Alcohol intake in patients admitted acutely to a general medical unit.

The role of alcohol in causing acute medical admissions is recognised but not well quantified. Using a questionnaire we have studied prospectively alcohol intake in patients aged 18-60 years admitted to a medical unit and have analysed the contribution of alcohol to their admission. One hundred and six patients (61 male: 45 female) who fulfilled our preset age criteria were studied. Alcohol intake (mean +/- SEM) was 9 +/- 1 and 12 +/- 1 units on average and heavy drinking days respectively, and 38 +/- 6 units during their last drinking week. Gamma glutamyl transferase (GGT) was > 60 U/l (upper limit of normal) in 29 (n = 92). Eighteen (30%) men had drunk > 50 units and seven (16%) women had taken > 35 units in their last drinking week. In 25 (41%) men and 11 (24%) women alcohol intake was felt to contribute to their admission. In this subgroup, intake was 15 +/- 2 and 20 +/- 1 units on average and heavy drinking days respectively, and 87 +/- 13 units in the last drinking week. GGT was available in 29 and was abnormal in 18. Admission diagnoses were drug overdose (n = 16), alcohol withdrawal symptoms (n = 7), liver disease (n = 6), haematemesis (n = 14) and others (n = 3). Fifteen (42%) felt they had a definite alcohol problem. The use and abuse of alcohol contributes significantly to the general medical workload in the age group studied.     

Risk factors for hypertension in Kimberley aborigines.

OBJECTIVE: To determine physical, biochemical and lifestyle factors associated with high blood pressure among Aborigines in the Kimberley region. DESIGN: Blood pressure and electrocardiographic (ECG) abnormalities in an age and sex stratified random sample of the Aboriginal population were related to other observations and measurements made at the same time specifically for the purpose of these comparisons. SETTING: A field study in which subjects were interviewed and measurements made mostly in community clinics. PARTICIPANTS: All 249 men and 241 women from the prevalence study were included although only complete data sets for the various comparisons were analysed. INTERVENTIONS: A sample of venous blood was obtained in addition to physical measurements and information at interview. MAIN OUTCOME MEASURES: Statistical analysis of the relationships between blood pressure or hypertension and alcohol consumption, plasma gamma-glutamyl transpeptidase (GGT) activity, use of tobacco, body mass index (BMI, kg/m2) and non-fasted plasma cholesterol level. Hypertension was defined as systolic blood pressure of 160 mmHg or greater or diastolic blood pressure of 95 mmHg or greater. RESULTS: High blood pressure in Aboriginal men below 30 years was associated both with current drinking status and with circulating GGT level. There was a positive association of diastolic hypertension with consumption of alcohol in middle aged men (30 to 49 years) and in older women. Drinking was highly prevalent among men, especially below 30 years, but was less prevalent among women. Both systolic and diastolic blood pressure were positively related to BMI across the population but obesity (BMI greater than or equal to 30 kg/m2) was highly prevalent only among middle-aged women. Both systolic and diastolic blood pressure were positively and strongly related to plasma cholesterol level independently of the latter's relationship to age and BMI. CONCLUSION: The high prevalence of drinking among Aboriginal men and of obesity among Aboriginal women involves a risk of hypertension. The association between plasma cholesterol and blood pressure in Aboriginal men and women may be relevant to the demonstrated link between systolic hypertension and ischaemic heart disease.     

A Study of Three Groups of Urban Men from the General Population with Different Alcohol Habits and Drug Use and Their Serum Levels of Liver-related Enzymes and Haematological Variables

A sample of 200 men from the general population was investigated concerning alcohol consumption in relation to laboratory findings. The relation between symptoms of alcoholism (subjective relative loss of control over drinking, blackouts and morning drinks) and the alcohol consumption was also studied. The subjects were divided into three groups: (I) a group with low alcohol consumption without symptoms of alcoholism, (II) an intermediate group with low, moderate or high alcohol consumption and one or more alcohol symptoms and (III) a heavy-drinking group with two or more symptoms. The heavy-drinking group had significantly higher serum bilirubin, aspartate amino-transferase (ASAT), creatine kinase and lactate dehydrogenase values than the other two groups. Gamma-glutamyl transpeptidase (GGT) showed no relation to alcohol consumption. The use of liver-metabolized drugs was investigated. Ten of the 53 heavy drinkers were taking such drugs, because of illness, and the other 43 were not. The heavy drinkers taking drugs showed pathological laboratory values throughout, in contrast to the subjects of the other subgroups. Serum GGT was high in the drug-using groups but was not significantly elevated in the groups taking only alcohol and no drugs.     

