Socioeconomic status and trends in alcohol drinking in the Danish MONICA population, 1982- 92

Aims: To examine trends in alcohol drinking in different educational groups.

Methods: Data from three cross-sectional WHO MONICA surveys conducted in 1982-84, 1987, and 1991-92 were analysed to estimate trends in abstention, moderate, heavy, and sporadic heavy alcohol use in relation to level of education, age and smoking. In total, 6,695 Danish men and women aged 30, 40, 50, and 60 years were included.

Results: Alcohol drinking decreased in both men and women during the study period, but changes were only significant among the highest educated. In the highest educated men the prevalence of moderate alcohol use increased from 77 to 82%, while heavy alcohol use declined from 19 to 12%. In the highest educated women the prevalence of abstention increased from 15 to 22%, while moderate alcohol use declined from 78 to 68%.

Conclusion: During the 1980s, alcohol drinking decreased among the highest educated men and women and an educational gradient in alcohol drinking widened in men and attenuated in women.

Cardiorespiratory fitness in 16 025 adults aged 18-91 years and associations with physical activity and sitting time

Our aim was to provide up-to-date cardiorespiratory fitness reference data for adults of all ages and to investigate associations between cardiores-piratory fitness and leisure time physical activity as well as sitting time. In the Danish Health Examination Survey 2007-2008, cardiorespiratory fitness was estimated in 16 025 individuals aged 18-91 years from validated cycle ergometer exercise tests. Level of leisure time physical activity (sedentary, light, moderate, and vigorous) and daily sitting time in hours was obtained from a self-administered questionnaire. Men had 20-33% higher cardiorespiratory fitness than women, depending on age, and cardiorespiratory fitness decreased by 0.26 and 0.23 mL/min/kg per year in men and women, respectively. Cardiorespiratory fitness was higher among participants who reported a high level of physical activity in leisure time compared with participants who were sedentary. Among sedentary or lightly physically active participants, inverse associations between total daily sitting time and cardiorespiratory fitness were found, while there was no association between sitting time and cardiorespiratory fitness among moderately or vigorously physically active participants. These data on cardiorespiratory fitness can serve as useful reference material. Although reluctant to conclude on causality, sitting time might impact cardiorespiratory fitness among individuals with low levels of leisure time physical activity.

Combined influence of leisure-time physical activity and hip circumference on all-cause mortality

Hip circumference has been shown to be inversely associated with mortality. Muscle atrophy in the gluteofemoral region may be a possible explanation and thus physical activity is likely to play an important role.

OBJECTIVE

To estimate the combined effects of hip circumference and physical activity on mortality.

DESIGN AND METHODS

From the Copenhagen City Heart Study, 3,358 men and 4,350 women aged 21 to 93 years without pre-existing diagnosis of diabetes, stroke, ischemic heart disease, or cancer in 1991-1994 and with complete information on the variables of interest were included in the analyses. The participants were followed to 2009 in the Danish Civil Registration System, with 1.3% loss to follow-up and 2,513 deaths. Hazard ratios (HR) were estimated for combinations of physical activity and hip circumference.

RESULTS

Hip circumference was inversely associated with mortality irrespective of being physically active or not. However, being physically active seemed to counterbalance some of the adverse health effects of a small hip circumference; when comparing inactive to active, the excess mortality at the 25th percentile of hip circumference is 40% in men (HR = 1.40, 95% CI: 1.14-1.72) and 33% in women (HR = 1.33, CI: 1.10-1.62). These associations were observed after adjustment for waist circumference and weight change in the 6 months before the examination.

CONCLUSION

Less effects of physical activity were found in individuals with greater hip circumferences. A small hip circumference appears hazardous to survival. However, being physically active may counterbalance some of the hazardous effects of a small hip circumference.

Loss of partner and breast cancer prognosis - a population-based study, Denmark, 1994-2010

BACKGROUND

The extent to which experiencing a stressful life event influences breast cancer prognosis remains unknown, as the findings of the few previous epidemiological studies are inconsistent. This large population-based study examines the association between a common major life event, loss of a partner and breast cancer recurrence and all-cause mortality.

METHODS

N=21,213 women diagnosed with a first primary breast cancer 1994-2006, who had a cohabiting partner in the 4 years before their breast cancer diagnosis, were followed for death and recurrence in population-based registers and clinical databases. Information on education, disposable income, comorbidity and prognostic risk factors were included in Cox regression analyses.

RESULTS

Women who had lost a partner either before diagnosis or in subsequent years were not at significantly higher risk of recurrence or dying than women who had not lost a partner.

CONCLUSION

Our results do not support the concern that experiencing a stressful life event, the loss of a partner, negatively affects prognosis of breast cancer.

Perceived stress as a risk factor for changes in health behaviour and cardiac risk profile: a longitudinal study

OBJECTIVE

The aim of this study was to evaluate the long-term effects of stress on changes in health behaviour and cardiac risk profile in men and women.

DESIGN

A prospective cohort study.

SETTING

The Copenhagen City Heart Study, Denmark.

SUBJECTS

The analyses were based on 7066 women and men from the second (1981-1983) and third (1991-1993) wave of the Copenhagen City Heart Study. All participants were asked questions on stress and health behaviour and they had their weight, height, blood pressure and level of blood lipids measured by trained personnel.

MAIN OUTCOME MEASURES

Changes in health behaviour (smoking, physical activity, alcohol consumption, overweight) and cardiac risk profile (cholesterol, HDL cholesterol, blood pressure, diabetes).

RESULTS

Individuals with high levels of stress compared to those with low levels of stress were less likely to quit smoking (OR = 0.58; 95% CI: 0.41-0.83), more likely to become physically inactive (1.90; 1.41-2.55), less likely to stop drinking above the sensible drinking limits (0.43; 0.24-0.79), and stressed women were more likely to become overweight (1.55; 1.12-2.15) during follow-up. Men and women with high stress were more likely to use antihypertensive medication (1.94; 1.63-2.30), and stressed men were more than two times as likely to develop diabetes during follow-up (2.36; 1.22-4.59).

CONCLUSION

This longitudinal study supports a causal relation between stress and cardiovascular diseases mediated through unfavourable changes in health behaviour and cardiac risk profile.

The positive and negative health effects of alcohol- and the public health implications

In this paper, the negative and the positive effects of alcohol on health are reviewed. It is first of all established facts that a high alcohol intake implies an increased risk of a large number of health outcomes, such as dementia, breast cancer, colorectal cancer, cirrhosis, upper digestive tract cancer and alcohol dependency. Second, it is justified that alcohol has beneficial effects for some individuals, especially with regard to prevention of thrombosis of the heart. The public health relevance of these results is considered. The sensible drinking limits, used in both the UK and Denmark, of a maximum of 21 drinks per week for men and 14 drinks per week for women seem valid. A broader public health message of the beneficial effects of alcohol does not seem to be of interest in Western societies, where only a very small fraction of the population are non drinkers and may have very good reasons therefore.

Use of nicotine replacement therapy during pregnancy and stillbirth: a cohort study

OBJECTIVE

The objective of this study was to examine whether the use of nicotine replacement therapy (NRT) during pregnancy increases the risk of stillbirth.

DESIGN

Cohort study with prospective data.

SETTING

Denmark 1996-2002.

POPULATION

A total of 87,032 singleton pregnancies enrolled in the Danish National Birth Cohort for which information on NRT use as well as smoking was available.

METHODS

Outcome of pregnancy was identified by register linkage, with <1% loss to follow up. We conducted Cox regression analyses to estimate the hazard ratio (HR) and 95% CI of stillbirth according to the use of NRT, type of NRT use and a combination of NRT use and smoking.

