Mean Daily Alcohol Intake Research Articles

Association Between Daily Alcohol Intake and Risk of All-Cause Mortality

A previous meta-analysis of the association between alcohol use and all-cause mortality found no statistically significant reductions in mortality risk at low levels of consumption compared with lifetime nondrinkers. However, the risk estimates may have been affected by the number and quality of studies then available, especially those for women and younger cohorts. To investigate the association between alcohol use and all-cause mortality, and how sources of bias may change results. A systematic search of PubMed and Web of Science was performed to identify studies published between January 1980 and July 2021. Cohort studies were identified by systematic review to facilitate comparisons of studies with and without some degree of controls for biases affecting distinctions between abstainers and drinkers. The review identified 107 studies of alcohol use and all-cause mortality published from 1980 to July 2021. Mixed linear regression models were used to model relative risks, first pooled for all studies and then stratified by cohort median age (<56 vs ≥56 years) and sex (male vs female). Data were analyzed from September 2021 to August 2022. Relative risk estimates for the association between mean daily alcohol intake and all-cause mortality. There were 724 risk estimates of all-cause mortality due to alcohol intake from the 107 cohort studies (4 838 825 participants and 425 564 deaths available) for the analysis. In models adjusting for potential confounding effects of sampling variation, former drinker bias, and other prespecified study-level quality criteria, the meta-analysis of all 107 included studies found no significantly reduced risk of all-cause mortality among occasional (>0 to <1.3 g of ethanol per day; relative risk [RR], 0.96; 95% CI, 0.86-1.06; P = .41) or low-volume drinkers (1.3-24.0 g per day; RR, 0.93; P = .07) compared with lifetime nondrinkers. In the fully adjusted model, there was a nonsignificantly increased risk of all-cause mortality among drinkers who drank 25 to 44 g per day (RR, 1.05; P = .28) and significantly increased risk for drinkers who drank 45 to 64 and 65 or more grams per day (RR, 1.19 and 1.35; P < .001). There were significantly larger risks of mortality among female drinkers compared with female lifetime nondrinkers (RR, 1.22; P = .03). In this updated systematic review and meta-analysis, daily low or moderate alcohol intake was not significantly associated with all-cause mortality risk, while increased risk was evident at higher consumption levels, starting at lower levels for women than men.

Identification of harmful drinking in subjects who have had their driving license suspended due to alcohol use: a retrospective Italian study.

Early identification of Harmful Drinking (HD) is difficult, and underestimated. The aim of our retrospective study was to investigate the presence of HD in a population of subjects who had their driving license suspended due to driving under the influence of alcohol. We retrospectively recruited 979 subjects. During the first appointment (T0), clinical and laboratory characteristics of patients were evaluated, and the AUDIT questionnaire was administered. Two groups were then defined: Harmful Drinking (HD) and non-HD, and all subjects underwent a brief interview for 5-10 minutes before being assigned to a group. 95.9% of our sample were identified as non-HD, whereas 4.1% of them were HD; twenty-one (2.1%) of the HD underwent a control appointment (T1), and 17 (1.7%) of them were diagnosed with alcohol use disorder (AUD); there was a statistically significant reduction in mean daily alcohol intake (p<0.009), and in the mean values of the blood markers of HD between T0 and T1 in HD. The present study shows that 4.1%, and 1.7% of subjects presented a diagnosis of HD and AUD, respectively, and their entry in a protocol of drinking monitoring proved beneficial in reducing alcohol intake. Thus, the implementation of strict surveillance of subjects found driving under the influence of alcohol involving a network of professional figures (from police forces to specialists in alcohol addiction treatment) may help to detect and to treat subjects with HD and AUD, and to monitor their alcohol use over time.

Tailored-Dose Baclofen in the Management of Alcoholism: A Retrospective Study of 144 Outpatients Followed for 3 Years in a French General Practice.

