Socio‐economic status predicts drinking patterns but not alcohol‐related consequences independently

Aim To identify independent relationships between socio‐economic status and drinking patterns and related consequences and to identify socio‐economic groups at risk for heavier consumption. Design and setting Three comparable national telephone surveys were utilized: 1995, 2000 and 2004. The respondents were aged 18–65 years. Contextual information includes that a number of liberalized alcohol policy changes occurred over the time of the surveys. Results Educational qualification, income and occupation were associated independently with alcohol consumption. There were indications that the different dimensions of drinking (quantity and frequency) had different relationships with socio‐economic status (SES). For example, lower SES groups drank heavier quantities while higher SES groups drank more frequently. SES, however, did not play a major role predicting drinking consequences once drinking patterns were controlled for, although there were some exceptions. It was the lower‐to‐average SES groups that were at greater risk for drinking heavier quantities compared to other SES groups in the population (as they had sustained increases in the quantities they consumed over time where other SES groups did not). Conclusion Socio‐economic status was related independently to drinking patterns and there were indications that SES interacted differently with the different dimensions of drinking (quantity and frequency). For the most part, socio‐economic status was not related independently to the experience of alcohol‐related consequences once drinking patterns were accounted for. It was the lower‐to‐average SES groups that were at greater risk for drinking heavier quantities compared to other SES groups in the population.     

Seven-year changes in alcohol consumption and subsequent risk of cardiovascular disease in men

BACKGROUND: Few studies have examined whether changes in alcohol consumption influence future cardiovascular risk. OBJECTIVE: To examine whether 7-year changes in alcohol consumption are associated with the subsequent risk of cardiovascular disease (CVD). METHODS: We prospectively followed up 18,455 men aged 40 to 84 years from the Physicians' Health Study with no history of CVD or cancer. Alcohol consumption was reported on the baseline and the 7-year questionnaires; follow-up for this analysis began after the 7-year questionnaire (median follow-up, 5.8 years). There were 1091 CVD cases, including myocardial infarction, angina pectoris, revascularization, stroke, and CVD-related death. RESULTS: Among men initially consuming 1 drink per week or less (n=7360), those with moderate increases (>1 to <6 drinks per week) in alcohol consumption had a borderline significant (P=.05) 29% reduced risk of CVD compared with men with no changes (-1 to 1 drink per week). Among men initially consuming greater than 1 to 6 drinks per week (n=6612), those with moderate increases had a nonsignificant (P=.32) 15% decrease in CVD risk compared with men with no changes. Finally, among men initially consuming 1 drink per day or more (n=4483), those who increased intake had a 63% increased risk of CVD compared with men with no changes. CONCLUSIONS: These prospective data suggest that, among men with initially low alcohol consumption (相似文献   

‘Alcohol,less is better’ project: outcomes of an Italian community‐based prevention programme on reducing per‐capita alcohol consumption

Aims To evaluate differences in the individual alcohol consumption after a community‐based prevention programme. Design settings and participants ‘Alcohol, less is better’ is a controlled intervention trial. The intervention adopted a community approach, based on the active involvement of community leaders and institutional or volunteer organizations. Between 1999 and 2006, 2.5 years of activities aiming at informing and sensitizing the community on the harmful effects of alcohol on social life and health were carried out in 10 selected small Italian communities, involving a total of 123 235 individuals. Eight communities were chosen as control group. Measurements Changes in self‐reported individual alcohol consumption before and after the intervention were assessed on a random sample of intervention (n = 3382) and control (n = 2644) populations, using telephone and mailed surveys. Linear and log‐linear models for repeated measures were used to evaluate differences between intervention and control samples. Findings Overall, a significant reduction (P < 0.001) of individual self‐reported alcohol consumption was observed in the intervention sample (?1.1 drinks/week) relative to control sample (+0.3 drinks/week). The reduction was significantly greater in males than in females (P for heterogeneity = 0.016). In the young (15–24‐year‐olds) intervention and control samples showed opposite trends (?0.4 drinks/week and +1.7 drinks/week, respectively). Conclusions A coordinated community‐based intervention can reduce alcohol consumption in the general population.     