MAIN OUTCOME MEASURES

Stillbirth, defined as delivery of a dead fetus after 20 completed weeks of gestation.

RESULTS

A total of 495 pregnancies (5.7 in 1000 births) ended in stillbirth, 8 of which were among NRT users (4.2 in 1000 births). After adjustment for confounders, women who used NRT during pregnancy had a HR of 0.57 (95% CI 0.28-1.16) for stillbirth compared with those who did not use NRT. Smoking during pregnancy was associated with an increased risk of stillbirth (HR 1.46, 95% CI 1.17-1.82), while women who both smoked and used NRT had a HR of 0.83 (95% CI 0.34-2.00) compared with nonsmoking women who did not use NRT.

CONCLUSION

Our study does not indicate that use of NRT during pregnancy increases the risk of stillbirth.

IQ in late adolescence/early adulthood, risk factors in middle age and later all-cause mortality in men: the Vietnam Experience Study

OBJECTIVE

To examine the role of potential mediating factors in explaining the IQ-mortality relation.

DESIGN, SETTING AND PARTICIPANTS

A total of 4316 male former Vietnam-era US army personnel with IQ test results at entry into the service in late adolescence/early adulthood in the 1960/1970s (mean age at entry 20.4 years) participated in a telephone survey and medical examination in middle age (mean age 38.3 years) in 1985-6. They were then followed up for mortality experience for 15 years.

MAIN RESULTS

In age-adjusted analyses, higher IQ scores were associated with reduced rates of total mortality (hazard ratio (HR)(per SD increase in IQ) 0.71; 95% CI 0.63 to 0.81). This relation did not appear to be heavily confounded by early socioeconomic position or ethnicity. The impact of adjusting for some potentially mediating risk indices measured in middle age on the IQ-mortality relation (marital status, alcohol consumption, systolic and diastolic blood pressure, pulse rate, blood glucose, body mass index, psychiatric and somatic illness at medical examination) was negligible (<10% attenuation in risk). Controlling for others (cigarette smoking, lung function) had a modest impact (10-17%). Education (0.79; 0.69 to 0.92), occupational prestige (0.77; 0.68 to 0.88) and income (0.86; 0.75 to 0.98) yielded the greatest attenuation in the IQ-mortality gradient (21-52%); after their collective adjustment, the IQ-mortality link was effectively eliminated (0.92; 0.79 to 1.07).

CONCLUSIONS

In this cohort, socioeconomic position in middle age might lie on the pathway linking earlier IQ with later mortality risk but might also partly act as a surrogate for cognitive ability.

Alcohol consumption and the risk of self-reported perennial and seasonal allergic rhinitis in young adult women in a population-based cohort study

BACKGROUND

Alcohol consumption has been suggested to be associated with the development of allergic rhinitis (AR), but there is limited data on the topic.

OBJECTIVES

The objective of this study was to investigate the association between alcohol consumption and the risk of developing AR among young women.

METHODS

Five thousand eight hundred and seventy Danish women aged 20-29 years participated in a prospective cohort study, and were free of seasonal and perennial AR at baseline (1991-1993). Alcohol consumption was assessed by a food frequency questionnaire. The main outcome measures were self-reported information on seasonal and perennial AR debuting during a mean follow-up period of 7.8 years.

RESULTS

During follow-up, 831 women developed seasonal AR and 523 women developed perennial AR, corresponding to 14% and 9%. Alcohol consumption was positively associated with the risk of developing perennial AR. The adjusted odds ratio (OR) for perennial AR was 1.78 (95% CI, 1.13-2.80) among women drinking more than 14 drinks/week compared with women drinking <1 drink/week. There was no association between alcohol consumption and seasonal AR. Having one or two parents with asthma was, after adjustment, significantly associated with the risk of developing seasonal (OR, 2.01; 95% CI, 1.65-2.45) and perennial AR (OR, 2.28; 95% CI, 1.70-2.74). Smoking was not associated with an increased risk of developing AR.

CONCLUSION

In this population of young adult women, alcohol consumption was associated with an increased risk of developing perennial AR.

Perceived stress and risk of colorectal cancer in men and women: a prospective cohort study

OBJECTIVE

We aim to assess the relationship between stress and risk of primary colorectal cancer in men and women.

DESIGN

A prospective cohort study.

SETTING

The Copenhagen City Heart Study, Denmark.

SUBJECTS

A total of 6488 women and 5426 men were included in the study. The participants were asked about intensity and frequency of stress at baseline in 1981-1983 and were followed until the end of 2000 in the Danish Cancer Registry. Less than 0.1% was lost to follow-up.

MAIN OUTCOME MEASURES

First time incidence of primary colorectal cancer.

RESULTS

During follow-up 162 women and 166 men were diagnosed with colorectal cancer. Women with moderate and high stress intensity had a hazard ratio of 0.60 (95% CI: 0.37-0.98) and 0.52 (0.23-1.14) for colorectal cancer, respectively, compared to women with no stress. For colon cancer, a one-unit increase on a seven-point stress-score was associated with an 11% lower incidence of the disease (HR = 0.89, 95% CI: 0.81-0.99) amongst women. There was no consistent evidence of an association between stress and colorectal cancer in men.

CONCLUSION

Perceived stress was associated with lower risk of particularly colon cancer in women, whilst there was no clear relationship between stress and colorectal cancer in men.

Drinking pattern and mortality in Danish nurses

BACKGROUND/OBJECTIVE

Moderate alcohol consumption has beneficial effects on survival. Sex differences, however, have been suggested implying less beneficial effect among women. We examined the impact of alcohol consumed on weekdays and at weekends, respectively, on risk of death among women.

SUBJECTS AND METHODS

At baseline in 1993, a total of 17 772 female members of the Danish Nurse Association completed questionnaires on alcohol intake and other lifestyle factors. The influence of alcohol intake on risk of death was analyzed using Cox proportional hazard model.

RESULTS

Alcohol intake of 1-3 drinks per week was associated with the lowest risk of death. Intake above six drinks per weekend (Friday through Sunday) increased risk of death from all causes by 3% for each additional drink consumed per weekend (corresponding to an increased risk by 9% per drink per weekend day). Consumption of one or more drinks per weekday (Monday, Tuesday, Wednesday or Thursday) increased risk by 4% for each additional drink consumed per day.

CONCLUSIONS

The results indicated an increasing risk of death for intake above six drinks per weekend and of one or more drinks per weekday.

Comparison of assessment methods for self-reported alcohol consumption in health interview surveys

OBJECTIVE

To select a simple method for assessing alcohol consumption and to compare how different reference periods and response categories influence the self-reported frequency of binge drinking.

DESIGN

Four random samples of 1000 adult Danes. Data were collected via personal interview at the respondents' home.

SETTING

Denmark, nationwide.

PARTICIPANTS

The total number of interviewed was 2593 individuals.

MEASUREMENTS

The assessment methods in the four samples were (1) the 7-day recall method, (2) intake each day in a typical week, (3) intake last weekend, and (4) intake in a typical week. Furthermore, binge drinking was assessed in the samples using different reference periods and response formats.

FINDINGS

The sex- and age-adjusted mean number of drinks in the last week (the 7-day recall method) was 10.6 drinks compared to 10.4 drinks among respondents reporting their intake for each day in a typical week and 8.7 drinks among subjects reporting the average intake in a typical week. Furthermore, subjects that reported their typical intake for each day were as likely as subjects that had the 7-day recall method to report a high weekly alcohol intake. Respondents who had close-ended questions were more likely to report binge drinking compared to respondents that had open-ended questions.