Background: More information is needed about the efficacy and safety of long-term baclofen in the treatment of alcohol use disorders. The objective of this study was to assess the effect of treatment with tailored-dose baclofen on alcohol consumption in patients with alcohol use disorders followed for 3 years after first initiating baclofen treatment.Methods: This retrospective descriptive cohort included outpatients followed in a French general practice clinic for 3 years and treated with tailored-dose baclofen to reduce or eliminate alcohol consumption. At 3 years, treatment was considered successful if alcohol consumption was at or below levels defined as low-risk by the WHO (≤ 40 g/d in men and ≤ 20 g/d in women).Results: The study population included 144 patients (88 men and 56 women). The participants' mean age was 46 ± 11 years and mean daily alcohol intake before treatment was 167 ± 77 grams. At the end of the study, treatment was successful for 91 (63.2%) patients. Participants' mean dose of baclofen at the end of study period was 100 ± 101 mg/d. We identified 75 (52.1%) patients for whom treatment was successful at each annual follow-up appointment: at 1, 2, and 3 years. The mean maximum dose of baclofen over follow-up of the 144 patients was 211 ± 99 mg/d (dose range: 40 mg/d to 520 mg/d).Conclusion: In this study, tailored-dose baclofen appears to be an effective treatment in patients with alcohol use disorders, with sustainable effect over time (3 years). There are many adverse effects but they are consistent with those already described in the literature.

Cirrhosis in Hemochromatosis: Independent Risk Factors in 368 HFE p.C282Y Homozygotes

Introduction and aim. We sought to identify independent risk factors for cirrhosis in HFE p.C282Y homozygotes in a cross-sectional study.Material and methods. We evaluated 368 p.C282Y homozygotes who underwent liver biopsy and compared characteristics of those with and without cirrhosis. We performed multivariable logistic regression on cirrhosis with: age; sex; race/ ethnicity; diabetes; blood pints/units donated voluntarily; erythrocyte pints/units received; iron supplement use; alcohol intake, g/d; body mass index, kg/m2; swollen/tender 2nd/3rd metacarpophalangeal joints; elevated alanine aminotransferase; elevated aspartate aminotransferase; steatosis/fatty liver; iron removed by phlebotomy, g; and GNPATp.D519G positivity.Results. Mean age of 368 participants (73.6% men) was 47 ± 13 (standard deviation) y. Cirrhosis was diagnosed in 86 participants (23.4%). Participants with cirrhosis had significantly greater mean age, proportion of men, diabetes prevalence, mean daily alcohol intake, prevalence of swollen/tender 2nd/3rd metacarpophalangeal joints, mean serum ferritin, elevated alanine aminotransferase, elevated aspartate aminotransferase, and mean iron removed; and significantly fewer mean blood pints/units donated. GNPATp.D519G positivity was detected in 82 of 188 participants (43.6%). In a multivariable model for cirrhosis, there were four significant positive associations: age (10-y intervals) (odds ratio 2.2 [95% confidence interval 1.5, 3.3]); diabetes (3.3; [1.1, 9.7]); alcohol intake (14 g alcohol drinks/ d) (1.5 [1.2, 1.8]); and iron removed, g (1.3 [1.2, 1.4]). There was no statistical evidence of two-way interactions between these variables.Conclusion. In conclusion, cirrhosis in HFE p.C282Y homozygotes is significantly associated with age, diabetes, daily alcohol intake, and iron removed by phlebotomy, taking into account the effect of other variables.

Prevalence of alcohol drinking in males aged 20-79 years in China, 2012

Objective: To understand the prevalence of alcohol drinking in 20-79 years old males with different educational backgrounds and smoking behaviors in different areas of China. Methods: A multi-stage cluster random sampling survey was conducted in 150 surveillance sites in 2010-2012 Chinese nutrition and health surveillance in China. At least 1 000 subjects were selected in each surveillance site. Alcohol drinking prevalence and pattern information were collected by using personal health and food frequency questionnaire in face to face interviews. Results: A total of 60 791 males aged 20-79 years were surveyed. The prevalence of alcohol drinking was 57.8% (58.3% in rural area, 57.3% in urban area). The mean daily alcohol intake level was 32.7 g (33.3 g in rural area, 32.1 g in urban area). The rate of almost drinking every day and daily alcohol intake level were highest among males aged 50-59 years. Mean daily alcohol intake level, rate of almost drinking every day and excessive drinking decreased with the increase of education level. Non-smokers had higher rate of never drinking and lower prevalence of drinking and excessive drinking, lower mean daily alcohol intake level, and lower rate of almost drinking every day compared with current and past smokers. Conclusions: Alcohol drinking was common in males aged 20-79 years in China, and, the difference was not obvious between rural residents and urban residents. The differences in daily intake level of different alcohol drinks among males with different characteristics had certain significance. Significant difference in excessive drinking was found among different age groups, those with different education levels and those with different smoking history.

Is Alcohol Drinking Associated with Renal Impairment in the General Population of South Korea?

