Distribution in correlates of waist-to-hip ratio in black adults: The Pitt county study. Keenan et al, Am J Epidemiology 1992; 135;678-84.
A voluminous literature now exists which assesses associations between not only body size but fat distribution and risk of disease. However, studies of these associations in black adults are somewhat sparse. Therefore, the authors investigates correlates of waist-to-hip ration (a measure if body fat distribution) in a community sample of black adults residing in North Carolina. The date foe this analysis were collected from a probability sample of 1,784 black men and women between the ages of 25 and 30. Among men, there was a strong significant association between physical activity and lower waist-to-hip ratio. Other variables, including alcohol consumption, socio-economic status and smoking were not correlated with waist-to-hip ratio. Among women, the measures of physical activity were not correlated with waist-to-hip ratio, but alcohol consumption and socio-economic status were.. Women who drink one- to six drinks per week had significantly higher waist-to-hip ratios than those who abstained. There was also a significant association between lower socio- economic statues and higher waist-to-hip ratio. These results did not change after simultaneous control for age, BMI, physical activity, alcohol consumption, socioeconomic status and smoking. These results corroborate those of others where physical activity is correlated with waist-to-hip ratio among men and alcohol consumption and waist-to-hip ratio among women. The results of this study are important in that they help us to understand how waist-to-hip ratio may be modifiable. Because the data are crossectional, we cannot assume a cause and effect association between physical activity or alcohol and waist-to-hip ratio. However, these results do add to the existing literature on correlates of waist-to-hip ratio. ER
Blood Pressure
A prospective study of nutritional factors and hypertension among US men. Ascherio et al Circulation 1992; 86:1475-84.
Although diet may platy a role in determining blood pressure, the role of specific nutrients is still undetermined. Therefore, the authors studies the association between dietary intake as reported by 30,681 men and incidence of hypertension in a four-year prospectiv study. The men, ages 40-75 years, completed a semi-quantitative food frequency questionnaire which was converted into average daily intakes of nutrients. As has been found in other studies, the authorts reported a significant increase in risk of developing hypertension amonf men drinkinf over 30 grams of alcohol compared with those who abstain. The relative risk of hypertension over this four year period was 1.4 (95% confidence intervals from 1.2 to 1.7) for men drinking more thabt 30 grams of alcohol compared to abstainers. At levels of alcohol consumption less than 30 grams per day, there was no association between alcohol level and incidence of hyp[ertension. The nutrients that were important in reducing risk of developing hypertension were dietary fiber, potassium, magnesium and calcium. The inverse association between calcium intake and development of hypertension wqas only apparent in htre leanest group (body mass index less htan 23 kg/m2). After simultaneous adjustment for age, relative weight, al;cohol consumption, physical activity, smoking, waist-to-hip ratio, of these nutrients only dietary fiber was still signifuicantly inversely associated with hypertension. Becasue of hte large size of the study, the investigatorts were able to tease out independent effects of nutrients, alcohol and obesity. ER
Morse BA, Idelson RK, Sachs WH, Weiner L, Kaplan LC, Pediatrician;s perspectives on fetal alcohol syndrome., Journal of Substance Abuse 1992; 4(2):187-95.
Fetal alcohol syndrome (FAS) and fetal alcohol effects(FAE) are not diagnosed in the clinical setting as often as research estimates would suggest.
This survey of pediatricians in Massachusetts evaluated knowledge, attitudes, and clinical experience with alcohol related birth defects in an attempt to identify the reasons for the discrepancies.
Anonymous surveys were completed by 234 pediatricians. A,most all had some understanding of the effects of alcohol on pregnancy. More than half of the respondents had diagnosed FAS, but only 25% had diagnosed FAE, which is a less serious effect of alcohol exposure in-utero.
Many considered themselves unprepared to deal with the topic. There was a positive association between making a diagnosis of FAS/FAE and the level of comfort in talking about alcohol use. Almost 75% reported that they would find additional professional education in this area helpful.
This study suggests a need for additional research and broader dissemination of information on diagnosis and treatment of alcohol related birth defects. LW
Bays J, The care of alcohol and drug affected infants., Pediatric Annals 1992; 21(8):485- 95.