Moderate alcohol intake is associated with survival in the elderly: the Dubbo Study

OBJECTIVE: To examine the relationship between alcohol intake and survival in elderly people. DESIGN AND SETTING: A prospective study over 116 months of non-institutionalised subjects living in Dubbo, a rural town (population, 34,000) in New South Wales. PARTICIPANTS: 1235 men and 1570 women aged 60 years and over who were first examined in 1988-89. MAIN OUTCOME MEASURES: All-causes mortality; gross cost of alcohol per life-year gained. RESULTS: Death occurred in 450 men and 392 women. Intake of alcohol was generally moderate (i.e., less than 14 drinks/week). Any intake of alcohol was associated with reduced mortality in men up to 75 years and in women over 64 years. In a proportional hazards model, the hazard ratio for mortality in men taking any alcohol was 0.63 (95% CI, 0.47-0.84) and in women was 0.75 (95% CI, 0.60-0.94). Cardiovascular deaths in men were reduced from 20/100 (95% CI, 14-26) to 11/100 (95% CI, 9-13) and in women from 16/100 (95% CI, 13-19) to 8/100 (95% CI, 6-10). The reduction in mortality occurred in men and women taking only 1-7 drinks/week--hazard ratios, 0.68 (95% CI, 0.49-0.94) and 0.78 (95% CI, 0.61-0.99), respectively, with a similar protective effect from intake of beer or other forms of alcohol. After almost 10 years' follow-up, men taking any alcohol lived on average 7.6 months longer, and women on average 2.7 months longer, compared with non-drinkers. The gross cost for alcohol per life-year gained if consuming 1-7 drinks/week was $5700 in men, and $19,000 in women. CONCLUSIONS: Moderate alcohol intake in the elderly appears to be associated with significantly longer survival in men 60-74 years and in all elderly women.     

Alcohol and blood pressure: a social comparison in Zimbabwe

The blood pressures of 252 men and 250 women, living in both urban and rural Zimbabwe, were measured on three separate occasions. Food and alcohol intakes were determined using a 3-day weighed diet survey checked by means of a detailed interview. Anthropometric data were also collected. No relationship was found between mean blood pressures and the alcohol intake for any socioeconomic group. Using only the first of the three blood pressure measurements, a correlation between systolic pressure and alcohol intake was found for white males (r = 0.234, P less than 0.05), and just missed statistical significance (r = 0.156, P = 0.065) for black middle class males. No relationship was found between blood pressure and alcohol consumption for black working class males, or for females. Epidemiological evidence suggests that alcohol consumption is associated with increased blood pressure. However, a convincing physiological mechanism is lacking. It is suggested that psychological factors may be partly responsible for this relationship.     

Blood lipid variability in relation to relative weight and biochemical markers of tobacco and alcohol consumption

Carboxyhaemoglobin (COHb%) and gamma-glutamyl-transferase (GGT) are today frequently used as objective indicators of tobacco and alcohol consumption. The relationships between COHb%, GGT and relative body weight, cholesterol, triglyceride and apolipoprotein AI (Apo-AI) were studied in middle-aged men attending a preventive medical programme in Malmö, Sweden. Although statistically significant the influence of COHb% on cholesterol and triglyceride was found to be clinically insignificant. GGT and body weight had, independent of each other, a significant influence on cholesterol and triglyceride. GGT was found to have a positive correlation to Apo-AI whereas body weight was found to have a negative correlation to Apo-AI. Four per cent of the cholesterol variability, 16% of the triglyceride variability and about 10% of the variability in Apo-AI could, in this study, be accounted for by COHb%, GGT and relative body weight.     

Prevalence and Determinants of Hypertension in a Rural Community

Background

There are few epidemiological studies on prevalence of hypertension and its determinants in rural population. This cross sectional study was done to determine the same in a rural community.

Methods

A random sample of 406 people (218 men and 188 women) of 30 years and above was selected from a rural area. The pre tested proforma was used to collect the data by trained doctors.