CONCLUSIONS

Questions concerning typical alcohol intake for each day of the week are feasible to use in epidemiological studies. Furthermore, it is more appropriate to use close-ended questions compared to open-ended questions in measuring binge-drinking when the reference period is long.

Stressful life events and cancer risk

In a prospective cohort study in Denmark of 8736 randomly selected people, no evidence was found among 1011 subjects who developed cancer that self-reported stressful major life events had increased their risk for cancer.

Do women give the same information on binge drinking during pregnancy when asked repeatedly?

OBJECTIVE

To study if pregnant women give the same answers to questions on frequency and timing of binge drinking when asked more than once during and after pregnancy.

DESIGN

Cohort study.

SETTING

The Danish National Birth Cohort.

SUBJECTS

The study is based on 76 307 pregnant women with repeated information on binge drinking during the early part of pregnancy and 8933 pregnant women with information on binge drinking during pregnancy weeks 30-36, obtained while pregnant and 6 months after delivery.

RESULTS

More women reported binge drinking, if the interview took place close to the period in question. As the report of binge drinking was highest in the first of two interviews referring to the same period, as well as women who participated in the first interview in pregnancy week 12 or earlier reported more binge drinking compared to women who participated in the interview later in pregnancy.

CONCLUSIONS

Self-reported information on binge drinking is more frequently under-reported when the recall period is long. To improve the validity of data on binge drinking, future birth cohorts should obtain information several times during pregnancy.

Spontaneous abortion: a prospective cohort study of younger women from the general population in Denmark. Validation, occurrence and risk determinants

OBJECTIVE

To assess the occurrence of spontaneous abortion, comparing two different data sources. To estimate the rate of spontaneous abortion over a 2-year period, and examine potential predictors of the risk for incident spontaneous abortion.

METHODS

We used interview data from a population-based prospective cohort study comprising 11,088 women and data from a linkage of the cohort with the Hospital Discharge Register to compare spontaneous abortions as reported in the interview with those identified in the register. Based on interview data, we estimated the rate of spontaneous abortion during the two-year follow-up. Finally, risk determinants for incident spontaneous abortion were analyzed by means of logistic regression.

RESULTS

A total of 654 spontaneous abortions before enrolment in the study were reported by the women compared to 531 abortions found in the register. More than 80% of the spontaneous abortions identified from both sources were recorded in the same year. During follow-up a total of 20.9% of pregnancies intended to be carried to term ended as a spontaneous abortion. In the risk factor analysis, we found that previous spontaneous abortion, being single, never having used oral contraceptives, and use of intrauterine device were associated with increased risk of subsequent spontaneous abortion. In addition, it was indicated that a short interpregnancy interval following a spontaneous abortion may confer an increased risk of abortion in the subsequent pregnancy.

CONCLUSION

We found a high rate of spontaneous abortion in the present study and an acceptable agreement between information obtained by interview and register information. More than 25% of the spontaneous abortions were only reported by the women, and this could not be explained by erroneously reported induced abortions, and may be early, nonhospitalized abortions. We confirm that number of previous spontaneous abortions is a strong determinant, and our data may also indicate a role of previous contraceptive habits. A role of the length of interpregnancy interval in the risk of spontaneous abortion cannot be ruled out.

Intake of wine, beer and spirits and risk of gastric cancer

The objective was to study prospectively the relation between quantity and type of alcohol and risk of gastric cancer. In a pooled database from three population studies conducted in 1964-1992, a total of 15,236 men and 13,227 women were followed for a total of 389,051 person-years. During follow-up 122 incident cases of gastric cancer were identified. Total alcohol intake itself was not associated with gastric cancer, but type of alcohol seemed to influence risk. Compared with non-wine drinkers, participants who drank 1-6 glasses of wine had a relative risk ratio of 0.76 (95% confidence interval (CI) 0.50-1.16), whereas those who drank >13 glasses of wine per week had a relative risk ratio of 0.16 (95% CI 0.02-1.18). Linear trend test showed a significant association with a relative risk ratio of 0.60 (95% CI 0.39-0.93) per glass of wine drunk per day. These relations persisted after adjustment for age, gender, educational level, body mass index, smoking habits, inhalation and physical activity. There was no association between beer or spirits drinking and gastric cancer. In conclusion, the present study suggests that a daily intake of wine may prevent development of gastric cancer.

Effect of red wine and red grape extract on blood lipids, haemostatic factors, and other risk factors for cardiovascular disease

OBJECTIVE

Some epidemiological studies found a lower risk of cardiovascular disease among wine drinkers than among drinkers of other types of ethanol. This difference might be due to an effect of nonalcohol compounds in wine on important cardiovascular risk factors. The objective of this study was to compare the effect of red wine, nonalcohol compounds of red wine and placebo on established cardiovascular risk factors.

DESIGN

A parallel, four-armed intervention study.

SUBJECTS

A total of 69 healthy 38-74-y-old men and women.

INTERVENTIONS

Subjects were randomised to either 1: red wine (males: 300 ml/day, 38.3 g alcohol/day, female subjects: 200 ml/day, 25.5 g alcohol/day), 2: water + red grape extract tablets (wine-equivalent dose), 3: water + red grape extract tablets (half dose), or 4: water + placebo tablets for a period of 4 weeks. No other sources of alcohol or anthocyanin were allowed. Plasma high-density lipoprotein (HDL)-cholesterol (HDL-C), low-density lipoprotein (LDL)-cholesterol (LDL-C), HDL-C/LDL-C-ratio, very-low-density lipoprotein (VLDL)-triacylglycerol, total cholesterol, fibrinogen, factor VII coagulant activity (FVIIc), blood pressure, and body weight were determined before and after intervention.

RESULTS

Wine consumption was associated with a significant 11-16% increase in fasting HDL-C and 8-15% decrease in fasting fibrinogen relative to not drinking wine. There were no significant treatment effects on fasting LDL-C, HDL-C/LDL-C-ratio, VLDL-triacylglycerol, total cholesterol, FVIIc, or blood pressure. Drinking wine was associated with relative body weight increments closely corresponding to the energy contributed by the alcohol component.

CONCLUSION

Moderate red wine consumption for 4 weeks is associated with desirable changes in HDL-C and fibrinogen compared with drinking water with or without red grape extract. The impact of wine on the measured cardiovascular risk factors thus seems primarily explained by an alcohol effect. Our finding suggests that the putative difference in cardiac risk associated with wine vs other alcoholic beverages might be rather explained by other life-style confounders than by red wine contents of nonalcohol components.

Is the effect of alcohol on risk of stroke confined to highly stressed persons?

BACKGROUND

Psychological stress and alcohol are both suggested as risk factors for stroke. Further, there appears to be a close relation between stress and alcohol consumption. Several experimental studies have found alcohol consumption to reduce the immediate effects of stress in a laboratory setting. We aimed to examine whether the association between alcohol and stroke depends on level of self-reported stress in a large prospective cohort.

METHODS

The 5,373 men and 6,723 women participating in the second examination of the Copenhagen City Heart Study in 1981-1983 were asked at baseline about their self-reported level of stress and their weekly alcohol consumption. The participants were followed-up until 31st of December 1997 during which 880 first ever stroke events occurred. Data were analysed by means of Cox regression modelling.

RESULTS

At a high stress level, weekly total consumption of 1-14 units of alcohol compared with no consumption seemed associated with a lower risk of stroke (adjusted RR: 0.57, 95% CI: 0.31-1.07). At lower stress levels, no clear associations were observed. Regarding subtypes, self-reported stress appeared only to modify the association between alcohol intake and ischaemic stroke events. Regarding specific types of alcoholic beverages, self-reported stress only modified the associations for intake of beer and wine.

