BackgroundObesity increases cancer risk, whereas surgery-induced weight loss is associated with reduced risk. Risk-based patient stratification may be needed to better understand and maximize benefits of weight loss interventions in individuals with obesity. To this end, comprehensive data from high-quality studies with extended follow-up are imperative. This study examines the link between bariatric surgery and long-term cancer outcomes, focusing on patient subgroups defined by previously suggested predictors of treatment benefit, such as sex and baseline insulin levels.Methods and findingsThis post-hoc analysis used data from the Swedish Obese Subjects (SOS) study, a prospective, controlled intervention trial, designed to investigate the long-term effects of bariatric surgery-induced weight loss (ClinicalTrials.gov, NCT01479452). The study was conducted at 25 public surgical departments and 480 primary healthcare centers across Sweden. Between Sept 1, 1987, and Jan 31, 2001, 2,007 per-protocol patients with obesity who underwent bariatric surgery (gastric bypass, n = 266; gastric banding, n = 376; vertical banded gastroplasty, n = 1,365) and 2,040 matched controls, receiving standard nonsurgical obesity-related care, were recruited. Inclusion criteria were age 37–60 years and a body mass index (BMI) ≥34 kg/m2 for men and ≥38 kg/m2 for women. The primary outcome measures were cancer events and cancer-related deaths, captured through nearly complete data sourced from national Swedish health registries. Female-specific cancers were defined as gynecologic and breast cancers. Analyses were adjusted (adj) for baseline age, sagittal diameter, alcohol consumption, smoking, and serum insulin levels. The study was closed on December 31, 2022. Median follow-up was 26.8 years (interquartile range (IQR) [22.9, 29.6]) in the surgery group and 24.9 years (IQR [18.7, 28.8]) in the control group. Bariatric surgery was associated with a lower overall cancer incidence rate in women (adjusted hazard ratio (HRadj) = 0.78; 95% confidence interval (CI) [0.67, 0.90]; p = 0.001), but not in men (sex–treatment interaction p = 0.013). The HRadj for overall cancer mortality rate in women was 0.78 (95% CI [0.61, 1.00]; p = 0.050). In women, surgery was associated with a lower incidence rate of both obesity-related cancers (HRadj = 0.70; 95% CI [0.58, 0.85]; p < 0.001) and female-specific cancers (HRadj = 0.60; 95% CI [0.47, 0.75]; p < 0.001). Importantly, subgroup analyses showed that the associations between surgery and female-specific cancer incidence, as well as female-specific cancer-related mortality, were stronger in women with high baseline insulin levels (insulin-treatment interaction p = 0.021 and 0.039, respectively). The main limitation is that cancer was not a predefined study outcome.ConclusionsBariatric surgery is associated with a lower risk of cancer and cancer-related mortality in women with obesity, with the strongest association observed for female-specific cancers in women with elevated baseline insulin levels. In men, bariatric surgery was not associated with overall cancer incidence or mortality. These findings support incorporating risk-based stratification to better tailor cancer prevention strategies in obesity care.

Obesity increases cancer risk, whereas surgery-induced weight loss is associated with reduced risk. Risk-based patient stratification may be needed to better understand and maximize benefits of weight loss interventions in individuals with obesity. To this end, comprehensive data from high-quality studies with extended follow-up are imperative. This study examines the link between bariatric surgery and long-term cancer outcomes, focusing on patient subgroups defined by previously suggested predictors of treatment benefit, such as sex and baseline insulin levels. This post-hoc analysis used data from the Swedish Obese Subjects (SOS) study, a prospective, controlled intervention trial, designed to investigate the long-term effects of bariatric surgery-induced weight loss (ClinicalTrials.gov, NCT01479452). The study was conducted at 25 public surgical departments and 480 primary healthcare centers across Sweden. Between Sept 1, 1987, and Jan 31, 2001, 2,007 per-protocol patients with obesity who underwent bariatric surgery (gastric bypass, n = 266; gastric banding, n = 376; vertical banded gastroplasty, n = 1,365) and 2,040 matched controls, receiving standard nonsurgical obesity-related care, were recruited. Inclusion criteria were age 37-60 years and a body mass index (BMI) ≥34 kg/m2 for men and ≥38 kg/m2 for women. The primary outcome measures were cancer events and cancer-related deaths, captured through nearly complete data sourced from national Swedish health registries. Female-specific cancers were defined as gynecologic and breast cancers. Analyses were adjusted (adj) for baseline age, sagittal diameter, alcohol consumption, smoking, and serum insulin levels. The study was closed on December 31, 2022. Median follow-up was 26.8 years (interquartile range (IQR) [22.9, 29.6]) in the surgery group and 24.9 years (IQR [18.7, 28.8]) in the control group. Bariatric surgery was associated with a lower overall cancer incidence rate in women (adjusted hazard ratio (HRadj) = 0.78; 95% confidence interval (CI) [0.67, 0.90]; p = 0.001), but not in men (sex-treatment interaction p = 0.013). The HRadj for overall cancer mortality rate in women was 0.78 (95% CI [0.61, 1.00]; p = 0.050). In women, surgery was associated with a lower incidence rate of both obesity-related cancers (HRadj = 0.70; 95% CI [0.58, 0.85]; p < 0.001) and female-specific cancers (HRadj = 0.60; 95% CI [0.47, 0.75]; p < 0.001). Importantly, subgroup analyses showed that the associations between surgery and female-specific cancer incidence, as well as female-specific cancer-related mortality, were stronger in women with high baseline insulin levels (insulin-treatment interaction p = 0.021 and 0.039, respectively). The main limitation is that cancer was not a predefined study outcome. Bariatric surgery is associated with a lower risk of cancer and cancer-related mortality in women with obesity, with the strongest association observed for female-specific cancers in women with elevated baseline insulin levels. In men, bariatric surgery was not associated with overall cancer incidence or mortality. These findings support incorporating risk-based stratification to better tailor cancer prevention strategies in obesity care.