Result

Prevalence of smoking and tobacco use was 16%, alcohol intake 9.4 %, daily salt intake (≥ 5 gram) 34.2%, daily saturated fat intake (≥ 10 % of daily energy intake) 47 .0 % and physical inactivity (work and leisure) as 18.5%. Body Mass Index (BMI) was ≥ 25 in 18 % and ≥ 30 in 3.2% men and women. Prevalence of truncal obesity (Waist Hip Ratio: men ≥ 0.9; women ≥ 0.8) was 8.5% with higher incidence in men. Prevalence of abdominal obesity (men ≥ 102 cms; women ≥ 88 cms) was found in 15.7 % with higher incidence in men. Differences in prevalence of risk factors between men and women were statistically significant in case of smoking, alcohol consumption and abdominal obesity. 18.5% men and women were suffering from systolic hypertension (≥ 140 mg Hg) and 15 % from diastolic hypertension (≥ 90 mg Hg). Prevalence of risk factors for hypertension was significantly more among subjects suffering from systolic and diastolic hypertension than normotensive subjects.

Conclusion

Prevalence of systolic hypertension in rural community was 18.5 % and of diastolic hypertension 15% with higher prevalence in the age group of 60 years and above, in case of men and women. There was a significant linear trend in prevalence of systolic hypertension with respect to age group in men whereas it was not significant in case of women.Key Words: Hypertension, Prevalence, Determinants, Rural community     

男性酒精摄入量与血清HDL-C水平的量效关系

目的分析男性酒精摄入量与血清高密度脂蛋白胆固醇(HDL-C)水平的量效关系。方法采用问卷调查结合血脂检测的方法,对758例只有饮用白酒习惯的男性,分析其酒精摄入量与HDL-C水平的相关性,并计算回归方程,对相关系数与回归系数进行统计学检验。结果男性日均摄入80g以内酒精者,酒精摄入量与血清HDL-C水平呈正相关,相关系数r=0.104(P<0.005);直线回归方程为Y=1.2348+0.0019x(回归系数检验,P<0.001)。男性日均摄入80g以上酒精者,酒精摄入量与血清HDL-C水平无相关性(P>0.05)。结论男性每日饮用酒精量在80g之内时,HDL-C水平随酒精摄入量增加而增加;随着酒精量的继续增加,这种量效关系则消失。建议男性酒精摄入量应控制在80g/d之内。     

Survey of alcoholism treatment services in Victoria. Relationship of alcoholics drug use to their use of medical facilities

A cooperative survey of 370 individuals presenting for treatment at nine Victorian alcoholism treatment centres showed that men and women in this population of alcoholics did not differ significantly in indices of their lifetime consumption of alcohol or tobacco per kilogram of body weight, despite considerable difference in their present use of these drugs. Physical disability was associated with extended tobacco consumption both in men and in women. Little relationship existed between use of medical services and the extended use of alcohol, though high present consumption was associated with increased general hospital admissions in men.     

Alcohol consumption and the risk of cirrhosis.

OBJECTIVE: To determine risk levels for the development of cirrhosis in Australian men who consume alcohol and to compare this risk with that of Australian women. DESIGN AND SETTING: A case-control study using an interview technique, based in two major tertiary referral hospitals in Sydney. PATIENTS: Forty-three men with newly diagnosed cirrhosis of the liver and a total of 115 male control subjects, age matched with the case subjects. The data for women (36 cases and 99 controls) have been reported previously. RESULTS: The risk of men developing cirrhosis increases significantly above the baseline when the alcohol intake exceeds 40 g per day. The risk to women is significant at a similar intake level. Dietary intake and past major illnesses appear to have no role in determining risk. CONCLUSION: The recommended safe drinking level for men and women should be 40 g per day, as suggested by the National Health and Medical Research Council.     

Association of working conditions and lifestyle with increased serum gamma-glutamyltransferase: a follow-up study

BACKGROUND: This study investigated the association of working conditions and lifestyle with the development of increased serum gamma-glutamyltransferase (GGT) in Japanese workers. METHODS: A follow-up study was carried out on workers of a telecommunication enterprise who received their first annual health check-up between 1992 and 1996, when they were between 40 and 54 years of age. Workers who had high serum GGT (> or =60 IU/L in males, > or =30 IU/L in females), a past history of disease, or current illness at their first check-up were excluded from the analysis. In total, the study included 15,586 workers. The association between working conditions and lifestyle and development of increased serum GGT (> or =60 IU/L in males, > or =30 IU/L in females) was investigated by pooled logistic regression analyses. RESULTS: In males, body mass index, consumption of alcohol (<2 times/week, 2-5 times/week, >5 times/week), smoking (<20 cigarettes/day, > or =20 cigarettes/day), rarely taking three meals a day, marked preference for salty meals, and little preference for vegetables were positively associated with the development of increased serum GGT. Preferences for fatty meals (marked, moderate) were negatively associated with the development of increased serum GGT. In females, age and BMI were positively associated with the development of increased serum GGT. CONCLUSIONS: Applying a new statistical analysis to this retrospective cohort study of 5 years, we revealed the health influences of alcohol consumption, smoking and eating habits on increased serum GGT. On the other hand, this study indicated that shift work or other working conditions are not significant risk factors for increased serum GGT.     