This paper reviews current literature on alcohol and drug exposed infants and children and describes clinical strategies for identification and treatment.
The author urges treatment of pregnant alcohol and substance abusers, citing the benefits to mother and child when abuse ceases. Strategies are provided for toxicology screens, for management of withdrawal in opiate exposed infants, and for care of drug- exposed newborns. Long-term care protocols are discussed for child-welfare issues and multidisciplinary discharge planning. Subsequent risks to children from abuse and neglect are explored.
This paper concludes that infants and families will benefit form early intervention and on-going treatment an d supervision. Children who are exposed to drugs or alcohol in utero are more vulnerable to problems associated with dysfunctional families. Treatment can help mitigate these problems. LW
Armstrong BG, McDonald AD, Sloan M, Cigarette, alcohol and coffee consumption and spontaneous abortion., American Journal of Public Health 1992; 82:85-7.
There has been concern that spontaneous abortions are associated with life-style factors, including alcohol, tobacco, and caffeine use.
All women (56,000) who delivered a baby or suffered a spontaneous abortion (miscarriage) in 11 Montreal hospitals during a two year period (1982-84) were interviewed. Information was obtained on occupational, personal, and social factors for the correct pregnancy and all previous pregnancies was analyzed.
Statistically significant relationships were observed between cigarette and alcohol consumption and miscarriages. A weaker relationship was seen with caffeine. If the observed associations were causal, cigarettes accounted for 11% of miscarriages (40% in women who smoked a pack or more a day); alcohol consumption for 5% (45% in women who had 3 or more drinks a day) and coffee 2% (16% in women having at least 10 cups per day).
Increased understanding of these risks will facilitate development od effective public health policies.
The large population in this study allows for analysis of many variables. However, a bias may result from the fact that questions about alcohol, tobacco, and caffeine use pertained to an earlier time period. The lapse of time varied with each individual's pregnancy history. Recall of patterns of use is not reliable, and may be particularly difficulty for casual users (1-2 drinks a week) for whom consumption is not na integral part of their lives. LW
Carcinogenic effects of tobacco smoking and alcohol drinking in anatomic sites of the oral cavity and esophagus.
This controlled study of 424 cancers evaluated at a U.S. Veterans Center clearly showed lower incidence of cancers at all sites in moderate drinkers (2 rr less drinks per day) and light smokers (1-5 per day) than heavy smokers or drinkers. Interactive effects between smoking and drinking on these anatomic sites was not fully explored. DM
Diet, smoking and alcohol in cancer of the larynx - a case-control study.
Laryngeal cancer risk was strongly associated with cigarette smoking ( but not with pipe or cigar) in 250 pathologically confirmed cases of laryngeal cancer.
There was no increased risk for heavier drinkers who were also light smokers, however, it is acknowledged that most studies including this one showed greater than additive effect on risk when combining alcohol with tobacco.\
This study was particularly persuasive in showing no significant risk of cancer of the larynx in wine drinkers.
Risk factors of cancer of the larynx: Results of the Heidelberg case-control study.
This study was done on 164? patients with histologically proven squamous cell cancer of the larynx. A strong dose related risk was established between smoking and alcohol consumption and laryngeal cancer. No differentiation was made between different alcoholic beverages.
Other environmental risk factors were also found in cement dust, coal-tar and pinewood dust in wood workers.
This study found like other major studies that the principal risk factors in Cancer of the larynx are tobacco and alcohol. Lowered risk was noted with fresh fruit and vegetables consumption plus vitamins including beta carotene, A,C, E, zinc and selenium,
Cigarette smoking, alcohol and nasopharyngeal cancer.
Strong dose relationship noted to cigarette smoking and these cancers i a study of a rare cancer in white Americans. There was a significant increased risk only in heavy alcohol consumers.
