Rehabilitation of a heavy drinker.

Alcohol abuse within the workforce is now a widely recognised problem. Brenda Coldwell describes how cooperation between management, trade unionists and the OH department of a large company helped resolve an employee's destructive drink problem.     

Alcoholic beverage preference,diet, and health habits in the UNC Alumni Heart Study

BACKGROUND: Moderate alcohol intake is related to better health, and additional benefits may be associated with wine. However, beverage preference may be confounded by lifestyle factors related to health. OBJECTIVE: The goal was to describe the associations between alcoholic-beverage preferences and indicators of a healthy diet and other health habits. DESIGN: This cross-sectional study included data from 2864 men and 1571 women enrolled in the UNC Alumni Heart Study. Self-reports of drinking habits were used as predictors of health behaviors and of intakes of nutrients and food groups. RESULTS: Subjects who preferred wine had healthier diets than did those who preferred beer or spirits or had no preference. Wine drinkers reported eating more servings of fruit and vegetables and fewer servings of red or fried meats. The diets of wine drinkers contained less cholesterol, saturated fat, and alcohol and more fiber. Wine drinkers were less likely to smoke. Compared with all drinkers, those who drank no alcohol consumed fewer vegetables but more fiber. Nondrinkers were less likely to exercise regularly and had a higher mean body mass index. Controlling for income and education had little effect on these associations. CONCLUSIONS: The apparent health benefits of wine compared with other alcoholic beverages, as described by others, may be a result of confounding by dietary habits and other lifestyle factors. Confounding by lifestyle variables could also be a factor in the previously observed health differences between drinkers and nondrinkers, although the evidence for this association is not as strong.     

Alcoholic beverage consumption and breast cancer incidence

Recent case-control studies have suggested that alcohol consumption may be associated with breast cancer incidence. This report is a retrospective cohort study of over 95,000 women who were members of the Kaiser Foundation Health Plan of Northern California. The stated alcohol consumption of these women was recorded at a multiphasic screening examination taken from 1964 to 1972 prior to any diagnosis of breast cancer. The incidence of breast cancer in this cohort was greater for women who drank, and among these drinkers, incidence increased in an irregular trend with heavier alcohol consumption. Control for the effects of race, education, smoking, and reproductive variables related to breast cancer all but eliminated the overall increased relative risk of drinkers compared with that of nondrinkers. However, the relatively small group of women who stated that they had three or more alcoholic drinks per day (5.2 per cent of the total) had a significantly elevated relative risk of 1.4 (p = 0.035) compared with nondrinkers, despite control for all available confounding variables. No significant interaction effect of smoking and alcohol was found. Women who had less than three drinks per day had no increased relative risk over nondrinkers. The results of this study might be explained either by an unrecognized carcinogenic effect of alcohol on breast tissue or by the confounding effect of other factors associated with heavy alcohol use.     

Alcoholic beverage consumption and breast cancer in a French case-control study

An association between regular consumption of alcohol with meals and breast cancer was found in a French case-control study of 1,010 women with breast cancer and 1,950 women with nonmalignant diseases; the relative risk of breast cancer for women drinking alcoholic beverages with meals compared with nondrinkers was 1.47 (p = 10(-4) allowing for classical risk factors. Detailed information on alcohol consumption was obtained from 500 cases and 945 controls; the risks of breast cancer were greater for women drinking beer and for women drinking wine than for nondrinkers, and the risk increased with the amount of beer, of wine and of total alcohol consumption in grams of pure alcohol.     

Alcoholic beverage consumption and the risk of endometrial cancer. Cancer and Steroid Hormone Study Group

Previous studies have suggested that alcoholic beverage consumption may lead to a decrease in a woman's oestrogen levels. It is possible that any such alcohol-associated decrease could lead to a decrease in endometrial cancer risk. To study the association between alcohol consumption and endometrial cancer, we examined data from the Cancer and Steroid Hormone Study, a multi-centre, population based, case-control study. A total of 351 women with primary epithelial endometrial cancer and 2247 women selected from the same geographical areas as the cases were interviewed for the study. As part of the interview, the participants provided information regarding their alcohol consumption during the preceding five years. Analysis of these data revealed that women who were non-drinkers had a risk of endometrial cancer of 1.83 relative to the risk of women who had consumed an average of 150 grams or more of alcohol per week (95% Cl, 1.11, 3.01). Women who drank, but who consumed less than 150 grams of alcohol per week, were at an intermediate risk. The increased risk associated with abstinence from alcohol consumption was particularly great in overweight women and was virtually absent in lean women. These results argue that alcohol ingestion may reduce a woman's risk of endometrial cancer, particularly if she is overweight.     