A prospective study of folate intake and the risk of breast cancer

CONTEXT: Folate is involved in DNA synthesis and methylation and may reduce breast cancer risk, particularly among women with greater alcohol consumption. OBJECTIVES: To assess the association between folate intake and risk of breast cancer and whether higher folate intake may reduce excess risk among women who consume alcohol. DESIGN: Prospective cohort study performed in 1980, with 16 years of follow-up. SETTING AND PARTICIPANTS: A total of 88818 women who completed the dietary questionnaire section of the Nurses' Health Study in 1980. MAIN OUTCOME MEASURE: Incidence of invasive breast cancer by levels of folate and alcohol intake. RESULTS: A total of 3483 cases of breast cancer were documented. Total folate intake was not associated with overall risk of breast cancer. However, among women who consumed at least 15 g/d of alcohol, the risk of breast cancer was highest among those with low folate intake. For total folate intake of at least 600 microg/d compared with 150 to 299 microg/d, the multivariate relative risk (RR) was 0.55 (95% confidence interval [CI], 0.39-0.76; P for trend = .001). This association was only slightly attenuated after additional adjustment for intake of beta carotene, lutein/zeaxanthin, preformed vitamin A, and total vitamins C and E. The risk of breast cancer associated with alcohol intake was strongest among women with total folate intake of less than 300 microg/d (for alcohol intake > or =15 g/d vs <15 g/d, multivariate RR, 1.32; 95% CI, 1.15-1.50). For women who consumed at least 300 microg/d of total folate, the multivariate RR for intake of at least 15 g/d of alcohol vs less than 15 g/d was 1.05 (95% CI, 0.92-1.20). Current use of multivitamin supplements, the major source of folate, was associated with lower breast cancer risk among women who consumed at least 15 g/d of alcohol (for current users of supplements vs never users, RR, 0.74; 95% CI, 0.59-0.93). CONCLUSIONS: Our findings suggest that the excess risk of breast cancer associated with alcohol consumption may be reduced by adequate folate intake.     

Alcohol consumption patterns in South Australia: 1983

The alcohol consumption patterns of adult South Australians were surveyed by the Australian Bureau of Statistics in October 1983. Results indicate that, since 1977, there has been a significant increase in alcohol consumption by women, while the overall consumption of alcohol, particularly beer, by older men has significantly decreased. Comparisons are made between the drinking behaviour of men and women, and the implications for medical personnel are presented.     

尿氨基己糖苷酶对乙醇性肝病的诊断

目的：检测乙醇性肝病（ALD）患者尿氨基己糖苷酶（uHex）,并与血清中的％缺糖基转铁蛋白（％CDT）与总转铁蛋白（Tf）的比值、γ-谷氨酰转移酶（GGT）、平均红细胞容积（MCV）、丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）等指标比较,评价其对ALD的诊断价值。方法：选择健康不饮酒对照组、非乙醇性肝病的其他肝病组（NALD组）、ALD组（三组均为男性）,分别检测uHex,％CDT,GGT,MCV,ALT,AST等指标,各指标在不同组间的比较用F检验;各项目之间的关系研究用直线相关,计算相关系数;同时绘制各指标的ROC曲线。结果：ALD组中的uHex显著高于对照组,但与NALD组无显著性差异。uHex诊断ALD的ROC曲线下面积为0．737,敏感度为0．60,特异度为0．76,而％CDT这三者分别为0．857,0．75,0．88,GGT分别为0．751,0．75,0．76,MCV分别为为0．669,0．30,0．78,ALT分别为为0．512,0．25,0．72,AST分别为为0．426,0．25,0．68。uHex与％CDT,GGT不相关,与这两者联合检测敏感度提高到1,0．9。结论：对于ALD的诊断,uHex,％CDT,GGT和MCV均具有一定的诊断价值,尤其％CDT是一个很好的辅助诊断指标,uHex也不失为一个较好的非损伤性的指标。uHex与％CDT,GGT联用可提高敏感度。     