Anxiety and depression among abstainers and low-level alcohol consumers. The Nord-Trøndelag Health Study

Aims The aim of this study was to examine the levels of anxiety and depression among individuals consuming low levels of alcohol. Design Prospective and cross‐sectional population‐based study. Setting and participants This study employed data from the Nord‐Trøndelag Health Survey (HUNT‐2, n = 38 930). Measurements Alcohol consumption was measured by self‐report of usual alcohol consumption during a 2‐week period. Low‐level alcohol consumption was defined as self‐reported abstainers and non‐abstainers currently consuming no alcohol. Anxiety and depression were measured using the Hospital Anxiety and Depression Rating Scale. Potential explanatory variables included somatic illness and symptoms, health‐related behaviour, socio‐economic status and social activity. In a subsample (n = 20 337), we also looked at the impact of previous heavy drinking among abstainers ('sick‐quitting'). Findings A U‐shaped association between alcohol consumption and the risk of anxiety and depression was found. Abstention was related to increased odds for both case‐level anxiety [1.34, 95% confidence interval (CI) 1.19–1.52] and depression (1.52, 95% CI 1.30–1.77). This association was accounted for partly by adjustments for socio‐economic status, social network, somatic illness, age (depression only), gender (anxiety only) and ‘sick‐quitting’. We also identified significant differences between participants who label themselves as abstainers compared to those who report no usual alcohol consumption, but who do not label themselves as abstainers. Conclusions The risk of case‐level anxiety and depression is elevated in individuals with low alcohol consumption compared to those with moderate consumption. Individuals who label themselves as abstainers are at particularly increased risk. This increased risk cannot fully be explained by somatic illness, social activity or ‘sick‐quitting’.     

Alcohol consumption and subclinical atherosclerosis among South Asians: Findings from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study

BackgroundSouth Asians are the second fastest growing ethnic group in the United States, and they have a high risk for cardiovascular disease (CVD). Moderate alcohol consumption has been associated with lower CVD risk in some race/ethnic groups, but the association of alcohol consumption and atherosclerosis in South Asians has not been investigated.Methods and ResultsWe used data from 906 South Asian participants who participated in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) cohort (2010–2012). Alcohol consumption was ascertained via questionnaire, coronary artery calcium (CAC) was measured with computed tomography, and common carotid artery intima-media thickness (cIMT) was measured using B-mode ultrasonography. We used multivariable regression models to examine cross-sectional associations of alcohol consumption with the presence and amount of CAC and cIMT.Compared with never drinkers, participants consuming 4–7 drinks/week had a 63% decreased odds of any CAC after adjusting for potential confounders and mediators. Participants consuming 4–7 drinks/week had significantly lower odds of CAC score between 1 and 300 [OR (95% CI): 0.34 (0.16–0.72)]. A similar inverse association was seen for the odds of CAC>300 [OR (95% CI): 0.28 (0.07–0.97)]. Alcohol consumption of >7 drinks/week was associated with a 0.096 mm increase in common-cIMT.ConclusionThere was an inverse association between the amount of alcohol intake and CAC among South Asians while a positive association was found between alcohol consumption and common-cIMT. Long-term follow-up of the MASALA cohort will examine prospective associations of alcohol intake with the progression of subclinical atherosclerosis, incident CVD events, and mortality.     

Relationship of alcohol consumption to 7-year blood pressure change in Japanese men

