Sodium Chloride Preference and Recognition Threshold in Normotensive Subjects on High and Low salt Diet

Young adult volunteers were placed on two week periods of high and low-salt diets following dietetic counselling and using normally available foodstuffs. Changes in sodium recognition threshold, salivary and urinary electrolytes and preference for NaCl, NaCl/KCl (1:1) mix and monosodium glutamate were measured during the high- and low-salt diet periods and during two-week control periods with subjects on their usual diet. Sodium preference was defined as the sodium concentration of unsalted tomato juice following ad libitum addition of a sodium salt till the most preferred taste was achieved. Subjects served as their own controls across the dietary periods in a cross-over design. While sodium excretion on the low-salt diet was significantly less than that on the high-salt diet, there were no significant changes in blood pressure, sodium recognition threshold, body weight or salivary electrolytes between these dietary periods. There was a significant increase in preference for NaCl, NaCl/KCl mix and monosodium glutamate on the high-salt diet when compared to the low-salt diet period. In all dietary periods less sodium was added to the unsalted tomato juice with monosodium glutamate than with NaCl/KCl and less sodium was added with the NaCl/KCl mix than with the NaCl. This study demonstrates that relatively short periods of increased sodium intake result in an increase in sodium preference in the absence of changes in salivary electrolytes or recognition threshold.     

Effect of Chronic Alcohol Ingestion on the Heart and Blood Pressure of Spontaneously Hypertensive Rats

The effect on the heart of a combination of high blood pressure and chronic alcohol ingestion was studied in spontaneously hypertensive rats (SHR) fed ethanol in their drinking water in concentrations of O%, 5% and 20% for sixteen weeks. Normotensive Wistar rats were used as controls (NCR). In addition some SHR were given alcohol for a shorter period of eight weeks at the end of which time there were no significant differences in mean arterial blood pressure between the groups. After sixteen weeks of ethanol the mean arterial pressure had fallen in those SHR receiving 20% ethanol to 136 ± 24 mmHg compared to control (180 ± 27 mmHg; P < 0.001). This was associated with a lower left ventricular (LV) dp/dt (control 4800 ± 872 mmHg sec^?1; 20% ethanol group = 3450 ± 1588 mmHg sec^?1; P < 0.025) and a reduced LV weight (corrected for body weight) due to an apparent lack of development of LV hypertrophy between eight and sixteen weeks. Similarly LV volume (corrected for LV weight), did not change from eight weeks to sixteen weeks in those SHR receiving 20% ethanol in contrast to the 0% ethanol SHR group in whom LV volume fell as LV hypertrophy developed. 5% Ethanol had no significant effect on mean arterial pressure, LV peak dp/dt, LV weight or LV volume. In the NCR ethanol had little effect on mean arterial pressure but those receiving 20% ethanol had significantly smaller LV volumes without any increase in LV weight probably reflecting blood volume depletion. Ethanol did not produce any blood pressure elevation in the NCR. No rats (SHR or NCR) develped overt heart failure or a typical cardimyo-pathy. However, this study has shown that a high intake of ethanol reduces the blood pressure of a hypertensinve rat most likely by its direct toxic action on the myocardium. Thus with chronic alcohol ingestion hypertension can be masked but may still contribute significantly to the development of myocardial disease.     

