Alcohol drinking patterns differentially affect central adiposity as measured by abdominal height in women and men

Alcohol drinking in light-to-moderate amounts has been associated with reduced coronary heart disease (CHD) risk. However, there is evidence that the way people consume alcohol (drinking pattern) may affect risk. Central adiposity, a known CHD risk factor may be one mechanism in the pathway between alcohol consumption and CHD risk. Our study examined whether various drinking patterns differentially affect fat distribution, particularly abdominal fat in women and men. In a randomly selected population-based cohort (n = 2343), 35-79 y old, we assessed drinking pattern as reported for the past 30 d, including beverage type and amount, frequency of consumption, percentage of time drinking while eating and number of drinks consumed/drinking day. Central adiposity was determined using an abdominal caliper to measure supine height of the abdomen. Current drinkers tended to have smaller abdominal heights than nondrinkers (women, P < 0.0001; men, P = 0.0559). For drinking pattern, frequency was inversely associated, but drinking intensity (drinks/drinking day) was positively associated with central adiposity in women (P trend for frequency, 0.0007; intensity, 0.0010) and men (P trend for frequency, 0.0005; intensity, 0.0004), even when age, education, physical activity, smoking status and amount of alcohol (g) were included in the models. When frequency and intensity were considered together, daily drinkers of <1 drink/drinking day had the smallest mean abdominal height measures with the largest measures in less than weekly drinkers who consumed 4 or more drinks/drinking day. These results support the hypothesis that drinking pattern affects the distribution of body fat, an important CHD risk factor.     

Associations of Alcoholic Beverage Consumption with Dietary Intake,Waist Circumference,and Body Mass Index in US Adults: National Health and Nutrition Examination Survey 2003-2012

Background

Findings from studies of alcohol and obesity measures (eg, waist circumference [WC] and body mass index [BMI; calculated as kg/m²]) are conflicting. Residual confounding by dietary intake, inconsistent definitions of alcohol consumption across studies, and the inclusion of former drinkers in the nondrinking comparison group can contribute to the mixed literature.

The association between stress and drinking: modifying effects of gender and vulnerability

AIMS: To assess the relationship between number and type of past-year stressful experiences and alcohol consumption, with a focus on how gender, poverty, and psychological vulnerability moderate this association. METHODS: Data from 26 946 US past-year drinkers 18 years of age and over, interviewed in the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), were used to construct multivariate linear regression models predicting six measures of drinking pattern and volume. RESULTS: There was a consistent positive relationship between number of past-year stressors experienced and all measures of heavy drinking. Frequency of heavy (5+ drinks for men; 4+ drinks for women) drinking increased by 24% with each additional stressor reported by men and by 13% with each additional stressor reported by women. In contrast, the frequency of moderate drinking (<5 drinks for men; <4 drinks for women) decreased as stress levels increased. Job-related and legal sources of stress were more strongly associated with alcohol consumption than were social and health-related stress. Men showed a stronger association than women between the number of stressors and the most consumption measures; they also responded more strongly to the presence of any legal and job-related stress. Having an income below the poverty level intensified the effects of job-related stress, but having a mood or anxiety disorder did not affect any of the associations between stress and consumption. CONCLUSIONS: Stress does not so much lead individuals to drink more often as to substitute larger quantities of alcohol on the days when they do drink. Treatment and brief interventions aimed at problem drinkers might benefit from addressing the issue of tension alleviation and the development of alternative coping mechanisms.     

Management of heavy drinkers.

1. The amount of alcohol consumed per capita in the UK has approximately doubled since 1950. 2. One unit of alcohol is equivalent to around 8 g of pure alcohol (half a pint of beer, a single bar measure of spirits or glass of wine). 3. Consumption of above 21 units a week for men and 14 units a week for women carries an increasing risk of alcohol-related damage. Pregnant women are usually advised to abstain. 4. Newly registered patients should be asked if they have consumed any alcohol in the last three months and if so how much they consume in an average week using a quantity frequency scale. 5. In those in whom there is concern about their drinking a systematic 7-day history gives the best estimate of consumption. 6. Heavy drinking should also be considered in a wide range of clinical circumstances, including hypertension, injuries and accidents, marital disharmony and child abuse, dyspepsia, hepatic damage, memory impairment and dementia. Sudden withdrawal may cause fits which may lead to a mistaken diagnosis of epilepsy. 7. Laboratory tests pick up only 30-50% of heavy drinkers but may be useful in monitoring progress and in motivating patients to cut down. 8. It is important to decide whether a patient is dependent on alcohol as dependent drinkers are unlikely to be able to keep their consumption at modest levels. The possibility of psychological and social problems due to alcohol should also be considered. The use of drugs should be explored in dependent drinkers.(ABSTRACT TRUNCATED AT 250 WORDS)     

