Drinking and its relation to smoking, BP, blood lipids, and uric acid. The Framingham study

The longitudinal associations between trajectory of and quantity of alcohol consumption and subsequent changes in blood pressure levels among non-hypertensive adults

Given the dynamic characteristic of an individual's drinking behaviours, comprehensive consideration of alcohol consumption variation using repeated measures may improve insight into the nature of its association with blood pressure (BP) change. We examined the association between longitudinal alcohol consumption (trajectory and quantity) and changes in BP and pulse pressure (PP) among Korean aged ≥ 40 years living in rural areas. Totally, 1682 hypertension-free participants who completed all three health examinations (median, 5·3 years) were included. All three visits were used to determine the cumulative trajectory of and quantity of alcohol consumption and the latest two visits and the last visit were used for the recent trajectory and the most recent quantity of alcohol consumption, respectively. Changes in BP and PP from the baseline to the third visit were used as outcome. In men, ≥30 ml/d cumulative average alcohol consumption was associated with the greatest increase in systolic BP (SBP) in both baseline outcome-unadjusted (2·9 mmHg, P = 0·032) and -adjusted models (3·6 mmHg, P = 0·001), and the given association for the most recent alcohol consumption was observed in the baseline outcome-adjusted model (3·9 mmHg, P = 0·003). For PP, similar associations were observed only in the baseline outcome-adjusted model. No meaningful associations in diastolic BP in men and any BP or PP in women existed. The quantity of alcohol consumption rather than the trajectory may be significantly related to raised SBP, and a possible short-term influence of the most recent alcohol consumption may exist when baseline SBP is adjusted in men.

Role of asymptomatic hyperuricemia in the progression of chronic kidney disease and cardiovascular disease

Previous research has investigated whether hyperuricemia serves as an independent risk factor for cardiovascular and renal diseases. Hyperuricemia is defined as an abnormally high level of uric acid (UA; i.e., serum urate level > 6.8 mg/dL). Hyperuricemia has been considered a complication of chronic kidney disease (CKD). However, it seems to play a pathogenic role in the progression of renal diseases. There has been increasing focus on the link between hyperuricemia and CKD. The results of randomized controlled trials have implied independent associations between hyperuricemia and the progression of cardiovascular and renal morbidities. These associations may be mediated by renin-angiotensin system activation, nitric oxide synthase inhibition, and macrovascular/microvascular disease development. There remains controversy regarding the use of serum UA level as an indirect index of renal vascular disease. This literature review focuses on the role of asymptomatic hyperuricemia in the progression of CKD, as well as the association between hyperuricemia and cardiovascular disease. It also provides a general overview of the physiological metabolism of UA.

Prevalence of and risk factors for high-altitude hyperuricaemia in Bai individuals: a cross-sectional study

OBJECTIVE

Hyperuricaemia is common in Bai individuals; however, its prevalence remains unclear. This work aimed to investigate high-altitude hyperuricaemia prevalence and risk factors in Bai individuals.

METHODS

All eligible participants of Bai ethnicity (aged ≥18 years and undergoing routine medical examination at the People's Hospital of Jianchuan County between January and December 2019) were consecutively enrolled. Demographic and laboratory data were collected to investigate hyperuricaemia prevalence and associated risk factors.

RESULTS

A total of 1393 participants were assessed, comprising 345 (24.8%) with hyperuricaemia showing a male predominance (287/865 [33.2%] males versus 58/528 [11.0%] females). Hyperuricaemia prevalence was significantly higher in participants aged ≥50 years (100/332 [30.1%]) versus those aged 30-40 years (59/308 [19.2%]), and in overweight/obese individuals compared with those showing an underweight or normal body mass index (BMI; 267/885 [30.2%] versus 78/508 [15.4%]). Finally, haemoglobin concentrations and serum uric acid levels were positively correlated.

CONCLUSION

Besides traditional risk factors, including age, sex and BMI, polycythaemia due to prolonged exposure to high altitude may also cause hyperuricaemia in Bai individuals residing in Yunnan Province.

Hyperuricemia and Its Associated Factors Among Adult Staff Members of the Ethiopian Public Health Institute, Ethiopia

Background

Hyperuricemia is related not only to an increased risk of gouty arthritis but also to an increased risk of cardiovascular diseases, resistant hypertension, insulin resistance and progression of type 2 diabetes mellitus. However, to the best of our knowledge, the prevalence of hyperuricemia and its associated factors have rarely been assessed in Ethiopian populations. Therefore, this study aimed to determine the prevalence of hyperuricemia and its associated factors among adult staff members of the Ethiopian Public Health Institute.

Methods

An institution-based cross-sectional study was conducted from July 1 to October 28, 2018. A total of 402 study participants were selected using a simple random sampling technique. An interviewer-administered questionnaire was used to collect the data. A blood sample of approximately 5 mL was collected from each study participant after overnight fasting through standardized methods for biochemical tests, and analyses were carried out with an automated COBAS 6000 analyzer. Data analysis was performed by SPSS version 20 software. The factors associated with the outcome variable were identified by bivariable and multivariable logistic regression analyses, and a p value <0.05 was used to declare statistical significance.

Results

The mean age of the study participants was 37.13±10.5 (mean ± SD), and 51.5% of the participants were male. The overall prevalence of hyperuricemia (>5.7 mg/dL for females and >7 mg/dL for males) was found to be 31.0%. The multivariable logistic analysis revealed that age (AOR=1.59, 95% CI 1.01–2.78), sex (AOR=1.66, 95% CI 1.02–2.70), cigarette smoking (AOR=2.05, 95% CI 1.01–4.19) and serum low-density lipoprotein (LDL) (AOR=1.70, 95% CI 1.01–2.87) were significantly associated with hyperuricemia.

Conclusion

The prevalence of hyperuricemia was relatively high compared to similar studies. Early screening for hyperuricemia in the general population, especially in those who are smokers, of older age and with high serum LDL levels, is vital to control its adverse effects at an early stage.

Association of Alcohol Intake With Hypertension in Type 2 Diabetes Mellitus: The ACCORD Trial

Background Heavy alcohol consumption has a well-established association with hypertension. However, doubt persists whether moderate alcohol consumption has a similar link. This relationship is not well-studied in patients with diabetes mellitus. We aimed to describe the association of alcohol consumption with prevalent hypertension in participants in the ACCORD (Action to Control Cardiovascular Risk in Diabetes) trial. Methods and Results Alcohol consumption was categorized as none, light (1-7 drinks/week), moderate (8-14 drinks/week), and heavy (≥15 drinks/week). Blood pressure was categorized using American College of Cardiology/American Heart Association guidelines as normal, elevated blood pressure, stage 1 hypertension, and stage 2 hypertension. Multivariable logistic regression was used to explore the association between alcohol consumption and prevalent hypertension. A total of 10 200 eligible participants were analyzed. Light alcohol consumption was not associated with elevated blood pressure or any stage hypertension. Moderate alcohol consumption was associated with elevated blood pressure, stage 1, and stage 2 hypertension (odds ratio [OR], 1.79; 95% CI, 1.04-3.11, P=0.03; OR, 1.66; 95% CI, 1.05-2.60, P=0.03; and OR, 1.62; 95% CI, 1.03-2.54, P=0.03, respectively). Heavy alcohol consumption was associated with elevated blood pressure, stage 1, and stage 2 hypertension (OR, 1.91; 95% CI, 1.17-3.12, P=0.01; OR, 2.49; 95% CI, 1.03-6.17, P=0.03; and OR, 3.04; 95% CI, 1.28-7.22, P=0.01, respectively). Conclusions Despite prior research, our findings show moderate alcohol consumption is associated with hypertension in patients with type 2 diabetes mellitus and elevated cardiovascular risk. We also note a dose-risk relationship with the amount of alcohol consumed and the degree of hypertension.

