Nutrition in the alcoholic.

Effective management of nutritional problems in the alcoholic patient requires that the clinician understand the complex interaction of alcohol and nutrition. Nutritional deficiencies should be prevented and, if present, corrected. However, experimental, clinical, and epidemiological evidence indicates that despite adequate diets, ethanol has direct toxic effects on the digestion, absorption and activation of foodstuff. Furthermore, recent studies have shown that even in well nourished populations relatively small amounts of alcohol may have cirrhogenic potential. For these reasons, the overall approach to the management of the alcoholic must involve the control of alcohol intake as well as the prevention and correction of nutritional disturbances.     

Baclofen: a new drug for the treatment of alcohol dependence

Recent preclinical and clinical studies have suggested that baclofen, the prototypic gamma-aminobutyric acid B (GABA(B)) receptor agonist, is a promising pharmacological compound for use in the treatment of alcohol dependence. In particular, baclofen has been found to suppress symptoms of alcohol withdrawal syndrome with an efficacy comparable with that of the 'gold standard' diazepam. Moreover, baclofen has proven effective in the prevention of relapse due to its ability to reduce alcohol intake and craving in alcoholic patients. Baclofen proved to be manageable, producing no significant side effects and displaying no addictive properties. The efficacy of the drug in the management of both alcohol withdrawal syndrome and relapse prevention should entail a vastly simplified pharmacotherapy of alcohol dependence.     

Separating the effects of alcohol and expectancy on brain activation: an fMRI working memory study

The aim of this study was to use BOLD fMRI to evaluate the effect of alcohol intoxication on neuronal activation, when controlling for expectancy. Behavioural studies have shown that both alcohol intoxication and expectancy affect cognition, mood and behaviour. However, previous neuroimaging studies have not separated the effects of alcohol intoxication from the possible confounding effects of expectancy. Forty-five healthy male participants participated in the study. A balanced placebo design with four groups was used together with a working memory paradigm. Half of the participants consumed a soft-drink before the MR scanning session (half of them were correctly informed about the content of their drink, and half were incorrectly informed that they consumed an alcoholic beverage), and the other half consumed an alcoholic beverage before the MR scanning session (half of them were correctly informed about the content of their drink, and half were incorrectly informed that they consumed a soft-drink). A blood alcohol concentration (BAC) of 0.08% was used as the alcohol intoxication level. The most conspicuous result was that alcohol intoxication decreased neuronal activation especially in the dorsal anterior cingulate cortex (dACC) and in prefrontal areas, while expectancy increased neuronal activation in the same areas. This study shows that alcohol intoxication and expectancy have opposite effects on neuronal activation. The present results could have implications for pharmacological imaging studies.     

ALDH2 in alcoholic heart diseases: molecular mechanism and clinical implications

Alcoholic cardiomyopathy is manifested as cardiac hypertrophy, disrupted contractile function and myofibrillary architecture. An ample amount of clinical and experimental evidence has depicted a pivotal role for alcohol metabolism especially the main alcohol metabolic product acetaldehyde, in the pathogenesis of this myopathic state. Findings from our group and others have revealed that the mitochondrial isoform of aldehyde dehydrogenase (ALDH2), which metabolizes acetaldehyde, governs the detoxification of acetaldehyde formed following alcohol consumption and the ultimate elimination of alcohol from the body. The ALDH2 enzymatic cascade may evolve as a unique detoxification mechanism for environmental alcohols and aldehydes to alleviate the undesired cardiac anomalies in ischemia-reperfusion and alcoholism. Polymorphic variants of the ALDH2 gene encode enzymes with altered pharmacokinetic properties and a significantly higher prevalence of cardiovascular diseases associated with alcoholism. The pathophysiological effects of ALDH2 polymorphism may be mediated by accumulation of acetaldehyde and other reactive aldehydes. Inheritance of the inactive ALDH2*2 gene product is associated with a decreased risk of alcoholism but an increased risk of alcoholic complications. This association is influenced by gene-environment interactions such as those associated with religion and national origin. The purpose of this review is to recapitulate the pathogenesis of alcoholic cardiomyopathy with a special focus on ALDH2 enzymatic metabolism. It will be important to dissect the links between ALDH2 polymorphism and prevalence of alcoholic cardiomyopathy, in order to determine the mechanisms underlying such associations. The therapeutic value of ALDH2 as both target and tool in the management of alcoholic tissue damage will be discussed.     