Racial and ethnic differences in all-cause mortality risk according to alcohol consumption patterns in the national alcohol surveys

Previous studies have found J-shaped relations between volume of alcohol consumed and mortality risk in white Americans but not in African Americans, suggesting the need for studies in which race/ethnicity-defined subgroups are analyzed in separate comparable models. In the present study, the authors utilized mortality follow-up data (through 2006) on respondents from the 1984 and 1995 National Alcohol Surveys, including similar numbers of black, white, and Hispanic respondents by oversampling the minority groups. Cox proportional hazards models controlling for demographic, socioeconomic, mental health, and drug- and tobacco-use measures were used to estimate mortality risk from all causes. Findings indicated a protective effect of moderate alcohol drinking (2-30 drinks/month for women and 2-60 drinks/month for men) with no monthly ≥5-drink days) relative to lifetime abstention for whites only. Elevated mortality risk relative to moderate drinking was found in former drinkers with lifetime alcohol problems. Moderate drinkers who consumed ≥5 drinks in 1 day at least monthly were also found to have increased risk, suggesting the importance of identifying heavy-occasion drinking for mortality analyses. These differential results regarding lifetime abstainers may suggest bias from differential unmeasured confounding or unmeasured aspects of alcohol consumption pattern or may be due to genetic differences in the health impact of alcohol metabolism.     

Harmful alcohol use in Goa, India, and its associations with violence: a study in primary care

AIMS: To determine (i) the prevalence and characteristics of harmful alcohol consumption in general practice attendees; (ii) social and psychological associations with harmful drinking and (iii) recognition of harmful drinking by GPs. METHODS: A cross-sectional study of ten general practices in Goa, India. A total of 1567 general practice attendees were recruited. RESULTS: A total of 338 men (41%) and 597 women (81%) reported that they never consumed alcohol. One hundred and twenty-eight people or 8.2% scored >or=8 on the AUDIT [123 (15%) men and five (0.7%) women] and were classified as harmful or dependent drinkers. The population attributable fraction of harmful drinking in the perpetration of any physical violence by men over 12 months was 0.36. The population attributable fraction of moderate drinking (vs abstention) in the perpetration of any physical violence by women over 12 months was 0.27. Doctors identified almost 60% of problem drinkers but misidentified approximately 5% of moderate drinkers as problem drinkers. CONCLUSIONS: The male pattern of drinking in Goa is one of the high rates of abstention coupled with relatively high rates of harmful and dependent drinking in those who consume alcohol. Most women are abstainers. These data provide the first evidence in India on (i) the role of the GP in identification of harmful alcohol use and (ii) the contribution of harmful drinking to the perpetration of physical violence from the perspective of the alcohol user.     

High-risk alcohol consumption and late-life alcohol use problems

OBJECTIVES: We used several different guidelines for appropriate alcohol use to identify patterns of high-risk alcohol consumption among older women and men and examined associations between these patterns and late-life alcohol use problems. METHODS: A sample of 1291 older adults participated in a survey of alcohol consumption and alcohol use problems and was studied again 10 years later. RESULTS: Depending on the guideline, 23% to 50% of women and 29% to 45% of men engaged in potentially unsafe alcohol use patterns. The likelihood of risky alcohol use declined over the 10 years; however, the numbers of drinks consumed per week and per day were associated with alcohol use problems at both assessment intervals. CONCLUSION: Our findings imply that guidelines for alcohol consumption should be no more liberal for older men than for older women.     