Prevalence of excessive or problem drinkers among patients attending somatic outpatient clinics: a study of alcohol related medical care

The prevalence of alcohol related morbidity was studied among 2038 patients attending somatic outpatient clinics. A further 76 patients had refused the study, giving an overall drop out rate of 3.6%. Several methods were combined so as to detect as many patients with problem drinking as possible. According to the criteria and definitions employed 17% of men (confidence interval 15% to 19%) and 4% of women (confidence interval 3% to 5%) were excessive consumers of alcohol or problem drinkers. The highest proportion of such patients--that is, 17%--was noted in the emergency rooms (27% of men, 8% of women). At other clinics the proportions varied from 11% to 17% of men and from 2% to 4% of women. The strongest relations between overconsumption of alcohol and consultation at the clinic were among patients attending the medical outpatient clinic and the emergency rooms; in 86% (confidence interval 75% to 97%) and 88% (confidence interval 81% to 95%) of problem drinkers attending these clinics, respectively, alcohol was related to the consultation. Consultations were related to alcohol in 82% of women with excessive or problem drinking and 73% of men defined in this way. There was a tendency to a higher proportion of men with excessive or problem drinking in the age group 40-49 years. These findings show that among patients classified as excessive or problem drinkers attending somatic outpatient clinics there was a close relation between alcohol consumption and utilisation of medical resources, especially in women.     

Effects of moderate alcohol intake on fasting insulin and glucose concentrations and insulin sensitivity in postmenopausal women: a randomized controlled trial

CONTEXT: Epidemiologic data demonstrate that moderate alcohol intake is associated with improved insulin sensitivity in nondiabetic individuals. No controlled-diet studies have addressed the effects of daily moderate alcohol consumption on fasting insulin and glucose concentrations and insulin sensitivity. OBJECTIVE: To determine whether daily consumption of low to moderate amounts of alcohol influences fasting insulin and glucose concentrations and insulin sensitivity in nondiabetic postmenopausal women. DESIGN, SETTING, AND PARTICIPANTS: Randomized controlled crossover trial of 63 healthy postmenopausal women, conducted at a clinical research center in Maryland between 1998 and 1999. INTERVENTIONS: Participants were randomly assigned to consume 0, 15, or 30 g/d of alcohol for 8 weeks each as part of a controlled diet. All foods and beverages were provided during the intervention. An isocaloric beverage was provided in the 0-g/d arm. Energy intake was adjusted to maintain constant body weight. MAIN OUTCOME MEASURES: Fasting insulin, triglyceride, and glucose concentrations, measured at the end of each dietary period; insulin sensitivity, estimated with a published index of glucose disposal rate corrected for fat-free mass based on fasting insulin and fasting triglyceride concentrations, compared among treatments with a mixed-model analysis of variance. RESULTS: A complete set of plasma samples was collected and analyzed for 51 women who completed all diet treatments. Consumption of 30 g/d of alcohol compared with 0 g/d reduced fasting insulin concentration by 19.2% (P =.004) and triglyceride concentration by 10.3% (P =.001), and increased insulin sensitivity by 7.2% (P =.002). Normal-weight, overweight, and obese individuals responded similarly. Only fasting triglyceride concentration was significantly reduced when comparing 0 and 15 g/d of alcohol (7.8%; P =.03), and no difference was found between consumption of 15 and 30 g/d of alcohol; however, there was a significant linear trend (P =.001). Fasting glucose concentrations were not different across treatments. CONCLUSIONS: Consumption of 30 g/d of alcohol (2 drinks per day) has beneficial effects on insulin and triglyceride concentrations and insulin sensitivity in nondiabetic postmenopausal women.     

Lipid and apolipoprotein levels in an Australian community

Serum levels of total and high density lipoprotein (HDL) cholesterol and apolipoproteins A1 and B were measured in over 600 men and women aged 30-69 years who were selected at random from an Australian community. Total cholesterol and apolipoprotein A1 and B levels increased with age, with this effect being most pronounced for total cholesterol and apolipoprotein B in women. Body mass index and waist-to-hip ratio were positively correlated with apolipoprotein B and total cholesterol levels, and negatively correlated with apolipoprotein A1 and HDL cholesterol levels. All lipid and apolipoprotein A1 levels increased with the quantity of alcohol consumed. After adjusting for age, body mass index and smoking, the association with alcohol was strongest for apolipoprotein A1 and HDL cholesterol levels in men (P = 0.0001), and for apolipoprotein A1 levels in women (P = 0.01). Levels of apolipoprotein A1 and HDL cholesterol were lower, and of apolipoprotein B and total cholesterol were higher, in current cigarette smokers than non-smokers, with significant associations for apolipoprotein B (P = 0.004) and HDL cholesterol levels (P = 0.04) in men. In general, the associations between apolipoprotein A1 levels and the other variables were weaker than those for HDL cholesterol levels, whereas the associations with apolipoprotein B levels were stronger than those for total cholesterol levels (except for alcohol consumption). Thus, obesity, alcohol consumption and cigarette smoking should be considered when interpreting apolipoprotein levels.     

