Alcohol consumption and NHMRC guidelines: has the message got out,are people conforming and are they aware that alcohol causes cancer?

Objective: To examine self‐reported alcohol consumption and relationships between consumption, awareness of the 2009 NHMRC guidelines of no more than two standard drinks per day, drinking in excess of the guideline threshold and perceptions of alcohol as a risk factor for cancer. Methods: Questions were included in annual, cross‐sectional surveys of approximately 2,700 South Australians aged 18 years and over from 2004 to 2012. Consumption data for 2011 and 2012 were merged for the majority of analyses. Results: In 2011 and 2012, 21.6% of adults drank in excess of the guideline threshold (33.0% males; 10.7% females). While 53.5% correctly identified the NHMRC consumption threshold for women, only 20.3% did so for men (39.0% nominated a higher amount). A large minority said they did not know the consumption threshold for women (39.2%) or men (40.4%). In 2012, only 36.6% saw alcohol as an important risk factor for cancer. Important predictors of excess consumption for men were: higher household income; and not perceiving alcohol as an important risk factor for cancer. Predictors for women were similar but the role of household income was even more prominent. Conclusions: Men were nearly three times as likely to drink in excess of the guidelines as women. The majority of the population did not see an important link between alcohol and cancer. Awareness of the latest NHMRC guidelines consumption threshold is still low, particularly for men. Implications: A strategy to raise awareness of the NHMRC guidelines and the link between alcohol and cancer is warranted.     

Formative evaluation of a policy-orientated print media campaign

A print media advertising campaign was developed as part ofa media advocacy strategy to support health promotion initiativeswith policy makers and opinion leaders, at a time when majorchanges were being proposed to New Zealand's liquor laws. Athree-part formative evaluation programme was undertaken towardsthe end of the first phase of the campaign to identify the bestcomponents to use in the second phase of the campaign. A quantitativegeneral population survey ascertained advertising recall andnotice taken of the advertising; the focus was on the responsesof higher socio-economic persons. Semi-quatitative studies withstakeholders and high socio-economic status women enabled amore in-depth examination of responses to the advertising. Theresearch identified successful and unsuccessful components ofthe campaign and highlighted the costs involved in not undertakingformative evaluation of the advertising material prior to thecampaign.     

Assessing alcohol guidelines in teenagers: results from a 10-year prospective study

Objective: To assess the value of drinking guidelines applied in adolescence for predicting alcohol-related outcomes in young adulthood.
Methods: We conducted an eight-wave, population-based cohort study of 696 males and 824 females in Victoria between 1992 and 2003. Adolescent drinking was assessed at five survey waves, in six month intervals, from mean age 15.4-17.4 years. We created three measures of adolescent alcohol use using categories from NHMRC drinking guidelines: risky/high-risk drinking in the short and long term (2001), and high-risk drinking (2007). Each measure was defined according to the number of waves at which drinking was reported at or above the designated level during adolescence: non-drinkers, zero waves (low-risk drinkers), one wave, and 2+ waves. Alcohol use disorders and alcohol-related sexual behaviours were assessed at mean age 24.1 years.
Results: Fourteen per cent of males and 17% of females were non-drinkers during adolescence. Using each NHMRC drinking guideline, the prevalence of each outcome for men increased with the number of waves at which drinking was reported above the low-risk level (p-values <0.007). The association was less clear for women. The prevalence of each outcome was lower among the nondrinkers compared to the low-risk drinkers for both men and women.
Conclusions and implications: These findings support the emphasis in the NHMRC guidelines on abstaining from alcohol during the adolescent years. Any drinking, even at the low-risk level, may not be appropriate in adolescence. However, refinements that could better capture the risk of adolescent drinking in women would be useful.     