Screening for Problem Drinking Comparison of CAGE and AUDIT

OBJECTIVE: To compare self-administered versions of three questionnaires for detecting heavy and problem drinking: the CAGE, the Alcohol Use Disorders Identification Test (AUDIT), and an augmented version of the CAGE. DESIGN: Cross-sectional surveys. SETTING: Three Department of Veterans Affairs general medical clinics. PATIENTS: Random sample of consenting male outpatients who consumed at least 5 drinks over the past year ("drinkers"). Heavy drinkers were oversampled. MEASUREMENTS: An augmented version of the CAGE was included in a questionnaire mailed to all patients. The AUDIT was subsequently mailed to "drinkers." Comparison standards, based on the tri-level World Health Organization alcohol consumption interview and the Diagnostic Interview Schedule, included heavy drinking (>14 drinks per week typically or >/=5 drinks per day at least monthly) and active DSM-IIIR alcohol abuse or dependence (positive diagnosis and at least one alcohol-related symptom in the past year). Areas under receiver operating characteristic curves (AUROCs) were used to compare screening questionnaires. MAIN RESULTS: Of 393 eligible patients, 261 (66%) returned the AUDIT and completed interviews. For detection of active alcohol abuse or dependence, the CAGE augmented with three more questions (AUROC 0.871) performed better than either the CAGE alone or AUDIT (AUROCs 0.820 and 0.777, respectively). For identification of heavy-drinking patients, however, the AUDIT performed best (AUROC 0.870). To identify both heavy drinking and active alcohol abuse or dependence, the augmented CAGE and AUDIT both performed well, but the AUDIT was superior (AUROC 0.861). CONCLUSIONS: For identification of patients with heavy drinking or active alcohol abuse or dependence, the self-administered AUDIT was superior to the CAGE in this population.     

Trajectories of Drinking Urges During Individual- and Couple-Based Cognitive-Behavioral Treatment for Alcohol Use Disorders

Individuals receiving treatment for alcohol use disorders (AUDs) often experience urges to drink, and reductions in drinking urges during cognitive-behavioral therapy (CBT) predict better treatment outcomes. However, little previous work has examined patterns of daily drinking urges during treatment. This study examined patterns of change in daily drinking urges among participants in two randomized clinical trials of males (N = 80 with 4,401 daily recordings) and females ( N = 101 with 8,011 daily recordings) receiving individual- or couples-based CBT. Drinking urges were common during treatment, occurring on 45.1% of days for men and 44.8% for women. Drinking urges and alcohol use for both genders decreased substantially during the course of treatment. Both genders had increases in drinking urges as more time elapsed since attending a treatment session. For men, this increase was most pronounced at the beginning of treatment, but for women it was most pronounced near the end of treatment. Alcohol use and drinking urges were both more likely to occur on weekends. The results suggest that these times may lead to higher risk for drinking, and clients may benefit from high-risk planning that is focused on these times.     

Alcohol use and cardiovascular health outcomes: a comparison across age and gender in the Winnipeg Health and Drinking Survey Cohort

Background: research has reliably demonstrated cardioprotectionfrom regular alcohol use. Heavy episodic drinking (HED), however,negates these beneficial effects and increases the risk of cardiovasculardisease (CVD). The impact of age on the health effects of episodicdrinking has not been evaluated. Objective: to examine the association between alcohol volumeand pattern of consumption on the risk of cardiovascular morbidityand mortality across the lifespan. Design and Setting: prospective, community-based cohort studyof adults in Winnipeg, Manitoba, Canada. Subjects: a total of 1,154 participants (580 men and 574 women)aged 18–64 surveyed at baseline (1990–91) on alcoholconsumption levels and pattern of use. Methods: usual alcohol consumption was measured using a quantity–frequencyapproach. HED was estimated by asking participants how oftenthey consumed eight or more drinks in one sitting in the pastyear. Questions were asked separately for wine, beer and spirits.Surveillance for cardiovascular events was conducted for 10years (i.e. up to age 74 years). Diagnoses of CVD were obtainedvia health utilization records. Cox proportional hazard modelswere derived for both genders and for ‘young adults’(baseline age 18–34), ‘middle-aged adults’(baseline age 35–49) and ‘older adults’ (baseline50–64). Models were adjusted for marital status, cigarettesmoking status and educational level. Results: Reduced risk of CVD was associated with usual consumption,whereas an increased risk was associated with HED. Among maleusual drinkers, cardioprotection was afforded only to middleand older age groups. The benefits of regular consumption wereseen only in the youngest age group among women. The heaviestusual consumption category was associated with a decreased riskof CVD in men. Heavy episodic drinking increased the risk ofcoronary heart disease in middle-aged men and was marginallysignificant in middle-aged women. Risk of hypertension was elevatedin older men with heavy episodic drinking. Conclusions: The well-established relationship between regularalcohol consumption and decreased risk of CVD may not becomeevident until middle age or older in men. Women may benefitfrom usual consumption at a much younger age. In both sexes,however, these beneficial effects of alcohol use are negatedwhen alcohol is consumed in a heavy episodic drinking pattern,particularly for middle-aged and older men.     