OBJECTIVE: To determine the association of alcohol consumption with years-long blood pressure (BP) change, as well as baseline BP, adjusted for potential confounders. DESIGN: A prospective cohort study. SETTING: A metal-products factory in Toyama, Japan. PARTICIPANTS: A total of 3900 men aged 20-59 years. MAIN OUTCOME MEASURES: BP was measured annually for 7 years after the baseline examination. The generalized estimating equation method was used to analyze the relationship of alcohol consumption to baseline BP and average annual BP change, adjusting for age, yearly weight, work-related factors, and lifestyle factors, including the frequency of intake of 22 food groups. RESULTS: The baseline systolic BP after multivariate adjustment was 3.9 and 5.0 mmHg higher in drinkers consuming 200-299 and > or = 300 g alcohol/week, respectively, than in non-drinkers (P < 0.001). The annual increase in systolic BP was 0.44 mmHg greater in drinkers consuming > or = 300 g/week than in non-drinkers after adjustment for age and weight change (P < 0.001), where the increase over 7 years was estimated to be 3.08 mmHg greater. Even after being adjusted for the frequency of intake of 22 food groups, drinkers consuming > or = 300 g/week showed a 0.33 mmHg greater annual increase in systolic BP than non-drinkers (P = 0.022). Baseline diastolic BP was significantly associated with alcohol consumption, but annual BP change was not. CONCLUSIONS: An alcohol intake > or = 300 g/week was associated with significantly greater annual BP increase, and baseline BP was significantly higher in drinkers consuming > or = 200 g/week. It is necessary to limit alcohol intake to less than 200 g/week to prevent hypertension.     

Alcohol use and mortality in older men and women

Aims To compare the effect of alcohol intake on 10‐year mortality for men and women over the age of 65 years. Design, setting and participants Two prospective cohorts of community‐dwelling men aged 65–79 years at baseline in 1996 (n = 11 727) and women aged 70–75 years in 1996 (n = 12 432). Measurements Alcohol was assessed according to frequency of use (number of days alcohol was consumed per week) and quantity consumed per day. Cox proportional hazards models were compared for men and women for all‐cause and cause‐specific mortality. Findings Compared with older adults who did not consume alcohol every week, the risk of all‐cause mortality was reduced in men reporting up to four standard drinks per day and in women who consumed one or two drinks per day. One or two alcohol‐free days per week reduced this risk further in men, but not in women. Similar results were observed for deaths due to cardiovascular disease. Conclusions In people over the age of 65 years, alcohol intake of four standard drinks per day for men and two standard drinks per day for women was associated with lower mortality risk. For men, the risk was reduced further if accompanied with 1 or 2 alcohol‐free days per week.     

Sickness absence diagnoses among abstainers,low‐risk drinkers and at‐risk drinkers: consideration of the U‐shaped association between alcohol use and sickness absence in four cohort studies

Aims

To estimate differences in the strength and shape of associations between alcohol use and diagnosis‐specific sickness absence.

Design

A multi‐cohort study. Participants (n = 47 520) responded to a survey on alcohol use at two time‐points, and were linked to records of sickness absence. Diagnosis‐specific sickness absence was followed for 4–7 years from the latter survey.

Setting and participants

From Finland, we had population cohort survey data from 1998 and 2003 and employee cohort survey data from 2000–02 and 2004. From France and the United Kingdom, we had employee cohort survey data from 1993 and 1997, and 1985–88 and 1991–94, respectively.

Measurements

We used standard questionnaires to assess alcohol intake categorized into 0, 1–11 and > 11 units per week in women and 0, 1–34 and > 34 units per week in men. We identified groups with stable and changing alcohol use over time. We linked participants to records from sickness absence registers. Diagnoses of sickness absence were coded according to the International Classification of Diseases. Estimates were adjusted for sex, age, socio‐economic status, smoking and body mass index.

Findings

Women who reported drinking 1–11 units and men who reported drinking 1–34 units of alcohol per week in both surveys were the reference group. Compared with them, women and men who reported no alcohol use in either survey had a higher risk of sickness absence due to mental disorders [rate ratio = 1.51, 95% confidence interval (CI) = 1.22–1.88], musculoskeletal disorders (1.22, 95% CI = 1.06–1.41), diseases of the digestive system (1.35, 95% CI = 1.02–1.77) and diseases of the respiratory system (1.49, 95% CI = 1.29–1.72). Women who reported alcohol consumption of > 11 weekly units and men who reported alcohol consumption of > 34 units per week in both surveys were at increased risk of absence due to injury or poisoning (1.44, 95% CI = 1.13–1.83).

Conclusions

In Finland, France and the United Kingdom, people who report not drinking any alcohol on two occasions several years apart appear to have a higher prevalence of sickness absence from work with chronic somatic and mental illness diagnoses than those drinking below a risk threshold of 11 units per week for women and 34 units per week for men. Persistent at‐risk drinking in Finland, France and the United Kingdom appears to be related to increased absence due to injury or poisoning.     

