Correlates of alcohol-related discussions between older adults and their physicians

OBJECTIVES: To identify predictors of alcohol‐related patient–physician discussions. DESIGN: Cross‐sectional study using baseline data from a randomized controlled trial. SETTING: Community‐based group practice. PARTICIPANTS: Thirty‐one physicians in Project Senior Health and Alcohol Risk Education and 3,305 of their patients aged 60 and older who use alcohol and completed a survey that included the Comorbidity Alcohol Risk Evaluation Tool (CARET). MEASUREMENTS: At study baseline, older adults were asked whether alcohol‐related discussions with a physician had occurred in the prior year. This outcome was modeled using logistic regression models with physician random effects. Predictor variables included patient‐level variables such as demographics and seven CARET‐defined risk factors, specifically a medical or psychiatric comorbidity that alcohol might worsen, a potentially alcohol‐related symptom, use of a medication that may interact negatively with alcohol, excessive quantity or frequency of alcohol use, binge drinking, concern from others about drinking, and drinking and driving. Physician‐level predictors (age, sex, years since graduation, specialty) were also included. RESULTS: The probability of reporting alcohol‐related discussions declined with patient age (e.g., odds ratio (OR)=0.40 for patients aged ≥80) and was significantly lower for Latinos (OR=0.38). Drinking and driving (OR=1.69) or concern from others (OR=6.04) were significantly associated with alcohol‐related discussions; having comorbidities or using medications that may interact with alcohol were not. CONCLUSION: Although patient demographics, including age and ethnicity, are associated with the occurrence of alcohol‐related discussions, clinical factors that may negatively interact with alcohol to increase risk are not. This suggests that physicians may not be attuned to the entire spectrum of alcohol‐related risks for older adults.     

Alcohol consumption and risk of microvascular complications in type 1 diabetes patients: the EURODIAB Prospective Complications Study

AIMS/HYPOTHESIS: The aim of this study was to investigate the association between alcohol consumption and risk of microvascular complications (retinopathy, neuropathy, nephropathy) in type 1 diabetes mellitus patients in the EURODIAB Prospective Complications Study. METHODS: The EURODIAB Prospective Complications Study is a follow-up study including 3,250 type 1 diabetes mellitus patients from 16 different European countries. We investigated the cross-sectional association between moderate alcohol consumption and risk of retinopathy, neuropathy and nephropathy among 1,857of these patients. RESULTS: We documented 304 cases of proliferative retinopathy, 660 cases of neuropathy and 157 cases of nephropathy (macroalbuminuria). Alcohol consumption was associated with risk of proliferative retinopathy, neuropathy and macroalbuminuria in a U-shaped fashion. Moderate consumers (30-70 g alcohol per week) had a lower risk of microvascular complications with odds ratios of 0.60 (95% CI 0.37-0.99) for proliferative retinopathy, 0.61 (0.41-0.91) for neuropathy and 0.36 (0.18-0.71) for macroalbuminuria in multivariate-adjusted models. These results were similar when excluding patients who had been advised to drink less alcohol because of their health. The relation was most pronounced for alcohol consumption from wine. Drinking frequency was significantly, inversely associated with risk of neuropathy, but a similar trend was visible for proliferative retinopathy and macroalbuminuria. Alcohol consumption was not associated with occurrence of ketoacidosis or hypoglycaemic attacks. CONCLUSIONS/INTERPRETATION: Consistent with its effects on macrovascular complications, moderate alcohol consumption is associated with a lower risk of all microvascular complications among type 1 diabetes patients.     