Stopping insulin and achieving a good metabolic control in a heavy drinker five months after stopping alcohol

In this case study, we describe a 25 year-old male who showed the symptoms of diabetes after a period of heavy drinking. (HbA1c=13%). Treatment was started with 120 units of insulin. After stopping alcohol consumption and taking an appropriate diet, insulin was tapered down. Five months after the start of treatment, insulin was stopped (HbA1c=5%). The results showed that he was in a good metabolic control after 18 months (HbA1c=5.9%).     

Alcohol consumption regression models for distinguishing between beverage type effects and beverage preference effects.

In relating health outcomes to alcohol consumption, several investigators have evaluated differences among beverage types, but there is no consistency with respect to models used for this purpose. Furthermore, beverage type effects and beverage preference effects have not been evaluated simultaneously. In this report, the authors propose regression models which permit the simultaneous evaluation of beverage type (congener dose response) effects and beverage preference (sociobehavioral) effects. The presence of sociobehavioral effects can be established even if the variables responsible for them have not been measured or identified. The models are applied to a data set from 589 women who participated in an oral contraceptive study at the Johns Hopkins University (Baltimore, Maryland) in 1988-1989.     

Nonlinear modeling of alcohol consumption for analysis of beverage type effects and beverage preference effects.

In a previous report (Kimball and Friedman, Am J Epidemiol, 1992;135:1279-86), linear models for relating health outcomes to alcohol consumption were proposed for differentiating between beverage type effects and beverage preference effects. The models were applied to data relating serum high density lipoprotein cholesterol to alcohol consumption. In this report, those models are extended to the nonlinear case and are applied to data from the 1982 Maryland Hypertension Survey relating systolic blood pressure to alcohol consumption.     

Lifetime cumulative adversity, mental health and the risk of becoming a smoker

We analyze the effect of stress exposure on the transition to heavy smoking, in a community sample of 1747 young adults in Miami, Florida. The effects of distal life stress are assessed in the context of recent stress exposure. Distal stress exposure predicts smoking independently of recent stress. Intervening stressful events do not appreciably mediate the influence of distal stress. We investigate the extent to which stress effects may be mediated by psychiatric and substance dependence disorders. We conclude that the effect of social stress on the risk for smoking is additive over time. The significant independent effect of early stress exposure implies that youths who are at greater risk for eventual heavy smoking may be identified at ages considerably younger than peak initiation age.     

Early childhood misbehavior and the estimated risk of becoming tobacco-dependent

In this study, the authors focused on signs of early childhood misbehavior that might be linked to the risk of becoming tobacco-dependent. Standardized teacher ratings of misbehavior were obtained for an epidemiologic sample of first graders entering an urban mid-Atlantic public school system in 1985 and 1986. Fifteen years later, 1,692 of the students were reassessed (nearly 75% of the original sample). As adults, 962 participants indicated that they had tried tobacco at least once; 66% of the 962 had become daily users. Latent class analysis of items on the Fagerstr?m Test for Nicotine Dependence gave evidence of three classes pertinent to tobacco dependence syndrome in smokers by young adulthood: one nondependent class of smokers (50% of smokers), a class of smokers experiencing a moderate number of dependence features (31%), and a third class that was more severely affected (19%), as manifest in the need to smoke immediately after waking and smoking when ill. With or without adjustment for covariates, higher levels of teacher-rated childhood misbehavior at entry into primary school were associated with a modest excess risk of becoming tobacco-dependent by young adulthood (risk ratio = 1.6, 95% confidence interval: 1.1, 2.5). Interventions that seek to improve childhood behavior might reduce early onset tobacco smoking and risk of tobacco dependence among smokers.     