Effects of alcohol on the central nervous system: implications for the neuroscience nurse

Alcoholism is a chronic, progressive disease that devastates the patient and family. The chronic abuse of alcohol results in a multitude of pathological changes, particularly in the central nervous system. The toxic effects of acetaldehyde, a metabolic by-product of alcohol, and alcoholic beverage congeners have been associated with pathological changes in the central nervous system. Toxic effects of alcohol and addiction to alcohol reflect central nervous system changes. The alcohol withdrawal syndrome poses a potential life-threatening complication for the alcoholic patient. This paper discusses the pathological changes in the central nervous system, pharmacology of alcohol, and the alcohol withdrawal syndrome. Nursing implications to assist the neuroscience nurse in providing a highly specialized plan of care for the alcoholic patient are presented.     

Serum low density lipoprotein of alcoholic patients is chemically modified in vivo and induces apolipoprotein E synthesis by macrophages.

This work was carried out to investigate the effect of alcohol drinking on serum LDL. Agarose gel electrophoresis showed that LDL samples from alcoholic patients without serious liver disease were more negatively charged and moved faster toward the cathode than LDL from nondrinking control subjects. Rabbit antibodies raised by using keyhole limpet hemocyanin modified in vitro by 4-hydroxynonenal or by acetaldehyde as immunogens reacted more strongly with patients' LDL than with control LDL, indicating the presence of oxidatively modified epitopes and acetaldehyde adducts in alcoholic patients' LDL. LDL of alcoholic patients has decreased vitamin E contents. The electromobility of LDL decreased after abstinence from alcohol and returned to normal in 2 wk, but this was not accompanied by a significant increase in its vitamin E contents. When incubated with mouse peritoneal macrophages, patients' LDL induced apolipoprotein E secretion by threefold over control LDL with a concomitant increase in cellular cholesterol. Our results thus demonstrate that LDL of alcoholic patients has lower vitamin E content, is chemically modified in vivo, and exhibits altered biological function. These changes in heavy alcoholic drinkers may render LDL more atherogenic and thereby may counter the antiatherosclerosis effects of moderate alcohol consumption.     

急性酒精干预对长期嗜酒者左心功能的超声心动图观察

目的 通过超声心动图观察急性酒精摄入对长期哮酒者左心功能的影响，评价其早期诊断酒精性心肌病的价值。方法 嗜酒组42例，对照组18例，分别测定急性饮酒及及饮酒后1h、2h、3h每搏输出量将结果进行统计学处理。结果 饮酒前嗜酒组与对照组左室收缩功能无明显差异，但哮酒组急性酒精摄入前后EF、SV无变化，CO增大，其中21例EF、SV下降；对照组EF、SV、CO均增大。左室舒张功能E值无变化，A值明显升高，酒后1h、2h、3hE／A下降。结论 虽饮酒前与对照组相比，哮酒组左室收缩功能无明显变化，E／A＞1，但哮酒组急性酒精摄入后左室收缩、功能均有不同程度下降，急性酒精摄入实验可作为酒精性心肌病早期敏感指标之一。     

Drinking patterns and problems in China

Although problem drinking in China is known to be a less severe issue than in many other countries, the pattern of alcohol use has been changing during the past two decades. The most notable changes are an increase in the sale of alcoholic beverages, the increase in per capita alcohol consumption, and an increase in the incidence of alcoholic related problems (Hao 1995). Unlike in western industrialized countries, however, reliable data on alcohol production, marketing, and various alcohol-related problems are not readily available in China. There is no systematic recording of most of the necessary information. Research on various aspects of alcohol dependence, particularly with a public health perspective, has only begun in the last 20 years. But they remain the best sources for the time being and do convey various trends and patterns as well as indicate the current magnitude of the problems.     

Where do adolescent recent drinkers obtain and use alcohol?

Background: Alcohol use among adolescents is a serious health issue in the United States. The purpose of the study is to determine factors associated with the locations and sources of last alcoholic beverages drank by adolescent recent drinkers. Method: A secondary data analysis of the NSDUH 2012 was performed including a sample of 2,321 recent alcohol users of 12–17 years of age nationwide. Results: Findings indicate someone else’s home was the top location for recent drinkers’ last alcoholic beverage. Regarding source, recent users report obtaining their last alcoholic beverage from someone not related to them who was older than 21 years. Several differences in location and source were found based on study variables. Discussion: Several variables were found to be associated with source and location of alcohol among adolescents. Expanding existing educational and social hosting programs to adults may be an important method of reducing adolescent access to alcohol.     