Alcohol and mortality: is there a U-shaped relation in elderly people?

OBJECTIVE: to assess the relation between alcohol intake and mortality among seven cohorts of middle-aged and elderly Danes. DESIGN: Prospective population study with baseline assessment of alcohol- and tobacco consumption, educational level and body mass index, and a mean of 11.5 years follow-up of mortality. SUBJECTS: 16304 men and women aged 50 years or more. MAIN OUTCOME MEASURE: number and time of deaths from 1974 to 1995 as ascertained by the national central person register. RESULTS: the effect of alcohol intake on mortality did not differ between middle-aged (50-64 years, mean = 56.6 years) and elderly subjects (>64 years old, mean = 69.9 years). There was a U-shaped risk function in both age groups, which persisted also when adjusting for age, sex, smoking habits, level of education and body mass index. Abstaining women had a relative risk of 1.29 (95% confidence limits 1.17-1.42) as compared with light drinkers (1-6 (drinks per week), while the relative risk for abstaining men was 1.22 (95% confidence limits; 1.08 to 1.37) as compared with light drinkers. Heavy drinking women (>28 drinks per week) had a relative risk of 1.23 (95% confidence limits; 0.85 to 1.78) and heavy drinking men (more than 69 drinks per week) had a relative risk of 2.11 (95% confidence limits 1.66-2.69), both compared with light drinkers. CONCLUSION: among the middle-aged and elderly women and men, a light alcohol intake is associated with lower mortality than abstention or heavy drinking.     

Alcohol intake, type of beverage, and risk of breast cancer in pre- and postmenopausal women

BACKGROUND: Most studies of the relation between alcohol consumption and breast cancer have shown a modestly increased risk, although the results are still conflicting. METHODS: The aim of this prospective population-based cohort study was to assess the influence of alcohol intake and type of beverage (beer, wine, or spirits) on breast cancer risk in relation to menopausal status. Among 13,074 women aged 20 to 91 years, we examined the relationship between breast cancer risk, total alcohol intake, and type of alcohol in relation to menopausal status. The women were classified as premenopausal or as postmenopausal at younger than 70 years or 70 years or more. RESULTS: During follow-up, 76 premenopausal and 397 postmenopausal women developed breast cancer. Premenopausal women who had an intake of more than 27 drinks per week had a relative risk of breast cancer of 3.49 (95% confidence limits, 1.36-8.99) compared with light drinkers (p = 0.011), whereas there were no differences in risk in the lower-intake categories. The increased risk of breast cancer among premenopausal women was independent of the type of alcohol. Postmenopausal women older than 70 years of age who had an intake of more than six drinks per week of spirits had a relative risk of breast cancer of 2.43 (95% confidence limits, 1.41-4.20) compared with women who consumed less than one drink of spirits per week (p = 0.0014). CONCLUSIONS: Total alcohol intake of more than 27 drinks per week increases breast cancer risk in premenopausal women independently of the type of alcohol. Among postmenopausal women, an intake of spirits of more than six drinks per week increases breast cancer risk.     

Alcohol use and mortality from coronary heart disease: the role of high-density lipoprotein cholesterol. The Multiple Risk Factor Intervention Trial Research Group.