CONCLUSIONS

This study indicates that the apparent lower risk of stroke associated with moderate alcohol consumption is confined to a group of highly stressed persons. It is suggested that alcohol consumption may play a role in reducing the risk of stroke by modifying the physiological or psychological stress response.

Alcohol during pregnancy and atopic dermatitis in the offspring

BACKGROUND

There is evidence that antenatal factors play a role in the development of atopic dermatitis (AD). However, little is known about the effects of maternal lifestyle factors during pregnancy on the risk of AD in the offspring.

OBJECTIVE

To investigate the effect of alcohol consumption during pregnancy on the incidence of AD in the offspring.

METHODS

A total of 24 341 mother-child pairs enrolled in the Danish National Birth Cohort were followed prospectively. Information about alcohol consumption was obtained by interview at 12 and 30 weeks of gestation. Information about symptoms, time of onset, and doctor's diagnosis of AD in the offspring was obtained by interview at 18 months of age. The effect of alcohol consumption during pregnancy on the incidence of AD was analysed by Cox regression allowing for different effects of alcohol before (early infancy) and after 2 months (60 days) of age.

RESULTS

Alcohol during pregnancy was associated with a significant and dose-dependent increased risk of AD in early infancy. This effect was mainly seen in high-risk infants (two parents with allergic disease). Thus, the highest risk of AD in early infancy was seen in high-risk infants of mothers who consumed four or more drinks per week at 30 weeks of gestation (adjusted relative risk 4.2, 95% confidence interval 1.7-10.1). There was no effect of alcohol during pregnancy beyond early infancy.

CONCLUSIONS

The results suggest that alcohol during pregnancy increases the risk of early-onset AD in predisposed infants.

Does caffeine and alcohol intake before pregnancy predict the occurrence of spontaneous abortion?

BACKGROUND

Consumption of caffeine and alcohol is suspected to affect pregnancy outcome. Use of both stimulants is widespread and even minor effects on fetal viability are of public health interest.

METHODS

We performed a nested case-control study using prospective data from a population-based cohort comprising 11088 women aged 20-29 years. From this cohort, women who experienced either a spontaneous abortion (n = 303) or who gave birth (n = 1381) during follow-up [mean time: 2.1 years (range: 1.6-3.4)] were selected. Associations between self-reported exposures to caffeine and/or alcohol at enrolment and spontaneous abortion were analysed by means of logistic regression.

RESULTS

Compared with women with a pre-pregnancy intake of <75 mg caffeine per day, the adjusted odds ratio (95% confidence interval) for spontaneous abortion was 1.26 (0.77-2.06), 1.45 (0.87-2.41), 1.44 (0.87-2.37) and 1.72 (1.00-2.96) for a pre-pregnancy intake on 75-300, 301-500, 501-900 and >900 mg caffeine per day respectively (P = 0.05 for trend). A pre-pregnancy intake of alcohol was not a predictor for spontaneous abortion.

CONCLUSIONS

A high intake of caffeine prior to pregnancy seems to be associated with an increased risk of spontaneous abortion, whereas a low-to-moderate alcohol intake does not influence the risk.

Is the relationship between type of alcohol and mortality influenced by socio-economic status?

OBJECTIVES

To assess the impact of socio-economic status on the relationship between type of alcohol and all-cause mortality.

DESIGN

A prospective population study.

SETTING

The Copenhagen City Heart Study, Denmark.

SUBJECTS

A total of 14,223 men and women participated in the first examination of The Copenhagen City Heart Study in 1976-1978. The participants were followed up until 18th of September 2001 during which 7208 persons died. The effect of beer, wine and spirits on mortality was stratified according to levels of education, income and cohabitation, and the association was examined after controlling for intake of the other types of alcohol, and for sex, smoking, physical activity and body mass index.

MAIN OUTCOME MEASURES

Number and time of death from all causes.

RESULTS

Consumers of wine were better educated and wealthier compared with beer and spirits drinkers. The association between type of beverage and mortality was noticed to differ according to socio-economic level, especially where the apparent protective effect of wine consumption tended to be strongest in the lower income and educational groups.

CONCLUSIONS

This study finds the specific effects of beer, wine or spirits to moderately diverge in the socio-economic groups. Future studies addressing the association between the type of beverage and mortality may need to more thoroughly take socio-economic factors into account.

A comparison of the alcohol-attributable mortality in four European countries

BACKGROUND

Deaths due to alcohol consumption are an important component of all-cause mortality, particularly premature mortality. However, there are considerable regional variations, the reasons for which are unclear.

METHODS

Estimates were made as reliably as possibly using vital statistics and best estimates of risk of the alcohol-attributable mortality, by age, sex and cause for four European countries (England and Wales, Germany, Denmark and Italy). Twenty-seven alcohol-related conditions were considered including the possible cardio-protective effects of alcohol.

RESULTS

It was estimated that there are approximately 2% fewer deaths annually in England and Wales than would be expected in a non-drinking population and 0.3% fewer deaths among East German females. In West Germany, Denmark, Italy and among East German males there are more deaths caused by alcohol than are prevented (between 0.7 and 2.6% of all deaths). The highest age-specific proportion of alcohol-attributable deaths is found in East Germany where around 30% of deaths among males aged 25-44 years are due to drinking. Among young men in all four countries the largest contributor to alcohol-related deaths is road traffic accidents involving alcohol.

CONCLUSIONS

Possible explanations for the variation in alcohol-attributable deaths between countries include different underlying heart disease rates, different patterns of alcohol consumption and beverage preferences, and different use of mortality classification. Differences in the reported alcohol consumption levels explain little of the variation in alcohol-attributable deaths. Estimating alcohol-attributable mortality by age and sex across countries may be a useful indicator for developing alcohol strategies and exploring ways of preventing premature mortality.

Relations between amount and type of alcohol and colon and rectal cancer in a Danish population based cohort study

BACKGROUND

There may be a weak association between total alcohol intake and colorectal cancer but the effect of different types of alcohol and effect on colon subsites have not been investigated satisfactorily.

AIMS

To investigate the relationship between amount and type of alcohol and the risk of colon and rectal cancer.

SUBJECTS

A population based cohort study with baseline assessment of weekly intake of beer, wine, and spirits, smoking habits, body mass index, educational level, and leisure time physical activity in Copenhagen, Denmark. The study included a random sample of 15 491 men and 13 641 women, aged 23-95 years. Incident cases of colorectal cancer were identified in the nationwide Danish Cancer Register.

RESULTS

During a mean follow up of 14.7 years, we observed 411 colon cancers and 202 rectal cancers. We observed a dose-response relationship between alcohol and rectal cancer. Drinkers of more than 41 drinks a week had a relative risk of rectal cancer of 2.2 (95% confidence limits 1.0-4.6) compared with non-drinkers. Drinkers of more than 14 drinks of beer and spirits a week, but not wine, had a risk of 3.5 (1.8-6.9) of rectal cancer compared with non-drinkers, while those who drank the same amount of alcohol but including more than 30% of wine had a risk of 1.8 (1.0-3.2) of rectal cancer. No relation between alcohol and colon cancer was found when investigating the effects of total alcohol, beer, wine, and spirits, and percentage of wine of total alcohol intake.

CONCLUSION

Alcohol intake is associated with a significantly increased risk of rectal cancer but the risk seems to be reduced when wine is included in the alcohol intake.

Waist circumference in relation to history of amount and type of alcohol: results from the Copenhagen City Heart Study

OBJECTIVE

To examine the long-term association between the amount and type of alcohol consumed and subsequent high waist circumference.

