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Sha M, Sun JQ, Xia Q. The alcohol flushing syndrome: A risk factor for cancer. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2024; 53:405-406. [PMID: 39132956 DOI: 10.47102/annals-acadmedsg.2024191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Abstract
Globally, alcohol consumption is responsible for an estimated 3 million deaths annually and contributes to over 740,000 new cancer cases each year.1 Acetaldehyde, a byproduct of alcohol metabolism, has been designated as first-class carcinogens by the International Agency for Research on Cancer.2 In East Asian countries such as China, Japan and Korea, approximately 36% of the population cannot effectively metabolise alcohol due to an inherited deficiency in the enzyme aldehyde dehydrogenase 2 (ALDH2).3 This deficiency leads to the accumulation of acetaldehyde in the blood, causing alcohol flushing syndrome (AFS), characterised by facial flushing, palpitations and nausea.4 AFS is a predictor of inactive ALDH2 and is associated with a higher risk of cancer development.
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Affiliation(s)
- Meng Sha
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jia-Qian Sun
- Department of Endocrine, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qiang Xia
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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2
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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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Yokoyama A, Yokoyama T, Kimura M, Matsushita S, Yokoyama M. Combinations of alcohol-induced flushing with genetic polymorphisms of alcohol and aldehyde dehydrogenases and the risk of alcohol dependence in Japanese men and women. PLoS One 2021; 16:e0255276. [PMID: 34310648 PMCID: PMC8312924 DOI: 10.1371/journal.pone.0255276] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 07/14/2021] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE The risk of alcohol dependence (AD) in Japanese men and women was evaluated according to combinations of alcohol flushing and aldehyde dehydrogenase-2 (ALDH2, rs671) and alcohol dehydrogenase-1B (ADH1B, rs1229984) genotypes, all of which are known to determine AD susceptibility in Asians. Previous studies have focused on men, since women account for a smaller proportion of AD subjects. METHODS Case control studies were conducted between 3721 male and 335 female AD Japanese and 610 male and 406 female controls who were asked about their current or former tendency to experience facial flushing after drinking a glass of beer and underwent ALDH2 and ADH1B genotyping. The time at which alcohol-induced facial flushing tendencies had disappeared in former-flushing AD subjects was also evaluated. RESULTS Current alcohol flushing, the inactive ALDH2*1/*2 genotype, and the fast-metabolizing ADH1B*2 allele were less frequently found in the AD groups. Although alcohol flushing was strongly influenced by the ALDH2 and ADH1B genotypes, multiple logistic model showed that never or former flushing and the genotype combinations were independent strong risk factors of AD in men and women. Never or former flushing (vs. current flushing) markedly increased the odds ratios of AD in carriers of each of the ALDH2 and ADH1B genotype combinations. The temporal profiles for drinking and flushing in former-flushing AD subjects revealed that the flushing response disappeared soon after or before the start of habitual drinking during young adulthood, regardless of the ALDH2 genotype. CONCLUSION Although alcohol flushing is influenced by the ALDH2 and ADH1B genotypes, constitutional or acquired flushing tolerance is an independent susceptibility trait for AD. The combination of the alcohol flushing status and the ALDH2 and ADH1B genotypes can provide a better new strategy for AD risk assessment than the alcohol flushing status alone or the genotypes alone in Asian men and women.
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Affiliation(s)
- Akira Yokoyama
- National Hospital Organization Kurihama Medical and Addiction Center, Yokosuka, Kanagawa, Japan
- * E-mail:
| | - Tetsuji Yokoyama
- Department of Health Promotion, National Institute of Public Health, Wako, Saitama, Japan
| | - Mitsuru Kimura
- National Hospital Organization Kurihama Medical and Addiction Center, Yokosuka, Kanagawa, Japan
| | - Sachio Matsushita
- National Hospital Organization Kurihama Medical and Addiction Center, Yokosuka, Kanagawa, Japan
| | - Masako Yokoyama
- Mitsukoshi Health and Welfare Foundation, Shinjuku-ku, Tokyo, Japan
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Kim HK, Lim Si En R, Wong Kang Min D. Psychosocial Motivators for Moderate Drinking among Young Asian Flushers in Singapore. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E1897. [PMID: 31146355 PMCID: PMC6603583 DOI: 10.3390/ijerph16111897] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 05/14/2019] [Accepted: 05/17/2019] [Indexed: 11/16/2022]
Abstract
Asians are more susceptible to alcohol flush syndrome and its associated health risks because they are genetically predisposed towards it. Guided by the theory of planned behaviour, this research examined the psychosocial factors associated with moderate alcohol consumption, in order to inform the development of a health campaign targeting young Asian "flushers" in Singapore. We employed a mixed-method design comprising an online survey and focus group discussions. The survey results identified perceived behavioural control as the most salient belief associated with moderate drinking intentions, particularly for Asian flushers. Although Asian flushers had more positive attitudes towards, and perceived behavioural control about drinking in moderation, they were more likely to consider that their peers disapprove of such a practice, compared to non-flushers. Additionally, Asian flushers did not consider themselves as having a higher risk of long-term health effects from alcohol consumption than non-Flushers despite their actual high-risk status. Focus group findings suggest that young Asian flushers have poor knowledge of, and skills associated with moderate drinking, in addition to feeling self-imposed social pressure. The study findings provide practical insights into bridging the information gap on Asian flush and promoting Asian flushers' drinking in moderation.