Adherence to Drinking Guidelines and Reasons for Alcohol Consumption Cessation in the Southern Cone of Latin America – Findings from the CESCAS Study

Introduction:Alcohol consumption is a risk factor for morbidity and mortality globally. Consumption levels in Southern Latin America are among the highest in the world.Objectives:To describe consumption patterns and adherence to guidelines in the general adult population of Southern Latin America, as well as exploration of reasons for alcohol cessation and the advising role of the health worker in this decision.Methods:In 7,520 participants from the Centro de Excelencia en Salud Cardiovascular para el America del Sur (CESCAS) cohort, consumption patterns were described and the proportion excessive drinkers (i.e. >7 units/week for women and >14 for men or binge drinking: >4 (women) or >5 (men) units at a single occasion) was calculated. Former drinkers were asked if they had quit alcohol consumption on the advice of a health worker and/or because of health reasons. Furthermore, among former drinkers, multivariable logistic regression analysis was performed to assess which participant characteristics were independently associated with the chance of quitting consumption on a health worker’s advice.Results:Mean age was 54.8 years (SD = 10.8), 42% was male. Current drinking was reported by 44.6%, excessive drinking by 8.5% of the population. In former drinkers, 23% had quit alcohol consumption because of health reasons, half of them had additionally quit on the advice of a health worker. The majority of former drinkers however had other, unknown, reasons. When alcohol cessation was based on a health worker’s advice, sex, country of residence, educational status and frequency of visiting a physician were independent predictors.Conclusion:In this Southern American population-based sample, most participants adhered to the alcohol consumption guidelines. The advising role of the health worker in quitting alcohol consumption was only modest and the motivation for the majority of former drinkers remains unknown. A more detailed assessment of actual advice rates and exploration of additional reasons for alcohol cessation might be valuable for alcohol policy making.     

From the Eyes of the Beholder: Alcohol Expectancies and Valuations as Predictors of Hazardous Drinking Behaviors among Female College Students

Research has shown that drinking expectancies are associated with alcohol use among college students; however, the bulk of these studies have focused exclusively on researcher-labeled “positive” or “negative” expectancies rather than on the student's valuation (i.e., rating of desirability) of these expectancies. The present study examined the utility of expectancies and valuations in predicting hazardous alcohol use in a sample of 330 female college students (mean age = 20.0; 18–25). Hierarchical regression analyses revealed that negative expectancies and favorable valuations of negative and positive expectancies were predictive of elevated hazardous use (controlling for age, athletic membership, and peer use). Expectancy valuations accounted for additional variance in the model beyond that of expectancies. The present findings shed light on the utility of expectancies and valuations of expectancies in predicting hazardous alcohol use among female college students. Future research directions and potential implications for prevention efforts are discussed.     

Outcomes of a Federally Funded Program for Alcohol and Other Drug Prevention in Higher Education

This paper presents the results of the Nationwide Campuses Study that measure the impact of programs supported by the Fund for the Improvement of Postsecondary Education (FIPSE) for collegiate alcohol and other drug (AOD) prevention efforts. Outcomes were measured by using standardized pre‐ and post‐program items on the Core Alcohol and Drug Survey and adjusted prevalences of AOD use. Although student awareness of AOD prevention programs increased during the funding period, there also were increases in the desire for drugs at parties and in the frequencies of arrests for driving while intoxicated or under the influence and of poor academic performance. Adjusted prevalences of alcohol, marijuana, and cocaine use among students increased, while tobacco use decreased. Curriculum infusion, administrative response, and faculty and community activities most clearly were associated with favorable outcomes. Overall, however, FIPSE funding had limited short‐term impact on AOD use and its consequences in higher education.     