Long-term aspirin use and heart failure incidence: A patient-level pooled analysis study.

BackgroundAlcohol consumption has been described to exhibit a J-shaped relationship with dementia risk, but previous observations may be partly biased due to “sick-quitters” and competing risks of death.ObjectiveTo examine the association between baseline and lifetime alcohol consumption and the risk of dementia and subtypes in a large Mediterranean cohort, accounting for lifetime drinking patterns, potential confounding, and competing risks of death.MethodsProspective study of 30,211 participants, 29–69 years at recruitment (1992–1996), from the EPIC-Spain dementia cohort. Alcohol intake was assessed using a validated dietary history and retrospective questionnaires covering ages 20, 30, and 40 years. Dementia cases (n = 1,114) were ascertained through linkage with healthcare and mortality databases and individual medical record review over a mean follow-up of 22.8 years. Multivariate competing risk models were used to estimate sub-hazard ratios (sHRs) for dementia by categories of baseline and lifetime alcohol consumption, using lifetime abstainers as the reference group.ResultsMean lifetime alcohol consumption was 41.9 and 4.4 g/d in men and women, respectively. No significant associations were found between baseline or lifetime alcohol consumption and risk of overall dementia (sHRcurrentvs.never = 0.96, 95% CI: 0.82, 1.13; sHRevervs.never = 0.96, 95% CI: 0.82, 1.11), Alzheimer's disease, or non-Alzheimer subtypes. These null findings remained consistent across strata of sex, BMI or smoking categories, and by beverage type. Sensitivity analyses excluding mis-reporters of energy intake or low-quality diagnoses yielded similar results.ConclusionsIn this large prospective cohort with over 1,100 dementia cases and long-term follow-up, alcohol consumption was not significantly associated with dementia risk. These findings challenge the notion of a protective effect of moderate drinking and warrant continued investigation using methodologically rigorous approaches to clarify the role of alcohol dose, timing, and pattern on dementia risk.

Background: Liver cancer is a significant disease burden, with metabolic factors potentially influencing its risk. Diabetics, due to metabolic abnormalities, may be more sensitive to environmental exposures. Beverages like tea and alcohol could impact liver cancer risk and may influence prevention in diabetics. Methods: This study included 30,289 diabetics and 482,292 non-diabetics aged 30–79 years from the China Kadoorie Biobank. Baseline alcohol and tea consumption during the past year was collected through questionnaires, including frequency, amount, duration, and types. Incident liver cancer cases were identified from the national health insurance system and local disease registries. Cox proportional hazards regression models estimated hazard ratios (HRs) and 95% confidence intervals (CIs). Results: During a median follow-up of 9.6 years for diabetics and 10.1 years for non-diabetics, 193 (0.69 cases/1000 person-years) and 398 (0.45 cases/1000 person-years) incident liver cancer cases were documented, respectively. Weekly alcohol consumption was associated with higher liver cancer risk in both groups, stronger in diabetics (HR = 1.62; 95% CI: 1.12, 2.34) than in non-diabetics (HR = 1.20, 95% CI: 1.07, 1.35). Among diabetics, the risk was higher in some weekly alcohol consumption subgroups: high-level intake (HR = 2.21; 95% CI: 1.28, 3.80), ≥30 years (HR = 1.70; 95% CI: 1.06, 2.71), or spirit (≥50% alcohol) alcohol-specific consumption (HR = 1.91; 95% CI: 1.20, 3.04), and these associations were stronger than those in non-diabetics. For weekly tea consumption, low-level intake (HR = 0.82; 95% CI: 0.68, 0.99), <10 years (HR = 0.74; 95% CI: 0.58, 0.93), 10–29 years (HR = 0.84; 95% CI: 0.71, 0.99), and green tea-specific consumption (HR = 0.86; 95% CI: 0.75, 0.98) were associated with reduced liver cancer risk in non-diabetics. However, these associations were not significant in those with diabetes. Conclusions: Weekly alcohol consumption is significantly associated with an increased risk of liver cancer, especially in diabetics, while tea consumption appears to lower risk only in non-diabetics, highlighting the need for alcohol reduction in diabetics.