DESIGN

Prospective population study with baseline assessment of alcohol intake, body mass index, smoking habit, physical activity, education, income and deliveries, and after 10 y, examination of waist circumference.

SUBJECTS

A sample of 2916 men and 3970 women aged 20-83 y from Copenhagen City Heart Study, Denmark.

MEASUREMENTS

A large waist circumference defined as a waist circumference more than 102 cm in men and 88 cm in women.

RESULTS

The odds ratios of having a high waist circumference after 10 y showed a linear increase in both men and women, and they were 1.65 (95% confidence interval (CI) 1.07-2.55) in men and 2.16 (0.86-5.14) in women who drank more than 28 beverages per week of total alcohol compared to those who drank one to six beverages per week. Men drinking more than 21 beers per week had odds ratio of having a large waist circumference after 10 y of 1.63 (0.99-2.67) and women drinking more than 14 beers per week had odds ratio of 2.53 (0.92-6.34), compared to men and women who drank no beer. Also for spirits, there was an increase in both men and women. No linear trend was found for wine in either men or women.

CONCLUSIONS

Moderate-to-high consumption of alcohol and of beer and spirits was associated with later high waist circumference, whereas moderate-to-high wine consumption may have the opposite effect.

Impact of a 10-year nation-wide alcohol campaign on knowledge of sensible drinking limits in Denmark

In Great Britain and in Denmark, strong efforts have been made to influence knowledge on upper threshold for hazardous drinking. In Denmark, a campaign has been repeated every week 40 from 1990 to 2000 with information on the sensible drinking limits of 21 drinks per week for men and 14 drinks per week for women. The aim of this study was to examine the effect of this ongoing campaign on the level of knowledge of sensible drinking limits for men and women. Random representative samples of 1030 adult Danes were telephone interviewed each year during 1994-1999. Our main finding was that the level of knowledge of sensible drinking limits for own sex increased in all subsets of the population throughout the period. However, at the end of the study period (1999) a total of 80% of highly educated young (18-25 years) men knew sensible drinking limits for own sex, while only 35% of uneducated older (more than 65 years) men had knowledge on sensible drinking limits. The proportions were similar among women. Subjects admitting an intake higher than sensible for own sex, i.e. 21 and 14 drinks per week, respectively, had the highest knowledge of these drinking limits. We conclude that public health campaigns, such as the sensible drinking limit campaign, certainly has an impact on level of awareness in the general population. Furthermore, those drinking more than 21 and 14 drinks per week, respectively, are reached by these campaigns.

Does the association between smoking status and selected healthy foods depend on gender? A population-based study of 54 417 middle-aged Danes

OBJECTIVE

Smoking serves different functions for men and women. Thus, we wanted to investigate the association between smoking behaviour and intakes of selected healthy foods in men and women with special focus on differences and similarities between the two genders.

DESIGN

In 1993-1997, a random sample of 80 996 men and 79 729 women aged 50-64 y was invited to participate in the study 'Diet, Cancer and Health'. In all, 27 179 men and 29 876 women attended a health examination and completed a 192-item food-frequency questionnaire (FFQ). The association between smoking status and low, median and high intakes of selected foods was examined among 25 821 men and 28 596 women.

SETTING

The greater Copenhagen and Aarhus area, Denmark.

RESULTS

For both men and women, smoking status group was associated with diet, such that increasing level of smoking status ranging from never smokers over ex-smokers to currently heavy smokers was associated with a lower intake of the healthy foods: fresh fruit, cooked vegetables, raw vegetables/salad, and olive oil. For wine, increasing level of smoking status category was associated with a higher fraction of abstainers and heavy drinkers. The difference between the extreme smoking status categories was larger than the difference between men and women within smoking status categories such that never smoking men in general had a higher intake of healthy foods than heavy smoking women. Correction for age, educational level, and body mass index (BMI) did not affect the results.

CONCLUSION

In this middle-aged population, intake of healthy foods were associated with smoking behaviour with a dose-response type of relationship. The overall pattern was similar for men and women.

Moderate alcohol consumption and waiting time to pregnancy

BACKGROUND

Recent research indicates that even a moderate consumption of alcohol in women trying to become pregnant is associated with longer waiting time to pregnancy. The findings, though, are based upon few observations.

METHODS

Self-reported data on alcohol intake and waiting time to pregnancy (0-2, 3-5, 6-12 and >12 months) was used for 39 612 pregnant women, recruited to the Danish National Birth Cohort within the first 24 weeks of pregnancy from 1997 to 2000. Main outcome measures were odds ratios (OR) for a prolonged waiting time to pregnancy according to alcohol intake.

RESULTS

In nulliparous women neither moderate nor high alcohol intake was related with longer waiting time to pregnancy compared with a low intake. In parous women, a modest association was seen only among those with an intake of >14 drinks per week (subfecundity OR 1.3; 95% confidence interval 1.0-1.7). Women who reported no alcohol intake had a slightly longer waiting time (subfecundity OR 1.2; 95% confidence interval 1.1-1.3) than women with a moderate intake of alcohol.

CONCLUSIONS

Our findings do not corroborate recent results suggesting a marked reduction in fecundity associated with a moderate intake of alcohol.

Factors influencing the relation between alcohol and mortality--with focus on wine

The impact of alcohol intake on mortality has been described in a large number of prospective population studies from many countries. Most have shown a J-shaped relation between alcohol intake and subsequent mortality, indicating that there are both beneficial and harmful effects of ethanol on health. In exploring the French paradox, it has been suggested that wine may have beneficial effects additional to that of ethanol. Recently, several prospective population studies have supported this idea. However, it is also likely that the apparent additional beneficial effect of wine on health is confounding.

Leisure-time physical activity levels and changes in relation to risk of hip fracture in men and women

The authors prospectively studied the effect of leisure-time physical activity level on hip fracture risk along with the influence of within-subject changes in activity levels, while taking possible confounding by other health behaviors and poor health into account. Analyses were based on pooled data from three population studies conducted in Copenhagen, Denmark. Among 13,183 women and 17,045 men, 1,121 first hip fractures were identified during follow-up. In comparison with being sedentary, the relative risk (RR) of hip fracture associated with being moderately physically active 2-4 hours per week was 0.72 (95% confidence interval (CI): 0.59, 0.89) in women and 0.75 (95% CI: 0.55, 1.03) in men after adjustment for confounders. Being in the most active leisure activity category did not decrease the risk of hip fracture further. Adjustment for poor health affected the risk estimates only modestly. Subjects who, during follow-up, reduced their physical activity level from the highest or the intermediate activity level to a sedentary level had a higher risk of hip fracture than did those who remained moderately physically active at the intermediate level (multivariate adjusted RR = 2.19, 95% CI: 1.00, 4.84 and RR = 1.89, 95% CI: 1.21, 2.95, for reduction from the highest and intermediate levels, respectively). There was no evidence of a fracture-protective effect from increasing physical activity. In conclusion, moderate levels of physical activity appear to provide protection against later hip fracture. Decline in the physical activity level over time is an important risk factor for hip fracture.