Alcohol intake, consumption pattern and beverage type, and the risk of Type 2 diabetes.

AIMS: To examine associations between amount and frequency of alcohol consumption, and Type 2 diabetes. METHODS: A prospective study of 36 527 adults aged 40-69 at baseline. Incident cases of Type 2 diabetes were identified by questionnaire 4 years later. Sex-specific logistic regression models, adjusting for country of birth, dietary glycaemic index, energy intake and age, and in a second model body mass index (BMI) and waist-hip ratio (WHR), were used. RESULTS: Diabetes status was ascertained for 31 422 (86%) participants, and 362 cases identified. Former drinkers had higher risks than lifetime abstainers. Female drinkers had lower risk than lifetime abstainers (ORs < 10 g/day 0.54, 95% CI 0.36-0.82; 10-19.9 g/day 0.57, 0.34-0.94; > or = 20 g/day 0.46, 0.24-0.88, P trend = 0.005). There was no relationship after adjustment for body size. For men, a weak inverse association was observed after adjustment for body size (ORs relative to lifetime abstainers: < 10 g/day 1.56, 0.95-2.55; 10-19.9 g/day 1.21, 0.69-2.10; 20-29.9 g/day 0.80, 0.40-1.60; = 30 g/day 0.86, 0.50-1.58, P trend = 0.036). Wine was the only beverage for which an inverse association was observed. Compared with men who did not drink in the week before baseline, men who drank > or = 210 g over 1-3 days had an increased risk of diabetes (OR 5.21, 1.79-15.19), while the same amount over more days did not increase risk. CONCLUSIONS: Total alcohol intake was associated with reduced risk only in women. Alcohol from wine was associated with reduced risk of Type 2 diabetes. A high daily intake of alcohol, even on only 1-3 days a week, may increase the risk of diabetes in men.     

Predictive Validity of the RIASI: Alcohol and Drug Use and Problems Six Months Following Remedial Program Participation

The ability of screening instruments for convicted drinking drivers to predict subsequent alcohol and drug-related problems rarely has been studied. The predictive validity of the Research Institute on Addictions Self-Inventory (RIASI) was investigated in a sample of 6,003 convicted drinking drivers who were participating in Back on Track (BOT), Ontario's remedial measures program for convicted drinking drivers. All BOT participants complete an assessment (which includes the RIASI), followed by a brief education or treatment program, and concluded 6 months later by a follow-up interview. The follow-up interview collects information on self-reported alcohol and other drug use and problems, and contacts with other health care providers in the 90 days prior to the follow-up contact. The ability of scores on the RIASI to predict these measures was assessed. The results revealed that, for almost all comparisons, individuals who used alcohol and other drugs, reported more substance-related problems at follow-up, and reported more contacts with other health and addictions providers had significantly higher scores on the RIASI total score and the RIASI recidivism scale at the initial assessment. The data indicate that this instrument appears to be able to identify individuals who will experience alcohol and drug related problems in the future.     

Alcohol Consumption and Its Influence on the Clinical Picture of Puumala Hantavirus Infection

Puumala hantavirus (PUUV) causes hemorrhagic fever with renal syndrome. Characteristic clinical findings include acute kidney injury (AKI), thrombocytopenia, and capillary leakage. Smoking increases the risk of severe AKI, but it is not known whether alcohol consumption predisposes patients to a more severe infection. Liver and pancreatic enzymes, as well as biomarkers of alcohol consumption (gamma-glutamyl transferase, GGT; carbohydrate-deficient transferrin, CDT; GGT-CDT combination; and ethyl glucuronide, EtG), were measured from 66 patients with acute PUUV infection during hospitalization and at the convalescence phase. Alcohol consumption was present in 41% of the study population, 15% showing signs of heavy drinking. Alcohol use did not affect the severity of PUUV induced AKI nor the overall clinical picture of the infection. Liver enzyme levels (GGT or alanine aminotransferase, ALT) were elevated in 64% of the patients, but the levels did not associate with the markers reflecting the severity of the disease. Serum amylase activities at the convalescent stage were higher than those at the acute phase (p < 0.001). No cases with acute pancreatitis were found. In conclusion, our findings indicate that alcohol consumption does not seem to affect the clinical course of an acute PUUV infection.     