Evidence suggests a J-shaped association between alcohol consumption and depression, but it remains unclear whether this reflects a true causal effect, reverse causation, or methodological bias. This uncertainty is particularly relevant in older adults, who are at increased risk for both depression and alcohol-related harms. This study aimed to examine the association between varying levels of alcohol consumption and depression risk in community-dwelling older adults. We analyzed 16,563 community-dwelling older adults (mean age 75.1 ± 4.6 years) from the ASPirin in Reducing Events in the Elderly (ASPREE) trial. Alcohol intake, reported at baseline and follow-up, was categorized as abstinent, occasional, moderate, or above-guideline. Both intention-to-treat (classified by baseline alcohol consumption, regardless of later changes) and per-protocol (using annual time-updated alcohol consumption ) analyses were performed. To address confounding, informative censoring, and selection bias, we applied marginal structural models with inverse probability weighting. In per-protocol analyses, abstainers (OR 1.17), occasional drinkers (OR 1.11), and above-guideline drinkers (OR 1.15) were significantly associated with a higher risk of depression compared with moderate drinkers, consistent with a J-shaped association. Sensitivity analyses excluding former drinkers and those with baseline depressive symptoms showed similar results. The association remained robust after adjusting for social isolation, social support, social interactions, physical activity, pain, sleep duration, sleep difficulties, and sleep medication use (n = 14,892; Australian sub-sample), and did not differ by sex. Moderate alcohol consumption was associated with the lowest depression risk, confirming a J-shaped relationship after comprehensive confounder adjustment.

ABSTRACT Background: Individuals with pre-existing heavy alcohol use, prior traumatic exposures, and psychiatric disorders were considered an at-risk group for increased alcohol use and problems in the context of the COVID-19 pandemic. Objective: This study recruited from a multi-centre longitudinal cohort study of US military service members/veterans with combat exposure to examine the trajectories of alcohol use and problems in the context of a prolonged stressor. Methods: Individuals who endorsed heavy drinking and completed a measure of PTSD symptoms prior to the pandemic were invited to participate in a longitudinal survey study at three time points, three months apart, during the second year of the pandemic. Participants (N = 44) completed surveys assessing alcohol consumption and alcohol-related problems (via the AUDIT), PTSD symptoms (via the PCL-5), and infection mitigation behaviours (via a COVID-19 specific survey). Random intercept models were fitted to the longitudinal data for each of these outcomes, covarying for demographics, pandemic quarantine/physical distancing experience, pre-pandemic baseline alcohol consumption and PTSD symptoms, and time-varying alcohol consumption and alcohol-related problems as well as PTSD symptoms. Results: We did not find an increase in alcohol consumption or problems over time. However, pre-pandemic alcohol consumption predicted alcohol consumption over time (B = 0.52, SE = 0.11, p < .01). Time-varying alcohol consumption and PTSD symptoms predicted alcohol problems over time (B = 0.84, SE = 0.18, p < .01; B = 0.04, SE = 0.02, p < .05, respectively). Conclusions: Findings highlight the relevance of pre-existing hazardous alcohol consumption prior to stressors as well as ongoing consumption and PTSD symptoms as risk factors for alcohol-related problems. Findings captured more chronic impacts of pandemic stressors and demonstrated that heavy drinking and PTSD are notable risk factors for alcohol-related problems even if in the context of stabilizing, albeit still high, alcohol use.

