National, regional, and global burdens of disease from 2000 to 2016 attributable to alcohol use: a comparative risk assessment study

Explanatory models and coping with alcohol misuse among conflict-affected men in Ukraine

Affecting nearly 10% of men globally, alcohol use disorders (AUDs) represent a significant public health burden. Existing work, including from Ukraine, suggests that living in conflict settings may exacerbate the risk of AUDs. However, there is a dearth of evidence regarding alcohol misuse, as well as knowledge of factors associated with alcohol misuse patterns, in conflict settings. The aim of this qualitative study was to investigate explanatory models of alcohol misuse among conflict-affected men in Ukraine. Purposive and snowball sampling were used to recruit 66 conflict-affected men with alcohol misuse, family members of men who misuse alcohol, community health workers, and mental health and psychosocial support providers from locations across Ukraine. In the group of men who misuse alcohol (n=25), we recruited individuals with diverse experiences of adversity: 1) internally displaced persons from eastern Ukraine and Crimea displaced after 2014; 2) Ukrainian military veterans or territorial defense volunteers from various regions; and 3) men living 5-15 kilometers from the frontline. Semi-structured interviews were conducted in Ukrainian or Russian, and analysed using deductive and inductive analysis. Qualitative data received from each subgroup were analysed separately. The resulting explanatory model represents how Ukrainian conflict-affected men describe causes of alcohol misuse. Participants identified that alcohol misuse among Ukrainian men is often used as "self-treatment" to address mental health symptoms and feelings of demoralization that are exacerbated by a lack of supportive social environments and socio-economic problems; these behaviours also occur in an environment that deems alcohol misuse to be culturally appropriate. Family members and service providers offered a similar understanding of alcohol misuse as the men themselves. Strategies suggested by conflict-affected men to protect against alcohol misuse included engaging in alternative activities, finding supportive social environments, fear of negative consequences from alcohol misuse and increasing self-awareness and self-control. These findings indicate possible implications for interventions that target alcohol misuse among conflict-affected men, as well as demonstrate a need for developing culturally sensitive interventions that can address this unaddressed public health need.

Adherence to alcohol consumption-related recommendations and predictors of heavy episodic drinking among patients with NCDs during the COVID-19 pandemic

INTRODUCTION

Managing non-communicable diseases (NCDs) requires adherence to lifestyle recommendations like a healthy diet, regular exercise, smoking cessation, and limiting alcohol intake. The COVID-19 pandemic introduced barriers to maintaining these habits, including limited healthcare access, increased stress, and reduced physical activity. This study assessed adherence to lifestyle recommendations, with a focus on heavy episodic drinking (HED), among NCD patients during the pandemic in Arba Minch, Ethiopia, to identify areas for public health intervention.

METHOD

A cross-sectional study was conducted among 310 randomly selected NCD follow-up patients at Arba Minch General Hospital. The data was collected using the WHO STEPS and Coronavirus Anxiety Scale (CAS) tool from March 1 to April 30, 2022. Data analysis included both descriptive and inferential statistics (bivariate analyses and multivariable logistic regression). Confounding variables were identified and controlled for to ensure result accuracy.

RESULTS

Adherence to lifestyle recommendations was found to be low, at just 16.1% [n=50, 95% Confidence Interval (CI) (12.5-20.6%)]. The prevalence of HED was 12.6%, with a higher prevalence among males (18.4%) compared to females (7.4%). Recent alcohol consumption was reported by 29.0% of participants, and among these, 43.3% engaged in HED. Factors significantly associated with HED included male gender (Adjusted Odds Ratio (AOR) 2.63, 95% CI 1.11, 6.24), higher education level (AOR 2.91, 95% CI 1.11, 7.58), and current tobacco use (AOR 6.36, 95% CI 1.62, 25.04). Healthcare disruptions due to COVID-19 (AOR 3.28, 95% CI 1.16, 9.26) and COVID-19-related anxiety (AOR 1.29, 95% CI 1.06, 1.56) were also linked to HED.