Background/Aims: We examined relationships between the average amount of daily alcohol intake, drinking patterns, and renal dysfunction among South Korean adultsaged ≥ 20 years. Methods: The analysis used data from the Korean National Health and Nutrition Examination Survey (KNHANES), a cross-sectional survey of Korean civilians, conducted from January to December 2011. In this study, a sample of 5,251 participants was analysed. Results: Compared with abstinence, the odds ratio for a decrease in estimated glomerular filtration rate (eGFR) was 0.14 (95% CI: 0.01-0.91) among heavy drinkers, and 0.42 (95% CI: 0.17-0.98) among binge drinkers and the association between the amount of mean daily alcohol intake, binge-drinking status and a likelihood of reduced eGFR value showed significant trends (p = 0.041 and p = 0.038, respectively), after adjusting for age, smoking status, amount of physical activity, morbid hypertension, diabetes, dyslipidaemia, anaemia and body mass index. There was no significant association between alcohol consumption and the urine albumin to creatinine ratio in men, or between alcohol consumption and renal dysfunction in women. Conclusions: Alcohol consumption was inversely associated with a reduction in eGFR in Korean men. However, these findings should be interpreted cautiously, given the other harmful effects related to alcohol consumption, especially heavy and binge drinking.

Paraduodenal Pancreatitis: An Italian Experience on 112 Patients

Context Paraduodenal pancreatitis (PP) is a special form of chronic pancreatitis, called also groove pancreatitis or cystic dystrophy of the duodenal wall, defined on surgical specimens. Characteristic findings at CT, MR and EUS has been published. Objective to evaluate the clinical and radiological features of PP, and the clinical outcome in a mixed clinical and surgical series. Methods All patients with a final diagnosis of PP in gastroenterology unit and surgical department have been enrolled. Clinical, radiological and pathological data have been collected. The diagnosis was based on surgical specimens in operated patients and on imaging in non operated patients. Results We studied 112 patients (108 males, 4 females; mean age 41.4±10 years), 96.4% of them were drinkers (mean daily alcohol intake: 129.3±65.4 g) and 97.3% smokers (29.2±13.6 cigarettes/day). The clinical onset was acute pancreatitis in 70 patients (63%) and continuous pain in 42 (38%). Other symptoms at onset were vomiting (42 patients, 38%), weight loss (26 patients, 23%) and jaundice (13 patients, 12%). Cystic variant was diagnosed in 79 patients (70%) and solid in 33 (30%). Pure form involving only the groove area was observed in 22 patients (20%) and diffuse form involving all pancreas in 90 (80%). Pancreatic calcifications were diagnosed in 68 patients (61%). Seventy-four patients (70%) underwent surgery, resective in 57 and derivative in 17. The indication for surgery were pain (67 patients, 86%), suspicion of cancer (5 patients, 6%) and duodenal obstruction (6 patients, 8%). Mean follow-up time was 5±7 years. Diabetes was diagnosed in 28% and steatorrhea in 25%. Ten patients (9%) died. Conclusion The clinical profile of PP are middle age males, heavy drinkers and smokers, with painful pancreatitis, associated with vomiting and weight loss. Resective surgery is the treatment of choice in our institution.

Determination of Carbohydrate-deficient Transferrin Levels by Using Capillary Electrophoresis in a Korean Population

Carbohydrate-deficient transferrin (CDT) levels have rarely been determined in an Asian population. We evaluated the analytical performance of a test for measuring CDT levels by using capillary electrophoresis (EP). We determined the precision of CDT measurement by using capillary EP and nephelometry and compared the CDT values obtained using both the methods. We included healthy control subjects, abstinent patients with liver disease, and individuals consuming varying amounts of alcohol. The CDT measurement by using capillary EP were correlated well with those CDT measurement by using nephelometry, N Latex CDT assay, Y=0.5706X+1.581, R=0.930. The results obtained from both methods showed good qualitative agreement with each other (κ coefficient=0.61). Genetic variants of transferrin isoforms were detected in 4.1% of the tested population. Both the CDT and γ-glutamyl transpeptidase (GGT) levels in the abstinent patients with liver disease were significantly higher than those in healthy abstinent individuals (0.9% vs. 0.5%, 109.5 mg/dL vs. 28.5 mg/dL, respectively), but the difference in CDT values in the 2 groups was less pronounced for the CDT values. Individuals who had a mean daily alcohol intake of more than 60 g/day showed significantly higher CDT levels than those who had a mean daily alcohol intake of less than 60 g/day (1.9% vs. 0.7%, P=0.03). The CDT test using capillary EP showed good performance, and this method has several advantages such as automation and detection of variant forms. Thus, CDT can be a more useful marker than GGT for monitoring alcohol abstinence, especially in patients with liver disease.