Book Reviews

Book reviewed in this article:
Drinking to Your Health: the Allegations and the Evidence DIGBY ANDERSON (Ed.)
Women, Alcohol and Drugs in the Nordic Countries ELINA HAAVIO-MANNILA (Ed.)
Perspectives on Controlled Drinking FANNY DUCKERT, ANJA KOSKI-JANNES & STEN RONNBERG (Eds)
Alcoholism and Drug Dependency: the Professional's Master Guide T. T. RANGANATHAN
Addiction to Alcohol and Drugs: Illustrated Guide for Community Workers
Drug Use and Abuse JAMES WILLIS
Addiction: Substance Abuse and Dependency NORMAN IMLAH
Drugs and Addictive Behaviour: a Guide to Treatment HAMID GHODSE
Psychological, Neuropsychiatric, and Substance Abuse Aspects of AIDS T. PETER BRIDGE, ALLAN F. MIRSKY & FREDERICK K. GOODWIN (Eds)     

Drinking and Alcohol-Related Harm Among New Zealand University Students: Findings From a National Web-Based Survey

Background: Alcohol‐related harm is pervasive among college students in the United States of America and Canada, where a third to half of undergraduates binge drink at least fortnightly. There have been no national studies outside North America. We estimated the prevalence of binge drinking, related harms, and individual risk factors among undergraduates in New Zealand. Methods: A web survey was completed by 2,548 undergraduates (63% response) at 5 of New Zealand’s 8 universities. Drinking patterns and alcohol‐related problems in the preceding 4 weeks were measured. Drinking diaries for the preceding 7 days were completed. Multivariate analyses were used to identify individual risk factors. Results: A total of 81% of both women and men drank in the previous 4 weeks, 37% reported 1 or more binge episodes in the last week, 14% of women and 15% of men reported 2+ binge episodes in the last week, and 68% scored in the hazardous range (4+) on the AUDIT consumption subscale. A mean of 1.8 (95% confidence interval 1.4, 2.3) distinct alcohol‐related risk behaviors or harmful consequences were reported, e.g., 33% had a blackout, 6% had unprotected sex, and 5% said they were physically aggressive toward someone, in the preceding 4 weeks. Drink‐driving or being the passenger of a drink‐driver in the last 4 weeks was reported by 9% of women and 11% of men. Risk factors for frequent binge drinking included: lower age, earlier age of drinking onset, monthly or more frequent binge drinking in high school, and living in a residential hall or a shared house (relative to living with parents). These correlates were similar to those identified in U.S. and Canadian studies. Conclusions: Strategies are needed to reduce the availability and promotion of alcohol on and around university campuses in New Zealand. Given the high prevalence of binge drinking in high school and its strong association with later binge drinking, strategies aimed at youth drinking are also a priority. In universities, high‐risk drinkers should be identified and offered intervention early in their undergraduate careers.     

Implementation of NIAAA College Drinking Task Force Recommendations: How Are Colleges Doing 6 Years Later?

Background: In 2002, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) College Drinking Task Force issued recommendations to reduce heavy drinking by college students, but little is known about implementation of these recommendations. Current discussion about best strategies to reduce student drinking has focused more on lowering the minimum legal drinking age as advocated by a group of college and university presidents called the Amethyst Initiative than the NIAAA recommendations. Methods: A nationally representative survey of administrators was conducted at 351 4‐year colleges in the United States to ascertain familiarity with and progress toward implementation of NIAAA recommendations. Implementation was compared by enrollment size, public or private status, and whether the school president signed the Amethyst Initiative. Results: Administrators at most colleges were familiar with NIAAA recommendations, although more than 1 in 5 (22%) were not. Nearly all colleges use educational programs to address student drinking (98%). Half the colleges (50%) offered intervention programs with documented efficacy for students at high risk for alcohol problems. Few colleges reported that empirically supported, community‐based alcohol control strategies including conducting compliance checks to monitor illegal alcohol sales (33%), instituting mandatory responsible beverage service (RBS) training (15%), restricting alcohol outlet density (7%), or increasing the price of alcohol (2%) were operating in their community. Less than half the colleges with RBS training and compliance checks in their communities actively participated in these interventions. Large colleges were more likely to have RBS training and compliance checks, but no differences in implementation were found across public/private status or whether the college president signed the Amethyst Initiative. Conclusions: Many colleges offer empirically supported programs for high‐risk drinkers, but few have implemented other strategies recommended by NIAAA to address student drinking. Opportunities exist to reduce student drinking through implementation of existing, empirically based strategies.     