Pattern of alcohol use associated with self-identified problem drinking.

To estimate the pattern and level of alcohol consumption leading to problem drinking, the drinking histories of 70 early stage problem drinkers were examined. An average consumption of four drinks (54 g/ethanol), on an average of three days/week, was the pattern that best separated the phase when patients were problem free from the phase when their drinking led to problems.     

Alcohol consumption and serum hormone levels during pregnancy.

Factors that change sex hormone levels during pregnancy may have long-term health consequences for the offspring, including changes in breast cancer risk. A cross-sectional analysis of alcohol consumption and hormone levels in 339 pregnant women sampled from the Child Health and Development Study cohort was undertaken. Alcohol intake was queried from 1959 to 1966, long before any hazards of drinking during pregnancy were publicized. Third trimester serum hormone levels including estradiol and testosterone were analyzed. Among 339 pregnant women, 196 reported some alcohol consumption during pregnancy. The drinkers were divided into three groups with intake levels of 0.2-0.5, 0.6-2.0, and 2.1-12.5 ounces of ethanol per week. The second group corresponds to a median intake of approximately 2 drinks per week, and the last group corresponds to a median intake of approximately 1 drink per day, which is considered "light" to "moderate" drinking. Maternal estradiol levels were not associated with alcohol intake during pregnancy. However, serum testosterone was significantly lower, by 12.2%, in the latter two groups of drinking pregnant women, [confidence interval (CI)=-3.0 to 25.2] and 25.6% (CI=9.2-39.5), respectively. The alcohol intakes reported are far below those shown to cause fetal alcohol syndrome, or any of the fetal alcohol effects so far studied. Light alcohol intake during pregnancy is associated with lower maternal testosterone. The health implications are uncertain, but may include an increased breast density in the daughters of drinking mothers.     

Validation of a single screening question for problem drinking

OBJECTIVE: The researchers hoped to confirm the sensitivity and specificity of a single screening question for problem drinking: "When was the last time you had more than X drinks in 1 day?", where X=4 for women and X=5 for men. STUDY DESIGN: Cross-sectional study. POPULATION: Adult patients presenting to 3 emergency departments in Boone County, Missouri, for care within 48 hours of an injury. OUTCOMES MEASURED: The answers to the question were coded as never, more than 12 months ago, 3 to 12 months ago, and within the past 3 months. Problematic drinking was defined as either hazardous drinking (identified by a 29-day retrospective interview) or a past-year alcohol use disorder (defined by questions from the Diagnostic Interview Schedule). RESULTS: There was a 70% participation rate. Of 2517 interviewed patients: 29% were hazardous drinkers; 20% had a past-year alcohol use disorder; and 35% had either or both. Considering "within the last 3 months" as positive, the sensitivity of the single question was 86%, and the specificity was 86%. In men (n=1432), sensitivity and specificity were 88% and 81%; in women, 83% and 91%. Using the 4 answer options for the question, the area under the receiver-operating characteristic curve was 0.90. Controlling for age, sex, tobacco use, injury severity, and breath alcohol level in logistic regression models changed the findings minimally. CONCLUSIONS: A single question about the last episode of heavy drinking has clinically useful sensitivity and specificity in detecting hazardous drinking and alcohol use disorders.     

Moderate Consumption of Beer and Its Effects on Cardiovascular and Metabolic Health: An Updated Review of Recent Scientific Evidence

There is growing interest in the potential health-related effects of moderate alcohol consumption and, specifically, of beer. This review provides an assessment of beer-associated effects on cardiovascular and metabolic risk factors to identify a consumption level that can be considered “moderate”. We identified all prospective clinical studies and systematic reviews that evaluated the health effects of beer published between January 2007 and April 2020. Five of six selected studies found a protective effect of moderate alcohol drinking on cardiovascular disease (beer up to 385 g/week) vs. abstainers or occasional drinkers. Four out of five papers showed an association between moderate alcohol consumption (beer intake of 84 g alcohol/week) and decreased mortality risk. We concluded that moderate beer consumption of up to 16 g alcohol/day (1 drink/day) for women and 28 g/day (1–2 drinks/day) for men is associated with decreased incidence of cardiovascular disease and overall mortality, among other metabolic health benefits.     