Alcohol and Atherosclerotic Vascular Disease Risk Factors in French Men: Relationships Are Linear, J-Shaped, and U-Shaped

Although it is well admitted that alcohol displays a U-shaped relationship with atherosclerotic vascular disease, individual relationships between alcohol and atherosclerosis risk factors may be different and have not been determined precisely for several of them. A cross-sectional study within the SU.VI.MAX French cohort study was performed to assess the curve of potential relationships between alcohol and atherosclerosis risk factors in 2126 healthy men. Mean daily alcohol intake was derived from 37 alcoholic beverages in twelve 24-hr dietary recalls. Logistic models were adjusted for age. Apolipoprotein B (ApoB), fasting glucose, body mass index, waist-to-hip ratio, and waist circumference displayed a linear relationship with alcohol. The odds ratios and 95% confidence intervals associated with abnormal values of the markers for the highest quintile of alcohol intake were 1.45 (1.06-1.97) for ApoB, 1.98 (1.40-2.80) for fasting glucose, and 1.74 (1.30-2.34) for body mass index. An inverse J-shaped relationship was assumed for ApoA1 and ApoB/ApoA1 ratio, whereas a U-shaped relationship was observed for serum triglycerides and mixed hyperlipidemia. Only the highest quintile of alcohol was associated with hypertension, although the test for linearity was also significant. No association was observed for Lp(a) or homocysteine. Associations were unmodified by further adjustment for carbohydrates, fiber, lipids, tobacco, or exercise. The aggregate of the disparate alcohol risk factor relationships suggests probable net benefit at 15 to 25 g of alcohol/day.

Body composition changes induced by chronic ethanol abuse: evaluation by dual energy x-ray absorptiometry

OBJECTIVE: Nutritional disorders in alcoholics remain one of the most relevant medical problems in Western societies. As ethanol can supply >50% of the dietary energy in alcoholics, body composition alterations may easily occur. The aim of the present study was to evaluate the influence of chronic alcohol consumption on body composition in alcoholics compared to healthy social drinkers. METHODS: A total of 34 alcoholics defined according to DSM III R criteria, aged 41.6 ± 9.3 yr and with a body mass index (BMI) 23.8 ± 3.2 kg/m 2, were consecutively enrolled in the study. In addition, 43 healthy male social drinkers were used as controls. Body composition was assessed using dual energy x-ray absorptiometry (DXA), and dietary habits were determined by a 3-day food diary. RESULTS: Mean daily alcohol intake was 194 ± 62.4 g/day in alcoholics and 35.7 ± 5.2 in healthy subjects ( p < 0.0001). Body weight did not differ between alcoholics and controls (70.1 ± 9.9 vs 71.8 ± 6.4 kg). Alcoholics had a lower percent body fat (PBF) than control subjects (18.7 ± 3.7 vs 23.9 ± 3.9%; p < 0.01), as well as a lower fat mass content (13.4 ± 3.8 vs 17.0 ± 3.7 kg; p < 0.01). BMI was highly correlated with PBF in the patient population studied (R = 0.79; p < 0.0001). Significantly higher waist-to-hip ratios were found in alcoholics than in healthy subjects ( p < 0.01). No correlation was found between dose of ethanol or duration of alcohol abuse and any of the variables examined. CONCLUSIONS: Alcoholics showed a reduced fat mass and a good preservation of lean body mass with respect to control subjects, and duration of alcohol use and alcohol dose did not seem to influence body composition. These data suggest that, unlike control subjects, alcoholics cannot store the calories provided by ethanol as fat deposits.

Investigation into the Use of Alcohol at Thermal Spas: Can a Spa Represent a Place for Primary Prevention?