Association between alcohol consumption and hypertension in Chinese adults: Findings from the CHNS

OBJECTIVES

To obtain information about alcohol consumption (henceforth "drinking") among Chinese adults from 1991 to 2011, and to explore the association between drinking behavior and hypertension.

METHODS

According to the longitudinal data obtained in the China Health and Nutrition Survey (1991-2011), 50,013 records of 12,577 adults were selected by applying eligibility criteria. The chi-test was employed to explore the association between drinking and hypertension, by considering the frequency of drinking, daily alcohol intake, alcohol type, and the prevalence of hypertension. A multilevel logistic regression model was used to analyze the longitudinal association between drinking frequency and the prevalence of hypertension.

RESULTS

The prevalence of hypertension was higher in participants with a high drinking frequency than in those with a low drinking frequency among both males and females (p < 0.001). A step increase in daily alcohol intake was not associated with any obvious changes in the prevalence of hypertension in males, but the prevalence in each drinking group was higher than that in the nondrinking group, the prevalence of hypertension in females was lowest among those with a daily alcohol intake below 15 g. The types of alcohol consumed differed significantly between males and females (p < 0.001). Longitudinal analysis results showed that compared with the nondrinking group, drinking frequency ≤2 times/week was positively correlated with hypertension in both males (OR = 1.51, 95% CI = 1.26-1.82, p < 0.001) and females (OR = 1.67, 95% CI = 1.08-2.58, p < 0.05) after adjusting for covariates, meanwhile, the same positive correlation also occurred in males with drinking frequency >2 times/week (OR = 2.13, 95% CI = 1.77-2.56, p < 0.05), the risk of hypertension increased with the increase in drinking frequency.

CONCLUSIONS

Drinking can increase the prevalence of hypertension in Chinese males and females. From the analysis results of longitudinal data, drinking alcohol is still an important risk factor for hypertension among Chinese subjects, especially those who drink with high frequency.

AHRR Methylation is a Significant Predictor of Mortality Risk in Framingham Heart Study

Background.-The ability to predict mortality is useful to clinicians, policy makers and insurers. At the current time, prediction of future mortality is still an inexact process with some proposing that epigenetic assessments could play a role in improving prognostics. In past work, we and others have shown that DNA methylation status at cg05575921, a well-studied measure of smoking intensity, is also a predictor of mortality. However, the exact extent of that predictive capacity and its independence of other commonly measured mortality risk factors are unknown. Objective.-To determine the capacity of methylation to predict mortality. Method.-We analyzed the relationship of methylation at cg05575921 and cg04987734, a recently described quantitative marker of heavy alcohol consumption, to mortality in the Offspring Cohort of the Framingham Heart Study using proportional hazards survival analysis. Results.-In this group of participants (n = 2278) whose average age was 66 ± 9 years, we found that the inclusion of both cg05575921 and cg04987734 methylation to a base model consisting of age and sex only, or to a model containing 11 commonly used mortality risk factors, improved risk prediction. What is more, prediction accuracy for the base model plus methylation data was increased compared to the base model plus known predictors of mortality (CHD, COPD, or stroke). Conclusion.-Cg05575921, and to a smaller extent cg04987734, are strong predictors of mortality risk in older Americans and that incorporation of DNA methylation assessments to these and other loci may be useful to population scientists, actuaries and policymakers to better understand the relationship of environmental risk factors, such as smoking and drinking, to mortality.

Interaction between gender and uric acid on hemoglobin A1c in community-dwelling persons

INTRODUCTION

Higher glycated hemoglobin (Hb) (HbA1c) is significantly associated with an increased risk of cardiovascular disease (CVD). Serum uric acid (SUA) levels are associated with glucose intolerance and type 2 diabetes. Whether gender-specific differences regarding the relationship between SUA levels and HbA1c exist is unknown.

AIM

We recruited 1636 (men, 696 aged of 70 ± 10 years; women, 940 aged of 70 ± 9 years) participants and enrolled in the study during their annual health examination from a single community. We investigated the association between SUA levels and HbA1c within each gender.

RESULTS

Multiple linear regression analysis showed that in men, SUA (β = -0.091, p = 0.014) with prevalence of antidiabetic medication (β = 0.428, p < 0.001) and eGFR (β = 0.112, p = 0.016) were significantly and negatively associated with HbA1c, and in women, SUA (β = 0.101, p = 0.002) with prevalence of antidiabetic medication (β = 0.458, p < 0.001) were significantly and positively associated with HbA1c. Moreover, the interaction between gender and SUA (β = 0.445, p < 0.001) as well as gender (β = -0.465, p < 0.001), prevalence of antidiabetic medication (β = 0.444, p < 0.001), eGFR_CKDEPI (β = 0.074, p = 0.014), and SUA (β = -0.356, p < 0.001) was a significant and independent determinant of HbA1c. A significant interactive effect of gender and SUA on determinants of HbA1c was noted in patients not on antidiabetic medications, regardless of age, HbA1c, and renal function.

CONCLUSIONS

The interaction between gender and SUA was associated with HbA1c independent of other metabolic factors in community-dwelling persons.

Baseline and changes in serum uric acid independently predict glucose control among community-dwelling women

BACKGROUND

Elevated serum uric acid (SUA) levels are associated with glucose control. However, whether baseline and changes in SUA predict long-term follow-up glucose control [e.g., glycated hemoglobin (HbA1c)] remains unclear.

METHODS

The subjects comprised 393 women aged 71 ± 8 years and 279 men aged 71 ± 10 years from a rural village. We have identified participants who underwent a similar examination 11 years prior, and subjects were divided into four groups based on the tertiles of baseline and changes in SUA, and examined the relationship between baseline and changes in SUA, and glucose control evaluated by follow-up HbA1c after 11-years.

RESULTS

In both genders, follow-up SUA were significantly higher in Group 4 (i.e., women: Group 4, baseline SUA ≥ 4.0 mg/dL and changes in SUA ≥ 0.8 mg/dL; men: Group 4, ≥ 5.3 mg/dL and ≥ 0.4 mg/dL) than in the other Groups, but eGFR was significantly lower. Only in women, there were significant differences among the four groups regarding follow-up HbA1c, and follow-up HbA1c was highest in Group 4. In addition, the interaction between baseline and changes in SUA (F = 5.391, p = 0.021) as well as baseline low-density lipoprotein cholesterol (LDL-C) (F = 13.793, p < 0.001), estimated glomerular filtration ratio (F = 10.715, p = 0.001), HbA1c (F = 118.285, p < 0.001), SUA (F = 9.457, p = 0.002), and changes in SUA (F = 7.757, p = 0.006) was a significant and independent determinant of follow-up HbA1c. Multivariate-adjusted follow-up HbA1c (p = 0.002) were significantly higher in Group 4 than the other groups.

CONCLUSIONS

These results suggested that combined assessment of baseline and changes in SUA provides increased information for long-term predictive glucose control, independent of other confounding factors in community-dwelling women.

Effects of alcohol consumption on blood pressure in hypertensive women

BACKGROUND

Problem drinking carries significant health burdens, including an increased risk of hypertension. The effect of chronic alcohol intake on blood pressure (BP) in women is understudied and poorly understood.

OBJECTIVES

We sought to examine the relationships between drinking habits and BP in hypertensive women.

METHODS

We analyzed drinking habits in 113 women followed in the Brigham and Women's Hospital Hypertension Clinic for at least one year.

RESULTS

Among these women with well-controlled hypertension, baseline diastolic BP was significantly lower in moderate drinkers compared with women who rarely or never drank. Changes in both systolic and diastolic BP over 12 months showed a significant negative association with changes in percent drinking days. In contrast, there was a trend toward higher baseline systolic BP among those women who consumed more drinks per drinking day.