Community norms of alcohol usage and blood pressure: Tecumseh, Michigan.

This research examines the relationship between alcohol usage and blood pressure in the adult population of a small community in Michigan. Findings suggest that blood pressure varies with alcohol usage linearly for men with a slight dip at 1-2 drinks per week, and curvilinearly for women with a low point at about 4 drinks per week. A method to measure public norms of alcohol intake and categories of drinking habits is presented. This technique may be useful in constructing drinking categories applicable in a community for both education and therapy.     

Alcohol use in pregnancy, craniofacial features, and fetal growth.

STUDY OBJECTIVE--The aim was to study the relationship between the level of alcohol consumption in pregnancy and craniofacial characteristics of the neonate. DESIGN--This was a prospective survey of a sample of pregnant women, stratified on prepregnancy level of alcohol consumption. SETTING--The study was carried out at the public antenatal clinic of Roubaix maternity hospital. PARTICIPANTS--During an eight month period, 684 women (89% of those eligible) were interviewed in a standardised way at their first antenatal clinic visit. Of these, all who were suspected of being alcoholic or heavy drinkers (at least 21 drinks per week) were selected for follow up, as was a subsample of light (0-6 drinks per week) and moderate (7-20 drinks per week) drinkers. Of 347 women selected in this way, 202 had their infants assessed by a standardised morphological examination. MEASUREMENTS AND AND MAIN RESULTS--Suggestive craniofacial characteristics of the infants, present either in isolation or in association with growth retardation ("fetal alcohol effects"), were compared in relation to maternal alcohol consumption (alcoholic 12%; heavy drinking 24%; moderate drinking 28%; light drinking 36%). No differences were found between light and moderate drinkers. Infants born to alcoholics had a greater number of craniofacial characteristics and the proportion with features compatible with fetal alcohol effects was higher. There was a similar trend for infants of heavy drinkers. Infants of heavy drinkers who had decreased their alcohol consumption during pregnancy had fewer craniofacial features. Infants of heavy smokers were also found to have increased numbers of craniofacial characteristics. CONCLUSIONS--Craniofacial morphology could be a sensitive indicator of alcohol exposure in utero. Altered morphology is usually considered specific for alcohol exposure, but the relation observed with smoking needs further exploration.     

Brief alcohol intervention as pragmatic intervention: Who is voluntarily taking an offered intervention?

Brief alcohol interventions (BAI) have shown the potential to decrease problematic alcohol use among adolescents and young adults. Most of the BAI studies have been efficacy trials designed to achieve high internal validity but have raised questions regarding the feasibility of large-scale implementation. Providing interventions for those voluntarily wanting them might offer an alternative, and studies using this design would be more similar to effectiveness studies. The present research compares randomly selected 20-year-old men who took part in a scientific trial (efficacy) with those who voluntarily sought an intervention (effectiveness). Sampling took place during army recruitment procedures that are mandatory for all males in Switzerland. At-risk drinking (20+ drinks per week, or more than one risky drinking occasion of 6+ drinks per month) was determined a posteriori; there was no screening. There were a higher percentage of at-risk drinkers in the volunteer arm at baseline, but at-risk drinkers did not differ from those in the trial arm on any of the assessed alcohol measures. This suggests that offering BAI on a large-scale, voluntary basis may reach at-risk drinkers as effectively as do more scientifically oriented trials, without needing to adhere to screening and stringent research procedures. Nevertheless, BAI was more effective for at-risk drinkers who were invited for trial participation versus those who volunteered. This could be due to behavior that is already consolidated and is difficult to change. Lacking further modifications, real-world implementations of BAI for young men may be less effective than randomized controlled trials designed to test the efficacy of BAI.     