新疆哈萨克族食管癌高发区居民膳食状况及一碳单位代谢相关营养素水平调查

  目的   探讨中国人群进食快对食管癌发病的影响,为食管癌的预防提供科学依据。  方法   检索中国知网数据库、万方数据库、PubMed数据库和Web of Science数据库,并辅以手工检索和文献追溯法收集1980年1月 —2017年2月公开发表的有关进食快与食管癌关系的相关文献;应用Stata 11.0软件对纳入的文献进行meta分析。  结果   最终纳入26篇文献（中文文献22篇,英文文献4篇）,均为病例对照研究,累计病例组8 418例,对照组11 710例;Meta分析结果显示,中国人群进食快者食管癌的发病风险为非进食快者的2.518倍（OR = 2.518,95 % CI = 2.024～3.131）;亚组分析结果显示,在不同地区、不同对照来源、不同发表年份、不同文献来源中进食快者食管癌发病风险均高于非进食快者（均P < 0.01）;敏感性分析和发表偏倚检验结果显示,本次meta分析纳入的文献不存在发表偏倚,结果较为稳定。  结论   进食快会增加中国人群中食管癌的发病风险。     

Salt preference and the risk of gastrointestinal cancers

The relationship between the consumption of salt and the risk of gastrointestinal cancer was examined using data from a case‐control study conducted in northern Italy. The study was conducted on 526 incident cases of gastric cancer, 621 of colon cancers, 382 of rectal cancers, and 1,223 controls admitted to hospital for acute, nonneoplastic, nondigestive tract disorders. Compared with those for people with low salt intakes, the relative risks (and 95% confidence intervals) for those with intermediate and high salt intakes were 1.3 (1.0–1.8) and 1.2 (0.8–1.7) for stomach, 1.0 (0.8–1.3) and 1.1 (0.8–1.5) for colon, and 1.2 (0.9–1.6) and 0.9 (0.6–1.3) for rectum. None of the trends in risk were statistically significant, and the risk estimates were not materially modified by allowance for major identified potential confounding factors. Thus, this study gives little support to the existence of any strong association between salt intake and gastrointestinal cancers. However, in view of the results obtained and of the uncertainties of salt intake measurement, the possibility exists of a real, although moderate, association of salt intake with gastric cancer.     

Salt preference and the risk of gastrointestinal cancers

The relationship between the consumption of salt and the risk of gastrointestinal cancer was examined using data from a case-control study conducted in northern Italy. The study was conducted on 526 incident cases of gastric cancer, 621 of colon cancers, 382 of rectal cancers, and 1,223 controls admitted to hospital for acute, nonneoplastic, nondigestive tract disorders. Compared with those for people with low salt intakes, the relative risks (and 95% confidence intervals) for those with intermediate and high salt intakes were 1.3 (1.0-1.8) and 1.2 (0.8-1.7) for stomach, 1.0 (0.8-1.3) and 1.1 (0.8-1.5) for colon, and 1.2 (0.9-1.6) and 0.9 (0.6-1.3) for rectum. None of the trends in risk were statistically significant, and the risk estimates were not materially modified by allowance for major identified potential confounding factors. Thus, this study gives little support to the existence of any strong association between salt intake and gastrointestinal cancers. However, in view of the results obtained and of the uncertainties of salt intake measurement, the possibility exists of a real, although moderate, association of salt intake with gastric cancer.     

Pre-pregnancy caffeine and caffeinated beverage intake and risk of spontaneous abortion

Purpose

To investigate the relation between pre-pregnancy caffeine and caffeinated beverage intake and risk of spontaneous abortion (SAB).

Methods

Our prospective cohort study included 15,590 pregnancies from 11,072 women with no history of SAB in the Nurses’ Health Study II (1991–2009). Beverage intake was assessed every 4 years using a validated questionnaire. Pregnancies were self-reported with case pregnancies lost spontaneously at <20 weeks gestation. Multivariable log-binomial regression models with generalized estimating equations were used to estimate the relative risks (RRs) and 95 % confidence intervals (CIs).

