.

METHODS

The study included 4,229,616 participants 40 yr or older from 414 geographically defined localities in China during the 7-yr period. Self-reported total physical inactivity was collected to determine the standardized prevalence of physical inactivity. Logistic regression analysis was used to examine the association between physical inactivity and stroke risk, obtaining odds ratios (OR) and 95% confidence intervals (CI).

RESULTS

Results showed that the standardized prevalence of physical inactivity increased from 22.12% (95% CI = 21.99%-22.45%) in 2013 to 28.79% (95% CI = 28.48%-29.19%) in 2019, with an absolute difference of 6.67% (95% CI = 6.15% to 7.16%) and a yearly increase rate of 5.03% (95% CI = 4.85% to 5.21%). In 2019, physical inactivity was higher in female and rural participants (female = 29.55%, rural = 29.46%) than in male and urban participants (male = 28.03%, urban = 28.26%). The prevalence of physical inactivity also varied by race/ethnic groups, with the highest prevalence observed among Uyghur (47.21%) and the lowest among Yizu (14.84%). Additionally, the prevalence of physical inactivity differed by province, ranging from 14.44% in Beijing to 50.09% in Tianjin in 2019. Multivariate analyses showed that physical inactivity was associated with a higher risk of stroke (OR = 1.17, 95% CI = 1.12-1.21, P < 0.001).

CONCLUSIONS

In conclusion, our study found an overall increase in physical inactivity prevalence among Chinese adults ≥40 yr old from 2013 to 2019, with significant variation across regions, sex, ages, and race/ethnic groups.

Associations between physical activity, sedentary behaviour, and alcohol consumption among UK adults: Findings from the Health Behaviours during the COVID-19 pandemic (HEBECO) study

INTRODUCTION

The COVID-19 pandemic and attendant lockdowns have had a substantial negative effect on alcohol consumption and physical activity globally. Pre-pandemic evidence in the adult population suggests that higher levels of physical activity were associated with higher levels of drinking, but it is unclear how the pandemic may have affected this. Therefore, this study aims to assess the association between alcohol consumption and physical activity in a UK cohort established during the COVID-19 pandemic.

METHODS

Analyses utilized data from the Health Behaviours during the COVID-19 pandemic (HEBECO) study involving 2,057 UK adults (≥18 years). Participants completed self-report measures of alcohol consumption [frequency, quantity, frequency of heavy episodic drinking (HED) and AUDIT-C score] and physical activity [moderate-vigorous physical activity (MVPA), frequency of muscle strengthening activity (MSA) and sedentary behaviour] between November 2020 and January 2021. Ordinal logistic regression models were conducted, adjusting for sociodemographic factors.

RESULTS

Fifteen percent of the sample reported abstinence from drinking. Overall, 23.4% of participants drank ≥4 times/week, 13.9% drank more than 6 units/single drinking occasion (HED), 7.5% reported HED daily/almost daily and 4.2% scored ≥11 on AUDIT-C. MSA 3 days/week compared with no MSA was significantly associated with higher odds of alcohol frequency [OR (95 CI%) = 1.41 (1.04-1.91)], quantity [OR (95 CI%) = 1.38 (1.02-1.87)], HED [OR (95 CI%) = 1.42 (1.05-1.94)] and possible dependence [OR (95 CI%) = 1.47 (1.05-2.06)]. The association of MVPA and sedentary behaviour with drinking measures was not significant (p>0.05).

CONCLUSION

In contrast with previous research, MSA rather than aerobic physical activity was associated with increased alcohol consumption during the COVID-19 pandemic. It is conceivable that during lockdown while drinking was used as a coping strategy, limited opportunities for aerobic exercise made MSA a more convenient form of physical activity. To guide public health interventions, more research is required to examine the temporal relationship between different forms of physical activity and alcohol consumption.

The effect of alcohol consumption on all-cause mortality in 70-year-olds in the context of other lifestyle risk factors: results from the Gothenburg H70 birth cohort study

BACKGROUND

In this study, we examined the effect of alcohol, as well as the combined effect of seven lifestyle factors, on all-cause mortality in older adults (baseline age 70 years).

METHODS

Data was derived from the population-based Gothenburg H70 Birth Cohort study, including 1124 participants from the 2014-16 examination. Risk consumption was defined as  > 98 g alcohol per week, and hazardous drinking was based on the Alcohol Use Disorders Identification Test-Consumption questionnaire (AUDIT-C). Cox regression models were used to examine the individual effect of alcohol consumption, as well as the combined effect of seven lifestyle risk factors (high alcohol consumption, lifetime smoking, unhealthy Body Mass Index, insufficient physical activity, sedentary behavior, insufficient/prolonged sleep, unhealthy dietary pattern) on all-cause mortality.

RESULTS

During a mean follow-up of 7.7 years, 81 (7.2%) participants died. Neither risk consumption nor hazardous drinking were associated with elevated mortality, but hazardous drinking was associated with an increased risk of mortality in those with insufficient physical activity. Those with at least five lifestyle risk factors had an increased all-cause mortality compared to those fulfilling criteria for a maximum of one lifestyle risk factor. High alcohol consumption showed a relatively minor impact on this risk, while physical activity and unhealthy dietary pattern had an independent effect on mortality.

CONCLUSIONS

In this particular sample, there was no independent effect of alcohol on the risk of 8-year all-cause mortality. However, an interaction effect of physical activity was observed. It may be that high alcohol consumption per se is less important for mortality among older adults. However, a combination of several unhealthy lifestyle behaviors was linked to a substantial increase in the risk of mortality in Swedish older adults. Also, it has to be emphasized that high alcohol consumption may have other adverse health effects apart from mortality among older adults.