OBJECTIVE: To study the association between alcohol consumption and death from coronary heart disease and to determine the extent to which the association can be explained by the high-density lipoprotein (HDL) cholesterol level. DESIGN: A cohort study involving men enrolled in the Multiple Risk Factor Intervention Trial (MRFIT). SETTING: Community-based study. PARTICIPANTS: Men (n = 11,688) at high risk for developing coronary heart disease but without clinical evidence of it. More than 90% of the men were white, and the average age was 46 years. Five percent of the men abstained from alcohol during the trial, 81% consumed fewer than 21 alcoholic drinks per week, and 14% consumed more than 21 alcoholic drinks per week. MEASUREMENTS: Average alcohol intake over 7 years was calculated for MRFIT participants who were alive at the end of the trial and who had at least three follow-up records of alcohol consumption. Post-trial mortality during a 3.8-year period was assessed. RESULTS: The adjusted relative risk for death from coronary heart disease for each increase of 7 drinks per week was 0.89 (95% CI, 0.80 to 1.00), with an apparent dose-response relationship. The average HDL level was associated with the average alcohol intake in a least-squares regression model (beta = -0.0074; P less than 0.01). When the average HDL level was included in the proportional hazards model for mortality from coronary heart disease, the absolute value of the coefficient for average drinks per week declined 45%, yielding an adjusted relative risk for each additional 7 drinks per week of 0.94 (CI, 0.84 to 1.05). CONCLUSION: In middle-aged men who are light to moderate drinkers, the inverse association between alcohol consumption and death from coronary heart disease can be explained, in large part, by the HDL cholesterol level, which increases with alcohol consumption. However, alcohol consumption cannot be recommended because of the known adverse effects of excess alcohol use.     

Dietary Fiber Intake is Associated with Cognitive Function in Older Adults: Data from the National Health and Nutrition Examination Survey

BackgroundAging is a global health challenge that is associated with a decline in cognitive function. In the United States, most older adults (≥50 years) do not meet the recommended daily fiber intake, although preliminary evidence suggests that dietary fiber consumption could elicit clinical benefits on cognitive function. We investigated the associations between dietary fiber intake and cognitive function in older adults.MethodsWe analyzed data from the US National Health and Nutrition Examination Survey (NHANES) between 2011 and 2014, with a study cohort of 1070 older adults (≥60 years). Cognitive function was assessed using the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) Word Learning Test (WLT), Word Recall Test (WRT) and their Intrusion Word Count Tests (WLT-IC and WRT-IC), the Animal Fluency Test (AFT), and the Digit Symbol Substitution Test (DSST). Multiple linear regression and cubic spline analyses were employed to examine the association between dietary fiber intake and cognitive performance on a test-by-test basis, after covariates adjustment (ie, age, sex, race, socioeconomic status, educational level, medical history, body mass index, alcohol, and energy intake).ResultsParticipants had a mean age of 69.2 years and were primarily non-Hispanic white of middle-high socioeconomic status with a college degree at minimum. The mean dietary fiber intake was 17.3 g/d. The analysis showed that dietary fiber intake was positively associated with DSST (P = .031). No associations with CERAD WLT (P = .41), WRT (P = .68), WLT-IC (P = .07), and WRT-IC (P = .28), and AFT (P = .40) scores were observed. A plateau in DSST score was revealed at a dietary fiber intake of 34 g/d.ConclusionsHigher dietary fiber intake is associated with improved specific components of cognitive function in older adults aged 60 years and older. Public health interventions that target a recommended dietary fiber intake may provide a promising strategy to combat cognitive decline in high-risk groups of older adults.     

Alcohol intake and the risk of hyperuricaemia: A 6-year prospective study in Japanese men

Background and aimsSince there is little information derived from prospective studies on the amount of alcohol drinking required to induce hyperuricaemia, we attempted to address this issue in a Japanese population.Methods and resultsA total of 3310 Japanese men aged 20–54 years that were free of hyperuricaemia were classified according to their alcohol intake per week at baseline. Incident hyperuricaemia, defined as >7.0 mg/dl and/or taking medication for hyperuricaemia, was assessed through annual heath examinations for 6 years after the baseline examination. During follow-up, 529 incident cases of hyperuricaemia occurred. There was a positive, dose-response relationship between alcohol intake and the risk of incident hyperuricaemia. The hazard ratio (95% confidence interval) for hyperuricaemia in drinkers compared with non-drinkers was 1.10 (0.85–1.42) for <10.0 drinks/week, 1.40 (1.07–1.84) for 10.0–19.9 drinks/week, 1.64 (1.23–2.21) for 20.0–29.9 drinks/week and 1.98 (1.40–2.80) for ≥30.0 drinks/week (one drink contained 11.5 g of ethanol) after adjusting for age, baseline serum uric acid, body mass index, smoking habits, exercise habits, serum creatinine, blood pressure, serum cholesterol and blood glucose. The fraction of hyperuricaemia in the population attributable to alcohol intake was 21.6%. A clear dose-response pattern was observed for both beer and sake, when the consumption of these two beverages was analysed separately.ConclusionHabitual alcohol intake significantly contributed to the development of hyperuricaemia in Japanese men, regardless of type of alcoholic beverage consumed. Therefore, it is essential to reduce excessive alcohol intake to prevent and manage hyperuricaemia.     