A Metric of Maternal Prenatal Risk Drinking Predicts Neurobehavioral Outcomes in Preschool Children

Background: Fetal Alcohol Spectrum Disorders (FASDs), including Fetal Alcohol Syndrome, continue to be high‐incidence developmental disorders. Detection of patterns of maternal drinking that place fetuses at risk for these disorders is critical to diagnosis, treatment, and prevention, but is challenging and often insufficient during pregnancy. Various screens and measures have been used to identify maternal risk drinking but their ability to predict child outcome has been inconsistent. This study hypothesized that a metric of fetal “at‐risk” alcohol exposure (ARAE) derived from several indicators of maternal self‐reported drinking would predict alcohol‐related neurobehavioral dysfunctions in children better than individual measures of maternal alcohol consumption alone. Methods: Self‐reported peri‐conceptional and repeated maternal drinking during pregnancy were assessed with semi‐structured interviews and standard screens, i.e., the CAGE, T‐ACE, and MAST, in a prospective sample of 75 African‐American mothers. Drinking volumes per beverage type were converted to standard quantity and frequency measures. From these individual measures and screening instruments, a simple dichotomous index of prenatal ARAE was defined and used to predict neurobehavioral outcomes in the 4‐ to 5‐year‐old offspring of these women. Study outcomes included IQ, attention, memory, visual‐motor integration, fine motor skill, and behavior. Statistical analyses controlled for demographic and other potential confounders. Results: The current “at‐risk” drinking metric identified over 62% of the mothers as drinking at risk levels—23% more than the selection criterion identified—and outperformed all individual quantity and frequency consumption measures, including averages of weekly alcohol use and “binge” alcohol exposures (assessed as intake per drinking occasion), as well as an estimate of the Maternal Substance Abuse Checklist ( Coles et al., 2000 ), in predicting prenatal alcohol‐related cognitive and behavioral dysfunction in 4‐ to 5‐year‐old children. Conclusions: A metric reflecting multiple indices of “at‐risk” maternal alcohol drinking in pregnancy had greater utility in predicting various prenatal alcohol‐related neurobehavioral dysfunction and deficits in children compared to individual measures of maternal self‐reported alcohol consumption or a previous maternal substance abuse index. Assessing fetal risk drinking in pregnant women was improved by including multiple indicators of both alcohol consumption and alcohol‐related consequences and, if appropriate practical applications are devised, may facilitate intervention by health care workers during pregnancy and potentially reduce the incidence or severity of FASDs.     

Prevalence and patterns of alcohol use in the Australian workforce: findings from the 2001 National Drug Strategy Household Survey

AIMS: To describe Australian workers' prevalence and patterns of alcohol use. DESIGN: A secondary analysis of the 2001 National Drug Strategy Household Survey. PARTICIPANTS: A total of 13 582 workers > or = 14 years old. MEASUREMENTS: Alcohol consumption levels associated with National Health and Medical Research Council (NHMRC) guidelines for short- and long-term harm were stratified by occupation and industry. FINDINGS: Approximately 8% of the workforce drank at least weekly at short-term risky or high risk levels, 17% drank at least monthly, 18% drank at least yearly and 11% drank at long-term risky or high risk levels. The prevalence of risky or high risk drinking was higher for younger than for older workers. Controlling for socio-demographic factors, the risk of workers frequently drinking at levels associated with short-term harm was lowest in the education industry and significantly higher in the hospitality, agriculture, manufacturing and construction industries. Drinking patterns associated with long-term harm were more prevalent in the agriculture, retail and manufacturing industries, compared to the education industry. Drinking patterns associated with both short- and long-term harm were more prevalent for blue-collar workers than professionals. CONCLUSIONS: Risky and high risk drinking occurred at least occasionally in 44% of Australian workers. Workers in the hospitality, agriculture, manufacturing, construction and retail industries, workers in blue-collar occupations and young workers were identified as at-risk subgroups. These data provide evidence that patterns of consumption differ between occupational and industry groups, and highlight the pressing need to develop policies, prevention and intervention strategies to reduce harmful alcohol use in Australia, particularly among young adults.     