Mortality in England and Wales attributable to current alcohol consumption

STUDY OBJECTIVE: To estimate the number of deaths attributable to current alcohol consumption levels in England and Wales by age and sex. DESIGN: Epidemiological approach using published relative risks and population data. SETTING: England and Wales. MAIN OUTCOME MEASURES: Numbers of deaths by age and sex and years of life lost for alcohol related conditions. RESULTS: Because of the cardioprotective properties of alcohol, it is estimated that there are approximately 2% fewer deaths annually in England and Wales than would be expected in a non-drinking population. This proportion varies greatly by age and sex and only among men aged over 55 years and women aged over 65 years is there likely to be found a net favourable mortality balance. It is also estimated that there were approximately 75 000 premature years of life lost in England and Wales in 1996 attributable to alcohol consumption. The main causes of alcohol attributable mortality among the young include road traffic fatalities, suicide and alcoholic liver disease. CONCLUSIONS: At a population level, current alcohol consumption in England and Wales may marginally reduce mortality. However, the benefit is disproportionately found among the elderly. Estimating alcohol attributable mortality by age and sex may be a useful indicator for developing alcohol strategies. More research into the possible effect modifications of pattern of consumption, beverage type, age and gender will enable these estimates to be improved.     

Alcohol consumption in the new millennium – weighing up the risks and benefits for our health

• 1 Introduction
• 2 An introduction to alcohol and alcoholic beverages
  • 2.1 How is alcohol produced
  • 2.2 The production of alcoholic beverages
  • 2.3 Calculation of alcohol content in beverages
  • 2.4 Other measures of alcohol
• 3 Guidelines for sensible drinking
  • 3.1 UK guidelines
  • 3.2 Guidelines for sensible drinking around the world
• 4 Alcohol consumption
  • 4.1 Current alcohol intakes in the UK
  • 4.2 Recent trends in alcohol intake in the UK
  • 4.3 Trends around the world
• 5 Absorption and metabolism of alcohol
  • 5.1 Absorption of alcohol
  • 5.2 Alcohol metabolism
• 6 Alcohol and nutrition
  • 6.1 Nutrient composition of alcoholic beverages
  • 6.2 The effect of alcohol on energy intake
  • 6.3 Nutritional implications of chronic excessive alcohol consumption
  • 6.4 Other components of alcoholic beverages
• 7 The burden of disease and mortality related to alcohol
• 8 Alcohol and disease risk
  • 8.1 Methodological problems of studies assessing associations between alcohol consumption and disease risk
  • 8.2 Alcohol and bodyweight
  • 8.3 Alcohol and coronary heart disease
  • 8.4 Alcohol and blood pressure
  • 8.5 Alcohol and stroke
  • 8.6 Alcohol and type 2 diabetes
  • 8.7 Alcohol and cancer
• 9 Alcohol and other conditions
  • 9.1 Adverse reactions to alcohol for some susceptible individuals
  • 9.2 Alcohol and peptic ulcers
  • 9.3 Alcohol during pregnancy
  • 9.4 Alcohol, bone mineral density and fracture risk
  • 9.5 Alcohol and renal dysfunction
• 10 Alcohol and social issues
  • 10.1 Short‐term psychological and psychomotor effects of alcohol intake
  • 10.2 Crime and public disorder as a result of drinking alcohol
  • 10.3 Alcohol‐related harms and other public health issues
  • 10.4 The economics of alcohol consumption
  • 10.5 Population‐based initiatives underway to reduce the incidence of binge drinking
• 11 Conclusions