CONCLUSIONS

Among these women with controlled hypertension, our data failed to demonstrate an association between drinking beyond recommended limits and higher disease burden. These findings parallel the widely reported difference between drinking frequency, associated with a host of positive health outcomes, and drinking intensity, associated with negative outcomes. Novel to this report is an observed reduction in blood pressure over the one-year follow-up period accompanying an increased drinking frequency in treated hypertensive women. Cautions include the suggestion that a greater number of drinks per drinking day was associated with higher baseline pressure. These data imply that drinking within sensible limits has no negative impact on chronic hypertension. In fact, for women with well-controlled hypertension, such a habit may impart benefit.

Sex-specific Relationship of Serum Uric Acid with All-cause Mortality in Adults with Normal Kidney Function: An Observational Study

OBJECTIVE

To explain the clinical effect of serum uric acid (SUA) levels as a risk factor for mortality, considering exclusion of kidney function.

METHODS

Participants aged over 40 years who underwent health checkups were recruited. Individuals with estimated glomerular filtrations rates < 60 ml/min/1.73 m² and who received laboratory study and colonoscopy on the same day were excluded.

RESULTS

SUA levels were higher in men than in women (5.7 ± 1.2 mg/dl for men and 4.2 ± 0.9 mg/dl for women, p < 0.001). During 12.3 ± 3.6 years of followup, 1402 deaths occurred among 27,490 participants. About 6.9% of men and 3.1% of women died. The overall mortality rate had a U-shaped association with SUA levels, a U-shaped association in men, and no association in women. There was a significant interaction of sex for the SUA-mortality association (p for interaction = 0.049); therefore, survival analysis was conducted by sex. In men, the lower SUA group had a higher mortality rate after adjustment (SUA ≤ 4.0 mg/dl, adjusted HR 1.413, 95% CI 1.158-1.724, p = 0.001) compared with the reference group (SUA 4.1-6.0 mg/dl). A higher SUA contributed to an insignificant increased mortality in men (> 8.0 mg/dl, adjusted HR 1.140, 95% CI 0.794-1.636, p = 0.479). Women failed to show any significant association between SUA and mortality.

CONCLUSION

This study provided novel evidence that SUA-mortality association differed by sex. We demonstrated that a lower SUA was an independent risk factor for all-cause mortality in men with normal kidney function.

Benchmark dose of alcohol consumption for development of hyperuricemia in Japanese male workers: An 8-year cohort study

BACKGROUND

To estimate the benchmark dose (BMD) and their 95% lower confidence limits (BMDL) of alcohol consumption as the reference level for the development of hyperuricemia based on the dose-response relationship.

METHODS

An 8-year prospective cohort study was conducted in 8097 male workers at a Japanese steel company who received annual health check-ups between 2002 and 2009. The endpoints for development of hyperuricemia were defined as a uric acid ≥7 mg/dL or taking any anti-hyperuricemic medication. The dose-response relationship of alcohol consumption was investigated using multivariate-pooled logistic regression analyses adjusted for other potential covariates. We estimated the BMD and BMDL of alcohol consumption for the development of hyperuricemia, using the parameters obtained by pooled logistic regression with a benchmark response (BMR) of 5% or 10%.

RESULTS

Mean observed years per person was 3.86 years. The incidence rate per 1000 person-years was 61.1. The odds ratio calculated for the development of hyperuricemia was 1.29 [95% confidence interval, (1.22-1.36)] with an increase in alcohol consumption per 1 gou/day (1 gou/day = alcohol 22 g/day). The estimated BMDL/BMD with a BMR of 5% was 2.5/2.8 gou/day (54.5/61.8 g/day) and with a BMR of 10% was 4.0/4.6 gou/day (88.9/100.9 g/day).

CONCLUSIONS

The present study showed that alcohol consumption of 2.5 gou/day (=ethanol 55 g/day) caused a distinct increase in the risk of hyperuricemia. Valuable information for preventing alcohol-induced hyperuricemia was obtained by a long-term follow-up study of a large cohort.

Association of alcohol consumption pattern with risk of hypertension in Korean adults based on the 2010-2012 KNHANES

We examined the association between alcohol-drinking pattern and hypertension in Korean adults. This cross-sectional study included 15,052 participants (7054 men and 7998 women) who were included in the 2010-2012 Korean National Health and Nutrition Examination Survey (KNHANES). We categorized alcohol-drinking patterns into three groups based on the Alcohol Use Disorders Identification Test (AUDIT) score: low-risk (score: 0-7), intermediate-risk (score: 8-14), and high-risk (score: ≥15). Hypertension was defined as systolic blood pressure ≥140 mm Hg, diastolic blood pressure ≥90 mm Hg, or current use of anti-hypertensive medications. In the study population, 25.2% of men and 4.6% of women were high-risk drinkers. Hypertension prevalence was 30.8% in men and 20.6% in women. Of the total population, 13.8% of men and 13.6% of women were using anti-hypertensive drugs. Age-adjusted hypertension prevalence was 30.8, 40.9, and 45.3% in men, and 24.6, 27.0, and 32.3% in women in the low-, intermediate-, and high-risk drinking group, respectively. Compared to the low-risk drinking group, the prevalence ratio (95% confidence interval [CI]) for hypertension was 1.664 (1.4331.933) and 2.070 (1.772-2.418) for men and 1.012 (0.774-1.323) and 1.650 (1.080-2.522) for women in the intermediate- and high-risk drinking group, respectively, after adjusting for age and other confounding factors. In conclusion, our study suggests high-risk drinking appears to be associated with a higher risk of hypertension in men and women.

Serum Uric Acid Is Positively Associated with Handgrip Strength among Japanese Community-Dwelling Elderly Women

Serum uric acid (UA) has strong anti-oxidant properties. Muscle strength and mass decrease with age, and recently, this decrease has been defined as sarcopenia. Sarcopenia may be triggered by oxidative stress. We investigated whether serum UA is associated with handgrip strength (HGS), which is a useful indicator of sarcopenia, among Japanese community-dwelling elderly persons. The present study included 602 men aged 72 ± 7 years and 847 women aged 71 ± 6 years from a rural village. We examined the cross-sectional relationship between serum UA and HGS. In both genders, HGS increased significantly with increased serum UA levels. A multiple linear regression analysis using HGS as an objective variable and various confounding factors as explanatory variables showed that in men age, drinking status, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and estimated glomerular filtration ratio (eGFRCKDEPI) were independently and significantly associated with HGS, and in women, serum UA as well as age, body mass index, drinking status, diastolic blood pressure, and eGFRCKDEPI were independently and significantly associated with HGS. In women, age and multivariate-adjusted HGS were significantly higher in the Quartile-3 (4.8-5.4 mg/dL) and Quartile-4 groups (5.5-9.3 mg/dL) of serum UA than in the lower groups (0.7-4.7 mg/dL). These results suggest that serum UA may have a protective role in aging-associated decline in muscle strength in community-dwelling elderly women.

Hyperuricaemia in patients with type 2 diabetes in a tertiary healthcare centre in sub-Saharan Africa: prevalence and determinants

Hyperuricaemia in type 2 diabetes mellitus (T2DM) has been less well investigated in sub-Saharan Africans. Our study of 438 patients found that alcohol intake, body mass index ≥25 kg/m², hydrochlorothiazide use, statin use, diabetic retinopathy and glomerular filtration rate <60 mL/min/1.73m² were independently positively associated with hyperuricaemia; whereas smoking reduced this risk. Hyperuricaemia is strongly associated with some modifiable factors, diabetic complications and certain drugs. Our results suggest that further studies should evaluate the potential cost-benefit of screening for hyperuricaemia in type 2 diabetes.