Socio-demographic status and alcohol drinking patterns among Greek healthy adults

AIM: To analyze socio-demographic correlates of alcohol drinking among Greek healthy adults. METHODS: Data related to alcohol consumption patterns of 5500 adult individuals, coming from 26 Hellenic provinces were abstracted from SESy-Europe database within a framework of the nationwide Hellenic anticancer-trial PACMeR 02 study. Statistic: chi2 test and logistic regression analyses were used. RESULTS: 42.5% of males and 82.5% of females did not consume alcoholic drinks. Among users, daily alcohol assumption was 28.50 g/day for men and 9.85 g/day for women. The mainland population presented higher proportions for both abstainers and moderate-heavy drinkers. Consumption rate was higher for sub-populations living in islands, but they were mostly light drinkers rather than heavy consumers. Among males, younger subjects, farmers and craftsmen had a higher tendency for alcohol abuse. Among females, the proportion of consumers and abusers was notably more elevated among younger individuals, especially among those living in urban areas of mainland, with higher educational level, employees and freelance professionals. A particular attention to the newly and rapidly growing patterns of alcoholism among young females should be given and prevention programs should be promptly developed.     

Alcohol consumption and blood pressure

The relationship between alcohol consumption and systolic and diastolic blood pressure was examined in a representative population sample of 1,429 men and women aged 35-64 years in Auckland, New Zealand during 1982. Univariate plots demonstrated a U-shaped relationship between alcohol consumption and systolic and diastolic blood pressures in men and in women aged 50 years and older, with light and moderate drinkers (less than 0-34 g alcohol/day) having lower blood pressure levels than either nondrinkers or heavy drinkers. No clear relationship was seen in younger women. The U-shaped relationship in men, particularly for systolic blood pressure, remained after controlling for potential confounders, whereas in women aged 50 years and older, there appeared to be a threshold level of approximately four drinks per day, below which drinkers had similar blood pressure levels to nondrinkers. In the multivariate analyses, it was calculated that among men, light and moderate drinkers had systolic levels 4.8 mmHg lower and diastolic levels 1.7 mmHg lower than nondrinkers and heavy drinkers, while among women aged 50-64 years, nondrinkers, light drinkers, or moderate drinkers had systolic levels 10.2 mmHg lower and diastolic levels 4.5 mmHg lower than heavy drinkers. These findings suggest that in men and in women aged 50 years and older, there is a nonlinear relationship between blood pressure and alcohol consumption, and that there is a level of alcohol consumption, of approximately four drinks per day, below which drinkers have either similar or lower blood pressure levels compared to nondrinkers.     

Patterns of alcohol drinking and all-cause mortality: results from a large-scale population-based cohort study in Japan

To evaluate the hypothesis that, in terms of all-cause death, drinking alcohol 1-4 days per week is less harmful than daily (5-7 days/week) drinking of the same quantity of alcohol, a prospective cohort study using a self-administered questionnaire was conducted in Japan between 1990 and 2003 of 88,746 subjects (41,702 men and 47,044 women) aged 40-69 years at baseline. Among male regular drinkers consuming alcohol more than 1 day per week, light drinkers (<300 g/week) showed no increase in all-cause mortality irrespective of frequency of alcohol intake. Heavy drinkers (> or = 300 g/week), however, showed an increased risk of all-cause mortality among those who consumed alcohol 5-7 days per week, while no obvious increase was observed among those who consumed alcohol less than 4 days per week. Hazard ratios for drinkers who consumed alcohol 5-7 days per week were 1.29 (95% confidence interval: 1.12, 1.50) for 300-449 g per week and 1.55 (95% confidence interval: 1.32, 1.81) for > or = 450 g per week when compared with those for occasional drinkers who consumed alcohol 1-3 days per month. These findings support the Japanese social belief that "liver holidays," abstaining from alcohol for more than 2 days per week, are important for heavy drinkers.     