The heterogeneity of alcohol and tobacco co-use suggests that only a subset of individuals will respond to a given pharmacotherapy. Toward identifying treatment responders, statistical learning was applied to a clinical trial combining naltrexone and varenicline for smoking cessation and drinking reduction. Individuals (N = 165) who smoke cigarettes daily and drink alcohol heavily completed a Phase 2, double blind, randomized clinical trial comparing the efficacy of combination varenicline plus naltrexone versus varenicline plus placebo. Smoking cessation was defined by bio-verified nicotine abstinence. Drinking reduction was defined as a 2-level reduction in the World Health Organization (WHO) risk drinking level. Three statistical learning methods (ridge regression, LASSO regression, and random forest) were tested psychosocial and biological predictors of clinical response. For drinking reduction, the LASSO regression had the highest overall accuracy (86%) and AUC (0.88). Important predictors included baseline alcohol consumption, baseline smoking urge, age of first cigarette use, and years of education. For nicotine abstinence, LASSO regression had the highest overall accuracy AUC (0.69). Important predictors included medication condition, expired alveolar CO level, baseline alcohol consumption, depression symptoms, and years of education. Baseline consumption patterns are a strong predictor of clinical outcome for both smoking cessation and drinking reduction. Results also underscore the important cross-relationship between drinking and smoking. Statistical learning models converged with previous hypothesis-driven studies and were well-suited for clinical trial datasets. These findings highlight candidate variables that, with further validation, may support the development of personalized treatment strategies.

Digital interventions can be effective for reducing alcohol consumption. However, most digital interventions that have been evaluated are websites and there is little evidence on the effectiveness of smartphone apps, especially in a United Kingdom context. We developed an evidence- and theory-informed app, Drink Less, to help increasing-and-higher-risk drinkers (Alcohol Use Disorders Identification Test score ≥ 8) reduce their alcohol consumption. To evaluate the effectiveness of Drink Less for reducing alcohol consumption compared with usual digital care in the United Kingdom. Two-arm, double-blind, parallel-group, randomised controlled trial with 1 : 1 group allocation and an embedded process evaluation, with 6-month follow-up. Remotely conducted among participants living in the United Kingdom, recruited from July 2020 to March 2022. Five thousand six hundred and two increasing-and-higher-risk drinkers aged 18+ who had access to an iPhone operating system device and wanted to drink less alcohol. Participants were recommended to use the intervention (Drink Less) or recommended the comparator (National Health Service alcohol advice web page). Drink Less is an app-based intervention to help increasing-and-higher-risk drinkers reduce their alcohol consumption. It consists of evidence-based modules (e.g. goal setting, self-monitoring) and was systematically and transparently developed and refined. The National Health Service alcohol advice web page was considered usual digital care and provides tips on cutting down. The primary outcome was self-reported weekly alcohol consumption at 6-month follow-up (derived from the extended Alcohol Use Disorders Identification Test - Consumption), adjusted for baseline alcohol consumption. The retention rate at 6-month follow-up was 80%. The data were not missing completely at random with differences detected in educational qualifications, occupation and income, indicating that multiple imputation was the most appropriate analytic approach. This found that Drink Less resulted in a 2.00 United Kingdom unit greater weekly reduction (95% confidence interval -3.76 to -0.24) at 6-month follow-up compared with the National Health Service alcohol advice web page. Compared with the National Health Service alcohol advice web page, Drink Less cost an additional £1.28 per user, when including the sunk costs (already incurred and cannot be recovered), but saved £0.04 per user when considering only the annual maintenance costs. Drink Less costs only an extra £0.64 per additional weekly unit of alcohol reduction, and may be cost saving if sufficient people use the app to cover the sunk costs. There was no statistically significant difference in quality-adjusted life-years between the two groups. This trial relied on retrospective self-reported alcohol consumption. Results from the pre-registered sensitivity analysis of multiple imputation were inconsistent with those from the pre-registered primary analysis (a conservative approach to missing data where non-responders were assumed to be drinking at baseline levels), which found a non-significant weekly reduction of 0.98 units (95% confidence interval -2.67 to 0.70) in the intervention compared with comparator group. Multiple imputation was recommended by the independent Data Monitoring Committee based on the pattern of missing data. Drink Less appears effective for reducing alcohol consumption among increasing-and-higher-risk drinkers compared with the National Health Service alcohol advice web page in the United Kingdom, and may be cost saving if widely used in the population. Drink Less is in a strong position to be promoted widely and provide inexpensive support to increasing-and-higher-risk drinkers in the United Kingdom. Future work should investigate different promotion strategies and ways of implementing the app within healthcare settings and adapting it for other countries. This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number NIHR127651.