Primary prevention is one of the most effective means used nowadays to make the general population aware of most of the problems connected with health, but information campaigns have not yet shown results of alcohol-related problems at thermal spas. The aim of this study was to assess the mean daily alcohol intake (grams/day) in a thermal spa population. The sample was conducted over a 6 month period and consisted of 290 subjects. The mean age was 59.01 years (range 23-89, SD +/-14.20) (150 males and 140 females). All of the subjects underwent a medical examination free of charge and an alcohol case history report. The medical staff working at the spa included two doctors, a biologist, a cardiologist, and a dietician. In the final 176 subjects studied, the mean daily alcohol intake was 32.33 g/day, significantly higher in the males than the females (p < 0.001). The 176 subjects were subsequently divided into three subgroups according to their daily alcohol intake: group A, <40 g/day; group B, 40 to 79 g/day; group C, > or =80 g/day. The number of subjects in group A was significantly greater than in group B and group C (p < 0.001). It is important to emphasize that 33.5% of the subjects studied presented a mean daily alcohol intake of > or =40 g/day and therefore were more exposed to the risk of the onset of alcohol-related problems. In view of these results, thermal spas should thus be considered an additional place in which to identify subjects at risk for problematic use of alcohol and represent an environment in which primary prevention campaigns could be started.

High-performance liquid chromatography improves diagnostic efficiency of carbohydrate-deficient transferrin.

Carbohydrate-deficient transferrin (CDT) is considered a useful biochemical marker of regular high alcohol intake. CDT was measured in the sera of 51 alcohol abusers, 20 patients with non-alcoholic liver disease and 30 healthy controls with an alcohol intake of < 30 g/day. The mean CDT levels of these three groups respectively were determined with high-performance liquid chromatography (HPLC; 4.6 +/- 5.2%; 0.7 +/- 0.2%; 0.7 +/- 0.2%) and with a radioimmunoassay after microcolumn anion-exchange chromatography (MAEC/RIA; 34.2 +/- 26.9 U/l; 16.9 +/- 3.8 U/l; 18.0 +/- 5.7 U/l). CDT levels in patients with severe alcohol abuse (161.6 +/- 96.4 g/day) were significantly higher than in the two other groups under investigation (P < 0.0001). In heavily drinking subjects, the mean daily alcohol intake correlated with aspartate aminotransferase levels (ASAT) but not with the CDT levels determined either with HPLC or MAEC/RIA. With both methods, the CDT levels were slightly higher in patients with an ASAT concentration > 30 U/l, which may indicate an advanced liver damage (P < 0.05). Analysis of receiver-operating characteristic (ROC) plots demonstrated that the diagnostic accuracy of the HPLC method, which determines the relative amount of CDT, was significantly higher than the established MAEC/RIA method, which measures the absolute amount of CDT (area under the ROC curve: 0.95 +/- 0.02 vs 0.73 +/- 0.05; P < 0.0001). At a specificity of > 95%, the sensitivity of CDT determined with HPLC and MAEC/RIA was 80 and 47%, respectively. In addition, HPLC may be a useful and reliable method for the determination of this important biochemical marker, since the HPLC chromatogram is a visible document of the successful isotransferrin separation and measurement.

DOUBLE-BLIND RANDOMIZED MULTICENTRE TRIAL OF ACAMPROSATE IN MAINTAINING ABSTINENCE FROM ALCOHOL

A prospective placebo-controlled, randomized double-blind study of Acamprosate at two dose levels in alcohol-dependent patients followed up for 12 months was performed. After detoxification, each of the 538 patients included was randomly assigned to one of three groups: 177 patients received placebo, 188 received Acamprosate at 1.3 g/day (low dose group) and 173 received 2.0 g/day (high dose group) for 12 months. This was followed by a single blind 6 month period on placebo. The patients' mean age was 43.2 +/- 8.6 years. Their mean daily alcohol intake was high (nearly 200 g/day) and of long duration (9.5 +/- 7.1 years). Abstinence figures followed the order high dose > low dose > placebo. The difference was significant at 6 months (P < or = 0.02) but not at 12 months (P = 0.096). The number of days of continuous abstinence after detoxification was 153 +/- 197 for the high-dose group versus 102 +/- 165 for the placebo group (P = 0.005), with the lose-dose group reporting 135 +/- 189 days. Clinic attendance was significantly better in the Acamprosate groups than in the placebo group at 6 months (P = 0.002) and 12 months (P = 0.005). During the 6-month post-treatment period, no increased relapse rate or residual drug effect was observed. The side effect profile for Acamprosate was good compared with controls with only diarrhoea being reported more frequently (P < 0.01). This study confirms the pharmacological efficacy of Acamprosate and its good acceptability. As an adjunct to psychotherapy, this study supports the inclusion of Acamprosate in a strategy for treating alcoholism.