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Affiliation(s)
- Hye Kyung Kim
- Wee Kim Wee School of Communication and Information, Nanyang Technological University, 31 Nanyang Link, Singapore 637718, Singapore.
| | - Rachel Lim Si En
- Wee Kim Wee School of Communication and Information, Nanyang Technological University, 31 Nanyang Link, Singapore 637718, Singapore.
| | - Dorothy Wong Kang Min
- Wee Kim Wee School of Communication and Information, Nanyang Technological University, 31 Nanyang Link, Singapore 637718, Singapore.
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Oh SS, Ju YJ, Lee S, Park EC. Primary Reason for Drinking Among Current, Former, and Never Flushing College Students. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16020211. [PMID: 30642132 PMCID: PMC6352046 DOI: 10.3390/ijerph16020211] [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: 11/08/2018] [Revised: 01/05/2019] [Accepted: 01/08/2019] [Indexed: 02/07/2023]
Abstract
Alcohol consumption among individuals who experience a flushing response (reddening of the face, nausea, dizziness, headache, anxiety, and increased heartbeat) can result in serious health problems. However, studies on reasons for drinking among flushers, especially in the college context, are limited. Thus, this study investigated the association between primary reason for drinking and alcohol use among a nationally representative sample of current, former, and never flushing college students. The aim was to measure whether college students with current or former experience of facial flushing have different primary reasons for drinking compared to students with no experience of facial flushing. We surveyed and analyzed the data of 4590 students in a nationally representative sample of 82 colleges in South Korea. Multiple regression analysis was used to identify the association between primary reason for drinking and alcohol intake. Alcohol intake was measured using the Alcohol Use Disorders Identification Test (AUDIT). Among 1537 current (33.5%), 152 former (3.3%), and 2901 (63.2%) never flushers, mean AUDIT scores were 7.715 ± 5.434, 11.039 ± 6.405, and 10.465 ± 5.779, respectively. Current flushers had significantly higher AUDIT scores when drinking for pleasure (β = 2.696, p < 0.0001) or stress/depression (β = 2.578, p < 0.0001). Primary reasons for drinking were not associated with alcohol intake for former flushers. Never flushers had significantly higher AUDIT scores when drinking for pleasure (β = 2.696, p < 0.0001), stress/depression (β = 2.578, p < 0.0001), or boredom (β = 0.740, p = 0.029) than peer pressure. Our results suggest that former and never flushers consume higher amounts of alcohol on average than never flushers. For current flushers, drinking for pleasure or stress/depression may increase alcohol intake, while for never flushers, drinking for pleasure, stress/depression, as well as boredom may have the same effect.
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Affiliation(s)
- Sarah Soyeon Oh
- Institute of Health Services Research, Yonsei University, Seoul 03722, Korea.
- Department of Public Health, Graduate School, Yonsei University, Seoul 03722, Korea.
| | - Yeong Jun Ju
- Institute of Health Services Research, Yonsei University, Seoul 03722, Korea.
- Department of Public Health, Graduate School, Yonsei University, Seoul 03722, Korea.
| | - San Lee
- Institute of Health Services Research, Yonsei University, Seoul 03722, Korea.
- Department of Psychiatry, Yonsei University College of Medicine, Seoul 03722, Korea.
| | - Eun-Cheol Park
- Institute of Health Services Research, Yonsei University, Seoul 03722, Korea.
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul 03722, Korea.