BackgroundMinimally invasive esophagectomy (MIE) has shown potential benefits in reducing postoperative complications and improving recovery for patients with esophageal squamous cell carcinoma (ESCC). This study aims to assess the effects of MIE on preoperative and postoperative quality of life and functional outcomes in ESCC patients.MethodsClinical data from 57 ESCC patients who underwent MIE were retrospectively analyzed. Baseline characteristics, including age, gender, BMI, TNM stage, smoking history, alcohol consumption, comorbidities, tumor location, differentiation, and lymph node metastasis, were collected. Postoperative quality of life scores, nutritional status, and functional outcomes were assessed. Paired t-tests and chi-square tests were used to compare preoperative and postoperative variables, while correlation analysis was conducted to evaluate associations between functional outcomes and quality of life.ResultsA total of 57 patients (41 males, 16 females; mean age: 67.61 ± 7.72 years) who underwent MIE were analyzed. Postoperative evaluation demonstrated significant improvements in quality of life scores across multiple dimensions, including physical symptoms (P = 0.006), emotional management (P = 0.013), role function (P = 0.013), cognitive function (P = 0.042), and social function (P = 0.021). Additionally, nutritional status improved postoperatively, with higher albumin levels (4.12 ± 0.34 g/dL vs. 3.78 ± 0.25 g/dL, P < 0.001) and reduced weight loss (1.98 ± 1.02 kg vs. 2.44 ± 1.12 kg, P = 0.026). Functional outcomes also showed significant improvements, including decreased dysphagia scores (3.45 ± 1.56 vs. 4.04 ± 0.31, P = 0.008), while cardiac physical activity and respiratory function remained stable (P > 0.05). Correlation analysis indicated significant associations between specific functional outcomes and quality of life (P < 0.05).ConclusionMIE improves quality of life, nutritional status, and functional outcomes in patients with esophageal squamous cell carcinoma, highlighting its potential benefits in postoperative recovery and patient well-being.Trial registrationNot applicable.

Sleep quality and depression are known to be associated with anaemia in adults, but studies are limited among children and adolescents. The present study aimed to assess the association between sleep quality, depression, and haemoglobin concentration in Indonesian adolescents aged 10-19years. Data of 452 adolescent boys and girls, aged 10-19years old, were collected across all subdistricts in Gunungkidul district, Yogyakarta province, Indonesia, in 2021 (baseline) and 2022 (follow-up). Sleep quality and depression were assesed using The Pittsburgh Sleep Quality Index (PSQI) and The Kessler-10 Psychological Distress Scale (K10), respectively. Haemoglobin concentration was measured, with corrections applied for altitude and smoking. Anaemia status was defined as haemoglobin <11.5g/dL for adolescents aged 10-11years old, <12g/dL for those aged 12-14years old and for girls aged 15years and older, and <13g/dL for boys aged 15years old and older. Latent Class Analysis (LCA) was employed to identify distinct subgroups of adolescents based on shared patterns of sleep quality and depression. Multiple linear regression was applied to identify associations between class membership and haemoglobin concentration at baseline and follow-up, with adjustments for baseline haemoglobin concentration, sex, age, pubertal status, alcohol consumption, smoking status, and household income. The overall prevalence of anaemia was 21% at baseline and 29% at follow-up, with girls being more affected than boys. LCA yielded 5 classes of sleep quality and depression. We did not find an association between class membership and haemoglobin concentration at baseline. However, in comparison to class A and after adjustments, membership of class B (moderate-to-good sleep quality and low risk of depression, with some tiredness) predicted a reduction of 0.43g/dL (95% CI: -0.79; -0.07), whereas membership of class C (moderate sleep quality and moderate risk of depression) predicted a reduction of 0.49g/dL (95% CI: -0.94; -0.04) in haemoglobin concentration at 1year follow-up. Our study found that poor sleep quality and depression symptoms are associated with lower haemoglobin concentrations over time. Mental health and sleep quality should therefore be considered in intervention programs that address anaemia.

AimsConditional average treatment effects are often reported in intervention studies, in which assumptions are made regarding how effects are similar across a heterogeneous sample. Nonetheless, differing factors, such as genetics, age, and sex, can impact an intervention’s effect on outcomes. The study aimed to estimate the individualized effects of a digital alcohol intervention among individuals looking online to reduce their drinking.MethodsWe used data from a randomized controlled trial (RCT), including 2129 adults from the Swedish general population. The RCT concerned a text message-based alcohol intervention that sought to engender change through increasing knowledge on how to change and instilling confidence in changing behaviour. Outcomes were total weekly alcohol consumption and monthly heavy episodic drinking. Individualized treatment effects were modelled using baseline characteristics (age, gender, alcohol consumption, and psychosocial variables) and engagement with the intervention content.ResultsWe found evidence that the effects of the digital alcohol intervention were heterogeneous concerning participants’ age, baseline alcohol consumption, confidence, and importance. For heavy episodic drinking, there was evidence that effects were heterogeneous concerning age, sex, and baseline alcohol consumption. Overall, women, older individuals, and heavier drinkers benefitted more from the intervention in terms of effect size. In addition, participants who engaged more with the goal-setting and screening content reported better outcomes.ConclusionsThe results highlight how different individuals respond differently to a digital alcohol intervention. This allows insight into who benefits the most and least from the intervention and highlights the potential merit of designing interventions adapted to different individuals’ needs.