Results

There was a positive linear trend across categories of pre-pregnancy caffeine intake and risk of SAB such that women consuming >400 mg/day had 1.11 (95 % CI 0.98, 1.25) times the risk of SAB compared to women consuming <50 mg/day (p trend = 0.05). Total coffee intake had a positive, linear association with SAB. Compared to women with no pre-pregnancy coffee intake, women consuming ≥4 servings/day had a 20 % (6, 36 %) increased risk of SAB (p trend = 0.01). There was no difference in the association between caffeinated and decaffeinated coffee and risk of SAB. Pre-pregnancy intake of caffeinated tea, caffeinated soda, and decaffeinated soda had no association with SAB.

Conclusions

Pre-pregnancy coffee consumption at levels ≥4 servings/day is associated with increased risk of SAB, particularly at weeks 8–19.

     

Effect of dilution of sports drink on water balance and beverage preference of heat-exposed steel workers

Eight skilled workers engaged in heat-exposed work in front of a blast furnace in a steel factory were asked to drink a sports drink or one of its dilutions of x 2, x 3, or x 5 during a regular daytime shift in the summer of 1999. A regular lunch was taken and the examined beverage was iced and was allowed to be consumed ad libitum. The beverage was changed each day during four days of the experiment without informing the dilution ratio. The non-diluted beverage contained 21 mEq/l of Na+, 5 mEq/l of K+, 6.7 g/dl of carbohydrate. In average, the body temperature measured in the ear canal was elevated by 0.34 degree C, the loss of body weight was 1.77 kg, total beverage intake was 1,875 g, total amount of urine was 291 g, and the total water loss was 3,732 g (1,350-5,810 g) during a single shift. Twenty out of 24 cases experienced more than 1.5% of weight reduction during morning work without noticing any subjective symptoms of dehydration. The amount of weight loss during morning work was significantly smaller when x 2 or x 3 dilution was taken compared to a non-diluted beverage. The mean value of urinary Na+ concentration was decreased after 8 hours of work; however, the difference was not significant. The urinary K+ concentration was significantly increased. When the total amount of urinary sodium excretion in stored urine was calculated, the x 3 dilution recorded the largest amount. Regarding palatability, the x 2 dilution received the best evaluation, whereas all subjects felt the original beverage as too condensed. We did not observe any adverse effect from diluting the sports drink for x 2 or x 3, when supplying them as water and electrolyte replacements for dehydrated steel workers.     

不同饮品与中国成人高尿酸血症的关系研究

目的 调查不同饮品对我国人群血尿酸水平及高尿酸血症的影响。方法 利用2009年中国营养与健康调查项目数据,收集研究对象的一般资料,包括年龄、性别、饮品消费情况、吸烟史、饮酒史、能量摄入情况、血尿酸水平等,根据血尿酸水平将研究对象分为高尿酸血症组和非高尿酸血症组。分别采用线性回归和logistic回归分析糖饮料、茶和水摄入频率与血尿酸水平及高尿酸血症的关系。结果 共纳入研究对象7 618例,高尿酸血症1 178例,非高尿酸血症6 440例。调整混杂因素后,与不饮用糖饮料者相比,每月饮用(β=0.039,95%CI:0.019～0.060,P<0.001)、每周饮用(β=0.036,95%CI: 0.014～0.059,P=0.001)和每天饮用(β=0.092,95%CI:0.024～0.160,P=0.008)糖饮料可增加血尿酸水平。每周饮水(β=-0.046,95%CI:-0.082～-0.011,P=0.011)和每天饮水(β=-0.033,95%CI:-0.052～-0.014,P=0.001)可降低血尿酸水平,而每天饮茶对血尿酸水平无显著影响(β=-0.053,95%CI:-0.146～0.039,P=0.259)。每天都喝糖饮料的人群高尿酸血症发生风险约为不喝糖饮料的2倍(OR=2.045,95%CI:1.081～3.869)。而每天饮茶(OR=0.800,95%CI:0.323～1.984)或饮水(OR=0.886,95%CI:0.733～1.070)对高尿酸血症的发生风险无显著影响。结论 糖饮料摄入增加可增高血尿酸水平,是高尿酸血症的危险因素之一,饮水可降低血尿酸水平,饮茶对血尿酸水平或高尿酸血症无显著影响。