This study confirmed the known risk of pharyngeal cancers and heavy alcohol consumption ( more than 3 drinks per day). DM
Cigarette and alcohol use in patients with adenocarcinoma of the gastric cardia or lower esophagus
The authors studied the cigarette and alcohol use of 243 patients with adenocarcinoma of the gastric cardia and lower esophagus, including 66 with Barrett's esophagus. They compared these findings with 303 patients with squamous carcinoma of the esophagus and 338 patients with adenocarcinoma of the stomach not involving the cardia. In squamous carcinoma of the esophagus, both cigarettes and alcohol are proven important etiologic agents. They are not in adenocarcinoma of the stomach not involving the cardia. Alcohol use was divided into three categories: (1) none, (2) moderate;and (3) heavy. The authors found that alcohol ad smoking use was significantly greater in the patients with squamous carcinoma of the esophagus compared with those of adenocarcinoma of he cardia and lower esophagus and adenocarcinoma of the more distal stomach. In view of the similar smoking and alcohol use in the adenocarcinoma groups, and hate absence of a proven relationship between these agents and adenocarcinoma of the distal stomach, the authors feel that these agents are not important causative factors in adenocarcinoma of the gastric cardia and lower esophagus and, moreover, cannot explain the apparent increasing incidence of these neoplasms. MN
Genetic and acquired factors that influence individual susceptibility to alcohol-associated liver disease.
As the title implies, the author reviews the known genetic and acquired factors that the determine the individual's susceptibility to develop alcohol-associated liver disease. Serving as a background for this discussion is the well-known fact that not all individuals consuming large amounts of alcohol develop cirrhosis. Also germane as background material is the knowledge that perivenular fibrosis at the fatty liver stage of alcoholic liver injury and alcoholic hepatitis are the precursor lesions for cirrhosis if drinking continues.
The genetic factors responsible for increased susceptibility to alcohol-induced cirrhosis include:
1) Female gender: This well-documented female predilection is probably attributable to the higher blood alcohol levels found in women when given corresponding equal amounts of alcohol as men.. The explanation for this appears to reside in the fact that in the female stomach there is decreased "first-pass" metabolism of ethanol because of decreased levels of alcoholic dehydrogenase.
2) Genetic predisposition to alcohol addiction: One group of authors feels that the presence of the dopamine Dreceptor gene, which is located on chromosome 11, amy confer susceptibility to at least one for m of alcoholism.
3) Genetic polymorphism of enzymes of alcohol metabolism: As a result of this type of change, differences in the rate of alcohol metabolism may occur. This mechanism may very well be the explanation for racial differences in alcohol-induced liver disease. For example, many Orientals experience an "alcohol sensitivity" because of the rapid and sustained elevation of acetaldehyde produced by active, atypical alcohol metabolizing enzymes. This sensitivity is manifested as facial flushing, sweating, headache and increased pulse rate. This probably accounts for the low incidence of alcoholism in Orientals since the unpleasantness if the sensitivity acts as a deterrent against drinking.
4) Histocompatibility antigens.
5) Immunological factors: These could exert their influence on either an autoimmune basis or an enhanced immune response.
The acquired factors mentioned in the review include:
10 Nutritional factors, a deficiency of which amy contribute to the alcohol-associated injury.
2) Hepatitis B virus: Numerous studies have revealed an increased incidence of HBV infection in patients with alcoholic liver disease. In individuals positive with alcoholic for both states, cirrhosis develops at an earlier age and there is also shortened survival time.
3)Hepatitis C virus: One study suggested that HCV infection may have a role in the pathogenies of hepatocellular carcinomas in patients with chronic liver disease related to alcohol.
4) Drugs and toxins: Through various mechanisms, chronic alcohol ingestion is known to potentiate the acute toxicity of many drugs and toxins. These include carbon tetrachloride, acetaminophen, Vitamin A, opioids, cocaine, halothane, aflatoxin B, and methotrexate.