The association of alcohol consumption and incident heart failure: the Cardiovascular Health Study.

OBJECTIVES: We investigated the association between alcohol consumption and incident congestive heart failure (CHF) both overall and after adjusting for incident myocardial infarction (MI). BACKGROUND: Moderate alcohol consumption has been associated with lower risk of CHF and MI. METHODS: The Cardiovascular Health study, a prospective cohort study of cardiovascular disease risk factors and outcomes, followed 5,888 subjects > or =65 years old for 7 to 10 years. Cox models were used to estimate the adjusted risk of CHF by reported alcohol consumption. RESULTS: There were 5,595 subjects at baseline at risk for incident CHF with alcohol data and 1,056 events during follow-up. Compared with abstainers, the adjusted risk of CHF was lower among subjects who reported consuming 1 to 6 drinks per week (hazard ratio [HR] 0.82, 95% confidence interval [CI] 0.67 to 1.00, p = 0.05) and 7 to 13 drinks per week (HR 0.66, 95% CI 0.47 to 0.91, p = 0.01). Time-dependent adjustment for incident MI altered only slightly the association between moderate alcohol consumption and CHF (for 1 to 6 drinks per week, HR 0.84, 95% CI 0.65 to 1.04; for 7 to 13 drinks per week, HR 0.69, 95% CI 0.49 to 0.99). Baseline former drinkers had a higher risk of CHF than abstainers (HR 1.51, p < 0.01), but those who quit during the study did not have a higher risk (HR 0.83, 95% CI 0.66 to 1.03). CONCLUSIONS: Moderate alcohol use is associated with a lower risk of incident CHF among older adults, even after accounting for incident MI and other factors.     

Late-life alcohol consumption and cognitive function in elderly men

Moderate alcohol consumption (one to two drinks per day) has been associated with better cognitive function and lower risk of developing dementia in the elderly. In light of alcohol’s well-known neurotoxic properties, more evidence from well-controlled population-based studies is required. The objective of this study was to examine whether self-reported alcohol intake at age 70 is linked to cognitive function (assessed by trail making tests (TMTs) A and B, which are measures of attention, mental speed, and flexibility) in a population-based cohort consisting of 652 cognitively healthy elderly men. Linear regression models were used to assess both cross-sectional (i.e., age 70) and prospective (i.e., age 77) associations between alcohol intake and cognitive function. The analyses were adjusted for education, body mass index, energy intake, self-reported physical activity, smoking, a history of hypertension or diabetes, apolipoprotein E ε4 status, and cholesterol levels at the age of 70. Baseline data were obtained from 1990 to 1996. Self-reported alcohol intake (mean 6.9 ± 7.1 g/day) was associated with better performance on TMT-B at ages 70 and 77 (β = −0.87, p < 0.001). In contrast, alcohol intake was not predictive of the difference in performance on these tests between ages 70 and 77. Despite cross-sectional associations with performance in a test of executive functioning, moderate intake of alcohol was not linked to differences in cognitive performance between ages 70 and 77 in the present study. Thus, our findings do not support the view that daily moderate alcohol consumption is a recommendable strategy to slow cognitive aging in elderly populations.     