Associations between Liver Enzymes, Lifestyle Risk Factors and Pre-Existing Medical Conditions in a Population-Based Cross-Sectional Sample

While alanine aminotransferase (ALT) and gamma-glutamyltransferase (GGT) enzymes are commonly used indicators of liver dysfunction recent studies have suggested that these may also serve as predictive biomarkers in the assessment of extrahepatic morbidity. In order to shed further light on the interactions between serum liver enzyme abnormalities, factors of lifestyle and health status we examined ALT and GGT activities in a population-based sample of 8743 adult individuals (4048 men, 4695 women from the National FINRISK 2002 Study, mean age 48.1 ± 13.1 years) with different levels of alcohol drinking, smoking, physical activity, body weight and the presence or absence of various pre-existing medical conditions. The assessments also included laboratory tests for inflammation, lipid status and fatty liver index (FLI), a proxy for fatty liver. The prevalence of ALT and GGT abnormalities were significantly influenced by alcohol use (ALT: p < 0.0005 for men; GGT: p <0.0005 for both genders), smoking (GGT: p <0.0005 for men, p =0.002 for women), adiposity (p < 0.0005 for all comparisons), physical inactivity (GGT: p <0.0005; ALT: p <0.0005 for men, p <0.05 for women) and coffee consumption (p <0.0005 for GGT in both genders; p <0.001 for ALT in men). The total sum of lifestyle risk factor scores (LRFS) influenced the occurrence of liver enzyme abnormalities in a rather linear manner. Significantly higher LRFS were observed in the subgroups of individuals with pre-existing medical conditions when compared with those having no morbidities (p <0.0005). In logistic regression analyses adjusted for the lifestyle factors, both ALT and GGT associated significantly with fatty liver, diabetes and hypertension. GGT levels also associated with coronary heart disease, angina pectoris, cardiac insufficiency, cerebrovascular disease, asthma and depression. Combinations of abnormal ALT and GGT activities significantly increased the odds for hypertension coinciding with abnormalities in biomarkers of inflammation, lipid status and FLI. The data indicates that ALT and GGT activities readily respond to unfavorable factors of lifestyle associating also with a wide array of pre-existing medical conditions. The data supports close links between both hepatic and extrahepatic morbidities and lifestyle risk factors and may open new insights on a more comprehensive use of liver enzymes in predictive algorithms for assessing mechanistically anchored disease conditions.

Association Between Daily Alcohol Intake and Risk of All-Cause Mortality: A Systematic Review and Meta-analyses

Importance

A previous meta-analysis of the association between alcohol use and all-cause mortality found no statistically significant reductions in mortality risk at low levels of consumption compared with lifetime nondrinkers. However, the risk estimates may have been affected by the number and quality of studies then available, especially those for women and younger cohorts.

Objective

To investigate the association between alcohol use and all-cause mortality, and how sources of bias may change results.

Data Sources

A systematic search of PubMed and Web of Science was performed to identify studies published between January 1980 and July 2021.

Study Selection

Cohort studies were identified by systematic review to facilitate comparisons of studies with and without some degree of controls for biases affecting distinctions between abstainers and drinkers. The review identified 107 studies of alcohol use and all-cause mortality published from 1980 to July 2021.

Data Extraction and Synthesis

Mixed linear regression models were used to model relative risks, first pooled for all studies and then stratified by cohort median age (<56 vs ≥56 years) and sex (male vs female). Data were analyzed from September 2021 to August 2022.

Main Outcomes and Measures

Relative risk estimates for the association between mean daily alcohol intake and all-cause mortality.

Results

There were 724 risk estimates of all-cause mortality due to alcohol intake from the 107 cohort studies (4 838 825 participants and 425 564 deaths available) for the analysis. In models adjusting for potential confounding effects of sampling variation, former drinker bias, and other prespecified study-level quality criteria, the meta-analysis of all 107 included studies found no significantly reduced risk of all-cause mortality among occasional (>0 to <1.3 g of ethanol per day; relative risk [RR], 0.96; 95% CI, 0.86-1.06; P = .41) or low-volume drinkers (1.3-24.0 g per day; RR, 0.93; P = .07) compared with lifetime nondrinkers. In the fully adjusted model, there was a nonsignificantly increased risk of all-cause mortality among drinkers who drank 25 to 44 g per day (RR, 1.05; P = .28) and significantly increased risk for drinkers who drank 45 to 64 and 65 or more grams per day (RR, 1.19 and 1.35; P < .001). There were significantly larger risks of mortality among female drinkers compared with female lifetime nondrinkers (RR, 1.22; P = .03).

Conclusions and Relevance

In this updated systematic review and meta-analysis, daily low or moderate alcohol intake was not significantly associated with all-cause mortality risk, while increased risk was evident at higher consumption levels, starting at lower levels for women than men.