BackgroundIt is unclear whether brief interventions using the combined classification of alcohol-metabolizing enzymes aldehyde dehydrogenase 2 (ALDH2) and alcohol dehydrogenase 1B (ADH1B) together with behavioral changes in alcohol use can reduce excessive alcohol consumption. This study aimed to examine the effects of a brief intervention based on the screening of ALDH2 and ADH1B gene polymorphisms on alcohol consumption in Japanese young adults.MethodsIn this open-label randomized controlled trial, we enrolled adults aged 20–30 years who had excessive drinking behavior (average amount of alcohol consumed: men, ≥ 4 drinks/per day and women, ≥ 2 drinks/per day; 1 drink = 10 g of pure alcohol equivalent). Participants were randomized into intervention or control group using a simple random number table. The intervention group underwent saliva-based genotyping of alcohol-metabolizing enzymes (ALDH2 and ADH1B), which were classified into five types. A 30-min in-person or online educational counseling was conducted approximately 1 month later based on genotyping test results and their own drinking records. The control group received traditional alcohol education. Average daily alcohol consumption was calculated based on the drinking diary, which was recorded at baseline and at 3 and 6 months of follow-up. The primary endpoint was average daily alcohol consumption, and the secondary endpoints were the alcohol-use disorder identification test for consumption (AUDIT-C) score and behavioral modification stages assessed using a transtheoretical model.ResultsParticipants were allocated to the intervention (n = 100) and control (n = 96) groups using simple randomization. Overall, 28 (29.2%) participants in the control group and 21 (21.0%) in the intervention group did not complete the follow-up. Average alcohol consumption decreased significantly from baseline to 3 and 6 months in the intervention group but not in the control group. The reduction from baseline alcohol consumption values and AUDIT-C score at 3 months were greater in the intervention group than in the control group (p < 0.001). In addition, the behavioral modification stages were significantly changed by the intervention (p < 0.001).ConclusionsGenetic testing for alcohol-metabolizing enzymes and health guidance on type-specific excessive drinking may be useful for reducing sustained average alcohol consumption associated with behavioral modification.Trial registrationR000050379, UMIN000044148, Registered on June 1, 2021.

Background and purposeThe prevalence of dementia is rapidly increasing. Attempts to further understand modifiable risk factors such as diabetes mellitus (DM) are urgently needed to inform public health policies for prevention. Thus, the objective of the current study was to assess the relationship between DM and risk of dementia and non‐dementia mortality amongst women in the California Teachers Study prospective cohort.MethodsWomen (n = 124,509) aged 22–104 years at baseline were included. DM was ascertained from self‐reported questionnaires and hospital‐linked records. Dementia‐related deaths were ascertained from state and national records. Competing risk regression models were used to estimate cause‐specific hazard ratios and 95% confidence intervals for the association of DM with dementia‐ and non‐dementia‐related mortality.ResultsThere were 10,511 total DM cases and 3625 deaths due to dementia over a mean of 21.3 years of follow‐up. Fully adjusted cause‐specific hazard ratios of the association with DM were 2.26 (2.01, 2.55) for dementia‐related and 1.97 (1.89, 2.05) for the competing risk of non‐dementia‐related mortality. This association was strongest amongst participants with incident DM, younger age at baseline and higher alcohol consumption or who were overweight.ConclusionsIn the California Teachers Study, women with DM had increased risk of mortality due to both dementia and non‐dementia causes; however, the risk of mortality due to dementia was elevated compared to non‐dementia causes only amongst participants with incident DM.

Excessive alcohol consumption has been associated with increased risk of atrial fibrillation, although the underlying mechanisms remain unclear. An enlarged left atrium and impaired left atrial function may lead to atrial fibrillation. The association of alcohol consumption with structural and functional left atrial measures, however, has received limited attention. We studied 503 participants from the PREDIMED-Plus (Prevención con Dieta Mediterránea) trial, a randomized trial testing intensive weight loss intervention with an energy-reduced Mediterranean diet and physical activity promotion in preventing cardiovascular disease in adults with metabolic syndrome. Participants underwent transthoracic echocardiography at baseline, year 3, and year 5 of the study. Outcomes of interest included volume index and reservoir, conduit, and contractile strains of the left atrium. Alcohol consumption was calculated through food frequency questionnaires and presented as drinks consumed per day. Multiple linear regression and mixed models estimated the association of alcohol consumption with left atrial measurements at baseline and through follow-up. Cross-sectionally, higher alcohol consumption (per 1 drink/day increases) was associated with larger left atrial volume (0.65 mL/m2 [95% CI, 0.18-1.11]) and lower left atrial reservoir and contractile strain (-0.44% [95% CI, -0.87 to -0.01]; and -0.44% [95% CI, -0.75 to -0.14]). Baseline alcohol consumption was not associated with changes in left atrial measurements, but increases in alcohol consumption (per 1 drink/day increase) during follow-up were associated with left atrial enlargement (0.71 mL/m2 [95% CI, 0.17-1.26]). In a population at high cardiovascular risk, increased alcohol consumption was associated with left atrial enlargement and worsening atrial function. URL: http://www.controlled-trials.com; Unique identifier: ISRCTN89898870.