The Obsessive Compulsive Drinking Scale: A Self-Rated Instrument for the Quantification of Thoughts about Alcohol and Drinking Behavior

It has been suggested that a crucial dimension of alcohol "craving" includes the concept of both obsessive thoughts about alcohol use and compulsive behaviors toward drinking. An interview-based rating scale, the Yale-Brown Obsessive Compulsive Scale-heavy drinkers (YBOCS-hd), has been found useful in quantifying this concept in alcohol-dependent individuals. A self-rating scale, the Obsessive Compulsive Drinking Scale (OCDS) has been developed by us as a modification of the YBOCS-hd. The YBOCS-hd showed excellent interrater reliability in our hands. The correlation between the YBOCS-hd and the OCDS total scores obtained on 60 alcohol-dependent individuals was 0.83. The test-retest correlation for the OCDS total score was 0.96, and the obsessive and compulsive sub-scales test-retest correlations were 0.94 and 0.86, respectively. The internal consistency of the items in the OCDS was high (0.86) and did not improve significantly with removal of individual items. The shared variance between the OCDS scores and alcohol consumption during the period of evaluation was only = 20%, indicating that the dimension measured by the scale was somewhat independent of actual drinking. As such, it might act as an independent measure of the "state of illness" for alcohol-dependent individuals.
When used during a prospective 12-week treatment research study, initial results indicate that the OCDS seems to validly measure a dimension of alcohol dependence, because it decreased from baseline during alcohol reduction and increased in relationship to relapse drinking. The ease of administration (5 min), reliability, and concurrent validity of the OCDS makes it particularly suitable as a screening and outcome measurement tool for various types of clinical treatment and research protocols.     

A systematic review of relative risks for the relationship between chronic alcohol use and the occurrence of disease

Alcohol use is causally linked to the development of and mortality from numerous diseases. The aim of this study is to provide an update to a previous systematic review of meta-analyses that quantify the sex-specific dose–response risk relationships between chronic alcohol use and disease occurrence and/or mortality. An updated systematic search of multiple databases was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria to identify meta-analyses published from January 1, 2017, to March 8, 2021, which quantified the risk relationships between chronic alcohol use and the risk of disease occurrence and/or mortality. This systematic review was not preregistered. The comparator was people who have never consumed at least one standard drink of alcohol. Measurements included relative risks, odds ratios, and hazard ratios of disease occurrence and/or mortality based on long-term alcohol intake measured in grams per day. The systematic search yielded 5953 articles, of which 14 were included in the narrative review. All diseases showed an increased risk of occurrence as alcohol use increased. At all doses examined, alcohol had a significant detrimental effect on tuberculosis, lower respiratory infections, oral cavity and pharyngeal cancers, esophageal cancer, colorectal cancer, liver cancer, laryngeal cancer, epilepsy, hypertension, liver cirrhosis, and pancreatitis (among men). For ischemic heart disease, ischemic stroke, and intracerebral hemorrhage, protective effects from low-dose chronic alcohol use among both men and women were observed. Low-dose alcohol consumption also had a protective effect for diabetes mellitus and pancreatitis among women (approximately to 50 g/day and 30 g/day, respectively). Alcohol use increases the risk of numerous infectious and noncommunicable diseases in a dose–response manner. Higher levels of alcohol use have a clear detrimental impact on health; however, at lower levels of use, alcohol can have both disease-specific protective and detrimental effects.