Moderate wine consumption and cancer risk in context

There is no doubt that excessive consumption of alcoholic beverages and binge drinking patterns increase the risk for cancer and many other diseases. Regarding the safety of light to moderate consumption of wine/alcoholic beverages, however, mixed messages exist. For decades, the potential health benefits of moderate wine consumption have been consistently shown, in particular for reducing cardiovascular mortality and morbidity. On the other hand, some population studies suggested that there is no safe limit of alcohol and ANY consumption is harmful to health, because of an increased cancer risk. Cancer is a multifactorial disease and it is increasingly accepted that certain lifestyle choices can affect the risk of developing cancer. Individuals do not drink only wine/alcoholic beverages, they eat different foods and have particular lifestyle habits. Besides several unmodifiable risk factors (age, sex, ethnicity and genetic disposition), improving lifestyle habits may contribute to reduce the risk of cancer. According to the World Health Organisation (WHO) and the World Cancer Research Fund (WCRF), one third of the cancers could be prevented by adopting a healthy lifestyle (such as avoiding smoking, maintaining a normal body weight, being physically active, avoiding excessive consumption of alcoholic beverages and keeping a healthy dietary pattern). Furthermore, the Mediterranean Diet is considered as one of the healthiest in the world by the WHO and is directly associated with a lower rate of mortality thanks to its effects on disease prevention. However, moderate consumption of wine is an important component of that diet. So recommendations for a healthy lifestyle which include a healthy, balanced diet and avoidance of any alcoholic beverage may be confusing. Can moderate wine drinkers still enjoy a glass of wine with the meal without jeopardizing their health? A detailed analysis of the scientific evidence will be provided and the risk of moderate wine consumption within the context of lifestyle will be examined.

Impact of Physical Activity on the Characteristics and Metabolic Consequences of Alcohol Consumption: A Cross-Sectional Population-Based Study

Sedentary lifestyle and excessive alcohol drinking are major modifiable risk factors of health. In order to shed further light on the relationships between physical activity and health consequences of alcohol intake, we measured biomarkers of liver function, inflammation, lipid status and fatty liver index tests in a large population-based sample of individuals with different levels of physical activity, alcohol drinking and other lifestyle risk factors. The study included 21,050 adult participants (9940 men, 11,110 women) (mean age 48.2 ± 13.3 years) of the National FINRISK Study. Data on physical activity, alcohol drinking, smoking and body weight were recorded. The participants were classified to subgroups according to gender, levels of physical activity (sedentary, low, moderate, vigorous, extreme), alcohol drinking levels (abstainers, moderate drinkers, heavy drinkers) and patterns (regular or binge, types of beverages preferred in consumption). Serum liver enzymes (GGT, ALT), C-reactive protein (CRP) and lipid profiles were measured using standard laboratory techniques. Physical activity was linearly and inversely related with the amount of alcohol consumption, with the lowest alcohol drinking levels being observed in those with vigorous or extreme activity (p < 0.0005). Physically active individuals were less frequently binge-type drinkers, cigarette smokers or heavy coffee drinkers than those with sedentary activity (p < 0.0005 for linear trend in all comparisons). In the General Linear Model to assess the main and interaction effects of physical activity and alcohol consumption on biomarker status, as adjusted for anthropometric measures, smoking and coffee consumption, increasing levels of physical activity were found to be associated with more favorable findings on serum GGT (p < 0.0005), ALT (p < 0.0005 for men), cholesterol (p = 0.025 for men; p < 0.0005 for women), HDL-cholesterol (p < 0.0005 for men, p = 0.001 for women), LDL-cholesterol (p < 0.03 for men), triglycerides (p < 0.0005 for men, p < 0.03 for women), CRP (p < 0.0005 for men, p = 0.006 for women) and fatty liver index (p < 0.0005). The data support the view that regular moderate to vigorous physical activity may counteract adverse metabolic consequences of alcohol consumption on liver function, inflammation and lipid status. The role of physical activity should be further emphasized in interventions aimed at reducing health problems related to unfavorable risk factors of lifestyle.

Alcohol Consumption and Adiposity: A Longitudinal Analysis of 45,399 UK Biobank Participants

The evidence on the association between alcohol consumption and adiposity is inconsistent and fragmented. We investigated the longitudinal association between alcohol consumption pattern and four different adiposity markers with repeated measures of adiposity and obesity incidence. We categorized current drinkers based on the sex-specific quartiles of their weekly alcohol consumption and the UK alcohol drinking guidelines. We used multivariable adjusted generalised linear models. With the exception of a direct association between alcohol volume and body fat percentage (BF%) in women (B = 0.42%; 95%CI: 0.04, 0.80% for women in the top quartile), we found no associations between alcohol consumption and adiposity markers for either sex. Red wine and champagne/white wine consumption were inversely associated with waist circumference (WC) for both sexes (B = -0.58 cm, 95%CI: -0.77, -0.38 cm and B= -0.49 cm, 95%CI: -0.68, -0.29 cm, respectively, for women; B = -0.28 cm, 95%CI: -0.47, -0.08 cm and B = -0.23 cm, 95%CI: -0.42, -0.04 cm, respectively, for men). Female and male spirit drinkers had higher WC than non-spirit drinkers. Alcohol consumption was associated with a lower risk of obesity incidence in women (OR:0.60, 95%CI:0.45, 0.80 for the 2nd quartile, OR:0.53, 95%CI: 0.40, 0.70 for the 3rd quartile and OR:0.61, 95%CI:0.46, 0.80 for the 4th quartile). We found limited evidence of longitudinal associations between alcohol intake and adiposity. The few statistically significant associations we observed are unlikely to be of clinical importance.