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Zhang F, Yuen LW, Ding L, Newman IM, Shell DF. Pilot Study of a Brief WeChat Intervention in China to Increase Students' Willingness to Assist a Flushing Student to Reduce Alcohol Use. J Prev Med Public Health 2018; 51:320-325. [PMID: 30514062 PMCID: PMC6283739 DOI: 10.3961/jpmph.18.127] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 10/29/2018] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES This pilot study tested the effectiveness of a brief alcohol-related intervention delivered by the social media app WeChat to teach about ethanol-induced facial flushing and increase the willingness of students who see another student flushing to suggest that he or she should reduce or stop drinking. In the context of Chinese drinking culture, it is sometimes socially difficult to refuse a drink, even when experiencing physical discomfort, such as flushing. METHODS Classrooms of students in a medical university in China were randomly assigned to the intervention or control group. Students in the intervention group were invited to view 3 alcohol education lessons on WeChat during a 2-week period. A pretest and posttest before and after the 2-week period assessed changes in students' willingness to intervene if they saw someone flush while drinking. Data were collected about students' alcohol use and their ratings of the lessons. RESULTS Mixed-design analysis of variance yielded a significant time-by-treatment interaction effect on the variable of willingness to suggest that a flushing person stop or slow down their drinking, and the change was significant between the intervention and control groups. One-way analysis of covariance yielded a significant treatment effect at the posttest, after controlling for the pretest score. Students rated the lessons above the midpoint of the scale for being informative, interesting, and useful. CONCLUSIONS The pilot study showed that a brief alcohol-related intervention delivered by WeChat could produce a measurable positive change in the willingness of university students to suggest that a student who flushes should stop drinking. This pilot study also suggested improvements for future lessons and evaluation design.
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Affiliation(s)
- Fan Zhang
- Department of Epidemiology, School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Lok-Wa Yuen
- Nebraska Prevention Center for Alcohol and Drug Abuse, Department of Educational Psychology, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Lanyan Ding
- Nebraska Prevention Center for Alcohol and Drug Abuse, Department of Educational Psychology, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Ian M Newman
- Nebraska Prevention Center for Alcohol and Drug Abuse, Department of Educational Psychology, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Duane F Shell
- Nebraska Prevention Center for Alcohol and Drug Abuse, Department of Educational Psychology, University of Nebraska-Lincoln, Lincoln, NE, USA
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Ding L, Yuen LW, Newman IM, Shell DF. University Students' Willingness to Assist Fellow Students Who Experience Alcohol-Related Facial Flushing to Reduce Their Drinking. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E850. [PMID: 29693597 PMCID: PMC5981889 DOI: 10.3390/ijerph15050850] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 04/20/2018] [Accepted: 04/23/2018] [Indexed: 12/16/2022]
Abstract
This study explored bystanders’ willingness to help a friend who flushes when drinking to reduce his/her drinking. Alcohol-related facial flushing is an indicator of an inherited variant enzyme, aldehyde dehydrogenase (ALDH), that impairs alcohol metabolism and increases drinkers’ lifetime risk of certain aerodigestive cancers. Individuals who flush should reduce their alcohol exposure, but they may continue to drink if social pressures and rules of etiquette make not drinking socially risky. The analysis used data from 2912 undergraduate students from 13 universities in southwestern, central and northeastern China from a survey asking how they respond to someone’s flushing in various scenarios. Latent class analysis grouped students by similar responses to flushing. A multinomial logistic regression explored how class membership was associated with knowledge, drinking status, and reactions to one’s own flushing. Five classes were derived from the latent class analysis, ranging from always intervene to mostly hesitate to help; in between were classes of students who were willing to help in some scenarios and hesitant in other scenarios. Only 11.6% students knew the connection between facial flushing and impaired alcohol metabolism, and knowledgeable students were somewhat more likely to assist when they saw someone flushing. In the absence of knowledge, other factors—such as drinking status, the gender of the bystander, the gender of the person who flushed, and degree of friendship with the person who flushed—determined how willing a person was to help someone reduce or stop drinking. Class membership was predicted by knowledge, gender, drinking status, and reactions to one’s own flushing. Of these 4 factors, knowledge and reactions to one’s own flushing could be influenced through alcohol education programs. It will take some time for alcohol education to catch up to and change social and cultural patterns of drinking. Meanwhile, motivational strategies should be developed to increase the willingness of bystanders to assist friends and to create a social expectation that flushers should stop or reduce their drinking.
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Affiliation(s)
- Lanyan Ding
- Department of Educational Psychology, University of Nebraska, Lincoln, NE 68588-0345, USA.
| | - Lok-Wa Yuen
- Department of Educational Psychology, University of Nebraska, Lincoln, NE 68588-0345, USA.
| | - Ian M Newman
- Department of Educational Psychology, University of Nebraska, Lincoln, NE 68588-0345, USA.
| | - Duane F Shell
- Department of Educational Psychology, University of Nebraska, Lincoln, NE 68588-0345, USA.
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Ding L, Newman IM, Buhs ES, Shell DF. Influence of Peer Pressure and Self-Efficacy for Alcohol Self-Regulation on Chinese University Physical Education Students’ Drinking Behaviors. ACTA ACUST UNITED AC 2018. [DOI: 10.4236/ape.2018.81006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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