Stroke incidence and case fatality in two populations: the Auckland Stroke Study and the Copenhagen City Heart Study

Comparison of stroke incidence and case fatality in different parts of the world provides information that may lead to a better understanding of the disease. In this report we have investigated these two aspects in two large populations, one in Auckland, New Zealand, and the other in Copenhagen, Denmark (the Copenhagen City Heart Study, CCHS). Incidence rates of stroke are higher for men than women in both studies. The stroke incidence rate ratios between Auckland men and CCHS men are significantly different in most age groups, whereas in women the incidence rates differ only in one age group. The age- and sex-adjusted incidence rates are higher in the CCHS for both men and women as compared to the Auckland Stroke Study. The age-adjusted incidence rate ratio is higher for men than women in both studies: 1.29 in the Auckland Stroke Study and 1.54 in the CCHS. The 28-day case fatality is also higher in the CCHS than in Auckland and is higher for women than men in both studies. The incidence rate of stroke and the 28-day case fatality is higher in the CCHS as compared to the Auckland Stroke Study in both men and women. A very high proportion of smokers in CCHS may explain some of the differences in incidence rates in the two populations.

Type of alcohol consumed and mortality from all causes, coronary heart disease, and cancer

BACKGROUND

Although the J-shaped relation between alcohol intake and mortality has been reproduced in many large cohort studies, the question of whether the effects of beer, wine, and spirits differ remains controversial.

OBJECTIVE

To examine the relation between intake of different types of alcohol and death from all causes, coronary heart disease, and cancer.

DESIGN

Pooled cohort studies in which intake of beer, wine, and spirits; smoking status; educational level; physical activity; and body mass index were assessed at baseline.

SETTING

Copenhagen, Denmark.

PARTICIPANTS

13 064 men and 11 459 women 20 to 98 years of age.

MEASUREMENTS

Number of deaths and time to death from all causes, coronary heart disease, and cancer during follow-up.

RESULTS

During 257 859 person-years of follow-up, 4833 participants died. J-shaped relations were found between total alcohol intake and mortality at various levels of wine intake. Compared with nondrinkers, light drinkers who avoided wine had a relative risk for death from all causes of 0.90 (95% CI, 0.82 to 0.99) and those who drank wine had a relative risk of 0.66 (CI, 0. 55 to 0.77). Heavy drinkers who avoided wine were at higher risk for death from all causes than were heavy drinkers who included wine in their alcohol intake. Wine drinkers had significantly lower mortality from both coronary heart disease and cancer than did non-wine drinkers (P = 0.007 and P = 0.004, respectively).

CONCLUSION

Wine intake may have a beneficial effect on all-cause mortality that is additive to that of alcohol. This effect may be attributable to a reduction in death from both coronary heart disease and cancer.

Smoking and alcohol intake as risk factors for bleeding and perforated peptic ulcers: a population-based cohort study

Both the incidence of and mortality from bleeding and perforated peptic ulcers are increasing. We assessed the association between smoking, intake of alcohol (including type of alcoholic beverage), and risk of a complicated peptic ulcer in a population-based study of 26,518 Danish subjects followed up for an average of 13.4 years. There were 214 cases of incident bleeding and 107 cases with perforated ulcers. We estimated relative risks (RRs) for incident bleeding and perforated peptic ulcers using Poisson regression analysis. Smoking more than 15 cigarettes per day compared with never smoking increased the risk of a perforated ulcer more than threefold [RR = 3.5; 95% confidence interval (CI) = 1.7-7.1)]. Drinking more than 42 drinks per week increased the risk of a bleeding ulcer fourfold (RR = 4.4; 95% CI = 2.3-8.3) compared with drinking less than one drink per week. Using the same comparison group, subjects who drank more than 21 drinks per week but no wine were at a higher risk of a bleeding ulcer (RR = 8.8; 95% CI = 2.2-35) than drinkers of the same amount of alcohol, but with more than 25% of their intake as wine (RR = 2.4; 95% CI = 1.0-6.0).

Tobacco smoking and risk of hip fracture in men and women

BACKGROUND

Previous findings suggest that tobacco smoking increases the risk of hip fracture in women. A similar adverse effect of smoking is suspected to be present in men, but bone mineral density studies have raised the concern that men may be more sensitive to the deleterious effect of smoking on bone than women. In this study we prospectively determined the influence of current, previous, and cumulative smoking history on risk of hip fracture in men and women and addressed the issue of possible gender difference in the susceptibility to tobacco smoking.

METHODS

Pooled data from three population studies conducted in Copenhagen with detailed information on smoking habit. A total of 13,393 women and 17,379 men, initially examined between 1964 and 1992, were followed until 1997 for first admission due to hip fracture. The relative risks (RR) of hip fracture associated with smoking were estimated by means of multiplicative Poisson regression models.

RESULTS

During follow-up, 722 hip fractures were identified in women, and 447 in men. After adjustment for potential confounders, including body mass index, female current smokers had an RR of hip fracture of 1.36 (95% CI: 1.12-1.65) and male smokers 1.59 (95% CI: 1.04-2.43) relative to never smokers. In both sexes, the RR of hip fracture gradually increased by current and accumulated tobacco consumption. The RR were consistently higher in men than in women, but the test for interaction between sex and tobacco smoking was insignificant. After 5 years, male ex-smokers had an adjusted RR of 0.73 (95% CI: 0.55-0.98) relative to current smokers, while no significant decrease in risk was observed in female ex-smokers (RR = 0.91; 95% CI: 0.72-1.17)). Approximately 19% of all hip fractures in the present study population were attributable to tobacco smoking.

CONCLUSION

Tobacco smoking is an independent risk factor for hip fracture in men and women, and there appears to be no gender differences in smoking related risk. Smoking cessation reduces the risk of hip fracture in men after 5 years, while the deleterious effect of smoking seems to be more long-lasting in female ex-smokers.

Type of alcohol and drinking pattern in 56, 970 Danish men and women

OBJECTIVE

To describe drinking patterns among individuals who prefer drinking wine, beer or spirits.

DESIGN

Cross-sectional study obtaining detailed information on intake of wine, beer and spirits and on frequency of alcohol intake. Adjustment for gender, age, smoking habits, educational attainment and body mass index.

SETTING

Denmark.

SUBJECTS

27, 151 men and 29, 819 women, randomly selected from Copenhagen and Aarhus, Denmark.

MAIN OUTCOME MEASURES

Drinking pattern-steady or binge drinking.

RESULTS

A vast majority (71%) of both men and women preferred wine or beer. At all levels of total alcohol intake, beer drinkers were most likely to be frequent drinkers. Thus, light drinkers of beer had an odds ratio for being frequent drinkers of 1.97 (95% confidence limits 1.50-2.58) as compared to light drinkers of wine (total alcohol intake 3-30 drinks per month), while people who preferred beer had an odds ratio of 1. 29 (1.19-1.40) compared with wine drinkers in the moderate drinking category (31-134 drinks per month). There were no significant differences in total alcohol intake between individuals preferring different alcoholic beverages.

CONCLUSION

If binge drinking is less healthy than steady drinking, the relation between wine intake and coronary heart disease mortality could be subject to negative confounding, since beer drinkers seem to have the most sensible drinking pattern.

SPONSORSHIP

Danish Cancer Society and the Danish National Board of Health. European Journal of Clinical Nutrition (2000) 54, 174-176

Hormone replacement therapy and hip fracture risk: effect modification by tobacco smoking, alcohol intake, physical activity, and body mass index

The authors prospectively studied the overall effect of hormone replacement therapy (HRT) on hip fracture risk and the effect modification by behavioral habits and body mass index. A total of 6,159 postmenopausal women from the Copenhagen Center for Prospective Population Studies, Copenhagen, Denmark, with initial examination in 1976-1978 were followed until 1993. During follow-up 363 hip fractures were identified. Women who reported current use of HRT had a lower risk of hip fracture as compared with women who were nonusers (relative risk (RR) = 0.71; 95 percent confidence interval (CI): 0.50, 1.01). Use of HRT was associated with a lower risk of hip fracture in former (RR = 0.55; 95 percent CI: 0.22, 1.37) and current (RR = 0.61; 95 percent CI: 0.38, 0.99) smokers but not in never smokers (RR = 1.10; 95 percent CI: 0.60, 2.03). HRT was also associated with lower risk of hip fracture among alcohol drinkers (RR = 0.36; 95 percent CI: 0.14, 0.90) and among sedentary women (RR = 0.42; 95 percent CI: 0.18, 0.98) but not among nondrinkers (RR = 0.99; 95 percent CI: 0.61, 1.61) and physically active women (RR = 0.92; 95 percent CI: 0.42, 2.04). There was no evidence of interaction between use of HRT and body mass index. In conclusion, the protective effect of HRT on hip fracture appears to be strongest in women who ever smoked, in women who drink alcohol, and in women who are sedentary. The results suggest that history of behavioral habits offers important information concerning the probable degree of protection against hip fracture afforded by HRT.