Global epidemiology of gout: prevalence, incidence and risk factors

Gout is a crystal-deposition disease that results from chronic elevation of uric acid levels above the saturation point for monosodium urate (MSU) crystal formation. Initial presentation is mainly severely painful episodes of peripheral joint synovitis (acute self-limiting 'attacks') but joint damage and deformity, chronic usage-related pain and subcutaneous tophus deposition can eventually develop. The global burden of gout is substantial and seems to be increasing in many parts of the world over the past 50 years. However, methodological differences impair the comparison of gout epidemiology between countries. In this comprehensive Review, data from epidemiological studies from diverse regions of the world are synthesized to depict the geographic variation in gout prevalence and incidence. Key advances in the understanding of factors associated with increased risk of gout are also summarized. The collected data indicate that the distribution of gout is uneven across the globe, with prevalence being highest in Pacific countries. Developed countries tend to have a higher burden of gout than developing countries, and seem to have increasing prevalence and incidence of the disease. Some ethnic groups are particularly susceptible to gout, supporting the importance of genetic predisposition. Socioeconomic and dietary factors, as well as comorbidities and medications that can influence uric acid levels and/or facilitate MSU crystal formation, are also important in determining the risk of developing clinically evident gout.

Análise de hábitos nocivos à saúde entre pacientes com lesões bucais

Objetivo Propõe-se identificar a prevalência dos hábitos tabagistas e etilistas entre pacientes diagnosticados com lesões bucais, assim como possíveis fatores associados. Material e método Estudo analítico, de caráter retrospectivo, entre pacientes assistidos por clínica odontológica universitária na área de Diagnóstico Bucal. Foram analisados os prontuários odontológicos e laudos histopatológicos dos pacientes que realizaram o procedimento de biópsia entre fevereiro de 2010 e julho de 2012. As variáveis dependentes – hábitos nocivos à saúde – foram construídas pelas informações referentes aos hábitos tabagistas e etilistas então atuais ou passados. Utilizou-se o software SPSS 19.0. Foram conduzidas análises descritivas e univariada pelo teste qui-quadrado de Pearson (p≤0,05). A normalidade da amostra foi investigada pelo teste Kolmogorov-Smirnov e Shapiro-Wilk (p<0,05). Resultado Dos 125 pacientes atendidos no período de avaliação, 110 foram incluídos. A presença de hábitos tabagistas e etilistas – então atuais ou passados – foi identificada em 42 (38,2%) e 21 (19,1%) pacientes, respectivamente. Na análise univariada, as variáveis estatisticamente significantes (p≤0,05) associadas ao hábito tabagista foram: sexo, faixa etária, tipo de biópsia e diagnóstico histopatológico. Quanto ao hábito etilista, as variáveis foram: sexo e tipo de biópsia. Conclusão Os hábitos tabagistas e etilistas estiveram ou permaneceram presentes na vida de uma parcela significativa dos indivíduos investigados, que desenvolveram lesões bucais. Nota-se, ainda, quão relevante é o sinergismo de ambos no desenvolvimento de tais lesões.

Causal associations of tobacco smoking with cardiovascular risk factors: a Mendelian randomization analysis of the HUNT Study in Norway

BACKGROUND

Tobacco smoking has been associated with cardiovascular risk factors including adverse serum lipid levels, central obesity and higher resting heart rate, but lower blood pressure and body mass index (BMI). We used a Mendelian randomization approach to study whether these associations may be causal. If smoking affects cardiovascular risk factors then rs1051730 T alleles, predictors of increased smoking quantity, should be associated with cardiovascular risk factors among smokers, but not among never smokers.

METHODS

Among 56,625 participants of a population-based study, we estimated associations of rs1051730 T alleles with cardiovascular risk factors and examined whether the associations differed by smoking status.

RESULTS

Rs1051730 T alleles were associated with lower BMI and waist and hip circumferences and higher resting heart rate and estimated glomerular filtration rate (eGFR), and the associations were strongest among current smokers (P interaction 5×10(-9) to 0.01). Rs1051730 T alleles were associated with lower systolic blood pressure and pulse pressure and higher HDL cholesterol concentrations, but these associations did not robustly differ by smoking status. There were no convincing associations of rs1051730 T alleles with waist-hip ratio, diastolic blood pressure and non-fasting serum concentrations of non-HDL cholesterol, triglycerides, glucose and C-reactive protein.

CONCLUSIONS

This Mendelian randomization analysis provides evidence that smoking may cause lower BMI and waist and hip circumferences and higher resting heart rate and eGFR. The findings further suggest that smoking is not a major determinant of waist-hip ratio or adverse blood pressure, serum lipid or glucose levels.

Alcohol-induced hypertension: Mechanism and prevention

Epidemiological, preclinical and clinical studies established the association between high alcohol consumption and hypertension. However the mechanism through which alcohol raises blood pressure remains elusive. Several possible mechanisms have been proposed such as an imbalance of the central nervous system, impairment of the baroreceptors, enhanced sympathetic activity, stimulation of the renin-angiotensin-aldosterone system, increased cortisol levels, increased vascular reactivity due to increase in intracellular calcium levels, stimulation of the endothelium to release vasoconstrictors and loss of relaxation due to inflammation and oxidative injury of the endothelium leading to inhibition of endothelium-dependent nitric oxide production. Loss of relaxation due to inflammation and oxidative injury of the endothelium by angiotensin II leading to inhibition of endothelium-dependent nitric oxide production is the major contributors of the alcohol-induced hypertension. For the prevention of alcohol-induced hypertension is to reduce the amount of alcohol intake. Physical conditioning/exercise training is one of the most important strategies to prevent/treat chronic alcohol-induced hypertension on physiological basis. The efficacious pharmacologic treatment includes the angiotensin-converting enzyme (ACE) inhibitors or angiotensin II type 1 receptor blockers (ARBs) which have antioxidant activity and calcium channel blockers. The most effective prevention and treatment of alcohol-induced hypertension is physical exercise and the use of ACE inhibitors or ARBs in the clinic

Relationship between obesity in Korean adolescents and the frequency of alcohol consumption, the amount of alcohol consumed, and the frequency of severe alcohol intoxication

SUMMARY

The purpose of this study is to determine whether the frequency of alcohol consumption, the amount of alcohol consumed, and the frequency of severe alcohol intoxication are related with obesity in Korean adolescents. In 2009, 72,399 students from the 7th to 12th grades participated in the 5th Korea Youth Risk Behavior Web-based Survey (KYRBWS-V) project. Multiple logistic regression analyses were used to assess whether body mass index (BMI) was associated with the frequency of alcohol consumption, the amount of alcohol consumed, and the frequency of severe alcohol intoxication, after controlling for covariate variables such as age, parent's education level, household economic status, frequency of vigorous and moderate physical activities, and frequency of muscular strength exercises during the week, sedentary lifestyle during the week, mental stress, and sleep duration. No relationship was observed between the frequency of alcohol consumption and body weight in adolescents. However, for boys, the odds ratio (95% confidence interval [CI]) between becoming overweight and the amount of alcohol consumed was 0.678 (range, 0.534-0.862; p = 0.002) for 2 to <3 bottles of beer and 0.810 (range, 0.674-0.973; p = 0.025) for 3 to <4 bottles of beer. The odds ratio (95% CI) between becoming obese and the amount of alcohol consumed was 0.794 (range, 0.653-0.964; p = 0.020) for 3 to <4 bottles of beer and that between becoming obese and the frequency of severe alcohol intoxication was 0.758 (range, 0.598-0.959; p = 0.021) when alcohol was consumed 1-2 times per month. For girls, the odds ratio (95% CI) between becoming overweight and the amount of alcohol consumed was 0.752 (range, 0.579-0.978; p = 0.033) for 3 to <4 bottles of beer and that between becoming obese and the amount of alcohol consumed was 1.753 (range, 1.033-2.972; p = 0.037) for ≥4 bottles of beer. We conclude that there is no relationship between the frequency of alcohol consumption and becoming overweight or obese. Although weight gain and obesity in boys and girls due to moderate consumption of alcohol are less prevalent, high alcohol consumption can increase weight gain in girls.:

Serum uric acid is more strongly associated with impaired fasting glucose in women than in men from a community-dwelling population

Serum uric acid (SUA) levels are associated with metabolic syndrome (MetS) and its components such as glucose intolerance and type 2 diabetes. It is unknown whether there are gender-specific differences regarding the relationship between SUA levels, impaired fasting glucose (IFG) and newly detected diabetes. We recruited 1,209 men aged 60±15 (range, 19–89) years and 1,636 women aged 63±12 (range, 19–89) years during their annual health examination from a single community. We investigated the association between SUA levels and six categories according to fasting plasma glucose (FPG) level {normal fasting glucose (NFG), <100 mg/dL; high NFG-WHO, 100 to 109 mg/dL; IFG-WHO, 110 to 125 mg/dL; IFG-ADA, 100 to 125 mg/dL; newly detected diabetes, ≥126 mg/dL; known diabetes} SUA levels were more strongly associated with the different FPG categories in women compared with men. In women, the associations remained significant for IFG-WHO (OR, 1.23, 95% CI, 1.00–1.50) and newly detected diabetes (OR, 1.33, 95% CI, 1.03–1.72) following multivariate adjustment. However, in men all the associations were not significant. Thus, there was a significant interaction between gender and SUA level for newly detected diabetes (P = 0.005). SUA levels are associated with different categories of impaired fasting glucose in participants from community-dwelling persons, particularly in women.