Preoperative Alcohol Use, Postoperative Pain, and Opioid Use After Coronary Artery Bypass Surgery

BackgroundResearch is lacking on predictors of outcome for the treatment of alcohol use disorder (AUD) with a goal of controlled drinking (CD). The aim of the study was to investigate one-year outcomes of an RCT, investigating Behavioral Self-Control Training (BSCT) and Motivational Enhancement Therapy (MET) and predictors of positive outcome for weekly alcohol consumption, CD and symptom reduction in AUD.MethodsThis study is based on secondary analyses from a randomized controlled trial including 250 individuals with AUD (52% men) recruited from three specialized addiction clinics in Stockholm, Sweden. Linear and logistic mixed regression models were used for outcomes at 52 weeks, and linear and logistic regression models for the predictor analyses.ResultsBSCT was superior to MET for the change between baseline to 52 weeks for the outcome of CD, defined as low-risk drinking below ten standard drinks per week for both genders (p = 0.048). A total of 57% of individuals in BSCT attained a level of CD, as opposed to 43% in MET. Females were significantly better in attaining low-risk drinking levels compared to men. The predictor for obtaining CD and reducing weekly alcohol consumption, was a lower baseline alcohol consumption. Predictors of symptom reduction in AUD were lower baseline level of AUD, and a lower self-rated impaired control over alcohol consumption.ConclusionsBSCT was superior to MET in obtaining CD levels, and women were superior to men for the same outcome. The study corroborated baseline consumption levels as an important predictor of outcome in CD treatments. The study contributes with important knowledge on key treatment targets, and knowledge to support and advice patients in planning for treatment with a goal of controlled drinking.Trial registration: The original study was registered retrospectively at isrtcn.com (14539251).

BackgroundPast research indicates dual users of tobacco and alcohol find it harder to quit smoking and may be more likely to relapse. This study investigated whether post-quit alcohol use predicted smoking relapse among ex-smokers, and whether this relationship varied by length of smoking abstinence. MethodThe study included 1064 ex-smokers (18+ years) from Canada (n = 340), US (n = 314), England (n = 261), and Australia (n = 149) who participated in the 2018 and 2020 International Tobacco Control Four Country Smoking and Vaping Survey, and we conducted analyses using multivariable logistic regression. We assessed alcohol consumption in 2018 using AUDIT-C and coded as never/low, moderate or heavy level and used alcohol consumption to predict smoking status in 2020. ResultsOverall 26 % and 21 % of ex-smokers consumed alcohol at a moderate and heavy level, respectively. Compared to never/low alcohol consumption, risk of smoking relapse among those who consumed alcohol at a moderate level was significantly lower within the first year of abstinence (OR = 0.34, 95 % CI = 0.14–0.81, p = 0.015) but higher thereafter (OR = 2.44, 95 % CI = 1.13–5.23, p = 0.023). The pattern of results was similar for those who consumed alcohol at a heavy level. ConclusionsOverall, baseline alcohol consumption of ex-smokers did not predict their smoking relapse risk. As expected, risk differed by smoking abstinence duration. However, the pattern was unexpected among the short-term quitters as the subgroup who drank moderately/heavily had lower relapse risk than their counterparts who never drink or at low level, underscoring the need to replicate this unexpected finding.