Does intake of alcohol increase the risk of presence and growth of colorectal adenomas followed-up in situ for three years?

BACKGROUND: Alcohol has been suggested as a promoter in the development of colorectal cancer (CRC). Our aim was to examine if alcohol intake was related to the presence and growth of colorectal adenomas <9 mm followed up in situ for 3 years. METHODS: We compared 87 adenoma cases to 35 'hospital' and 35 healthy controls (age- and sex-matched and proven to be polyp-free). These cases were participating in a 3-year intervention study against growth and recurrence of polyps. Alcohol data were obtained using a structured interview (I) and a 5-day dietary record by weighing (DR). RESULTS: The median intakes of alcohol were 5 g/day (I) and 6 g/day (DR). Increasing differences were found between I and DR with increasing alcohol intake. Increasing total alcohol intake showed a tendency to an inverse association with adenoma occurrence (ORs <0.5), in contrast to the tendency of a positive association with adenoma growth (ORs >5.8). No significant beverage-specific effects were observed at this low alcohol intake level. Those with an intake of >20 g alcohol/day (18%) had several indicators of an 'unhealthy' lifestyle that may also be independently associated with adenomas, and even CRC. CONCLUSION: A very low intake of alcohol (<5 g/day) did not increase the risk of presence and of growth of adenomas followed-up in situ for 3 years, but we cannot exclude that an increased intake may increase the risk of adenoma growth.     

Acetaldehyde inhibits the formation of retinoic acid from retinal in the rat esophagus

Background: Alcohol has been suggested as a promoter in the development of colorectal cancer (CRC). Our aim was to examine if alcohol intake was related to the presence and growth of colorectal adenomas &#104 9 mm followed up in situ for 3 years. Methods: We compared 87 adenoma cases to 35 'hospital' and 35 healthy controls (age- and sex-matched and proven to be polyp-free). These cases were participating in a 3-year intervention study against growth and recurrence of polyps. Alcohol data were obtained using a structured interview (I) and a 5-day dietary record by weighing (DR). Results: The median intakes of alcohol were 5 g/day (I) and 6 g/day (DR). Increasing differences were found between I and DR with increasing alcohol intake. Increasing total alcohol intake showed a tendency to an inverse association with adenoma occurrence (ORs <0.5), in contrast to the tendency of a positive association with adenoma growth (ORs >5.8). No significant beverage-specific effects were observed at this low alcohol intake level. Those with an intake of >20 g alcohol/day (18%) had several indicators of an 'unhealthy' lifestyle that may also be independently associated with adenomas, and even CRC. Conclusion: A very low intake of alcohol (<5 g/day) did not increase the risk of presence and of growth of adenomas followed-up in situ for 3 years, but we cannot exclude that an increased intake may increase the risk of adenoma growth.     