Anti-HCV antibodies in patients with chronic liver disease and different amounts of alcohol intake

To investigate the association between the mean daily alcohol intake and positivity for serum anti-hepatitis C virus antibodies in patients with chronic liver disease of varying severity. To test the hypothesis that alcohol intake and hepatitis C virus infection have an independent role in determining chronic liver disease. Retrospective study using a multivariate analysis model. In 212 consecutive patients with chronic liver disease, serum anti-hepatitis C virus antibodies were detected using a second-generation test and recombinant immunoblotting assay. The lifetime mean daily alcohol intake was measured by a standardized questionnaire. Patients were subsequently divided according to the histological presence or absence of liver cirrhosis and stratified into progressive categories of alcohol intake. The dose-effect relationship between anti-hepatitis C virus status and mean daily alcohol intake was assessed by a model of unconditional logistic regression, where age, gender, degree of severity of liver disease and chronic hepatitis B virus infection were considered as covariates. There was a strong negative association between the mean daily alcohol intake and the presence of anti-hepatitis C virus antibodies, with odds ratio decreasing down to 0.01 for the category of highest alcohol intake; no association was found for the other variables considered. Our data support the hypothesis that alcohol intake and infection with hepatitis viruses are independent determinants of chronic liver disease.

The impact of gender on clinical characteristics and outcome in alcohol withdrawal

Few studies have compared the social and clinical features of alcoholism for women and men, and none has focused on patients entering treatment for withdrawal. We investigated the role of gender by analyzing the data for 179 patients (34 women, 145 men) who underwent outpatient withdrawal. Our analysis focused on two questions: 1) How do women and men compare in terms of baseline social and clinical features? and 2) Do women and men have similar treatment outcomes in alcohol withdrawal? Baseline sociodemographic features revealed that women were more likely to be poor (90% vs. 71%, p=.03) but less likely to be uninsured (32% vs. 51%, p=.05), homeless (6% vs. 20%, p=.05), or have legal problems (29% vs. 54%, p=.02). Surprisingly, women and men reported a similar mean daily alcohol intake (240g vs. 243g). Women reported a shorter duration of alcohol abuse prior to entering treatment (16.1y vs. 19.1y). Although women experienced a higher treatment failure rate (53% vs. 43%), this difference is not significant. Our analysis highlights gender similarities and differences among patients antering treatment for withdrawal. We conclude that women and men have similar treatment outcomes in the management of alcohol withdrawal.

EVALUATION OF PLASMA CHOLESTERYL ESTER TRANSFER PROTEIN (CETP) ACTIVITY AS A MARKER OF ALCOHOLISM

Plasma cholesteryl ester transfer protein (CETP) activity was measured in 52 alcoholics and 38 controls and compared with conventional laboratory markers of alcoholism. Mean daily alcohol intake was 180 g/day among the alcoholics and 10 g/day among the controls. Plasma CETP activity was 26% lower in the alcoholics (P < 0.001) and was inversely correlated with daily alcohol intake (r = -0.288, P < 0.05). CETP activity detected 63% of the alcoholics, and its specificity was 82% if the cut-off point was set at the mean CETP activity of the controls -1 SD. The mean -2 SD gave a very low sensitivity for CETP (8%) and cannot be used as its cut-off point. The sensitivities and specificities of gamma glutamyltransferase, aspartate aminotransferase, alanine aminotransferase, mean corpuscular volume and high-density lipoprotein cholesterol were similar to those of CETP activity when the cut-off point for CETP was mean -1 SD. The results thus indicate that plasma CETP activity is not sufficient as a single marker of alcoholism but could be used as an additional method to detect alcohol misuse, although its wide variation in normal population and the elaborate analysis limit its usefulness.

Alcoholic liver disease in heterozygotes of mutant and normal aldehyde dehydrogenase-2 genes