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

BACKGROUND AND AIMS

Since there is little information derived from prospective studies on the amount of alcohol drinking required to induce hyperuricaemia, we attempted to address this issue in a Japanese population.

METHODS AND RESULTS

A total of 3310 Japanese men aged 20-54 years that were free of hyperuricaemia were classified according to their alcohol intake per week at baseline. Incident hyperuricaemia, defined as >7.0 mg/dl and/or taking medication for hyperuricaemia, was assessed through annual heath examinations for 6 years after the baseline examination. During follow-up, 529 incident cases of hyperuricaemia occurred. There was a positive, dose-response relationship between alcohol intake and the risk of incident hyperuricaemia. The hazard ratio (95% confidence interval) for hyperuricaemia in drinkers compared with non-drinkers was 1.10 (0.85-1.42) for <10.0 drinks/week, 1.40 (1.07-1.84) for 10.0-19.9 drinks/week, 1.64 (1.23-2.21) for 20.0-29.9 drinks/week and 1.98 (1.40-2.80) for ≥30.0 drinks/week (one drink contained 11.5 g of ethanol) after adjusting for age, baseline serum uric acid, body mass index, smoking habits, exercise habits, serum creatinine, blood pressure, serum cholesterol and blood glucose. The fraction of hyperuricaemia in the population attributable to alcohol intake was 21.6%. A clear dose-response pattern was observed for both beer and sake, when the consumption of these two beverages was analysed separately.

CONCLUSION

Habitual alcohol intake significantly contributed to the development of hyperuricaemia in Japanese men, regardless of type of alcoholic beverage consumed. Therefore, it is essential to reduce excessive alcohol intake to prevent and manage hyperuricaemia.

Genetic polymorphisms in alcohol metabolizing enzymes as related to sensitivity to alcohol-induced health effects

Three hundred sixty-seven middle-aged Japanese men were analyzed for genotypes of low K(m) aldehyde dehydrogenase (ALDH2) and cytochrome P450 2E1, and for the association with alcohol-induced health effects. Homozygotes for the normal ALDH2 gene (NN) and for the mutant gene (MM) and heterozygotes (NM) were found in 60, 6 and 33%, and homozygotes for the c1 gene (c1/1) and c2 gene (c2/2) of P450 2E1, and heterozygotes (c1/2) in 55, 5 and 40% of subjects, respectively. Mean alcohol consumption significantly differed in the three ALDH2 genotypes: 297 g per week in NN, 158 g in NM and 18 g in MM. It was not different in the three P450 2E1 genotypes, but tended to increase from cl/1 to c2/2 in the NN subjects while there was an inverse relationship in the subjects having the M gene. No difference in alcohol-induced health effects was observed in ALDH2 genotypes, but c2/2 genotype showed higher blood pressure and serum uric acid than the other P450 2E1 genotypes in the subjects consuming 200 g or more of alcohol per week. These results suggest an interactive effect of ALDH2 and P450 2E1 genes on alcohol consumption and a higher sensitivity to alcohol-induced health effects in c2/2 genotypes, although larger scale studies are required to confirm these findings.

Demographic and clinical features of gout patients in Turkey: a multicenter study

Gout results from multifactor interactions between gender, age, genetic and environmental factors. Environmental factors underlying gout and precipitating factors triggering acute attacks might vary in different populations with different lifestyles. In this study, we aimed to collect data regarding the demographic and clinical features, comorbid factors, and precipitating factors associated with the initiation of acute attacks in gout patients in Turkey. A total of 312 patients were included in this study (mean age, 58.8 ± 13.8 years; female/male ratio, 55/257). The demographic features, alcohol intake, clinical and laboratory features, and comorbid conditions including obesity, diabetes mellitus, hyperlipidemia, hypertension, and coronary heart disease were noted in a standard questionnaire. Precipitating factors initiating acute attacks (if any) were also noted. The patients were divided into 4 groups according to the region of location as central Anatolian region, southeast Anatolian region, Aegean region, and Trakya region. Our results were compared according to the gender and the location of the patients. The mean age at the start of the symptoms was 10 years higher in women (60.4 ± 14.8 and 50.6 ± 13.5 years in women and men, respectively, p < 0.001).Obesity was present in 40.1 %, diabetes mellitus in 17.9 %, hyperlipidemia in 30.1 %, hypertension in 53.5 %, coronary artery disease in 17 %, and nephrolithiasis in 21.8 % of patients. Precipitating factors triggering gout flares were as follows: diet (high consumption of meat or fish) in 46.5 %, alcohol consumption in 15.7 %, diuretics in 8.3 %, diet or diuretics in 5.1 %, diet or alcohol in 4.5 %, diet or alcohol or diuretics in 1.6 %, others in 4.2 %, and none in 14.1 %. The presence of diabetes and diuretic use was more common among women. Use of diuretics is a more common trigger for gout flares among women. On the other hand, various comorbid conditions, such as obesity and hypertension, and triggers for gout flares may differ between patients living in different geographic regions. In summary, we reported the first data regarding clinical and demographic characteristics of gout in Turkey. The majority of our patients could describe at least one "trigger" that initiated gout flare. Both comorbid conditions and triggers of attack might differ between men and women, and in different geographic areas. Better knowledge of the modifiable risk factors can be useful for the management strategy to optimize long-term patient outcomes in local clinics.

Uric acid is an independent risk factor for carotid atherosclerosis in a Japanese elderly population without metabolic syndrome

Background

Carotid intima-media thickness (IMT) is an useful surrogate marker of cardiovascular disease. Associations between uric acid (UA), metabolic syndrome (MetS) and carotid IMT have been reported, but findings regarding the relationship have been inconsistent.

Methods

A total of 1,579 Japanese elderly subjects aged ≥65 years {663 men aged, 78 ± 8 (mean ± standard deviation) years and 916 women aged 79 ± 8 years} were divided into 4 groups according to UA quartiles. We first investigated the association between UA concentrations and confounding factors including MetS; then, we assessed whether there is an independent association of UA with carotid IMT and atherosclerosis in participants subdivided according to gender and MetS status.

Results

Carotid IMT was significantly increased according to the quartiles of UA in both genders without MetS and women with MetS. Multivariate logistic regression analysis showed that odds ratio (OR) {95% confidence interval (CI)} in men for carotid atherosclerosis was significantly increased in the third (OR, 1.75; 95% CI, 1.02-3.02), and fourth quartiles (OR, 2.01; 95% CI, 1.12-3.60) of UA compared with that in the first quartile of UA, and the OR in women was significantly increased in the fourth quartile (OR, 2.10; 95% CI, 1.30-3.39). Similarly, the ORs were significantly associated with increasing quartiles of UA in both genders without MetS, but not necessarily increased in those with MetS.

Conclusions

UA was found to be an independent risk factor for incidence of carotid atherosclerosis in both genders without MetS.