Integrative neurobiology of the alcohol withdrawal syndrome--from anxiety to seizures

This article represents the proceedings of a symposium presented at the 2003 Research Society on Alcoholism meeting in Ft. Lauderdale, Florida, organized and chaired by Carl L. Faingold. The presentations were (1) Overview, by Carl L. Faingold; (2) Stress, Multiple Alcohol Withdrawals, and Anxiety, by Darin Knapp; (3) Relationship Between Genetic Differences in Alcohol Drinking and Alcohol Withdrawal, by Julia Chester; (4) Neuronal Mechanisms in the Network for Alcohol Withdrawal Seizures: Modulation by Excitatory Amino Acid Receptors, by Carl L. Faingold; and (5) Treatment of Acute Alcohol Withdrawal and Long-Lasting Alterations in Hippocampal Neuronal Networks, by Larry P. Gonzalez. The presentations emphasized the importance of using intact behaving animals to advance the understanding of the human alcohol withdrawal syndrome. This involves applying and amplifying the neurophysiological and neurotransmitter findings observed in vitro to the network-based neurobiological mechanisms that are involved in several important aspects of the specific behaviors observed clinically. The symposium provided evidence that the organizational aspects of neuronal networks in the intact nervous system add another nexus for the action of alcohol and drugs to treat alcohol withdrawal that may not be readily studied in isolated neural elements used in in vitro approaches.     

Alcohol Availability and Injury: The Role of Local Outlet Densities

BACKGROUND: We analyzed the relationship between alcohol availability and injury that occurred during the 6 months before survey administration. METHOD: The data examined were from a general population survey administered to 13,440 California respondents as part of a community-based project to reduce alcohol-involved injury and death. Two separate analyses were performed. The first considered individual local outlet densities (which included both on-premise establishments such as bars and restaurants and off-premise establishments such as liquor and grocery stores) as they affect individual phone survey respondents' self-reported injuries. To address potential spatially autocorrelated errors and geographically lagged effects, a second analysis considered aggregate outlet densities within geographic areas as they affect the proportion of survey respondents who reported injury. No spatial autocorrelation or significant lagged effects were found, which supported our individual-level analyses. RESULTS: Our analyses indicated an association between both on-premise and off-premise individual-level outlet densities and self-reported injuries. CONCLUSION: Alcohol availability seems to be related to self-reported injury. The mechanisms behind this relationship, however, are not clear, and further study is indicated.     

Effects of prazosin, an α1-adrenergic receptor antagonist, on the seeking and intake of alcohol and sucrose in alcohol-preferring (P) rats

Background: Previous studies show that prazosin, an α₁‐adrenergic receptor antagonist, decreases alcohol drinking in animal models of alcohol use and dependence [Rasmussen et al. (2009) Alcohol Clin Exp Res 3:264–272; Walker et al. (2008) Alcohol 42:91–97] and in alcohol‐dependent men [Simpson et al. (2009) Alcohol Clin Exp Res 33:255–263]. This study extended these findings by using a paradigm that allows for separate assessment of prazosin on motivation to seek versus consume alcohol or sucrose in selectively bred rats. Methods: Alcohol‐preferring (P) rats were trained to complete an operant response that resulted in access to either 2% sucrose or 10% alcohol. A 4‐week Seeking Test Phase examined responding in single, weekly extinction sessions when no reinforcer could be obtained. A 4‐week Drinking Test Phase consisted of rats lever‐pressing to “pay” a specified amount up front to gain access to unlimited alcohol (or sucrose) for a 20‐minute period. On Seeking and Drinking test days, prazosin (0.0, 0.5, 1.0, and 1.5 mg/kg) was administered intraperitoneally 30 minutes prior to behavioral sessions. Results: Rats were self‐administering an average of 0.9 (±0.09) g/kg alcohol on vehicle test day and had pharmacologically relevant blood ethanol concentrations. Prazosin significantly decreased alcohol seeking at all doses tested. The highest dose of prazosin also increased the latency to first response for alcohol and decreased alcohol intake. While sucrose‐seeking and intake were similarly affected by prazosin, the high dose of prazosin did not increase response latency. Conclusions: These findings are consistent with and extend previous research and suggest that prazosin decreases motivation to initiate and engage in alcohol consumption. The specificity of prazosin in attenuating the initiation of alcohol‐ but not sucrose‐seeking suggests that this effect is not because of prazosin‐induced motor‐impairment or malaise. Together with previous findings, these data suggest that prazosin may be an effective pharmacotherapy, with specific application in people that drink excessively or have a genetic predisposition to alcohol abuse.     