Changes in alcohol intake and mortality: a longitudinal population-based study

BACKGROUND: Using alcohol intake at one point in time, numerous studies have shown a J- or U-shaped relation with all-cause mortality. Mortality is lowest among the light to moderate drinkers, with the risk of dying from coronary heart disease higher among nondrinkers and the risk of dying from cancer higher among heavy drinkers. We studied whether changes in individual alcohol intake result in corresponding changes in mortality. METHODS: In a longitudinal study of 6644 men and 8010 women, age 25 to 98 years, who had attended at least 2 health surveys with a 5-year interval between them, we addressed the risk of death after combinations of changes in alcohol intake. RESULTS: Mortality after changes in alcohol intake was consistent with the mortality observed among those who reported stable drinking. Stable drinkers showed a U-shaped all-cause mortality, with relative risks of 1.29 (95% confidence interval [CI] = 1.13-1.48) for nondrinkers (< 1 drink per week) and 1.32 (1.15-1.53) for heavy drinkers (> 13 drinks per week) compared with light drinkers (1 to 6 drinks per week). For coronary heart disease mortality, stable nondrinkers had a relative risk of 1.32 (0.97-1.79) compared with stable light drinkers and those who had reduced their drinking from light to none increased their risk (1.40; 1.00-1.95), and those who had increased from nondrinking to light drinking reduced their relative risk ratio (0.71; 0.44-1.14). Cancer mortality was increased in all groups of heavy drinkers. CONCLUSION: Persons with stable patterns of light and moderate alcohol intake had the lowest all-cause mortality. Individual changes in alcohol intake were followed by corresponding changes in mortality.     

Alcohol and survival in the Italian rural cohorts of the Seven Countries Study

BACKGROUND: Middle-aged men who regularly drink a moderate amount of alcohol have lower mortality rates from all causes in comparison with abstainers and heavy drinkers. This cohort study looks at the relationship between alcohol consumption and long-term survival, adjusting for smoking habit and physical activity. METHODS: In 1965, a total of 1536 Italian males aged 45-65 years underwent an examination which included: a general questionnaire, anthropometric measurements, an overall physical examination, ECG recording, blood pressure and serum cholesterol measurements and measurement of food consumption including alcohol. The cohort was followed for total mortality from 1965 to 1995. RESULTS: During a period of 30 years 1096 deaths occurred. Age-adjusted life expectancy for men assuming a mean daily quantity of 63 g of alcohol (range 4-7 drinks per day) was 21.6 +/- 0.4 years, roughly 2 years more than men taking a mean quantity of 3.7 g (10 drinks per day. Taking smoking habit into account, the longest survival of 22.4 +/- 0.5 years was observed in non-smokers drinking 4-7 drinks daily; the lowest, 18.5 +/- 0.7 years, in smokers drinking >10 drinks. Stratifying for physical activity, the longest survival (23.4 +/- 0. 7 years) was experienced by men engaged in heavy physical activity at work drinking 1-4 drinks per day. CONCLUSIONS: The relationship between life expectancy and alcohol consumption (97% wine in this Italian cohort and mostly red wine) is confirmed to be non-linear. Men aged 45-64 at entry drinking about 5 drinks per day have a longer life expectancy than occasional and heavy drinkers.     

Type of alcohol and drinking pattern in 56, 970 Danish men and women

OBJECTIVE: To describe drinking patterns among individuals who prefer drinking wine, beer or spirits. DESIGN: Cross-sectional study obtaining detailed information on intake of wine, beer and spirits and on frequency of alcohol intake. Adjustment for gender, age, smoking habits, educational attainment and body mass index. SETTING: Denmark. SUBJECTS: 27, 151 men and 29, 819 women, randomly selected from Copenhagen and Aarhus, Denmark. MAIN OUTCOME MEASURES: Drinking pattern-steady or binge drinking. RESULTS: A vast majority (71%) of both men and women preferred wine or beer. At all levels of total alcohol intake, beer drinkers were most likely to be frequent drinkers. Thus, light drinkers of beer had an odds ratio for being frequent drinkers of 1.97 (95% confidence limits 1.50-2.58) as compared to light drinkers of wine (total alcohol intake 3-30 drinks per month), while people who preferred beer had an odds ratio of 1. 29 (1.19-1.40) compared with wine drinkers in the moderate drinking category (31-134 drinks per month). There were no significant differences in total alcohol intake between individuals preferring different alcoholic beverages. CONCLUSION: If binge drinking is less healthy than steady drinking, the relation between wine intake and coronary heart disease mortality could be subject to negative confounding, since beer drinkers seem to have the most sensible drinking pattern. SPONSORSHIP: Danish Cancer Society and the Danish National Board of Health. European Journal of Clinical Nutrition (2000) 54, 174-176