Summary Alcohol is produced via the anaerobic fermentation of sugars by yeast and involves glucose molecules (C₆H₁₂O₆) being broken down to yield ethanol (C₂H₅OH), carbon dioxide (CO₂) and energy. The amount of alcohol contained in different alcoholic beverages varies considerably and is referred to as the ‘strength’ of the drink, which is expressed as the percentage of alcohol by volume (ABV). A standard unit of alcohol in the UK equates to 8 g or 10 ml of pure alcohol. Guidelines for sensible drinking set by the UK government are 3–4 units (24–32 g) a day or less for men, and 2–3 units (16–24 g) a day or less for women. Specific recommendations have been set for those planning pregnancy and pregnant women, who should drink no more than 1–2 units of alcohol once or twice a week and should avoid heavy drinking sessions. Guidelines for sensible drinking are similar in other countries. When taking into account the standard drink unit used to define guidelines, the most commonly recommended limit is 24 g/day for men and 20 g/day for women. Older people are more likely to drink in line with the sensible drinking guidelines, as they tend to consume alcohol over a period of time, as opposed to consuming large quantities on one or two days of the week, a practice that is more popular among younger people. Consuming double the sensible drinking guidelines in one day is classified as binge drinking (an alternative definition is drinking until intoxicated). It has become recognised that binge drinking is a common phenomenon in the UK, particularly among younger people. Other factors, such as income, ethnicity and region of residence, are also recognised to be predictive of the quantity of alcohol consumed; for example, higher‐income households are more likely to consume large quantities of alcohol and consume alcohol more frequently. The quantity of alcohol consumed is an important factor in determining how it affects health and well‐being. In terms of nutritional health, chronic excessive alcohol intake is well recognised to affect an individual’s nutrient status, because it reduces food intake and/or may interfere with the digestion, absorption, metabolism and utilisation of some nutrients. However, when consumed in moderation, alcohol is unlikely to interfere with the metabolism of nutrients or be associated with impaired vitamin function or depletion to an extent that may harm health, provided that dietary intakes are adequate. Alcoholic beverages contain alcohol, carbohydrate and only small amounts of some vitamins, trace elements and minerals. They are therefore unlikely to contribute significantly to micronutrient intake. Any association that exists between moderate alcohol consumption and the absorption and metabolism of nutrients from the diet is dependant on a number of factors, including: the nutrient in question; habitual intake of the nutrient and the nutritional status of the individual; and the quantity of alcohol consumed over a period of time. Overall, little information exists about the implications of binge drinking on nutrient status; but it may alter food intake, and excessive alcohol consumption can cause disturbances to the digestive system. While infrequent binge drinking is unlikely to have any long‐term nutritional implications (although it may affect nutrient status in the short‐term), regular binge drinking may have a more negative impact. Although alcoholic beverages tend to have few nutrients, they can be a significant source of energy, as alcohol provides 7 kcal per gram. Studies indicate that alcoholic beverages are usually additive to an individual’s normal energy intake and individuals are unlikely to compensate for energy from them during the day. The aperitif effect of alcohol may also encourage an increase in energy intake. It is therefore not surprising that alcohol intake has been associated with weight gain and an increase in body mass index (BMI) (with the exception of chronic excessive drinkers). However, there are a number of methodological problems that need to be considered when comparing the findings of studies investigating the association between alcohol intake and disease risk, including: potential misreporting of total intake; the use of an appropriate control group; and the need for comparable measurement units. Consumption of alcoholic beverages has also been associated with increasing the risk of ill‐health associated with pre‐existing conditions. For example, it may contribute to ulcer development or aggravate symptoms of existing ulcers. There is evidence that moderate alcohol consumption during pregnancy may affect the development