5) Hepatic siderosis: A mild degree of this is not uncommon in patients with alcoholic liver disease. MN
Alcohol consumption and the etiology of colorectal cancer: A review of the scientific evidence from 1957 to 1991.
since 1957, when a possible relatioship was first suggested, there have been 52 major studies dealing with alcohol consumption in humans and the etiology if colorectal cancer. The studies were examined according to the methodology used (correlational, case-control or cohort), the site of the large bowel neoplasm and the type and amount of alcohol consumption as well as the duration of the alcohol consumption. From the data examined, the authors concluded that there is an etiologic link between alcohol consumption and colorectal cancer. This link is, however, weak being of the order of a two-fold risk. This increased risk was found more often in males than females and more frequently with rectal that colon cancer. The increased risk was related almost entirely to beer consumption. There was also some evidence for a relationship with spirits consumption, but non for wine consumption with the exception of sake. The mechanisms involved in this increased risk are not clear. MN
The risk of alcohol abuse and dependence in adulthood: The association with educational level.
In the American Journal of Epidemiology, Crum st al surveyed 11,871 household residents in 5 US cities as a prospective study (1980-84) of association between educational level and alcohol abuse/dependence. A follow-up interview one year after and initial baseline interview demonstrated adults who had attended high school without graduation were at the highest risk while adults who had attended college without obtaining a degree were at increased risk compared with college graduates who showed the least risk. In contrast risk of alcohol disorders among high school graduates with no college was not reliably greater than for those with a college degree.
At greater risk were men, adults not working for pay, and adults not married. Becoming intoxicated for the first time before age 18 was associated with a sevenfold risk. Being black was not strongly associated with the risk of developing alcohol abuse- dependence. WJD
Alcohol consumption regression models for distinguishing beverage type effects and beverage preference effects.
To make a simultaneous evaluation of beverage type effect and beverage preference effects, 589 women in a contraceptive study showed that drinkers of wine only consumed less total ethanol per week than other drinkers, and have average HDL cholesterol levels close to 1.3 mg/dl higher than preferrers of beer or spirits even though both beer and spirits consumption showed positive correlations with HDL cholesterol while wine consumption showed a negative (but not significantly different form zero) correlating to HDL. Why preferrer of wine only have these higher levels is not clear. WJD
Nonlinear modeling of alcohol consumption for analysis of beverage type effects and beverage preference effects.
In this analysis of data from the 1982 Maryland Hypertension Survey, wine emerged as the type of beverage least likely to be related to increased blood pressure.
Positive and negative consequences of alcohol drinking among young university students in Finland.
In a sample of 2370 Finnish freshmen, 74.6% of 1663 women and 80.0% of 707 men reported "more positive than negative effects from alcohol." About 95% of young university students in Finland use alcohol. Alcohol was consumed as a way of making social contacts. Stress, competence, depression, tension or anxiety did not correlate with alcohol consumption, frequency of drinking for intoxication, alcohol problems or with positive or negative consequences of drinking. The female students drank less, less frequently and less often for intoxication. Young Finnish university students drink for the positive benefits of drinking. WJD
Alcohol consumption and mortality in an American male population: recovering the U- shaped curve - findings form the Normative Aging Study
To investigate the criticism that sick former drinkers are included in the non-drinker category of previous studies showing moderate consumers of alcohol to have a lower risk of death from coronary heart disease (CHD) than teetotalers and heavy drinkers, de Labry et al followed 1,823 male subjects participating in a longitudinal study who were prescreeed for absence of serious chronic disease. After 12 years of follow-up per subject, the authors found that overall mortality rates were lowest for moderate drinkers (nondrinker = 0-29 drinks per year, moderate = 30-1,094 dpy, heavier + 1,094 or more dpy). Authors used the U.S. Department of Agriculture's definition of a drink - 12 oz. beer, 5 oz.wine and 1.5 oz of distilled spirits or .60 oz of absolute alcohol.
The authors conclude, "Copious evidence shows that heavy drinking is harmful to health. On the other hand, a growing body of evidence indicates that moderate drinking may have long-term beneficial health effects. Thus, public perception of alcohol has come under the influence of two conflicting trends. One segment of the public health community, influenced by anticipated difficulty in teaching controlled-drinking practices in some populations of problem drinkers, tends to regard alcohol use as wholly inadvisable. The other trend is based on both a realistic acknowledgemt of drinking as a deeply ingrained social practice within Western cultures and a willingness to consider evidence that moderate drinking may be beneficial. The present study offers supporet for the latter trend."