Alcohol intake and mortality risk of COVID-19, pneumonia, and other infectious diseases: An analysis of 437191 UK biobank participants

This study aims to investigate the association between alcohol consumption and COVID-19, infectious diseases, and pneumonia mortality. This is a prospective analysis of 437,191 UK Biobank participants (age 56.3 years, 54% female). The main exposure was self-reported alcohol consumption. In addition to never and previous drinkers, we applied quartiles-based and UK guidelines-based criteria to divide current drinkers by weekly consumption into four groups. Outcomes included COVID-19, infectious diseases, and pneumonia mortality, obtained from the national death registries until May 2020. After an 11-year follow-up, compared to never drinkers, previous drinkers had higher mortality risks of infectious diseases and pneumonia (adjusted HR: 1.29 [95% CI 1.06-1.57] and 1.35 [1.07-1.70], respectively), but not COVID-19. There was a curvilinear association of alcohol consumption with infectious diseases and pneumonia mortality. Drinking within-guidelines (<14 UK units/wk) and amounts up to double the recommendation (14 to < 28 UK units/wk) was associated with the lowest mortality risks of infectious diseases (0.70 [0.59-0.83] and 0.70 [0.59-0.83], respectively) and pneumonia (0.71 [0.58-0.87] and 0.72 [0.58-0.88], respectively). Alcohol consumption was associated with lower risks of COVID-19 mortality (e.g., drinking within-guidelines: 0.53 [0.33-0.86]). Drinkers reporting multiples of the recommended alcohol drinking amounts did not have higher mortality risks of COVID-19 and other infectious diseases than never drinkers. Despite the well-established unfavorable effects on general health, we found no deleterious associations between alcohol consumption and the risk of infectious diseases, including COVID-19. Future research with other study designs is needed to confirm the causality.

A review of physical activity in pancreatic ductal adenocarcinoma: Epidemiology, intervention, animal models, and clinical trials

Pancreatic ductal adenocarcinoma (PDAC) is one of the deadliest types of cancer, and the increasing incidence of PDAC may be related to the prevalence of obesity. Physical activity (PA), a method known to mitigate obesity by increasing total energy expenditure, also modifies multiple cellular pathways associated with cancer hallmarks. Epidemiologic evidence has shown that PA can lower the risk of developing a variety of cancers, reduce some of the detrimental side effects of treatments, and improve patient's quality of life during cancer treatment. However, little is known about the pathways underlying the correlations observed between PA interventions and PDAC. Moreover, there is no standard dose of PA intervention that is ideal for PDAC prevention or as an adjuvant of cancer treatments. In this review, we summarize relevant literature showing how PDAC patients can benefit from PA, the potential of PA as an adjuvant treatment for PDAC, the studies using preclinical models of PDAC to study PA, and the clinical trials to date assessing the effects of PA in PDAC.

Lifestyle risk factors and infectious disease mortality, including COVID-19, among middle aged and older adults: Evidence from a community-based cohort study in the United Kingdom

In this community-based cohort study, we investigated the relationship between combinations of modifiable lifestyle risk factors and infectious disease mortality. Participants were 468,569 men and women (56.5 ± 8.1, 54.6% women) residing in the United Kingdom. Lifestyle indexes included traditional and emerging lifestyle risk factors based on health guidelines and best practice recommendations for: physical activity, sedentary behaviour, sleep quality, diet quality, alcohol consumption, and smoking status. The main outcome was mortality from infectious diseases, including pneumonia, and coronavirus disease 2019 (COVID-19). Meeting public health guidelines or best practice recommendations among combinations of lifestyle risk factors was inversely associated with mortality. Hazard ratios ranged between 0.26 (0.23-0.30) to 0.69 (0.60-0.79) for infectious disease and pneumonia. Among participants with pre-existing cardiovascular disease or cancer, hazard ratios ranged between 0.30 (0.25-0.34) to 0.73 (0.60-0.89). COVID-19 mortality risk ranged between 0.42 (0.28-0.63) to 0.75 (0.49-1.13). We found a beneficial dose-response association with a higher lifestyle index against mortality that was consistent across sex, age, BMI, and socioeconomic status. There was limited evidence of synergistic interactions between most lifestyle behaviour pairs, suggesting that the dose-response relationship among different lifestyle behaviours is not greater than the sum of the risk induced by each behaviour. Improvements in lifestyle risk factors and meeting public health guidelines or best practice recommendations could be used as an ancillary measure to ameliorate infectious disease mortality.

Optimal design of sin taxes in the presence of nontaxable sin goods

Sin good consumption entails health damage, which is in general not fully perceived by individuals, what results in its overconsumption. One way to tackle this problem is to tax these unhealthy goods. However, not all the individual choices that affect health status can be easily observed and effectively taxed by the government. This paper considers a setting where individuals can consume two types of sin goods that differ in their observability (taxability) by the government. As a benchmark, the first-best taxes for the observable and non-observable sin good are derived, considering homogeneous individuals. In the second-best setting, where observability on sin good consumption is limited, the rule for the taxable sin good is shown to depend on the degree of complementarity or substitutability with the unobservable sin good. Finally, redistributional considerations are incorporated by extending the analysis to a setting where individuals differ in their wealth and in their degree of misperception of the health damage caused by sin good consumption. Policy implications are illustrated considering physical inactivity and illicit drugs as examples of non-taxable sin goods, while alcohol, tobacco, fat and sugar account for the taxable sin goods.

Is Cohort Representativeness Passé? Poststratified Associations of Lifestyle Risk Factors with Mortality in the UK Biobank

Supplemental Digital Content is available in the text.

The UK Biobank (UKB) has been used widely to examine associations between lifestyle risk factors and mortality outcomes. It is unknown whether the extremely low UKB response rate (5.5%) and lack of representativeness materially affects the magnitude and direction of effect estimates.