of the fetus’s central nervous system, and may result in low birthweight. However, there is currently no consensus as to whether alcohol should be completely avoided during pregnancy. However, it is well recognised that excess alcohol consumption during pregnancy can put the fetus at risk of fetal alcohol syndrome. Quantity of alcohol consumed is particularly important when considering the association between alcohol and chronic diseases; for example, there is now strong evidence that light to moderate (1–3 drinks per day) consumption decreases the risk of a coronary heart disease (CHD) episode compared with abstainers (with particular benefits in men aged over 55 years and post‐menopausal women). However, heavy drinking is associated with an increased risk of CHD. Further information is required to determine the association between drinking patterns and heart health. However, there is a consensus of opinion that it is the alcohol per se that influences heart health, rather than a particular type of alcoholic beverage; and other factors that affect an individual’s choice of drink may be important in distorting the findings from studies that show otherwise. As with risk of CHD, light to moderate alcohol consumption is associated with a decreased risk (of 30–40%) of type 2 diabetes, when compared with teetotallers. Heavy drinking may be associated with an increased risk, resulting in a ‘J’ or ‘U’ shaped relationship between alcohol consumption and the incidence of type 2 diabetes. A ‘J’ shaped relationship has also been reported between alcohol consumption and blood pressure. It is widely accepted that heavy alcohol intake is a risk factor for high blood pressure, and evidence indicates that moderate intakes may exert a short‐term lowering effect, while abstainers/teetotallers are reported to have a higher blood pressure. The type of stroke is important when considering the association between stroke and alcohol, as any alcohol consumption is associated with an increased risk of haemorrhagic stroke, but low intakes (i.e. one drink per day) may have a protective effect on ischaemic stroke. Heavy drinking is associated with an increased risk of both types of stroke. Alcohol intake has also been associated with an increased risk of cancers at a number of sites. However, a consensus for a likely causal association has only been identified between alcohol and cancers of the upper‐aero digestive tract and liver. The mechanisms to explain the positive associations between alcohol and breast cancer, and alcohol and colorectal cancer, have yet to be identified. It is unclear whether some types of alcoholic beverage are more strongly associated with increased risk of cancer than others. Mechanisms identified to date suggest that it is the alcohol per se that exerts damage and, therefore, quantity of alcohol consumed is the most important variable. Studies looking at the relationship between alcohol and mortality suggest that 10–80 g (approximately 1–8 drinks) of alcohol each week is optimal to reap the health benefits, but increased risk is noted at higher intakes (thus indicating a ‘U’ shaped relationship between alcohol intake and mortality). Gender and age are important factors when considering the association between alcohol and mortality. For example, for younger people, the benefits of alcohol may be outweighed by the increased risk of other diseases (e.g. alcohol‐related cancers, liver cirrhosis) and increased risk of violence and accidents. Aggressive behaviour, increased risk taking and decreased responsiveness to social expectations, which may lead to personal ‘harm’, including accidents and violence, are usually the result of alcohol intoxication (i.e. through binge drinking). Excess alcohol consumption may also result in a ‘hangover’, which disrupts normal life through symptoms of fatigue and increased anxiety, and has economic consequences in the workplace through poor performance or absenteeism. The extent to which a hangover can affect an individual’s performance, including psychomotor, recognition and managerial skills, is still being debated. Binge drinking is also associated with an increased risk of sexually transmitted diseases and unplanned pregnancies. Although the cost of binge drinking in terms of long‐term health has yet to be established, the significant economic cost is well recognised. A number of population‐based initiatives are underway to try and change the ‘drinking culture’, and thus reduce the incidence of binge drinking. Initiatives include: advertising campaigns; changes to alcohol advertising regulations; and changes to pub licensing regulations.     