The prevalence of hyperuricemia in China: a meta-analysis

Background

The prevalence of hyperuricemia varied in different populations and it appeared to be increasing in the past decades. Recent studies suggest that hyperuricemia is an independent risk factor for cardiovascular disease. However, there has not yet been a systematic analysis of the prevalence of hyperuricemia in China.

Methods

Epidemiological investigations on hyperuricemia in China published in journals were identified manually and on-line by using CBMDISC, Chongqing VIP database and CNKI database. Those Reported in English journals were identified using MEDLINE database. Selected studies had to describe an original study defined by strict screening and diagnostic criteria. The fixed effects model or random effects model was employed according to statistical test for homogeneity.

Results

Fifty-nine studies were selected, the statistical information of which was collected for systematic analysis. The results showed that the pooled prevalence of hyperuricemia in male was 21.6% (95%CI: 18.9%-24.6%), but it was only 8.6% (95%CI: 8.2%-10.2%) in female. It was found that thirty years was the risk point age in male and it was fifty years in female.

Conclusions

The prevalence of hyperuricemia is different as the period of age and it increases after 30 years in male and 50 in female. Interventions are necessary to change the risk factors before the key age which is 30 years in male and 50 in female.

Weight change over eight years in relation to alcohol consumption in a cohort of continuing smokers and quitters

INTRODUCTION

Stopping smoking results in weight gain. Avoidance of alcohol is often advocated to reduce cues to smoking, but the effect of alcohol consumption on body weight is unclear.

METHODS

We used regression models to examine weight change by baseline alcohol consumption in quitting and continuing smokers. Weight was measured at baseline and at 8 years, and weekly alcohol consumption was reported at baseline in participants from the Oxfordshire general practices nicotine patch/placebo trial. Of 698 smokers attempting to stop smoking, 85 were abstinent for 8 years and 613 continued to smoke.

RESULTS

The association between baseline alcohol consumption and weight change depended upon smoking status (p for interaction = .019). In smokers, there was no association with weight change, 0.005 (95% CI: -0.037 to 0.056) kg per UK unit (U) (8 g of ethanol) consumed each week. This was unmodified by gender and baseline body mass index (BMI). In quitters, there was a negative association with weight change, -0.174 (95% CI: -0.315 to -0.034) kg per U consumed each week (unmodified by gender and baseline BMI). Quitters who consumed 14 U (112 g ethanol) a week weighed a mean 2.4 kg less than quitters who did not drink.

CONCLUSIONS

Quitting smokers who drink more alcohol appear to gain less weight after quitting than those who do not drink. This is consistent across studies, it may be accounted for by unmeasured confounders or it may be that alcohol reduces weight gain. If alcohol reduces weight gain, the advice for quitting smokers must balance the benefits and hazards of alcohol consumption. However, there is currently insufficient evidence to advise quitters who drink little or no alcohol to increase consumption.

Relation of uric acid with components of metabolic syndrome before and after Roux-en-Y gastric bypass in morbidly obese subjects

OBJECTIVE: The purpose of the study was to investigate the prevalence of hyperuricemia in morbidly obese subjects before and after Roux-en-Y gastric bypass (RYGBP) and its relationship with metabolic syndrome abnormalities. SUBJECTS AND METHOD: We evaluated 420 morbidly obese patients. Pre and postoperative (8 months after RYGBP) blood samples were drawn. Obese patients underwent laparoscopic RYGBP and after eight months all the tests were repeated. RESULTS: The overall prevalence of hyperuricemia was 34.28%. Hyperuricemia was more common in men than in women (51.72 vs. 29.72%; p = 0.0002). Men with hyperuricemia were more likely to have diabetes (p = 0.034) and more elevated fasting plasma glucose levels (p = 0.027). Women with hyperuricemia were more likely to have hypertension (p = 0.003), metabolic syndrome (p = 0.001), elevated triglycerides (p = 0.001) and GGT (p = 0.009), and decreased HDL (p = 0.011). After surgery, uric acid levels decreased from 5.60 ± 1.28 to 4.23 ± 1.20 (p < 0.0001). The prevalence of hyperuricemia decreased from 33.6% to 6.4% (p < 0.0001), in men from 48.3% to 17.2% (p < 0.0001) and in women from 29.7% to 3.6% (p < 0.0001). CONCLUSION: Concentrations of uric acid were associated with the prevalence of metabolic abnormalities in this sample of morbidly obese patients. Also, weight loss after RYGBP can reduce uric acid levels and the prevalence of hyperuricemia.

Age-related changes in drinking patterns from mid- to older age: results from the Wisconsin longitudinal study

BACKGROUND

Drinking has generally been shown to decline with age in older adults. However, results vary depending on the measure of alcohol consumption used and the study population. The goals of this study were to (i) describe changes in drinking in a current cohort of older adults using a variety of measures of drinking and (ii) examine a number of different possible predictors of change.

METHODS

This is a longitudinal study of a community-based sample surveyed at 2 time points, ages 53 and 64 years. We estimated a series of logistic regressions to predict change and stability in drinking categories of nondrinking, moderate drinking, and heavy drinking. Linear regressions were used to predict change in past-month drinking days, past-month average drinks per drinking day, and past-month total drinks.

RESULTS

From age 53 to 64, average drinks per drinking day and heavy drinking decreased. Frequency of drinking increased for men and women, and total drinks per month increased for men. The most consistent predictors of drinking changes were gender, health, and education. Other factors predicted drinking change but were not consistent across drinking measures including: adolescent IQ, income, lifetime history of alcohol-related problems, religious service attendance, depression, debt, and changes in employment.

CONCLUSIONS

Heavy drinking decreases with age, but we may see more frequent moderate drinking with current and upcoming cohorts of older adults. Components of quantity and frequency of drinking change differently. Composite measures of total alcohol consumption may not be adequate for describing relevant changes in drinking over time. A number of factors predicted patterns of change in drinking and warrant further exploration.

Alcohol, cardiovascular diseases and all causes of death: a review of the epidemiological evidence

This paper reviews the epidemiological evidence on the association of alcohol consumption with the major cardiovascular diseases (hypertension, stroke and coronary heart disease), and all causes of death. The focus is on light and moderate consumption and several important methodological issues are apparent with the epidemiological evidence on alcohol and mortality. The epidemiological data justify the following recommendations on alcohol consumption. The evidence does not support the unqualified claim that light and moderate drinking confers overall health benefits. However, in persons over 35 years of age, there is no consistent evidence that daily consumption of up to 2-3 drinks in men or up to 1-2 drinks in women increases the risk of dying. Non-drinkers should not be encouraged to change their drinking status. The consumption of more than 2-3 drinks per day in men and more than 1-2 drinks per day in women should be actively discouraged. Further research on the effects of light and moderate alcohol consumption on cardiovascular disease and all causes of death are required, particularly in young people, women and the elderly.

Warfarin and uric acid after myocardial infarction

In order to assess the influence of warfarin on serum urate concentration, changes in serum urate were studied in 50 patients after myocardial infarction. The patients studied were part of a prospective, randomized placebo-controlled study of warfarin after myocardial infarction. Twenty-three of the patients were treated with warfarin and 27 received placebo. The mean uric acid level fell in both groups during an average of 10 months (range 6-20 months), the reduction being of the same order of magnitude in either group. This implies that warfarin, in contrast to some other oral anticoagulants, does not exert any uric acid lowering effect.

The time course and determinants of blood pressure within the first 48 h after ischemic stroke

BACKGROUND AND PURPOSE

Previous research suggests that blood pressure falls acutely after ischemic stroke. We aimed to further characterize this fall with a statistical technique that allows the application of regression techniques to serial blood pressure outcome data.

METHODS

In a prospectively recruited ischemic stroke cohort, systolic (SBP) and diastolic (DBP) blood pressure was recorded every 4 h until 48 h after stroke. Potential determinants of blood pressure, including stroke severity and acute infection, were also recorded. Mixed effects models were used to model serial blood pressure measurements over time, adjusted for significant determinants.