'Alcohol causes cancer': a difficult message for Australians to swallow

Alcohol is a modifiable risk factor for cancer. Public awareness of the link between alcohol and cancer risk is poor; thus, alcohol consumers may be unknowingly putting themselves at increased risk of cancer. One way to raise awareness of alcohol-related cancer is through placing labels warning of cancer risk on alcoholic beverage containers; however, little is known about the impact of such labels. We conducted seven focus groups, comprising participants who self-identified as low-to-moderate alcohol consumers, to gauge public attitudes towards the labels and messages relating to alcohol-related cancer risk. Transcripts of discussions were coded to identify emergent themes. Participants expressed a negative response to the alcohol warning labels, and their talk worked to challenge the legitimacy of alcohol-related cancer messages, and the entities responsible for disseminating the information. These responses functioned to counter any implied recommendation for reduction in speakers' alcohol consumption. These findings illustrate how the general population make sense of information about health risks, using this knowledge to make decisions about personal behaviour. In combination with other public health initiatives, alcohol-warning labels have the potential to increase awareness of cancer risk and help in the fight against cancer, but any messaging will need to account for probable consumer resistance.

Is Alcohol Consumption Related to Lifestyle Factors in Romanian University Students?

Poor eating habits and substance abuse are major public health concerns among young adults transitioning into university life. This study's objective was to assess Romanian students' alcohol consumption and correlate it with other lifestyle factors. We performed a cross-sectional study of 1212 students with a mean age of 21.1 ± 2.4 years. We applied a valid online questionnaire to evaluate and statistically analyze the interrelation between alcohol consumption and lifestyle factors by multivariate statistical analysis. The prevalence of alcohol consumption among the student population enrolled in the study was 79.9%. Multiple regression showed that alcohol consumption was positively associated with gender (p < 0.001), level of physical activity (p = 0.009), number of cigarettes (p < 0.001), and fast-food consumption (p < 0.001), and negatively associated with sleep (p = 0.012) and study hours (p < 0.001). The study revealed a high prevalence (18%) of binge drinking among males. The frequent use of illicit drugs is associated with alcohol consumption (p < 0.001) but present at low levels (1.6%). The study evidenced a high prevalence of alcohol consumption in students, especially in males, and poor food behavior related to the intake of vegetables and fruits. Health promotion campaigns regarding the harmful effects of alcohol, smoking, poor nutrition, and ongoing illicit drug prevention campaigns are needed to improve students' performances.

Hospital admissions for non-communicable disease in the UK military and associations with alcohol use and mental health: a data linkage study

BACKGROUND

Since the recent conflicts in Iraq and Afghanistan, the short-term focus of military healthcare research has been on the consequences of deployment for mental health and on those wounded or injured in combat. Now that these conflicts have ended for the UK Armed Forces, it is important to consider the longer term physical and mental health consequences, and just as importantly, the links between these. The aims of this study were to determine the most common physical conditions requiring a hospital admission in UK military personnel and whether they were more common in personnel with a mental health condition, smokers, and/or those misusing alcohol compared to those without.

METHODS

Data linkage of a prospective UK military cohort study to electronic admitted patient care records for England, Wales and Scotland. Nine thousand nine hundred ninety military personnel completed phase 2 of a military cohort study (56% response rate, data collected from 2007 to 2009), with analyses restricted to 86% of whom provided consent for linkage to healthcare records (n = 8602). Ninety percent were male and the mean age at phase 2 was 36 years. The outcome was physical non communicable diseases (NCDs) requiring a hospital admission which occurred after phase 2 of the cohort when the mental health, smoking and alcohol use exposure variables had been assessed until the end of March 2014.

RESULTS

The most common NCDs requiring a hospital admission were gastrointestinal disorders 5.62% (95% Confidence Intervals (CI) 5.04, 6.19) and joint disorders 5.60% (95% CI 5.02, 6.18). Number of NCDs requiring a hospital admission was significantly higher in those with a common mental disorder (Hazard ratio (HR) 1.40 (95% CI 1.16-1.68), post-traumatic stress disorder (HR 1.78 (95% CI 1.32-2.40)) and in current smokers (HR 1.35 (95% CI 1.12-1.64) compared to those without the disorder, and non-smokers, respectively.

CONCLUSIONS

Military personnel with a mental health problem are more likely to have an inpatient hospital admission for NCDs compared to those without, evidencing the clear links between physical and mental health in this population.

Exploration of Alcohol Consumption Behaviours and Health-Related Influencing Factors of Young Adults in the UK

Hazardous alcohol consumption is ranked above illicit drug use with regards to health deterioration and social and economic burden. This study sought to clarify the factors influencing alcohol consumption and its prevalence in young adults. Demographics, alcohol consumption and lifestyle information were gathered via anonymous questionnaires during 2011-2019, crossing Reading, Surrey and Farnborough universities, UK. Controlling for confounders, a multinomial logistic regression was performed using SAS® 9.4 software. A total of 1440 students (43.5% males, 56.5% females; 54.4% Caucasians) with a mean (SD) age of 19.9 (2.73) were included. Among them, 68.9% consumed alcohol frequently and 31.7% had ≥12 units/week. Statistical analysis revealed that males consumed twice more alcohol than females, odds ratio (OR) 1.67 (95% confidence interval (CI) = 1.34-2.09), p-value < 0.01. Caucasians consumed up to five times more alcohol than other ethnicities, OR 4.55 (3.57-5.56), p-value < 0.01. Smokers consumed three times more alcohol than non-smokers, OR 2.69 (1.82, 3.99), p-value < 0.01. In general, the levels of alcohol consumption were positively associated with the levels of physical activity, OR 2.00 (1.17-3.42), p-value < 0.05 and negatively associated with recreational sedentary screen-time activities in males, OR 0.31 (0.12-0.86), p-value = 0.03. Focusing alcohol interventions toward Caucasians, smokers and physically active students, particularly males, may guide university strategies to reduce alcohol-related societal harm and risks of morbidity and mortality.