Alcohol consumption in patients with primary sclerosing cholangitis

AIM: To assess the alcohol drinking patterns in a cohort of primary sclerosing cholangitis (PSC) patients and the possible influence on the development of fibrosis.METHODS: Ninety-six patients with PSC were evaluated with a validated questionnaire about a patient’s lifetime drinking habits: the lifetime drinking history (LDH) questionnaire. In addition, clinical status, transient elastography and biochemistry values were analysed and registered. Patients were defined as having either significant or non-significant fibrosis. Significant fibrosis was defined as either an elastography value of ≥ 17.3 kPa or the presence of clinical signs of cirrhosis. Patients were divided into two groups depending on their alcohol consumption patterns; no/low alcohol consumption (one drink or unit/d) and moderate/high alcohol consumption (≥ 1 drink or unit/d). LDH data were calculated to estimate lifetime alcohol intake (LAI), current alcohol intake, drinks per year before and after diagnosis of PSC. We also calculated the number of episodes of binge-drinking (defined as consuming ≥ 5 drinks per occasion) in total, before and after the diagnosis of PSC.RESULTS: The mean LAI was 3882 units of alcohol, giving a mean intake after onset of alcohol consumption of 2.6 units per week. Only 9% of patients consumed alcohol equal to or more than one unit per day. Current alcohol intake in patients with significant fibrosis (n = 26) was less than in patients without significant fibrosis (n = 70), as shown by lower values of phosphatidylethanol (B-PEth) (0.1 μmol/L vs 0.33 μmol/L, respectively, P = 0.002) and carbohydrate-deficient transferrin (CDT) (0.88% vs 1.06%, respectively, P = 0.02). Self-reported LAI was similar between the two groups. Patients with significant fibrosis reduced their alcohol intake after diagnosis from 103 to 88 units per year whereas patients without fibrosis increased their alcohol intake after PSC diagnosis from 111 to 151 units/year. There were no correlations between elastography values and intake of alcohol (units/year) (r = -0.036).CONCLUSION: PSC patients have low alcohol consumption. The lack of correlation between fibrosis and alcohol intake indicates that a low alcohol intake is safe in these patients.     

A Double‐Blind,Placebo‐Controlled Study With Quetiapine as Adjunct Therapy With Lithium or Divalproex in Bipolar I Patients With Coexisting Alcohol Dependence

Background: This study evaluated the efficacy of quetiapine versus placebo as an adjunct to lithium or divalproex in reducing alcohol consumption in patients with bipolar I disorder and coexisting alcohol dependence. Methods: Male and female outpatients (21 to 60 years) with a history of bipolar I disorder and alcohol dependence were included in this 12‐week, placebo‐controlled study. Patients treated with lithium or divalproex (ongoing or assigned at screening) were randomized to receive quetiapine (dosed up to 400 mg/d over 7 days, followed by 300 to 800 mg/d flexible dosing until study end) or placebo. The primary outcome measure was the change in the proportion of heavy drinking days from baseline to Week 12 (as derived from the Timeline Followback method). Secondary outcome measures included time to the first consecutive 2 weeks of abstinence, changes from baseline to Week 12 in the proportion of nondrinking days, mean number of standardized drinks per day, and Clinical Global Impressions‐Severity of Illness score. Results: Of 362 enrolled patients (mean 38.6 years), 176 were randomized to receive quetiapine and 186 to placebo. The mean proportion of heavy drinking days at baseline was 0.66 in the quetiapine group and 0.67 in the placebo group. At Week 12, the mean change in the proportion of heavy drinking days was ?0.36 with quetiapine and ?0.36 with placebo (p = 0.93). No statistically significant differences in any of the secondary outcome measures were noted between the quetiapine and placebo groups. The incidence of adverse events was consistent with the previously known tolerability profile of quetiapine. Conclusions: The efficacy of quetiapine in the treatment of bipolar disorder is already well established. In this study, however, quetiapine added to lithium or divalproex did not result in significantly greater improvement compared with placebo in measures of alcohol use and dependence in patients with bipolar I disorder and alcohol dependence.     

Dietary Oily Fish Intake and Blood Pressure Levels: A Population‐Based Study

The effect of fish consumption on blood pressure is controversial. The authors measured blood pressure and calculated oily fish servings per week in 677 community‐dwellers aged 40 years and older living in rural coastal Ecuador. Using regression models with linear splines, the authors evaluated whether dietary fish intake was related to blood pressure levels, after adjusting for relevant confounders. Mean oily fish consumption was 9.1±5.6 servings per week. There was a nonlinear relationship between systolic pressure and fish servings. In the group of individuals consuming up to five servings per week, each serving significantly reduced systolic pressure by 2.3 mm Hg (P=.020). Any extra serving provided no further effects. The study shows an inverse relationship between oily fish consumption and systolic pressure. Currently recommended amounts of dietary oily fish intake per week (1–2 servings) might be insufficient to exert beneficial effects of fish in the control of blood pressure.     