RESULTS

In 156 patients, SBP and DBP fell by 14.9 mm Hg (95% CI 6.2-22.6 mm Hg) and 6.2 mm Hg (95% CI 1.4-10.6 mm Hg), respectively, over the first 48 h after stroke. SBP was higher in patients with premorbid hypertension, a previous history of stroke or TIA, current alcohol use, increasing age, stroke of mild to moderate severity (NIHSS 3-13) and in patients treated with antihypertensives. SBP was lower in smokers. There was a progressive rise in SBP in patients with acute infection. No factors other than time were associated with DBP.

CONCLUSIONS

The use of mixed effects models has identified a linear SBP and DBP fall over the first 48 h after stroke. The timing and magnitude of this fall should be accounted for in the design of future prognostic and intervention studies.

Association between serum uric acid level and components of the metabolic syndrome

BACKGROUND

Serum uric acid (UA) level has been suggested to be associated with factors that contribute to the metabolic syndrome. However, the association between metabolic syndrome and UA has not been elucidated. We sought to determine the association between serum UA level and the number of components that contribute to the metabolic syndrome, and which component was associated most with higher serum UA level.

METHODS

A consecutive sample was taken of the health examinations of all hospital staff who were assessed between January 2004 and December 2004 in a medical center. A total of 3,065 subjects aged 18 to 81 years (635 males, 2,430 females) participated. Blood tests and all physical variables were examined using standard methods. Subjects were divided into 5 groups according to their possession of 0, 1, 2, 3 or > or = 4 components of the metabolic syndrome. The differences in all variables between groups were analyzed by ANOVA. The relationship between serum UA level and the number of metabolic components was determined by linear regression analysis. The contribution to elevated UA of possessing different risk factors was determined by a multivariate linear regression model.

RESULTS

Mean serum UA level increased as the number of metabolic factors increased. Serum UA level was higher in subjects with abnormal triglyceride (TG), waist circumference, high-density lipoprotein cholesterol (HDL-C) level and blood pressure (BP),with mean increases in UA level of 22.8, 21.4, 14.4 and 9.4 micromol/L, respectively (p < or = 0.001), compared to subjects with normal levels. After controlling for body mass index, abnormal TG, HDL-C and BP continued to account, in order of influence, for elevated UA.

CONCLUSION

Serum UA level was elevated significantly as the number of metabolic components increased. Abnormal TG had the most influence on serum UA. A prospective study is warranted to determine if the prevention or treatment of hyperuricemia affects the development of metabolic syndrome.

Alcohol consumption as a trigger of recurrent gout attacks

BACKGROUND

Alcohol consumption has long been considered a trigger for recurrent gout attacks; however, this hypothesis has not been formally tested.

METHODS

We conducted an Internet-based case-crossover study to assess several putative risk factors, including alcohol consumption, thought to trigger recurrent gout attacks. Subjects who had an attack within the past year were recruited online and asked to provide access to medical records pertaining to their gout. Data were obtained on the amount and type of alcoholic beverage consumed on each day over the 2-day period before a gout attack and on each day over a 2-day period during the intercritical period. We examined the amount and type of alcohol consumption and the risk of recurrent gout attacks using a conditional logistic regression adjusting for diuretic use and purine intake.

RESULTS

A total of 197 subjects were recruited online over a 10-month period. Of those, 179 (91%) fulfilled the American College of Rheumatology Criteria for gout. Compared with no alcohol consumption, odds ratios for recurrent gout attacks were 1.1, 0.9, 2.0, and 2.5 for 1 to 2, 3 to 4, 5 to 6, and 7 or more drinks consumed over the 2-day period, respectively (P<.005). A dose-response relationship of risk of gout attacks was more evident for alcohol consumed over the last 24 hours. An increased risk of recurrent gout attacks was found for each type of beverage consumed.

CONCLUSION

Alcohol consumption triggers recurrent gout attacks. This effect was likely to occur within 24 hours after its consumption.

Incidence of hypertension by alcohol consumption: is it modified by race?

OBJECTIVE

To investigate the influence of race, binge drinking and alcohol addiction on the association between consumption of alcoholic beverages and incidence of hypertension.

METHODS

In a population-based cohort study, 1089 adults were interviewed and had blood pressure and anthropometric measurements carried out at home. Their alcohol consumption was ascertained by an amount-frequency questionnaire. Binge drinking was defined as consumption of five or more drinks on one occasion for men or four drinks for women, and abuse of alcohol as consumption of 30 g/day or more in men or 15 g/day or more in women. Incident cases of hypertension were characterized by blood pressure > or = 140/90 mmHg or use of hypertension medication.

RESULTS

Among 589 normotensive individuals in the baseline visit, 127 incident cases of hypertension were identified, after a follow-up of 5.6 +/- 1.1 years. Binge drinking and alcohol dependency were not associated with the incidence of hypertension. Adjusted (age, education) risk ratios for the incidence of hypertension (95% confidence interval) were significant only for non-white abusers of ethanol: 11.8 (1.6-86.9). Systolic blood pressure of black abusers increased by 16.1 +/- 3.5 mmHg, in comparison with 4.9 +/- 1.5 mmHg among white abusers (P = 0.004).

CONCLUSION

Individuals with an African ancestry, who consumed larger amounts of ethanol, are at higher risk of developing hypertension. This risk is not explained by a binge drinking pattern or addiction to alcohol.

Moderate Alcohol Consumption Is Associated With Reduced Arterial Stiffness in Older Adults: The Rotterdam Study

BACKGROUND

Light-to-moderate alcohol consumption has been associated with a lower risk of cardiovascular disease. The protective effect of alcohol could involve arterial properties as arterial stiffness and distensibility.

METHODS

The relationship between alcohol and arterial stiffness was studied within the framework of the Rotterdam Study, a population-based study in individuals aged 55 and older. The present study included 3178 participants in the third examination phase. Arterial stiffness was measured by two different methods, i.e., the carotid-femoral pulse wave velocity and the DC of the common carotid artery. Categories of alcohol consumption were defined as follows: < or =3 glasses of alcohol per week, 4-10 glasses per week, 11-20 glasses per week, and > or =21 glasses per week. Linear regression analysis was used to investigate the association between alcohol consumption and measures of arterial stiffness.

RESULTS

In multivariate-adjusted models, women drinking 4-10, 11-20, and > or =21 glasses of alcoholic beverage per week had a -0.07 (0.22 to -0.38), -0.18 (0.12 to -0.49), and 0.12 (0.19 to -0.43) m/s difference in mean pulse wave velocity compared to those drinking 0-3 glasses per week (reference group). Corresponding differences in the carotid DC were 0.68 (1.21 to 0.15), 0.28 (0.82 to -0.25), and 0.36 (0.91 to -0.18) 10(-3)/kPa. In men, the estimates were not statistically significant, although a similar trend was observed.

CONCLUSIONS

Moderate alcohol consumption is associated with lower arterial stiffness in women independently of cardiovascular risk factors and atherosclerosis.

Is alcohol consumption a risk factor for weight gain and obesity?