Is There a Link between Different Types of Alcoholic Drinks and Obesity? An Analysis of 280,183 UK Biobank Participants

Understanding the associations between types of alcoholic drinks and adiposity has public health relevance, considering that adult overweight and obesity prevalence are increasing worldwide. We aimed to evaluate the association between overall alcohol consumption and types of alcohol drinks with markers of adiposity from the UK Biobank baseline data (n = 280,183, 48.3% female). Generalized linear models were used to examine the associations between alcohol consumption with body mass index (BMI) and body fat percentage. Those drinking within the public health guidelines had a lower BMI by 1.34 kg/m² (95% CI 1.42, 1.26 kg/m²) compared to never drinkers. Association between alcohol consumption and body fat percentage were not statistically significant. Compared to those who never drink wines (red wine, champagne and fortified wine), drinkers of these alcoholic beverages had lower BMI (difference of -0.75 kg/m², 95% CI -0.78, -0.72 kg/m²; -0.48 kg/m², 95% CI -0.52, -0.45 kg/m²; and -0.24 kg/m², 95% CI -0.29, -0.18 kg/m², respectively). Beer and spirits drinkers had higher BMI compared to never drinkers of beer and spirits (difference of 0.18 kg/m², 95% CI 0.14, 0.22 kg/m² and 0.64 kg/m², 95% CI 0.61, 0.68 kg/m², respectively). Our data did not find a link between alcohol drinking and higher risk of obesity.

Associations between alcohol consumption and physical activity in breast cancer survivors

Alcohol use and physical inactivity are associated with increased risk of cancer diagnosis and recurrence. Physical activity (a health protective behavior) is positively associated with alcohol use (a health risk behavior) in the general population but has yet to be examined in breast cancer survivors. This study examined associations between weekly alcohol use and physical activity in 197 post-treatment breast cancer survivors (Mage = 55.04, SDage = 10.92). Participants wore an accelerometer and provided self-reported alcohol intake for five 7-day waves every 3 months. Survivors who engaged in more light intensity physical activity had increased odds of consuming alcohol (odds ratio = 1.14, p = .02) but did not differ in the amount of alcohol consumed. When promoting physical activity among this population, it is important to consider the increased likelihood of alcohol consumption.

Does a physically active lifestyle attenuate the association between alcohol consumption and mortality risk? Findings from the UK biobank

Alcohol consumption is common across Western culture, despite its associations with adverse health outcomes, including cancer and cardiovascular disease (CVD). Physical activity (PA) has beneficial effects on many alcohol related outcomes, with data suggesting PA may offset the association between alcohol consumption and mortality. This study examined the joint associations of PA and alcohol on all-cause, CVD and cancer mortality. Participants were recruited between 2006 and 2010 in the United Kingdom. Alcohol consumption was categorised based on current UK guidelines (14 units/week). PA was categorised based on the Metabolic Task Equivalent of PA as low, moderate and high. Data were analysed using Cox proportional-hazard models. The final analysis, conducted in 2019, included 297,988 adults aged ≥40. Over an average follow-up of 6.9 years, 6079 deaths were recorded, including 1219 CVD deaths and 3112 cancer deaths. We observed greater point estimates for risk of all-cause mortality among low PA individuals who consumed alcohol at the same level as active individuals. For example, low PA participants who reported alcohol consumption ≥double guidelines had a greater HR (1.55, 95% CI 1.25, 1.93) than active individuals (moderate PA HR 1.21, 95% CI 0.95, 1.54; high PA HR 1.21, 95% CI 1.00, 1.46). Considering CVD, we observed a similar trend with lower point estimates of risk of mortality among active individuals. We found some evidence that PA modified the associations of alcohol and all-cause and CVD mortality in this large population sample of British adults.

Intensity-Weighted Physical Activity Volume and Risk of All-Cause and Cardiovascular Mortality: Does the Use of Absolute or Corrected Intensity Matter?

BACKGROUND

Previous epidemiological studies examining the association between physical activity (PA) and mortality risk have measured absolute PA intensity using standard resting metabolic rate reference values that fail to consider individual differences. This study compared the risk of all-cause and cardiovascular mortality between absolute and corrected estimates of PA volume.

METHODS

49,982 adults aged ≥40 years who participated in the Health Survey for England and Scottish Health Survey in 1994-2008 were included in our study. PA was classified as absolute or corrected metabolic equivalent (MET)-hours per week, taking participant's weight, height, age, and sex into account. Cox regression models were used to examine the association between absolute and corrected PA volumes and all-cause and cardiovascular mortality.

RESULTS

The authors found no difference in the association between levels of PA and risk of all-cause and cardiovascular mortality for absolute and corrected MET-hours per week, although there was a consistent decrease in mortality risk with increasing PA. There was no difference in mortality when analyses were stratified by sex, age, and body mass index.

CONCLUSIONS

The association between PA volume and risk of mortality was similar regardless of whether PA volume was estimated using absolute or corrected METs. There is no empirical justification against the use of absolute METs to estimate PA volume from questionnaires.