Internalization of ideal body shapes in 9-12-year-old girls

OBJECTIVE: Body dissatisfaction is reported in girls as young as 9 years old in Western countries. In the current study, internalization of the "thin ideal" was predicted to be a critical influence on the development of body dissatisfaction. METHOD: Participants (n = 356) were weighed and completed measures of body dissatisfaction, awareness and internalization of the thin ideal, and peer and maternal attitudes and behavior. Exposure to relevant print media was also assessed. RESULTS: Body dissatisfaction was associated with a higher body mass index, although it was not restricted to overweight girls. Internalization mediated the relationship between awareness of the sociocultural standard of appearance and body dissatisfaction. Media exposure and peer and maternal weight-related attitudes and behavior were, in turn, related to awareness, supporting the hypothesized sociocultural processes. DISCUSSION: Internalization operates as a central component in the development of body dissatisfaction, occurring at a young age in some girls. Internalization may be a suitable target for preventive strategies.     

Young Australian adults' beliefs about alcohol's role in sexual aggression and victimisation

Beliefs and misconceptions about sex, gender, and rape have been explored extensively to explain attributions concerning alcohol-involved sexual violence. However, less is known about the specific beliefs that people hold about how alcohol facilitates sexual aggression and victimisation. The present study aimed to identify these alcohol-related beliefs among young Australian adults. Six men and nine women (N = 15; 18–24 years) in focus groups (n = 13) and interviews (n = 2) were asked to discuss the role of alcohol in a hypothetical alcohol-involved rape. Using a consensual qualitative research methodology, the effects of alcohol that were seen to introduce, progress, and intensify risks for rape were: increased confidence; character transformation; impaired cognition; behavioural disinhibition; altered sexual negotiation; enhanced self-centredness; impaired awareness of wrongdoing; increased/decreased sexual assertiveness; and compromised self-protection. Some of the beliefs identified in this study are not currently captured in alcohol expectancy measures which assess people's beliefs about alcohol's effects on cognition, emotion, and behaviour. This study's findings offer a conceptual basis for the development of a new alcohol expectancy measure that can be used in future rape-perception research.     

Addiction and personal responsibility as solutions to the contradictions of neoliberal consumerism

The article analyses the idealization of moderate alcohol consumption and of personal responsibility for controlling drinking behaviour as a sociocultural solution for a central contradiction in modern consumer societies. The application of neoliberal ideals of consumer sovereignty, free market access at any hour of the day or night and unrestrained market promotion tends to push upward the population's alcohol consumption. But in many aspects of daily life – for instance, when at work, when driving a car, when minding children – modern societies require sobriety. The ideological solution to this societal dilemma is to individualize the responsibility for handling it, apotheosizing the ideal of the moderate drinker, at the cultural level as a dream to reach for and at the individual level as an ideal of a secular pilgrim's progress.     

Prevalence and patterns of problematic alcohol use among Australian parents

Objective: Limited research data exists on the prevalence, and characteristics associated with parental alcohol use, particularly in Australia. This study aims to examine the drinking patterns of Australian parents, and to determine whether the drinking pattern differs by family type. The characteristics associated with regular parental alcohol use were also assessed. Methods: Data from a representative sample of 23,356 Australians were analysed from the 2007 National Drug Strategy Household Survey. Results: The study found that parents were less likely to drink at levels defined as risky. Additionally, single mothers were more likely to report monthly and weekly binge drinking, compared to other mothers. Four predictors of risky parental alcohol use were identified: male; a current tobacco smoker; reporting higher levels of psychological distress; and lower levels of education. Conclusions: Although this study found that parents were less likely to consume alcohol at risky levels, population estimates suggest a considerable number of Australian children live in households where risky parental alcohol use occurs. Implications: This study provides the first step to extending the knowledge base on the prevalence of parental alcohol use which will help to inform public health policy and early intervention programs.     

Relationship between emergent literacy and early social–emotional development in preschool children from low-income backgrounds

Sixty-one preschool children and their parents and teachers participated in a cross-sectional study of the social–emotional correlates of emergent literacy skills. The children's emergent literacy skills were assessed with the standard language and literacy tests: Expressive Vocabulary Test, Peabody Picture Vocabulary Test (third edition), and Test of Early Reading Ability (third edition). These tests measure oral language (expressive language and receptive language) and print awareness. The children's positive and negative behaviours were measured by the standard behaviour rating scales: the Behavior Assessment System for Children (second edition) and the Devereux Early Childhood Assessment. These behaviours are grouped into four subcategories, namely, externalising behaviour, internalising behaviour, approaches to learning, and interpersonal skills. Results showed a wide range of significant associations between the components of emergent literacy and social–emotional development. Age and sex were found to moderate these significant correlations in different ways. Implications for educational practitioners and suggestions for future research are discussed.     