Beer, wine, spirits and subjective health

STUDY OBJECTIVE

To examine the association between intake of different types of alcoholic beverages and self reported subjective health.

DESIGN

Cross sectional health survey with assessment of intake of beer, wine and spirits (at last non-weekend day), smoking habits, social networks, physical activity, body mass index, educational level, presence of chronic disease, and self reported health.

SETTING

WHO Copenhagen Healthy City Survey, Denmark.

PARTICIPANTS

4113 men and 7926 women aged 18 to 100 years.

MAIN RESULTS

Of the 12,039 subjects, 8680 reported their health as optimal, and 3359 reported a suboptimal health. After controlling for the covariates, the relation between total alcohol intake and the proportion reporting suboptimal health was J shaped. Heavy drinkers of any of the three types of alcoholic beverages had a higher prevalence of suboptimal health than non-drinkers. However, only light (1-2 glasses of wine yesterday) and moderate (3-5) wine drinkers had significantly lower odds ratios for suboptimal health--0.72 (95% confidence limits; 0.56 to 0.92) and 0.65 (0.49 to 0.87), respectively--when compared with non-wine drinkers. Moderate beer or spirits drinkers did not differ significantly from non-drinkers of these beverages with regard to prevalence of suboptimal health. Consistently, beer preference drinkers had an odds ratio of 1.50 (1.25 to 1.80) for suboptimal health compared with wine preference drinkers.

CONCLUSIONS

A light to moderate wine intake is related to good self perceived health, whereas this is not the case for beer and spirits. The causal relations creating this association are unknown and should be considered when interpreting the relation between different types of alcoholic beverages and subsequent morbidity and mortality.

Type of alcohol and mortality from cardiovascular disease

Many epidemiological studies have described a U-shaped relation between alcohol intake and all-cause mortality (Boffetta and Garfinkel, 1990; Fuchs et al., 1995; Gronbaek et al., 1994; Marmot et al., 1981). Most researchers attribute the 'U' to a combination of beneficial and harmful effects of ethanol itself. It has, on the other hand, been explained as an artefact due to misclassification or confounding (Shaper et al., 1998). Most of the studies of the effect of total alcohol intake have found that the descending leg of the curve mainly is attributable to death from cardiovascular disease (Rimm et al., 1991; Stampfer et al., 1988). Until recently, most studies addressed the effect of the three beverages taken together as ethanol. Studies of the correlation between wine intake per capita in different countries and incidence of ischaemic heart disease gave rise to the hypothesis that there is a a more beneficial effect of wine than of beer and spirits. Leger et al., Renaud and de Lorgeril and later Criqui and Rigel found an inverse relation between incidence rates of ischemic heart disease and wine consumption in different countries, but no such relation for the other types of beverages (Criqui and Rigel, 1994; Leger et al., 1979; Renaud and de Logeril, 1992).

Fish consumption and coronary heart disease mortality. A systematic review of prospective cohort studies

OBJECTIVES

To review all prospective cohort studies examining the relationship between fish intake and coronary heart disease mortality, and to assess the strength and consistency of their findings.

DESIGN

Systematic review of studies based on individual records of fish or n-3 polyunsaturated fatty acid consumption and coronary heart disease death. Studies were given scientific quality scores and divided into categories of high, intermediate, or insufficient quality.

MAIN OUTCOME MEASURE

Coronary heart disease mortality.

RESULTS

Eleven studies were identified. The cohorts counted a total of 116764 individuals. Of four studies judged to be of high quality, the two largest (n = 44895 and 20051) were performed in populations at low risk of coronary heart disease. They found no protective effect of fish consumption. The other two high-quality studies were relatively small (n = 852 and 1822) and included individuals at higher risk. They both found an inverse relationship between fish consumption and coronary heart disease death, suggesting that 40-60 g fish per day is optimal and associated with a risk reduction of 40-60%. Results of four studies of intermediate quality support that fish consumption is inversely associated with coronary heart disease mortality in high-risk populations only. Three studies were judged to be of insufficient quality to be used for drawing conclusions.

CONCLUSIONS

Fish consumption is not associated with reduced coronary heart disease mortality in low-risk populations. However, fish consumption at 40-60 g daily is associated with markedly reduced coronary heart disease mortality in high-risk populations. The underlying biochemical mechanism is not known and causal inference premature.

Alcohol intake, beverage preference, and risk of hip fracture in men and women. Copenhagen Centre for Prospective Population Studies

The authors prospectively studied the association between quantity and type of alcohol intake and risk of hip fracture among 17,868 men and 13,917 women. Analyses were based on pooled data from three population studies conducted in 1964-1992 in Copenhagen, Denmark. During follow-up, 500 first hip fractures were identified in women and 307 in men. A low to moderate weekly alcohol intake (1-27 drinks for men and 1-13 drinks for women) was not associated with hip fracture. Among men, the relative risk of hip fracture gradually increased for those who drank 28 drinks or more per week (relative risk (RR) = 1.75, 95% confidence interval (CI) 1.06-2.89 for 28-41 drinks; RR = 5.28, 95% CI 2.60-10.70 for 70 or more drinks) as compared with abstainers. Women who drank 14-27 drinks per week had an age-adjusted relative risk of hip fracture of 1.44 (95% CI 1.03-2.03), but the association weakened after adjustment for confounders (RR = 1.32, 95% CI 0.92-1.87). The risk of hip fracture differed according to the type of alcohol preferred: preferrers of beer had a higher risk of hip fracture (RR = 1.46, 95% CI 1.11-1.91) than preferrers of other types of alcoholic beverages. The corresponding relative risks for preferrers of wine and spirits were 0.77 (95% CI 0.58-1.03) and 0.82 (95% CI 0.58-1.14), respectively. In conclusion, an alcohol intake within the current European drinking limits does not influence the risk of hip fracture, whereas an alcohol intake of more than 27 drinks per week is a major risk factor for men.

Alcohol intake and the risk of lung cancer: influence of type of alcoholic beverage

Alcohol consumption has been associated with an increased risk of lung cancer, but the antioxidants in wine may, in theory, provide protection. This association was studied in 28,160 men and women subjects from three prospective studies conducted in 1964-1992 in Copenhagen, Denmark. After adjustment for age, smoking, and education, a low to moderate alcohol intake (1-20 drinks per week) was not associated with an increased risk of lung cancer. Men who consumed 21-41 and more than 41 drinks per week had relative risks of 1.23 (95% confidence interval (CI) 0.88-1.74) and 1.57 (95% CI 1.06-2.33), respectively. The risk of lung cancer differed according to the type of alcohol consumed: After abstainers were excluded, drinkers of 1-13 and more than 13 glasses of wine per week had relative risks of 0.78 (95% CI 0.63-0.97) and 0.44 (95% CI 0.22-0.86), respectively, as compared with nondrinkers of wine (p for trend = 0.002). Corresponding relative risks for beer intake were 1.09 (95% CI 0.83-1.43) and 1.36 (95% CI 1.02-1.82), respectively (p for trend = 0.01); for spirits, they were 1.21 (95% CI 0.97-1.50) and 1.46 (95% CI 0.99-2.14), respectively (p for trend = 0.02). In women, the ability to detect associations with high alcohol intake and type of beverage was limited because of a limited range of alcohol intake. The authors concluded that in men, a high consumption of beer and spirits is associated with an increased risk of lung cancer, whereas wine intake may protect against the development of lung cancer.