Impacts of unfavourable lifestyle factors on biomarkers of liver function, inflammation and lipid status

BACKGROUND

Adopting a healthy lifestyle is associated with prolonged life expectancy. The main modifiable lifestyle-related risk factors are hazardous alcohol drinking, smoking, excess body weight and lack of physical activity. Our aim was to estimate the impact of unfavourable lifestyle factors on abnormalities in laboratory tests reflecting liver status, inflammation and lipid metabolism in a population-based cross-sectional study.

METHODS

The study included 22,273 participants (10,561 men, 11,712 women) aged 25-74 years from the National FINRISK Study. Data on alcohol use, smoking, body weight, and physical activity were recorded from structured interviews. The risk scores for the various life style factors were established on a 0-8 scale and used to stratify the population in classes to allow estimates of their joint effects. Serum liver enzymes (GGT, ALT), C-reactive protein (CRP) and lipid profiles were measured using standard laboratory techniques.

RESULTS

Consistent dose-response relationships were observed between the number of unfavourable risk factors and serum levels of GGT, ALT, CRP, cholesterol, HDL, LDL and triglycerides (p < 0.0005 for linear trend in all comparisons). When compared with those with zero risk factors, the multivariable-adjusted odds ratios (ORs) for abnormalities in all biomarkers were significantly higher in those with a sum of risk score two or more. The most striking increases in ORs in the group with the highest numbers of risk factors were observed among men in serum GGT: 26.6 (12.4-57.0), ALT: 40.3 (5.3-307.8), CRP: 16.2 (7.8-33.7) and serum triglycerides: 14.4 (8.6-24.0).

CONCLUSIONS

The data support the view that the presence of unfavourable life style risk factors is associated with distinct abnormalities in laboratory tests for liver function, inflammation and lipid status. Such biomarkers may prove to be of value in the assessment of interventions aimed at reducing unfavourable risk factors and in helping individuals in long-term maintenance of lifestyle modifications.

From scientific evidence to media and policy: Wine – part of a balanced diet or a health risk?

Recently, some studies [1, 2] and media reports alerted scientists, health and wine professionals alike. The health benefits of moderate wine consumption were questioned with headlines such as “One drink a day can shorten life” and “Moderate drinking guidelines are too loose, study says”. One publication [2] asserted that there is no safe level of consumption and that the adverse health effects associated with the consumption of alcoholic beverages, including wine, outweigh any beneficial effects; this kind of media attention not only contributed to a considerable uncertainty among moderate wine drinkers but also among physicians advising their patients. What about the existing body of evidence and the research results during the last two and half decades that have established the J-curve? It describes the association between the consumption of alcoholic beverages and the total mortality where light to moderate drinkers are at a lower risk of death from all causes than either abstainers or heavy drinkers. However, excessive drinking is always associated with an increased risk of death and various health risks. Are these previous scientific data no longer valid? Is cutting down or even eliminating wine consumption a public health goal? A detailed scientific analysis of these publications will be provided and discussed whether the drinking guidelines worldwide should be adjusted. The risk of moderate wine drinkers within the scope of other risk factors will be examined.

Self-monitoring physical activity with a smartphone application in cancer patients: a randomized feasibility study (SMART-trial)

Purpose

Evidence accumulates that an active lifestyle positively influences cancer treatment outcome. A “smartphone application” (app) such as “RunKeeper,” to self-monitor physical activity (PA) might be helpful. This study aimed to examine whether using RunKeeper to increase self-reported PA is feasible in cancer patients and to evaluate patients’ opinion about using RunKeeper in a 12-week program.

Methods

Adult patients (n = 32), diagnosed with cancer, were randomized between usual care (n = 16) or a 12-week intervention with instructions to self-monitor PA with RunKeeper (n = 16). Changes in PA were determined with the Physical Activity Scale for the Elderly (PASE) at baseline (T0), 6 weeks (T1), and 12 weeks (T2). Usability and patients’ experiences were tested at T2 with the System Usability Scale (SUS) and a semi-structured interview.

Results

Patient mean age was 33.6 years. Between T0 and T1, an increase in PA of 51% (medium estimated effect size r = 0.40) was found in PASE sum score in the intervention group compared with usual care. In addition, total minutes of PA increased with 46% (r = 0.37). These effects decreased over time (T2). Sedentary time decreased with 19% between T0 and T1 and 27% between T0 and T2. Usability was rated “good” and most patients found RunKeeper use helpful to improve PA.

Conclusions

Self-monitoring PA with RunKeeper was safe and feasible in cancer patients. The RunKeeper use resulted in an increase in PA after 6 weeks. RunKeeper usability was rated good and can be used to study PA in cancer patients.

Trial registration

NCT02391454

Electronic supplementary material

The online version of this article (10.1007/s00520-018-4263-5) contains supplementary material, which is available to authorized users.