CONCLUSION

The study revealed low adherence to lifestyle recommendationsand significant prevalence of HED among NCD patients during the pandemic. Associations between HED, healthcare disruptions, and anxiety highlight the critical role of mental health and healthcare access in risky behaviors. Targeted public health interventions are essential, including community-based alcohol reduction programs, improved mental health support, and stronger healthcare systems. Integrating mental health services and culturally sensitive health education and community engagement can help improve adherence to lifestyle recommendations.

Effectiveness of a Mobile Phone-Delivered Multiple Health Behavior Change Intervention (LIFE4YOUth) in Adolescents: Randomized Controlled Trial

BACKGROUND

Although mobile health (mHealth) interventions have demonstrated effectiveness in modifying 1 or 2 health-risk behaviors at a time, there is a knowledge gap regarding the effects of stand-alone mHealth interventions on multiple health risk behaviors.

OBJECTIVE

This study aimed to estimate the 2- and 4-month effectiveness of an mHealth intervention (LIFE4YOUth) targeting alcohol consumption, diet, physical activity, and smoking among Swedish high school students, compared with a waiting-list control condition.

METHODS

A 2-arm parallel group, single-blind randomized controlled trial (1:1) was conducted from September 2020 to June 2023. Eligibility criteria included nonadherence to guidelines related to the primary outcomes, such as weekly alcohol consumption (standard drinks), monthly frequency of heavy episodic drinking (ie, ≥4 standard drinks), daily intake of fruit and vegetables (100-g portions), weekly consumption of sugary drinks (33-cL servings), weekly duration of moderate to vigorous physical activity (minutes), and 4-week point prevalence of smoking abstinence. The intervention group had 16 weeks of access to LIFE4YOUth, a fully automated intervention including recurring screening, text message services, and a web-based dashboard. Intention-to-treat analysis was conducted on available and imputed 2- and 4-month self-reported data from participants at risk for each outcome respectively, at baseline. Effects were estimated using multilevel models with adaptive intercepts (per individual) and time by group interactions, adjusted for baseline age, sex, household economy, and self-perceived importance, confidence, and know-how to change behaviors. Bayesian inference with standard (half-)normal priors and null-hypothesis testing was used to estimate the parameters of statistical models.

RESULTS

In total, 756 students (aged 15-20, mean 17.1, SD 1.2 years; 69%, 520/756 females; 31%, 236/756 males) from high schools across Sweden participated in the trial. Follow-up surveys were completed by 71% (539/756) of participants at 2 months and 57% (431/756) of participants at 4 months. Most participants in the intervention group (219/377, 58%) engaged with the intervention at least once. At 2 months, results indicated positive effects in the intervention group, with complete case data indicating median between-group differences in fruit and vegetable consumption (0.32 portions per day, 95% CI 0.13-0.52), physical activity (50 minutes per week, 95% CI -0.2 to 99.7), and incidence rate ratio for heavy episodic drinking (0.77, 95% CI 0.55-1.07). The odds ratio for smoking abstinence (1.09, 95% CI 0.34-3.64), incidence rate ratio for weekly alcohol consumption (0.69, 95% CI 0.27-1.83), and the number of sugary drinks consumed weekly (0.89, 95% CI 0.73-1.1) indicated inconclusive evidence for effects due to uncertainty in the estimates. At 4 months, a remaining effect was observed on physical activity only.

CONCLUSIONS

Although underpowered, our findings suggest modest short-term effects of the LIFE4YOUth intervention, primarily on physical activity and fruit and vegetable consumption. Our results provide inconclusive evidence regarding weekly alcohol consumption and smoking abstinence.

TRIAL REGISTRATION

ISRCTN Registry ISRCTN34468623; https://doi.org/10.1186/ISRCTN34468623.