Alcohol-induced oxidative stress and reduction in oxidation by ascorbate/l-cys/ l-met in the testis, ovary, kidney, and lung of rat

Chronic exposure to high doses of alcohol results in many pathophysiologic changes in cellular function caused by the alcohol itself and the effects of its metabolism (ie, generation of acetaldehyde, nicotinamide adenine dinucleotide [NADH], free radicals, and oxidative stress). However, the role of each of these effects on the testis, ovary, kidney, and lung in chronic alcoholism must be investigated. It is hypothesized that cysteine-methionine and vitamin C might neutralize harmful compounds and potentiate the antioxidant capacity of the cell or tissue. In this study, rats were fed regular diets and were maintained in the following groups for 90 days: control group; alcoholic group (2.5 g of 50% ethanol/kg body wt administered intragastrically every other day); and alcoholic with antioxidant supplement group (2.5 g of 50% ethanol plus a solution containing 200 mg vitamin C, 100 mg cysteine, and 100 mg methionine/kg body wt administered intragastrically every other day). After treatment had been completed, rat blood, testis, ovary, kidney, and lung were taken for biochemical analysis. Mean alcohol level in the alcoholic group was raised (by 40%) compared with that in the control group, but it was lower (by 30%) in the antioxidantsupplemented group than in the alcoholic group. In accordance with the levels of alcohol, oxidized protein and lipid content in the testis, ovary, kidney, and lung were low in the control group, higher in the antioxidant-supplemented group, and highest in the alcoholic group. It is interesting to note that levels of glutathione in the testis and lung of the alcoholic group were lower than those in both the control and antioxidant-supplemented groups. In conclusion, chronic alcohol administration led to a significant increase in the level of protein oxidation in the ovary and kidney of rats. Simultaneous intake of ascorbate/l-cys/l-met, along with ethanol, partly attenuated the amount of lipid and protein oxidation that occurred in tissues with oxidative stress caused by alcohol consumption.     

Alcohol and migraine: trigger factor, consumption, mechanisms. A review

This study investigates the importance of alcohol as a migraine trigger factor, the prevalence of alcohol consumers and the mechanism of headache provocation. A MEDLINE search from 1988 to October 2007 was performed for “headache and alcohol”, “headache and wine”, “migraine and alcohol” and “migraine and wine”. In retrospective studies, about one-third of the migraine patients reported alcohol as a migraine trigger, at least occasionally, but only 10% of the migraine patients reported alcohol as a migraine trigger frequently. Regional differences were reported, perhaps depending in part on alcohol habits. No differences were found between migraine and tension headache and different genders. However, prospective studies limit considerably the importance of alcohol as a trigger. Recent studies show that migraine patients consume less alcohol than controls. Red wine was reported to be the principal trigger of migraine, but other studies show that white wine or other drinks are more involved. Then, the discussion based on the different composition of the various alcoholic beverages, in order to discover the content of alcoholic drinks responsible for migraine attack, reflects this uncertainty. Biogenic amines, sulphites, flavonoid phenols, 5-hydroxytryptamine mechanisms and vasodilating effects are discussed. The fact that few headache patients cannot tolerate some alcoholic drinks does not justify the consideration that alcohol is a major trigger and the suggestion of abstinence. In fact, low doses of alcohol can have a beneficial effect on patients such as migraineurs, who were reported to have an increased risk of cardiovascular disease.     

Effects of alcohol on recall of social interactions

This experiment used a balanced placebo design and investigated the effects of alcohol, expectancy, and sex of subject on normal drinkers' recall of social interactions. In a 2 ×2 ×2 factorial design, 48 males and 48 females were (a) administered an alcoholic (.7 g/kg) or a nonalcoholic beverage, and (b) instructed that they had received an alcoholic or a nonalcoholic beverage. Subjects then heard four audiotaped dyadic interactions, and their recall for factual aspects of each interaction was assessed. A significant Beverage ×Instruction interaction showed that alcohol consumption impaired subjects' recall under the told nonalcohol instructional condition, and that the best recall scores were attained by subjects whose beverage and instruction conditions were congruent. Females showed better recall than males. With qualifications, these data support the use of an information-processing approach to investigate cognitive functions relevant to the social behavioral effects of alcohol.     

The role of alcohol in asthma: a review of clinical and experimental studies

Asthma is among the most common ED diagnoses. Asthma exacerbations are generally treated by medications that cause bronchodilation and those that reduce airway inflammation. The effect of alcohol on asthma has been studied by investigators with mixed results. Some studies have reported that alcohol has a beneficial effect on asthma; others report worsening of symptoms. It has been suggested in some quarters that additives in alcoholic drinks cause bronchoconstriction and that pure ethanol has a salutary effect on asthma. If further research bears out this supposition, ethanol may play a limited therapeutic role in asthma that is refractory to other therapy. Emergency physicians should counsel asthmatic patients to avoid alcoholic beverages because they may cause an exacerbation of asthma.     