Indices of Alcohol Intake

A comparison was performed on the validity of serum-gamma-glutamyltransferase (S-GT) and serum-alkaline phosphatase (S-ALP) concentrations for establishing the increased alcohol intake in a group of middle-aged men in Uppsala. These men were all born in 1915 and were participants of a special health investigation performed at their age of 60 years. Subjects who were registered at the Temperance Board, or had ethyl alcohol in urine or gave a positive reply to a question of alcohol intake were designated alcohol index cases. The mean S-GT values of these different alcohol index groups were significantly higher than that of a randomly selected subgroup devoid of alcohol findings in the same population. No such differences were found when comparing the corresponding mean S-ALP values. The authors thus point to the superiority of S-GT determinations to S-ALP determinations, especially in patients where the alcohol consumption certainly not is to be regarded as excessive.     

乙醇对慢性丙型病毒性肝炎患者临床转归的影响

目的研究乙醇对慢性丙型病毒性肝炎患者临床转归的影响。方法回顾性对比分析非饮酒与饮酒的慢性丙型病毒性肝炎患者在临床表现、病毒学、预后方面的差异。结果162例慢性丙型病毒性肝炎病人中,非饮酒者99例,少量饮酒者34例,大量饮酒者29例,3者的病程中位数分别为12、9、8年,差异有统计学意义(P=0.005)。非饮酒者的谷丙转氨酶(alanine transam inase,ALT)、谷草转氨酶(aspartate transam inase,AST)、γ-谷氨酰转移酶(gamma-glutamyl transferase,GGT)、总胆红素(total bilirubin,TBIL)、平均红细胞容积(mean corpuscular volume,MCV)与少量饮酒及大量饮酒患者相比差异有统计学意义(P<0.05)。大量饮酒者中,高病毒载量患者的比例明显高于非饮酒者,差异有统计学意义(分别为31.0%和14.1%,P=0.037)。非饮酒者中肝硬化32例(32.3%),少量饮酒者为13例(43.3%),大量饮酒者为18例(62.1%),差异有统计学意义(P=0.015)。非饮酒者中死亡2例(4.0%),少量饮酒者死亡2例(5.9%),大量饮酒者死亡5例(17.2%),差异有统计学意义(P=0.000)。非饮酒者与饮酒者肝癌的发生率差异无统计学意义。结论饮酒可加重慢性丙型病毒性肝炎患者肝损害,加速病情的进展,增加肝硬化的发生率及病死率;大量饮酒有可能促进丙型肝炎病毒(hepatitis C virus,HCV)的复制。     

Lifestyle factors and risk of dementia: Dubbo Study of the elderly

OBJECTIVE: To identify risk factors for dementia in an elderly Australian cohort. DESIGN AND SETTING: A longitudinal cohort study conducted in Dubbo, NSW. PARTICIPANTS: 2805 men and women aged 60 years and older living in the community and initially free of cognitive impairment, first assessed in 1988 and followed for 16 years. MAIN OUTCOME MEASURE: Admission to hospital or nursing home with any kind of dementia. RESULTS: There were 115 cases of dementia in 1233 men (9.3/100) and 170 cases in 1572 women (10.8/100). In a proportional hazards model for dementia, any intake of alcohol predicted a 34% lower risk, and daily gardening a 36% lower risk. Daily walking predicted a 38% lower risk of dementia in men, but there was no significant prediction in women. The lowest tertile of peak expiratory flow predicted an 84% higher risk of dementia, the upper tertile of depression score predicted a 50% higher risk. CONCLUSION: While excess alcohol intake is to be avoided, it appears safe and reasonable to recommend the continuation of moderate alcohol intake in those already imbibing, as well as the maintenance of physical activity, especially daily gardening, in the hope of reducing the incidence of dementia in future years.