Alcohol, tobacco and obesity are synergistic risk factors for hepatocellular carcinoma

BACKGROUND/AIMS: Alcohol has been shown to be an important risk factor for hepatocellular carcinoma (HCC). The role of tobacco as a risk factor for HCC is controversial. Recently, obesity has been reported to be a risk factor for HCC. We investigated whether these factors increase the risk of HCC in American patients. METHODS: Consecutive patients with HCC, cirrhosis without HCC and, control patients without liver disease were enrolled and exposure to risk factors was assessed. RESULTS: When HCC cases were compared to cirrhotic controls, the risk of HCC increased 6-fold for alcohol (OR 5.7; 95% CI: 2.4-13.7), 5-fold for tobacco (OR 4.9; 95% CI: 2.2-10.6), and 4-fold with obesity (OR 4.3; 95% CI: 2.1-8.4). Using spline regression, a dose-dependent relationship between alcohol and tobacco exposure with risk of HCC was noted. There was significant interaction between alcohol, tobacco and obesity, with synergistic indices greater than 1. CONCLUSIONS: Alcohol, tobacco and obesity are independent risk factors for HCC in our patient population, and they interact synergistically to increase the risk of HCC. Data from this study may allow us to stratify cirrhotics into low- and high-risk groups for the development of HCC surveillance strategies.     

Trajectories of Drinking Urges During Individual- and Couple-Based Cognitive-Behavioral Treatment for Alcohol Use Disorders

Individuals receiving treatment for alcohol use disorders (AUDs) often experience urges to drink, and reductions in drinking urges during cognitive-behavioral therapy (CBT) predict better treatment outcomes. However, little previous work has examined patterns of daily drinking urges during treatment. This study examined patterns of change in daily drinking urges among participants in two randomized clinical trials of males (N = 80 with 4,401 daily recordings) and females ( N = 101 with 8,011 daily recordings) receiving individual- or couples-based CBT. Drinking urges were common during treatment, occurring on 45.1% of days for men and 44.8% for women. Drinking urges and alcohol use for both genders decreased substantially during the course of treatment. Both genders had increases in drinking urges as more time elapsed since attending a treatment session. For men, this increase was most pronounced at the beginning of treatment, but for women it was most pronounced near the end of treatment. Alcohol use and drinking urges were both more likely to occur on weekends. The results suggest that these times may lead to higher risk for drinking, and clients may benefit from high-risk planning that is focused on these times.     

The epidemiology of drinking among women of child-bearing age

OBJECTIVES: To estimate the prevalence of drinking, binge drinking (4 or more drinks), and alcohol abuse and dependence and to identify predictors of heavier drinking among women of child-bearing age (18-44 years). METHODS: Subjects are part of a national multistage random sample from the 2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). RESULTS: Binge drinking, abuse, and dependence are higher in younger (<30 years) pregnant and nonpregnant women. Among pregnant women, binge drinking is highest among Whites; alcohol abuse and dependence rates are relatively low and similar in all racial/ethnic groups. Among nonpregnant women, Whites and mixed race women have the highest rates of binge drinking. Alcohol abuse and dependence are highest among Native Hawaiian/Pacific Islanders, followed by Native American/Alaska Native women. Women who are White, younger (21-29 years), single, or cohabiting and with a higher income (> 40,000 US dollars) are at a higher risk for heavier drinking. CONCLUSIONS: Drinking and heavier drinking remain at high levels among women of child-bearing age. Prevention efforts must be comprehensive and should target pregnant women who are drinking and those who could become pregnant and are drinking at high-risk levels.     

A new alcohol provocation head up tilt protocol in the patients with alcohol-related syncope.