‘SI VIS VITAM,PARA MORTEM’ terror management theory and psychosocial healthcare practice

Terror management theory (TMT) contends that the need to manage the anxiety evoked by the awareness of one's own mortality, through proximal and distal defenses, lies at the heart of any human motivation. Proximal defenses aim at dismissing death awareness. Distal defenses aim at keeping them out of frame. The terror management health model (TMHM) applies TMT to issues of health and illness. TMT and TMHM are both explored mainly through empirical positivist research and theoretical discussions. Very few publications relate to the implementation of TMT. This article suggests further applications of the TMHM in social work practice.     

Sodium and potassium contents of home-cooked and cafeteria foods

Nineteen main meal foods from cafeterias and six from households were analysed for sodium and potassium. Similar home-cooked and commercially-prepared foods did not differ in sodium contents, except for roast beef. In addition to salt, ingredients such as spreads, bottled sauces and stock cubes contributed sodium to the foods. Potassium levels were higher in four of the home-cooked foods, possibly due to more conservative cooking methods and the use of potassium-rich ingredients such as herbs.     

Making sense of drinking: the role of techniques of neutralisation and counter‐neutralisation in negotiating alcohol consumption

This article contributes to the understanding of how students neutralise potential feelings of guilt and stigmatisation regarding their alcohol consumption. We report findings from two qualitative studies with students at a UK university. The aim of the research was to uncover the range and ways in which neutralisation and counter‐neutralisation techniques are used by drinkers and abstainers/near‐abstainers in managing their alcohol position. Study 1 consisted of five focus groups with heavy drinkers and Study 2 comprised nine one‐to‐one interviews with abstainers and near‐abstainers. Analysis highlights the importance of alcohol consumption in students’ lifestyles, but also the potential identity conflicts experienced by all drinkers, regardless of the amount consumed. Heavy drinkers primarily employ neutralisation techniques as a means to rationalise the negative impacts of their actions, whereas abstainers and near‐abstainers mainly use counter‐neutralisation techniques as a means to reinforce their commitment to lifestyles which run counter to mainstream student life expectations. However, regardless of the amount of alcohol consumed, all participants employed neutralising and counter‐neutralising arguments in some social situations. The article discusses the usefulness of neutralisation theory to account for the adoption of risky health behaviours, such as excessive alcohol consumption, and the potential implications for public health interventions.     

Impacts from repeated mass media campaigns to promote sun protection in Australia

Campaigns using television, radio and print media were conducted over three summers in New South Wales, Australia, aiming to increase the use of sun protection measures among children under 12 years. The evaluation entailed cross-sectional telephone surveys before and after each of the first two campaigns and following the third campaign. The study group were parents of children under 12 years. Random digit dialling yielded samples of approximately 800 for each survey. Measures addressed campaign recall and sun protection knowledge, attitudes and behaviours. The surveys revealed significant levels of campaign recall. Knowledge about the protective benefits of sunscreens, hats and protective clothing was high at baseline and showed little improvement over the campaigns. Knowledge levels about the benefits of shade cover and of the relative risks of skin cancer from childhood sun exposure were lower, and also did not show improvement. Just one of the four attitude factors showed significant improvement, and this concerned the importance that parents placed on the issue of child sun protection. After the final campaign there were increases compared with baseline in childrens' use of sunscreen, protective clothing and shade, but it was notable that between campaigns levels of these behaviours were similar to or below those at baseline. There was no evidence of a campaign-related increase in hat wearing by children. All sun protection measures were used less often by adults than children, but these showed similar trends. Mass media campaigns may contribute to short-term increases in some sun protection behaviours; however, as their impact is not sustained they should be repeated and supplemented by educational, policy and environmental strategies.     