The effectiveness and cost-effectiveness of population-level policies to reduce alcohol use: A systematic umbrella review

OBJECTIVE

To systematically review and synthesize evidence from reviews about the effectiveness and cost-effectiveness of population-level policies to reduce alcohol use.

METHODS

We searched peer-reviewed literature using eight electronic bibliographic databases, grey literature using two databases, two search engines, and two working paper repositories, and examined references of included studies. At least two reviewers independently screened articles for inclusion, extracted detailed characteristics, and assessed the risk of bias of each included study. We considered all reviews that included studies which quantitatively examined the relationship between alcohol consumption and population-level policies that seek to regulate the public availability and marketing of alcoholic beverages. After screening according to a set of predetermined criteria, we included 32 reviews.

SYNTHESIS

We found consistent evidence that addressing alcohol availability (introducing or increasing minimum purchasing age, restrictions on temporal availability, decreasing outlet density, government monopolization) was associated with lower alcohol use; and a general lack of evidence on the associations between alcohol marketing (marketing self-regulation, advertising from government authorities, regulating the volume of advertising from alcohol manufacturers, and introducing warning labels) and alcohol consumption, which precludes any conclusions about these regulations. Additionally, we found scarce evidence about the cost-effectiveness of population-level policies to reduce alcohol use, which is likely due to the relatively low cost of implementation and enforcement of these policies.

CONCLUSION

The Government of Ontario began expanding privatized alcohol sales in 2015 with further expansions starting in August 2024. Evidence from reviews suggests that this increase in availability will result in increased alcohol consumption.

Once-Weekly Semaglutide in Adults With Alcohol Use Disorder: A Randomized Clinical Trial

Importance

Preclinical, observational, and pharmacoepidemiology evidence indicates that glucagon-like peptide 1 receptor agonists (GLP-1RAs) may reduce alcohol intake. Randomized trials are needed to determine the clinical significance of these findings.

Objective

To evaluate the effects of once-weekly subcutaneous semaglutide on alcohol consumption and craving in adults with alcohol use disorder (AUD).

Design, Setting, and Participants

This was a phase 2, double-blind, randomized, parallel-arm trial involving 9 weeks of outpatient treatment. Enrollment occurred at an academic medical center in the US from September 2022 to February 2024. Of 504 potential participants assessed, 48 non-treatment-seeking participants with AUD were randomized.

Intervention

Participants received semaglutide (0.25 mg/week for 4 weeks, 0.5 mg/week for 4 weeks, and 1.0 mg for 1 week) or placebo at weekly clinic visits.

Main Outcomes and Measures

The primary outcome was laboratory alcohol self-administration, measured at pretreatment and posttreatment (0.5 mg/week). Secondary and exploratory outcomes, including prospective changes in alcohol consumption and craving, were assessed at outpatient visits.

Results

Forty-eight participants (34 [71%] female; mean [SD] age, 39.9 [10.6] years) were randomized. Low-dose semaglutide reduced the amount of alcohol consumed during a posttreatment laboratory self-administration task, with evidence of medium to large effect sizes for grams of alcohol consumed (β, -0.48; 95% CI, -0.85 to -0.11; P = .01) and peak breath alcohol concentration (β, -0.46; 95% CI, -0.87 to -0.06; P = .03). Semaglutide treatment did not affect average drinks per calendar day or number of drinking days, but significantly reduced drinks per drinking day (β, -0.41; 95% CI, -0.73 to -0.09; P = .04) and weekly alcohol craving (β, -0.39; 95% CI, -0.73 to -0.06; P = .01), also predicting greater reductions in heavy drinking over time relative to placebo (β, 0.84; 95% CI, 0.71 to 0.99; P = .04). A significant treatment-by-time interaction indicated that semaglutide treatment predicted greater relative reductions in cigarettes per day in a subsample of individuals with current cigarette use (β, -0.10; 95% CI, -0.16 to -0.03; P = .005).