To clarify the pathogenetic role of acetaldehyde in the development of alcoholic liver disease, genotyping of aldehyde dehydrogenase-2 genes was performed and the clinical features of the alcoholic liver disease patients with different genotypes were compared. Genotyping of aldehyde dehydrogenase-2 was performed in 47 patients with alcoholic liver disease using the polymerase chain reaction and slot-blot hybridization. Of the 47 patients with alcoholic liver disease, 40 were homozygous for the normal aldehyde dehydrogenase-2 gene and the remaining seven cases were heterozygous for the normal and mutant aldehyde dehydrogenase-2 genes. No homozygote was found for the mutant aldehyde dehydrogenase-2 genes. Daily alcohol intake was less than 100 gm in all heterozygotes without relation to the type of alcoholic liver disease. On the other hand, all but four patients homozygotic for the normal aldehyde dehydrogenase-2 gene drank more than 100 gm alcohol/day. The mean daily alcohol intake in the heterozygotes was significantly lower than that in the normal homozygotes. The incidence of alcoholic fibrosis tended to be lower in the heterozygotes than in the normal homozygotes (14.2% vs. 52.5%). On the other hand, the incidence of alcoholic hepatitis and/or cirrhosis tended to be higher in the heterozygotes than in the normal homozygotes. These results indicate that alcoholic liver disease develops even with moderate amounts of alcohol intake in heterozygotes of the aldehyde dehydrogenase-2 genes, in which acetaldehyde metabolism in the liver is impaired and liver damage in the heterozygotes is more severe than that in the normal homozygotes, suggesting that habitual drinkers who are heterozygotes of the aldehyde dehydrogenase-2 genes may be at high risk for alcoholic liver disease.

The Assessment of Alcohol Consumption by a Simple Self-administered Questionnaire

The authors evaluated the reproducibility and validity of alcohol consumption measured by a mailed, self-administered questionnaire in two large prospective studies. Subsamples of 173 women and 136 men from these cohorts completed two food-frequency questionnaires and multiple 1-week diet records (four for women and two for men) and provided a fasting blood sample. Intakes of alcohol reported over the previous year by food frequency questionnaire 2 correlated highly with intake assessed by multiple week diet records completed over this period (Spearman r = 0.90 in women and 0.86 in men). Mean daily alcohol intake as assessed by the diet records and the questionnaires was very similar. Serum high density lipoprotein cholesterol levels were significantly correlated with alcohol intakes estimated from the questionnaire (r = 0.40 in women and 0.35 in men) and for the diet records (r = 0.33 in women and 0.38 in men). Four years after completing the diet records, women were asked to report their alcohol intake of 4 years earlier; this estimate was highly correlated with the diet records (r = 0.84) and with the earlier high density lipoprotein cholesterol (r = 0.40). These data suggest that a simple self-administered questionnaire can provide useful estimates of alcohol intake over an extended period of time in subjects participating in prospective epidemiologic studies.

Alcohol and new onset atrial fibrillation: a case-control study of a current series.

The aetiological role of alcohol in new onset atrial fibrillation was evaluated in a case-control study of 100 consecutive patients aged 21-64 years. Clinical examination, routine diagnostic tests, and echocardiography revealed an underlying disease or other identifiable factor for atrial fibrillation in 65 patients (group 1); 35 patients had idiopathic atrial fibrillation (group 2). The most common diseases associated with atrial fibrillation were ischaemic heart disease (21%), hypertension (13%), and cardiomyopathy (8%). Data on alcohol consumption were obtained by interviewing the patients and their age and sex matched controls on admission. The mean daily alcohol intake of group 2 patients during the week preceding atrial fibrillation was significantly larger than that of either controls or group 1 patients. Compared with controls significantly more patients in both groups with atrial fibrillation had consumed alcohol within two days of the onset of the arrhythmia. Significantly more patients had onset of arrhythmia on Wednesday, Thursday, or Friday than on any other weekday, including patients with high alcohol intake. This study establishes alcohol as an important precipitating factor for new onset atrial fibrillation.

Nature of questionnaire options affects estimates of alcohol intake.

To estimate the degree of underreporting of alcohol consumption caused by questionnaire options for the frequency and quantity of drinking, two questionnaires (one oriented toward light alcohol consumption and the other toward heavy consumption) were administered to each of 86 patients (13 women) admitted for withdrawal treatment. The estimated mean daily alcohol intake was 137 g of absolute alcohol as measured by the "light" questionnaire and 302 g as measured by the "heavy" one. The Spearman correlation coefficient between individual mean intakes recorded by the two questionnaires was .58, indicating some influence on the rank ordering of drinkers. The intake estimate based on the heavy questionnaire correlated better with the number of drinks needed to overcome the subjective feelings of hangover than did the estimate based on the light questionnaire. A good deal of the underreporting commonly found in general population surveys might be related to the nature of questionnaire options. More detailed options for heavy intake might reveal previously unnoticed correlations between alcohol intake and various health hazards.