Changes in health professionals' knowledge, attitudes and practice following provision of educational resources about prevention of prenatal alcohol exposure and fetal alcohol spectrum disorder

We provided health professionals in Western Australia (WA) with educational resources about prevention of prenatal alcohol exposure and fetal alcohol spectrum disorder and assessed changes in their knowledge, attitudes and practice concerning fetal alcohol syndrome (FAS) and alcohol consumption in pregnancy. Following our 2002 survey of health professionals in WA, we developed and distributed educational resources to 3348 health professionals in WA in 2007. Six months later we surveyed 1483 of these health professionals. Prevalence rate ratios [PRR] and 95% confidence intervals [CI] were calculated to compare 2007 results with results from the 2002 survey. Of the 1001 responding health professionals, 69.8% had seen the educational resources; of these 77.1% have used them and 48.5% said the resources had assisted them to change their practice or their intention to change their practice. Compared with 2002, there was an increase in the proportion who knew all the essential features of FAS from 11.7% to 15.8% [PRR 1.35; 95% CI 1.09, 1.67] and had diagnosed FAS, from 4.8% to 7.3% [PRR 1.52; 95% CI 1.08, 2.13]. In 2007, 98.1% of health professionals stated they would advise pregnant women to consider not drinking at all or advise them that no alcohol in pregnancy is the safest choice. Health professionals surveyed in 2007 have increased their knowledge, changed their attitudes and practice about FAS, and altered the advice they give to pregnant women about alcohol consumption since our survey in 2002. It is essential that we build on this change and continue to support health professionals' knowledge, attitudes and practice about the prevention of prenatal alcohol exposure and fetal alcohol spectrum disorder. The educational resources for health professionals may be ordered as hard copies and downloaded from the internet http://www.ichr.uwa.edu.au/alcoholandpregnancy.     

Alcohol consumption and alcohol control policy: the case of the Netherlands.

In the last decades the Netherlands have experienced a strong increase in heavy drinking, alcohol-related morbidity and, to a lesser extent, alcohol-related mortality. Along with an increase in leisure time and income, it is possible that two more specific factors contributed to these developments in alcohol consumption, i.e. catching up with the drinking habits of neighbouring countries and a process of secularization. The strong increases mentioned have until recently not provoked any strong negative reactions, either from the public at large or from the government. Moreover, the Dutch government has no tradition in developing and implementing a restrictive alcohol policy. In two large-scale studies in Rotterdam and Limburg we have found that in the population at large, there are, with one exception, no strong sentiments in favor of or against concrete preventive measures. We argue that an effective prevention policy is necessary, which should at least contain the following elements: (1) a public health campaign to support the implementation of possible restrictive measures; (2) measures aimed at a stabilization or reduction of the per capita consumption; (3) specific preventive measures for high risk groups; and (4) a social and political structure which facilitates the formulation and implementation of a prevention policy.     

Consumption of Tea,Alcohol, and Fruits and Risk of Kidney Stones: A Prospective Cohort Study in 0.5 Million Chinese Adults

A few prospective studies have suggested that tea, alcohol, and fruit consumption may reduce the risk of kidney stones. However, little is known whether such associations and their combined effect persist in Chinese adults, for whom the popular tea and alcohol drinks are different from those investigated in the aforementioned studies. The present study included 502,621 participants from the China Kadoorie Biobank (CKB). Information about tea, alcohol, and fruit consumption was self-reported at baseline. The first documented cases of kidney stones during follow-up were collected through linkage with the national health insurance system. Cox regression was used to calculate the hazard ratio (HR) and 95% confidence interval (CI). During a median of 11.1 years of follow-up, we collected 12,407 cases of kidney stones. After multivariable adjustment, tea, alcohol, and fruit consumption were found to be negatively associated with kidney stone risk, but the linear trend was only found in tea and fruit consumption. Compared with non-tea consumers, the HR (95% CI) for participants who drank ≥7 cups of tea per day was 0.73 (0.65–0.83). Compared with non-alcohol consumers, the HR (95% CI) was 0.79 (0.72–0.87) for participants who drank pure alcohol of 30.0–59.9 g per day but had no further decrease with a higher intake of alcohol. Compared with less-than-weekly consumers, the HR (95% CI) for daily fruit consumers was 0.81 (0.75–0.87). Even for those who did not drink alcohol excessively, increasing tea and fruit consumption could also independently reduce the stone risk. Among Chinese adults, tea, alcohol, and fruit consumption was associated with a lower risk of kidney stones.