The stability of baseline‐defined categories of alcohol consumption during the adult life‐course: a 28‐year prospective cohort study

Background and aims

Studies that report the relationship between alcohol consumption and disease risk have predominantly operationalized drinking according to a single baseline measure. The resulting assumption of longitudinal stability may be simplistic and complicate interpretation of risk estimates. This study aims to describe changes to the volume of consumption during the adult life‐course according to baseline categories of drinking.

Design

A prospective observational study.

Setting

United Kingdom.

Participants

A cohort of British civil servants totalling 6838 men and 3372 women aged 34–55 years at baseline, followed for a mean 19.1 (standard deviation = 9.5) years.

Measurements

The volume of weekly alcohol consumption was estimated from data concerning the frequency and number of drinks consumed. Baseline categories were defined: non‐current drinkers, infrequent drinkers, 0.1–50.0 g/week, 50.1–100.0 g/week, 100.1–150.0 g/week, 150.1–250.0 g/week and >250.0 g/week. For women, the highest category was defined as > 100.0 g/week. Baseline frequency was derived as ‘daily or almost daily’ and ‘not daily or almost daily’. Trajectories were estimated within baseline categories using growth curve models.

Findings

Trajectories differed between men and women, but were relatively stable within light‐to‐moderate categories of baseline consumption. Drinking was least stable within the highest categories of baseline consumption (men: > 250.0 g/week; women: > 100.0 g/week), declining by 47.0 [95% confidence interval (CI) = 40.7, 53.2] and 16.8 g/week (95% CI = 12.6, 21.0), respectively, per 10‐year increase in age. These declines were not a consequence of sudden transitions to complete abstention. Rates of decline appear greatest in older age, with trajectories converging toward moderate volumes.

Conclusion

Among UK civil servants, consumption within baseline drinking categories is generally stable during the life‐course, except among heavier baseline drinkers, for whom intakes decline with increasing age. This shift does not appear to be driven by transitions to non‐drinking. Cohorts of older people may be at particular risk of misclassifying former heavy drinkers as moderate consumers of alcohol.     

The dimensionality of alcohol use disorders and alcohol consumption in a cross‐national perspective

Aims To replicate the finding that there is a single dimension trait in alcohol use disorders and to test whether the usual 5+ drinks for men and 4+ drinks for women and other measures of alcohol consumption help to improve alcohol use disorder criteria in a series of diverse patients from emergency departments (EDs) in four countries. Design Cross‐sectional surveys of patients aged 18 years and older that reflected consecutive arrival at the ED. The Composite International Diagnostic Interview Core was used to obtain a diagnosis of DSM‐IV alcohol dependence and alcohol abuse; quantity and frequency of drinking and drunkenness as well as usual number of drinks consumed during the last year. Setting Participants were 5195 injured and non‐injured patients attending seven EDs in four countries: Argentina, Mexico, Poland and the United States (between 1995–2001). Findings Using exploratory factor analyses alcohol use disorders can be described as a single, unidimensional continuum without any clear‐cut distinction between the criteria for dependence and abuse in all sites. Results from item response theory analyses showed that the current DSM‐IV criteria tap people in the middle–upper end of the alcohol use disorder continuum. Alcohol consumption (amount and frequency of use) can be used in all EDs with the current DSM‐IV diagnostic criteria to help tap the middle–lower part of this continuum. Even though some specific diagnostic criteria and some alcohol consumption variables showed differential item function across sites, test response curves were invariant for ED sites and their inclusion would not impact the final (total) performance of the diagnostic system. Conclusions DSM‐IV abuse and dependence form a unidimensional continuum in ED patients regardless of country of survey. Alcohol consumption variables, if added, would help to tap patients with more moderate severity. The DSM diagnostic system for alcohol use disorders showed invariance and performed extremely well in these samples.