Wine intake and diet in a random sample of 48763 Danish men and women

BACKGROUND

Variation in diet associated with drinking patterns may explain why wine seems to reduce ischemic heart disease mortality.

OBJECTIVE

Our objective was to study the association between intake of different alcoholic beverages and selected indicators of a healthy diet.

DESIGN

This was a cross-sectional study conducted in Copenhagen and Aarhus, Denmark, from 1995 to 1997, and included 23 284 men and 25 479 women aged 50-64 y. The main outcome measures were groups of selected foods that were indicators of a healthy dietary pattern.

RESULTS

Wine, as compared with other alcoholic drinks, was associated with a higher intake of fruit, fish, cooked vegetables, salad, and the use of olive oil for cooking in both men and women. Men who preferred beer and spirits had odds ratios of 0.42 (95% CI: 0.39, 0.45) and 0.51 (95% CI: 0.43, 0.60), respectively, for a high intake of salad compared with those who preferred wine. Higher wine intake was associated with a higher intake of healthy food items compared with intake of < or = 2.5 glasses of wine/mo; odds ratios for drinkers of between 30 and 135 glasses of wine/mo for all the chosen indicators of healthy diet varied between 1.23 and 4.20, and were all strongly significant.

CONCLUSION

Wine drinking is associated with an intake of a healthy diet. This finding may have implications for the interpretation of previous reports of the relation between type of alcoholic beverage and mortality.

Alcohol and mortality: is there a U-shaped relation in elderly people?

OBJECTIVE

to assess the relation between alcohol intake and mortality among seven cohorts of middle-aged and elderly Danes.

DESIGN

Prospective population study with baseline assessment of alcohol- and tobacco consumption, educational level and body mass index, and a mean of 11.5 years follow-up of mortality.

SUBJECTS

16304 men and women aged 50 years or more.

MAIN OUTCOME MEASURE

number and time of deaths from 1974 to 1995 as ascertained by the national central person register.

RESULTS

the effect of alcohol intake on mortality did not differ between middle-aged (50-64 years, mean = 56.6 years) and elderly subjects (>64 years old, mean = 69.9 years). There was a U-shaped risk function in both age groups, which persisted also when adjusting for age, sex, smoking habits, level of education and body mass index. Abstaining women had a relative risk of 1.29 (95% confidence limits 1.17-1.42) as compared with light drinkers (1-6 (drinks per week), while the relative risk for abstaining men was 1.22 (95% confidence limits; 1.08 to 1.37) as compared with light drinkers. Heavy drinking women (>28 drinks per week) had a relative risk of 1.23 (95% confidence limits; 0.85 to 1.78) and heavy drinking men (more than 69 drinks per week) had a relative risk of 2.11 (95% confidence limits 1.66-2.69), both compared with light drinkers.

CONCLUSION

among the middle-aged and elderly women and men, a light alcohol intake is associated with lower mortality than abstention or heavy drinking.

Population based cohort study of the association between alcohol intake and cancer of the upper digestive tract

OBJECTIVE

To examine the relation between different types of alcoholic drinks and upper digestive tract cancers (oropharyngeal and oesophageal).

DESIGN

Population based study with baseline assessment of intake of beer, wine, and spirits, smoking habits, educational level, and 2-19 years' follow up on risk of upper digestive tract cancer.

SETTING

Denmark.

SUBJECTS

15 117 men and 13 063 women aged 20 to 98 years.

MAIN OUTCOME MEASURE

Number and time of identification of incident upper digestive tract cancer during follow up.

RESULTS

During a mean follow up of 13.5 years, 156 subjects developed upper digestive tract cancer. Compared with non-drinkers (drinkers of <1 drink/week), subjects who drank 7-21 beers or spirits a week but no wine were at a risk of 3.0 (95% confidence interval 1.5 to 6.1), whereas those who had the same total alcohol intake but with wine as >=30% of their intake had a risk of 0.5 (0.2 to 1.4). Drinkers of >21 beers and spirits but no wine had a relative risk of 5.2 (2.7 to 10.2) compared with non-drinkers, whereas those who drank the same amount, but included wine in their alcohol intake, had a relative risk of 1.7 (0.6 to 4. 4).

CONCLUSION

A moderate intake of wine probably does not increase the risk of upper digestive tract cancer, whereas a moderate intake of beer or spirits increases the risk considerably.

[Positive effects of alcohol drinking?]

Findings in more than 30 population studies have suggested the relationship between alcohol consumption and mortality rates to be described by a U-shaped or J-shaped curve. The downstroke of the U is probably to be explained by a beneficial effect of moderate alcohol consumption on the risk of ischaemic heart disease. Various sources of bias in our interpretation of the downstroke of the curve have been reviewed and to some extent excluded. In all likelihood, however, both the drinking pattern and the type of alcohol used are determinants of the shape of the curve. One study has shown steady drinking to be more protective than binge drinking against heart disease, and a couple of studies have suggested wine-drinkers to enjoy greater protection than beer and spirits drinkers. Moreover, it is emphasised that the effect of alcohol on the risk of cardiovascular and other diseases is highly dependent on the distribution of other risk factors in the population under study. The pultative beneficial effects of moderate alcohol consumption should therefore be considered to apply only to individuals at risk of cardiovascular disease. Finally, it is stressed that available evidence of the efficacy of alcohol as a "heart medicine" is insufficient.

Trends in stroke incidence. The Copenhagen City Heart Study

BACKGROUND AND PURPOSE

Stroke incidence has increased in some countries and decreased in others. After 20 years of intensive antihypertensive treatment the latter could be expected, and we have evaluated the sex-specific temporal trends in stroke incidence using 17 years of follow-up in the Copenhagen City Heart Study.

SUBJECTS AND METHODS

Our cohort comprised 19,698 subjects living in Copenhagen, Denmark. They were invited for health examinations in the following time periods: 1976 through 1978, 1981 through 1983, and 1992 through 1994. Trends are presented for all persons who attended at least one of the two first examinations as well as the total cohort including nonresponders. Subjects between 45 and 84 years of age were followed from March 1, 1976 until March 1, 1993. Changes in age-specific stroke incidence were calculated by means of Poisson regression analysis.

RESULTS

For subjects aged 45 to 64 years, no significant trends were observed, with an annual incidence rate ratio of 1.00 (95% confidence interval [CI], 0.97 to 1.03) and 1.04 (95% CI, 0.99 to 1.08) for men and women, respectively. In subjects aged 65 to 84 years a significant decrease in stroke incidence was found in men, whose annual rate ratio was 0.97 (95% CI, 0.95 to 0.99), but not in women, whose annual rate ratio was 0.98 (95% CI, 0.95 to 1.00). Throughout four observed periods the stroke incidence among men remained significantly higher than that for women.

CONCLUSIONS

During the period from 1976 to 1993 there has been a decline in incidence of stroke in men and women aged 65 to 84 years that was significant only in men, whereas no changes were found for persons aged 45 to 64 years.