AIMS: Drinking alcohol is known to be one of the triggering factors of neurally-mediated syncope. Little is known about the diagnostic utility of the conventional and alcohol provocation head up tilt-test (HUT) in patients with alcohol-related syncope. We investigated the effect of the alcohol provocation HUT. METHODS AND RESULTS: We studied 12 patients (8 males, age 51 +/- 19 years) who had a history of unexplained post-alcohol ingestion syncope. An alcohol provocation protocol HUT (alcohol HUT), in which the protocol required 350 mL of 5% alcohol beer to be drunk over 5 min followed by positioning with the table tilted up for up to 30 min, was performed after the control and isoproterenol (ISP) HUT. None of the subjects (0/12) exhibited a positive response in the control HUT, and only one subject had a positive response (1/12; 8.3%) in the ISP HUT. In the alcohol HUT a positive response (9/12; 75%) increased in the patient group, whereas there were no positive responses in the normal control group. CONCLUSION: In the conventional HUT protocols, including ISP provocation, it was difficult to produce a positive response in the patients with alcohol-related syncope. Alcohol ingestion was a useful diagnostic provocation method in such patients.     

Risk factors for alcoholic liver disease in China

AIM: To examine the association of daily alcohol intake,types of alcoholic beverage consumed, drinking patterns and obesity with alcoholic liver disease in China.METHODS: By random cluster sampling and a 3-year follow-up study, 1 270 alcohol drinkers were recruited from different occupations in the urban and suburban areas of Xi‘an City. They were examined by specialists and inquired for information on: Medical history and family medical history, alcohol intake, types of alcoholic beverage consumed, drinking patterns by detailed dietary questionnaires. Routine blood tests and ultrasonography were done.RESULTS: Multivariate analysis showed that: (1) The risk threshold for developing alcoholic liver disease was ingestion of more than 20 g alcohol per day, keeping on drinking for over 5 years in men. The highest OR was at the daily alcohol consumption ≥160 g, the occurrencerate of ALD amounted to 18.7% (P&lt;0.01). No ALD occurred when ingestion of alcohol was less than 20 g per day. (2) 87.9% of all drank only at mealtimes. The cumulative risk of developing ALD was significantly higher in those individuals who regularly drank alcohol without food than in those who drank only at mealtimes, especially for those who regularly drank hard liquors only and multiple drinks (P&lt;0.05). (3) The alcohol consumption in those with BMI ≥25 was lower than in those with BMI&lt;25, but the risk increased to 11.5%, significantly higher than that of general population, 6.5% (P&lt;0.01). (4) Abstinence and weight reduction could benefit the liver function recovery.CONCLUSION: In the Chinese population the ethanol risk threshold for developing ALD is 20 g per day, and this risk increases with increased daily intake. Drinking 20 g of ethanol per day and for less than 5 years are safe from ALD. Drinking alcohol outside mealtimes and drinking hard liquors only and multiple different alcohol beverages both increase the risk of developing ALD. Obesity also increases the risk, Abstinence and weight reduction will directly affect the prognosis of ALD, Doctor‘s strong advice might influence the prognosis indirectly.     

The J-shape effect of alcohol intake on the risk of developing acute coronary syndromes in diabetic subjects: the CARDIO2000 II Study.