Exercise Mitigates Alcohol Induced Endoplasmic Reticulum Stress Mediated Cognitive Impairment through ATF6-Herp Signaling

Chronic ethanol/alcohol (AL) dosing causes an elevation in homocysteine (Hcy) levels, which leads to the condition known as Hyperhomocysteinemia (HHcy). HHcy enhances oxidative stress and blood-brain-barrier (BBB) disruption through modulation of endoplasmic reticulum (ER) stress; in part by epigenetic alternation, leading to cognitive impairment. Clinicians have recommended exercise as a therapy; however, its protective effect on cognitive functions has not been fully explored. The present study was designed to observe the protective effects of exercise (EX) against alcohol-induced epigenetic and molecular alterations leading to cerebrovascular dysfunction. Wild-type mice were subjected to AL administration (1.5 g/kg-bw) and subsequent treadmill EX for 12 weeks (5 day/week@7-11 m/min). AL affected mouse brain through increases in oxidative and ER stress markers, SAHH and DNMTs alternation, while decreases in CBS, CSE, MTHFR, tight-junction proteins and cellular H2S levels. Mechanistic study revealed that AL increased epigenetic DNA hypomethylation of Herp promoter. BBB dysfunction and cognitive impairment were observed in the AL treated mice. AL mediated transcriptional changes were abolished by administration of ER stress inhibitor DTT. In conclusion, exercise restored Hcy and H2S to basal levels while ameliorating AL-induced ER stress, diminishing BBB dysfunction and improving cognitive function via ATF6-Herp-signaling. EX showed its protective efficacy against AL-induced neurotoxicity.

Associations between alcohol and obesity in more than 100 000 adults in England and Scotland

The objective of this cross-sectional study was to clarify the association between alcohol and obesity using data from 106 182 adults in England and Scotland (46·7 % male; mean 46·9 (sd 16·9) years). Trained interviewers asked participants about alcohol intake. Obesity was defined as BMI≥30 kg/m2. Potential confounders included age, sex, smoking, physical activity, longstanding illness, psychological distress and socioeconomic status. Compared with those who drank at least five times a week, obesity risk was 1·21 (95 % CI 1·15, 1·27) in those who drank one to four times a week, 1·53 (95 % CI 1·43, 1·62) in those who drank one to two times a month, 1·61 (95 % CI 1·52, 1·71) in those who drank less than once every couple of months, 1·34 (95 % CI 1·23, 1·47) in those who were former drinkers, and 1·03 (95 % CI 0·95, 1·11) in those who were never drinkers. Compared with those who drank a harmful volume, obesity risk was 0·78 (95 % CI 0·68, 0·90) in those who drank within guidelines, 0·69 (95 % CI 0·54, 0·88) in former drinkers and 0·50 (95 % CI 0·40, 0·63) in never drinkers; and, these associations were biased away from the null after adjustment for drinking volume. Abstinence was associated with increased risk of obesity in women. These data suggest that the association between drinking frequency and obesity is bell-shaped, with obesity risk not significantly different in those who drink most often and never drinkers. Drinking volume has a positive confounding effect on the association between drinking frequency and obesity, which may help explain the conflicting findings of other studies.

Alcohol, adipose tissue and liver disease: mechanistic links and clinical considerations

Adipose tissue represents a large volume of biologically active tissue that exerts substantial systemic effects in health and disease. Alcohol consumption can profoundly disturb the normal functions of adipose tissue by inducing adipocyte death and altering secretion of adipokines, pro-inflammatory mediators and free fatty acids from adipose tissue, which have important direct and indirect effects on the pathogenesis of alcoholic liver disease (ALD). Cessation of alcohol intake quickly reverses inflammatory changes in adipose tissue, and pharmacological treatment that normalizes adipose tissue function improves experimental ALD. Obesity exacerbates liver injury induced by chronic or binge alcohol consumption, and obesity and alcohol can synergize to increase risk of ALD and progression. Physicians who care for individuals with ALD should be aware of the effects of adipose tissue dysfunction on liver function, and consider strategies to manage obesity and insulin resistance. This Review examines the effect of alcohol on adiposity and adipose tissue and the relationship between alcohol, adipose tissue and the liver.

Where should the safe limits of alcohol consumption stand in light of liver enzyme abnormalities in alcohol consumers?

Objectives

To estimate the prevalence and risk factors for abnormal liver enzymes in a large age- and gender stratified population-based sample of apparently healthy individuals with or without alcohol consumption and other health-related risk factors (adiposity, physical inactivity, smoking).

Methods

Data on alcohol use, smoking, diet and physical activity were recorded using structured questionnaires from 13,976 subjects (6513 men, 7463 women, aged 25–74 years) in the national FINRISK studies. Alcohol data was used to categorize the participants into abstainers, light drinkers, moderate drinkers and heavy drinkers. Serum gamma-glutamyltransferase (GGT) and alanine aminotransferase (ALT) activities were measured using standard kinetic methods.

Results

Male light drinkers, moderate drinkers and heavy drinkers showed significantly higher relative risks of abnormal GGT than abstainers: 1.37 (95% confidence interval 1.11 to 1.71, p < 0.01), 2.72 (2.08 to 3.56, p < 0.0005), and 6.10 (4.55 to 7.17, p < 0.0005), respectively. Corresponding values for women were 1.22 (0.99 to 1.51, p = 0.065), 1.90 (1.44 to 2.51, p < 0.0005), and 5.91 (3.80 to 9.17, p < 0.0005). Estimated threshold doses for a significant GGT elevation was 14 standard weekly alcohol doses for men and 7 for women. Excess body weight and age over 40 years modulated the thresholds towards smaller quantities of alcohol. The risk of abnormal GGT was also significantly influenced by physical inactivity and smoking. The relative risks of abnormal ALT activities were increased in male heavy drinkers, especially in those presenting with adiposity and sedentary lifestyle.

Conclusions

Alcohol use markedly increases the risk for abnormal liver enzyme activities in those presenting with age over 40 years, obesity, smoking or sedentary lifestyle. The data should be considered in public health recommendations and in the definitions of safe limits of alcohol use.