超声在评价牛磺酸保护酒精性脂肪肝中的应用

目的通过牛磺酸保护酒精性脂肪肝动物模型实验,对于超声和病理2种效果评价手段进行比较。方法采用白酒灌胃的方式建立大鼠酒精性脂肪肝模型,治疗组分别给予高低2种剂量的牛磺酸,对照组给予生理盐水,实验末进行肝脏超声检查、测量平均动脉压、血清甘油三酯(TG),并对大鼠肝脏进行冷冻切片量化分析。结果与酒精性脂肪肝模型组相比,高低2种浓度的(2%和5%)牛磺酸均可以显著降低酒精性脂肪肝大鼠血清甘油三酯含量(P0.05);高剂量组牛磺酸还能降低酒精性肝损伤大鼠血压(P0.05);肝脏超声量化积分结果表明,高低2种剂量牛磺酸均可显著降低酒精对肝脏的损伤(P0.05),且高低剂量组的保护效果无显著性差异(P0.05),这与冷冻切片量化分析结果相一致。结论牛磺酸能够降低酒精对肝脏的损伤,超声对于诊断和评价酒精性脂肪肝可能具有较高的临床价值。     

Collaborative investigation of adult children of alcoholics with anxiety

The literature reports an increased incidence of anxiety disorders in alcoholic families. Whether anxiety is a complication of alcoholism or a precursor to alcohol abuse is not understood. Studies suggest that there are psychological as well as genetic components in substance abuse and anxiety disorders. The purpose of this paper is to describe a collaborative effort designed to explore the complex interaction between the etiologic factors that lead to anxiety and substance abuse. This collaboration brings together the unique perspectives of both psychiatric medicine and psychiatric nursing.     

Alcohol consumption habits in a population of 40- to 59-year-old men and its prognostic value in relation to mortality

Alcohol consumption practice was studied by a method of interview in an unorganized male population aged 40 to 59 investigated by a program of multifactorial CHD prevention. The frequency of spreading of this habit and its intensity were determined. The frequency of alcohol consumption was decreased with age and was associated with the examinees' educational level. Persons consuming alcohol more frequently had raised arterial hypertension and smoked. These factors increased the risk of CHD development which was confirmed by a 5-year prospective study of mortality. Alcohol abusers were characterized by higher rates of general mortality, including that from cardiovascular diseases, traumas and accidents, in particular, alcoholic intoxication.     

Consuming non-alcoholic beer and other beverages during pregnancy and breastfeeding

Question An increasing number of my patients are asking about the safety of consuming non-alcoholic beer and other alcohol-free versions of alcoholic beverages during pregnancy and breastfeeding, as they believe that these drinks might be a “safer” alternative to regular alcoholic beverages. What are Motherisk’s recommendations regarding these products?Answer Such drinks might contain higher ethanol levels than what is indicated on their labels. As there is no known safe level of alcohol intake in pregnancy, abstinence from non-alcoholic beverages would eliminate any risk of fetal alcohol spectrum disorder. Although it is likely that moderate intake of non-alcoholic beverages would pose no harm to breastfed infants, briefly delaying breastfeeding after consumption of such drinks would ensure that the infant is not exposed to alcohol.     

γ-谷氨酰基转移酶与过量饮酒关系探讨

目的　通过观察GGT在过量饮酒患者中的活性分布,探讨GGT检测在对过量饮酒者酒精性疾病防治工作中的意义和价值。方法　过量饮酒者4 7例,采用罗氏公司生产的MODULAR全自动生化分析仪进行GGT测定。结果　4 7例过量饮酒者血清GGT含量明显高于对照组(P <0 .0 0 1) ,其中脂肪肝的患者GGT含量与非脂肪肝者有明显差异(P <0 .0 5 ) ,禁酒后血清GGT含量与禁酒前有明显差异(P <0 .0 0 1)。结论　对于过量饮酒者,血清GGT是敏感性很高的检测指标,GGT的监测有利于酒精性疾病的早期发现     

Typical sources and locations where recent youth drinkers obtain and consume alcohol based on intensity of use

Background: The purpose of the present study was to examine whether typical sources and locations where youth recent drinkers, defined as youth who drank alcohol in the past month, obtain and consume alcohol differed significantly based on intensity of use. Intensity of use was based on binge drinking, which was defined as drinking five or more alcoholic beverages in a row on the same occasion. Methods: Youth recent drinkers from 12 to 17 years of age (N?=?2321) who participated in the National Survey on Drug Use and Health were included. After running a series of logistic regression models, all statistically significant variables were retained and included in final multiple logistic regression analyses. Results: Predictors for sources of last alcoholic beverage drank based on intensity were race/ethnicity, age, number of days drank in the past 30 days and usual number of drinks per day in past 30 days. Predictors for locations where alcohol users drank their last alcoholic beverage based on intensity of use were race/ethnicity, number of days binge drank in the past 30 days, usual number of drinks per day in past 30 days and age first drank alcohol. Conclusion: Recommendations for future studies are included.