Alcohol represents an important source of energy. Despite its comparatively high energy content of 7.1 g/kcal, it is still controversial whether moderate amounts of alcohol represent a risk factor for weight gain and obesity. Epidemiologic data showed a positive, negative, or no relationship between alcohol intake and body weight. Despite the difficulty in assessing alcohol intake as well as controlling for different confounders of the energy-balance equation, the conflicting epidemiologic data can be explained in most instances. Every component of the energy-balance equation is affected by the ingestion of alcohol. Moderate amounts of alcohol enhance energy intake due to the caloric content of the alcohol as well as its appetite-enhancing effects. Alcohol-induced thermogenesis is approximately 20% in healthy nonalcoholic subjects, i.e., moderate alcohol consumers, which is higher than for other energy substrates but considerably lower than in heavy alcohol consumers. This would suggest that a major fraction of the alcohol energy represents a navailable energy source for ATP synthesis in moderate non-daily alcohol consumers. Experimental evidence from several metabolic studies showed a suppression of lipid oxidation by alcohol and thus the enhancement of a positive fat balance. The nonoxidized fat is preferentially deposited in the abdominal area. The experimental metabolic evidence suggests that the consumption of moderate amounts of alcohol has to be accounted for in the energy-balance equation and may represent a risk factor for the development of a positive energy balance and thus weight gain. In the heavy alcohol consumer and eventually also in daily moderate alcohol consumers, a larger fraction of the alcohol energy might not be an available source of energy due to the induction of the microsomal ethanol-oxidizing system (MEOS). Experimental data in combination with epidemiologic findings suggest that alcohol energy counts more in moderate nondaily alcohol consumers than in some moderate daily and all heavy consumers. Accordingly the question is not "Whether alcohol calories do count" but "How much do alcohol calories count?". There seems to be a large individual variability according to the absolute amount of alcohol consumed, the drinking frequency as well as genetic factors. Presently it can be said that alcohol calories count more in moderate nondaily consumers than in daily (heavy) consumers. Further, they count more in combination with a high-fat diet and in overweight and obese subjects.

Alcohol consumption and hypertension

Hypertension is a major independent risk factor for cardiovascular disease. In alcohol-consuming populations, the amount of alcohol consumption has significant impact on blood pressure values, the prevalence of hypertension, and cardiovascular as well as all-cause mortality. In this review, we focus on the connection between alcohol consumption and hypertension, and discuss the consequences on cardiovascular risk.

Longitudinal patterns and predictors of alcohol consumption in the United States

OBJECTIVES

We examined demographic predictors of longitudinal patterns in alcohol consumption.

METHODS

We used mixed-effects models to describe individual alcohol consumption and change in consumption with age, as well as the associations between consumption and birth year, national alcohol consumption, and demographic factors, among 14 105 adults from the National Health and Nutrition Examination Survey I Epidemiologic Follow-Up Study.

RESULTS

Alcohol consumption declined with increasing age, and individual consumption mirrored national consumption. Higher consumption was associated with male gender, being White, being married, having a higher educational level, having a higher income, being employed, and being a smoker. Faster age-related decline in consumption was associated with earlier cohorts, being male, being married, having a lower educational level, and being a smoker.

CONCLUSIONS

Compared with alcohol consumption among earlier cohorts, that among recent cohorts declined more slowly with increasing age, suggesting that negative health effects of alcohol could increase in the future.

Alcohol intake and 8-year weight gain in women: a prospective study

OBJECTIVE

To examine prospectively the relationship between alcohol and 8-year weight gain in women.

RESEARCH METHODS AND PROCEDURES

A prospective study of 49,324 women 27 to 44 years old who did not have a history of cardiovascular disease, cancer, or diabetes, who were not pregnant during the study period, and who reported weights in 1991 and 1999.

RESULTS

In cross-sectional analyses, there was a significant inverse relationship between alcohol and BMI even after adjustment for dietary factors and a wide range of confounders. In multivariate prospective analyses, a nonlinear relationship was seen between alcohol and weight gain (>or=5 kg) in all women. Compared with nondrinkers, the adjusted relative odds [95% confidence interval (CI)] of weight gain according to grams per day were 0.94 (0.89, 0.99) for those consuming 0.1 to 4.9 g/d, 0.92 (0.85,0.99) for 5 to 14.9 g/d, 0.86 (0.76, 0.78) for 15 to 29.9 g/d, and 1.07 (0.89,1.28) for those consuming 30+ g/d (p < 0.0001 for quadratic trend). Women who continued to drink heavily and those who became heavy drinkers showed similar increased odds of weight gain. The increased odds of weight gain associated with heavy drinking (30+ g/d) were most marked in the younger women (<35 years) (odds ratio 1.64; 5% CI 1.03 to 2.61). In African-American women, light drinking was associated with increased odds of weight gain compared with nondrinkers (odds ratio = 2.43; 95% CI 1.22 to 4.82).

DISCUSSION

Our data suggest that light to moderate drinking (up to 30 g/d) is not associated with weight gain in women except possibly in African-American women. Heavier drinking may promote weight gain in women.

Alcohol consumption and the metabolic syndrome in Korean adults: the 1998 Korean National Health and Nutrition Examination Survey

BACKGROUND

The metabolic syndrome is associated with a high risk of cardiovascular disease morbidity and mortality. Light and moderate alcohol consumption have been associated with reduced cardiovascular disease morbidity and mortality.

OBJECTIVE

This study was performed to examine the association between alcohol consumption and the metabolic syndrome.

DESIGN

The study sample comprised 7962 Korean adults (3597 men, 4365 women) who had participated in the 1998 Korean National Health and Nutrition Examination Survey.

RESULTS

The prevalence of the metabolic syndrome was 20.8% in men and 26.9% in women. The adjusted odds ratio for the metabolic syndrome in the group consuming 1-14.9 g alcohol/d was 0.71 (95% CI: 0.53, 0.95) in men and 0.80 (95% CI: 0.65, 0.98) in women. Alcohol consumption had a significant inverse relation with the odds ratio for low HDL cholesterol in all alcohol groups. Heavy alcohol consumption (> or =30 g/d) was associated with significantly higher odds ratios for high blood pressure and high triacylglycerol in men and high fasting blood glucose and high triacylglycerol in women. Odds ratios for the metabolic syndrome and its components tended to increase with increasing alcohol consumption. The dose-response relation of the odds ratio between alcohol consumption and the clustering of > or =3 risk factors was significant in both the high and low HDL-cholesterol groups.

CONCLUSIONS

Although alcohol consumption had a significant inverse relation with the odds ratio for low HDL cholesterol in all alcohol groups, an increasing dose-response relation was found between alcohol consumption and the odds ratio for the metabolic syndrome. This might be due to the opposite relation of alcohol consumption to other components of the metabolic syndrome.

Prevalence of hyperuricemia and relation of serum uric acid with cardiovascular risk factors in a developing country

BACKGROUND

The prevalence of hyperuricemia has rarely been investigated in developing countries. The purpose of the present study was to investigate the prevalence of hyperuricemia and the association between uric acid levels and the various cardiovascular risk factors in a developing country with high average blood pressures (the Seychelles, Indian Ocean, population mainly of African origin).

METHODS

This cross-sectional health examination survey was based on a population random sample from the Seychelles. It included 1011 subjects aged 25 to 64 years. Blood pressure (BP), body mass index (BMI), waist circumference, waist-to-hip ratio, total and HDL cholesterol, serum triglycerides and serum uric acid were measured. Data were analyzed using scatterplot smoothing techniques and gender-specific linear regression models.

RESULTS

The prevalence of a serum uric acid level >420 micromol/L in men was 35.2% and the prevalence of a serum uric acid level >360 micromol/L was 8.7% in women. Serum uric acid was strongly related to serum triglycerides in men as well as in women (r = 0.73 in men and r = 0.59 in women, p < 0.001). Uric acid levels were also significantly associated but to a lesser degree with age, BMI, blood pressure, alcohol and the use of antihypertensive therapy. In a regression model, triglycerides, age, BMI, antihypertensive therapy and alcohol consumption accounted for about 50% (R2) of the serum uric acid variations in men as well as in women.

CONCLUSIONS

This study shows that the prevalence of hyperuricemia can be high in a developing country such as the Seychelles. Besides alcohol consumption and the use of antihypertensive therapy, mainly diuretics, serum uric acid is markedly associated with parameters of the metabolic syndrome, in particular serum triglycerides. Considering the growing incidence of obesity and metabolic syndrome worldwide and the potential link between hyperuricemia and cardiovascular complications, more emphasis should be put on the evolving prevalence of hyperuricemia in developing countries.