AIMS: To identify the threshold of alcohol consumption above which the balance of risk and benefit becomes adverse in diabetic subjects. METHODS: We studied demographic, lifestyle, dietary and clinical information in 216 hospitalized diabetic patients (171 men, 63 +/- 9 years old, 45 women, 67 +/- 5 years old) with a first event of an acute coronary syndrome (ACS) and 196 frequency matched (age-sex) diabetic controls, without any clinical evidence of coronary heart disease. Alcohol consumption was quantified and a measure for the comparisons was predetermined to be a wine glass (100 ml of wine, 12 g of ethanol) and its alcohol equivalents. RESULTS: Alcohol consumption was associated with an age-adjusted J-shape relationship with total cholesterol, blood pressure and smoking (all P < 0.001). A J-shape association was also found between alcohol intake and the risk of ACS (OR = 2.54-2.43 x (alcohol intake) + 0.80 x (alcohol intake)2, R2 = 0.96, P < 0.001), adjusted for several risk factors and interactions between alcohol intake and smoking status, job and familial stress, and low income. In particular, low alcohol consumption (< 12 g/day) was associated with a 47% (OR = 0.53, 95% CI 0.28-0.97) reduction of the prevalence of ACS, while a higher intake (12-24 and > 24 g/day) increased the prevalence by 2.7-fold (OR = 2.72, 95% CI 1.39-5.38) and 5.4-fold (OR = 5.44, 95% CI 1.21-24.55), respectively. CONCLUSIONS: Alcohol intake is a significant predictor of coronary events. Low-to-moderate intake seems to be associated with a reduction in the prevalence of ACS in diabetes, whereas higher consumption is associated with an increase in lipids and blood pressure levels, and also the risk of developing ACS.     

Alcohol and type 2 diabetes. A review

AimsTo describe a) the association between alcohol consumption and the risk of type 2 diabetes (T2D) and b) the impact of alcohol on the glycemic control with and without anti-diabetic drugs.Data synthesisWe searched MEDLINE and the Cochrane Library data base with the key words “Diabetes Mellitus, type 2” and “Alcohol Drinking” in English-language studies in adults. For the first part of the review we selected meta-analyses, review articles and observational studies more recent than year 1990 including at least 1000 participants. For the second part of the review we included all articles more recent than year 1990. Most observational studies find a J-shaped association between alcohol intake and incidence of T2D. Interestingly, drinking pattern plays a role, i.e. binge drinking increases the risk of T2D. Opposing information exists about the influence of beverage type. In T2D the acute effects on plasma glucose, insulin, fatty acids and triglyceride vary, in part depending on concomitant intake of food. Acute alcohol intake does not induce hypoglycemia in diet treated T2D, but increases the risk of hypoglycemia in sulphonylurea treated patients. In most studies, long-term alcohol use is associated with improved glycemic control in T2D.ConclusionsAlcohol consumption reduces the incidence of T2D, however, binge drinking seems to increase the incidence. Acute intake of alcohol does not increase risk of hypoglycemia in diet treated subjects with T2D, only when sulphonylurea is co-administered. Long-term alcohol use seems to be associated with improved glycemic control in T2D probably due to improved insulin sensitivity.     

Alcohol and drug use disorders, HIV status and drug resistance in a sample of Russian TB patients.

SETTING: Alcohol use, tuberculosis (TB) drug resistance and human immunodeficiency virus (HIV) risk behavior are of increasing concern in Russian TB patients. DESIGN: A prevalence study of alcohol use and HIV risk behavior was conducted in a sample of 200 adult men and women admitted to TB hospitals in St Petersburg and Ivanovo, Russia. RESULTS: Of the subjects, 72% were men. The mean age was 41. Active TB was diagnosed using a combination of chest X-ray, sputum smears and sputum cultures. Sixty-two per cent met DSM-IV criteria for current alcohol abuse or dependence. Drug use was uncommon, with only two patients reporting recent intravenous heroin use. There was one case of HIV infection. The mean total risk assessment battery score was 3.4. Depression was present in 60% of the sample, with 17% severely depressed. Alcohol abuse/dependence was associated with an eight-fold increase in drug resistance (OR 8.58; 95% CI 2.09-35.32). Patients with relapsing or chronic TB were more likely to meet the criteria for alcohol abuse/dependence (OR 2.56; 95% CI 1.0-6.54). CONCLUSION: Alcohol use disorders are common in patients being treated for active TB, and are associated with significant morbidity. Additional surveys are needed to examine the relationship between alcohol use disorders and anti-tuberculosis drug resistance.