Abstract Disclosure: L.S. Probst: None. S. Monnerat: None. S. Lengsfeld: None. C. Bathelt: None. A. Meienberg: None. T. Burkard: None. M. Christ-crain: None. B.F. Winzeler: None. Introduction: Alcohol use disorder causes high socio-economic costs and has a detrimental impact on health globally, being considered a key factor contributing to non-communicable diseases. In Switzerland four substances are currently approved for treatment of alcohol use disorder with only limited to moderate effects. Thus, the need for new treatment options in alcohol and substance use disorder is evident. Recent research has shed light on a new potential target for treatment of addiction: a body of preclinical studies provide evidence for the attenuating effects of GLP-1 agonists on addictive behavior in rodents and non-human primates. A few studies have shown a link between GLP-1 receptors and reward related processes in humans, and a trial from denmark examined the effect of exenatide in patients treated for alcohol use disorder, however clinical data are scarce and results remain inconclusive. Methods: This is a secondary analysis of the SKIP study, a double-blind, randomized, placebo-controlled trial to evaluate treatment with the GLP-1 agonist dulaglutide (Trulicy®) as a new therapy for smoking cessation. In the present analysis, the primary objective was to assess differences in alcohol consumption after 12 weeks of treatment with dulaglutide compared to placebo in alcohol-consuming smokers willing to quit smoking. We selected patients out of the cohort (n=255) who consumed alcohol at baseline and completed 12 weeks of treatment (n= 151). The independent effect of dulaglutide on alcohol consumption was analysed by fitting a multivariate generalized linear regression model with quasipoisson distribution and adjustment for baseline alcohol consumption. Preliminary Results: One hundred and fifty-one patients (placebo n=75, dulaglutide n=76) were included in the primary analysis. Baseline patient characteristics were well balanced between groups. The median age was 42 [IQR 33, 53] years with 61% (n=92) females. At baseline, patients in both treatment groups consumed 3 [IQR 2, 7] standard glasses of alcohol per week on average. At week 12, patients in the dulaglutide group drank an estimated 29% (IRR = 0.71; 95% CI 0.52, 0.97; p=0.04) less compared to the placebo group. For each additional glass consumed at baseline, alcohol consumption at week 12 increased by 6% (95% CI 5, 7; p&amp;lt;0.001). Conclusion: These preliminary findings suggest that in patients who drink, alcohol intake tends to increase during smoking cessation. In the present analysis we were able to show that this increase was attenuated by the addition of a 12-week treatment with dulaglutide to standard smoking cessation therapy. Presentation: Thursday, June 15, 2023

The aims of this study were to estimate the rates of regular exercise and its trends among the adult population in Jiangsu, from 2010 to 2018, China, and to assess associations with sociodemographic factors. Chronic disease and risk factor surveillance data from adults aged ≥18 years were gathered in Jiangsu Province from 2010 to 2018. Rates of regular exercise were calculated after post-stratification weighting, and time trends were compared among participants with different characteristics, including gender, age, urban-rural region, educational level, occupation, annual household income, body mass index (BMI), baseline self-reported chronic diseases, smoking status, alcohol consumption, and region. Multivariable logistic regression analyses were performed to assess the associations of sociodemographic characteristics with regular exercise. A total of 33,448 participants aged 54.05 ± 14.62 years and 55.4% female (8,374 in 2010, 8,302 in 2013, 8,372 in 2015, and 8,400 in 2018) were included in this study. The weighted rate of regular exercise was 12.28% (95% confidence interval [CI]: 9.11-15.45%) in 2010 and 21.47% (95% CI, 17.26-25.69%) in 2018, showing an overall increasing trend (P for trend = 0.009). Nevertheless, stratification analysis showed that the regular exercise rate decreased from 33.79% in 2010 to 29.78% in 2018 among retired adults. Significant associations were observed between regular exercise and age >45 years (45- < 60 years, odds ratio [OR]: 1.24, 95% CI: 1.14-1.34; ≥60 years, OR: 1.20, 95% CI: 1.08-1.34), urban residence (OR: 1.43, 95% CI: 1.32-1.54), higher education (primary, OR: 1.30, 95% CI: 1.16-1.46; secondary, OR: 2.00, 95% CI: 1.79-2.25; college or higher, OR: 3.21, 95% CI: 2.77-3.72), occupation (manual work, OR: 1.52, 95% CI: 1.33-1.73; non-manual work, OR: 1.69, 95% CI: 1.54-1.85; not working, OR: 1.22, 95% CI: 1.03-1.44; retired, OR: 2.94, 95% CI: 2.61-3.30), higher income (¥30,000- < ¥60,000, OR: 1.16, 95% CI: 1.06-1.28; ≥¥60,000, OR: 1.20, 95% CI: 1.10-1.32), higher BMI (overweight, OR: 1.12, 95% CI: 1.05-1.20), self-reported chronic disease at baseline (OR: 1.24, 95% CI:1.16-1.33), former smoking (OR: 1.15, 95% CI: 1.01-1.31) and ever (30 days ago) drinking (OR: 1.20, 95% CI: 1.11-1.29). The rate of regular exercise among adults in Jiangsu Province was low, but this rate increased by 9.17% from 2010 to 2018, showing an upward trend. There were differences in the rate of regular exercise among different sociodemographic factors.