Alcohol and mortality in the Italian rural cohorts of the Seven Countries Study.
Farchi et al examined the relation of alcohol consumption to mortality using the data of the Italian rural cohorts of the Seven Countries Study and analysing the the dietary habits and food consumption, including alcoholic beverages, of 1,536 men aged 45-64. Of them, 463 men died in a follow-up period of 15 years. The cohort was divided into five groups based on consumption: 1 = 23 grams per day (mean value), 2 = 56 g/d, 3 = 78 g/d, 4 = 108 g/d, and 5 = 168 g/d. The authors note that this cohort drank much higher quantites of alcohol than those reported in other studies. The authors also looked at alcohol consumption as a percentage of total caloric intake and suggst that high alcohol consumption is always dangerous but more so if it is concomitant with low consumption of cpmpeting nutrients.
The authors conclude that "heavy alcohol consumption is a high-risk factor for all causes of death," and that "moderate consumption has not been proven to be beneficial to health, neither is it a risk. It remains to be ascertained whether there is a threshold value above which alcohol is a risk factor. IOn this study, a relatively wide range of daily alcohol consumption has no measurable effect o nmortality." They also caution that these results may not necessarily apply to other groups with different consumption patterns than this cohort of physicially active, middle-aged men drinking mainly or exclusively wine, and usually at mealtimes.
Alcohol-related mortality in the United States, 1979-1988.
Stinson et al explore the trends in alcohol-related mortality using the most recently refined estimates of the level of alcohol involvement in various specific causes of death and find that overall alcohol-related deaths were about 5% of all deaths in the United States in 1988. Their findings also indicate that mortality rates for deaths attributable to alcohol decreased from 1979 to 1988. The authors discuss various issues surrounding the use of currently available alcohol-attributable fractions for estnmimating alcohol-related mortality.
Light to moderate alcohol consumption and mortality in the elderly. Scherr PA et al, J Am Geriatr Soc 1992; 40:651-657.
While the association between light and moderate alcohol consumption and reduced risk if coronary heart disease is established among middle-aged individuals, little is known about the association in the elderly. The authors studied the association of alcohol consumption and mortality among three elderly population s living in East Boston, Massachusetts, Iowa, and New Haven, Connecticut. At baseline, 6,891 men and women were asked questions concerning consumption of alcoholic beverages. The vital status of all participants was determined after five years as part of the regular follow-up cycle at each location. Cause of death was abstracted from death certificates. The distribution of alcohol consumption differed between East Boston, Iowa and New Haven. About 42% of men in Iowa did not drink in the past year, whereas in East Boston and New Haven, only 23% were abstainers. Similarly, for women in Iowa, 63% did not consume alcohol in the past year, whereas about 40% of the women in East Boston and New Haven had not consumed alcohol. After adjusting for cardiovascular risk factors, relative risk was 1.6 (confidence intervals 1.0-2.8). For just cardiovascular mortality, the differences were not as striking. The authors speculate that the differences in Iowa may be attributed to both the lower rates of heart disease in the mid-west as well as to the lower levels of alcohol consumption. Because of limited numbers in moderate to heavier alcohol consumption levels, the authors were unable to look at a wider distribution of alcohol consumption beyond the three categories (abstainer, <1 ounce/day, > 1 ounce-day). ER
Cerebrovascular disorders and alcohol intake: preliminary results of a case-control study.
Beghi et al conducted a study of 200 middle-aged and elderly stroke patients and 200 controls matched for age, sex and hospital admission date to determine whether or not alcohol consumption is a risk factor for stroke and to evaluate the relationship between stroke, standard biological markers of alcohol intake and diagnosis of alcoholism based on a standard screening instrument. Drinking levels were defined as abstainers, moderate drinkers = < 60 grams per day for men < 40 g/d for women, and heavy drinkers = > 60g/d men and >40 g/d women. "Our findings seem to suggest that alcohol is not an independent risk factor for strike in the middle-aged and elderly. The data are, however, preliminary and are discussed in the light of methodolgical problems."
Stroke risk from alcohol consumption using different control groups.