Conclusions and Relevance

These findings provide initial prospective evidence that low-dose semaglutide can reduce craving and some drinking outcomes, justifying larger clinical trials to evaluate GLP-1RAs for alcohol use disorder.

Trial Registration

ClinicalTrials.gov Identifier: NCT05520775.

Combined pharmacological and psychosocial interventions for alcohol use disorder

BACKGROUND

Alcohol use disorder (AUD) is a mental disorder characterised by a strong desire to consume alcohol and impaired control of alcohol use, with devastating consequences. Many people with AUD do not respond to psychosocial or pharmacological interventions when these are provided alone. Combining these interventions may improve the response to treatment, though evidence remains limited.

OBJECTIVES

To assess the effects of combined pharmacological and psychosocial interventions for the treatment of AUD in adults.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, three other databases, and two trials registers in November 2023, without language restrictions.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) comparing combined pharmacological and psychosocial interventions versus pharmacological or psychosocial interventions alone, or no intervention/treatment as usual (TAU), in adults with AUD. Our primary outcomes were continuous abstinent participants, frequency of use (measured as heavy drinkers, percentages of abstinent days, heavy-drinking days), amount of use (number of drinks per drinking day), adverse events, serious adverse events, dropouts from treatment, and dropouts due to adverse events.

DATA COLLECTION AND ANALYSIS

We assessed risk of bias using Cochrane's RoB 1 tool, performed random-effects meta-analyses, and evaluated the certainty of evidence according to the GRADE approach.

MAIN RESULTS

We included 21 RCTs (4746 participants). The most studied pharmacological and psychosocial interventions were naltrexone (81.0%) and cognitive behavioural therapy (66.7%), respectively. Most participants were men (74%), aged about 44 years, with AUD, without comorbid mental disorders or other substance use disorders; 15 RCTs detoxified participants before treatment. We judged 28.5% of the studies as at low risk of bias for random sequence generation, allocation concealment, performance bias for objective and subjective outcomes, and detection bias for subjective outcomes; all studies were at low risk of detection bias for objective outcomes; 85.7% of studies were at low risk of attrition bias; 14.2% of studies were at low risk of reporting bias. 1) Compared to psychosocial intervention alone, combined pharmacological and psychosocial interventions probably reduce the number of heavy drinkers (above the clinically meaningful threshold (MID) of 2%; absolute difference (AD) -10%, 95% confidence interval (CI) -18% to -2%; risk ratio (RR) 0.86, 95% CI 0.76 to 0.97; 8 studies, 1609 participants; moderate-certainty evidence). They may increase continuous abstinent participants (MID 5%; AD 5%, 95% CI 1% to 11%; RR 1.17, 95% CI 1.02 to 1.34; 6 studies, 1184 participants; low-certainty evidence). They probably have little to no effect on: • the rate of abstinent days (MID 8%; mean difference (MD) 4.16, 95% CI 1.24 to 7.08; 10 studies, 2227 participants); • serious adverse events (MID 1%; AD -2%, 95% CI -3% to 0%; RR 0.20, 95% CI 0.03 to 1.12; 4 studies; 524 participants); • dropouts from treatment (MID 10%; AD -3%, 95% CI -5% to 0%; RR 0.89, 95% CI 0.79 to 1.01; 15 studies, 3021 participants); and • dropouts due to adverse events (MID 5%; AD 2%, 95% CI 0% to 5%; RR 1.91, 95% CI 1.04 to 3.52; 8 studies, 1572 participants) (all moderate-certainty evidence). They may have little to no effect on: • heavy-drinking days (MID 5%; MD -3.49, 95% CI -8.68 to 1.70; 4 studies, 470 participants); • number of drinks per drinking day (MID 1 drink; MD -0.57, 95% CI -1.16 to 0.01; 7 studies, 805 participants); and • adverse events (MID 30%; AD 17%, 95% CI -5% to 46%; RR 1.25, 95% CI 0.93 to 1.68; 4 studies, 508 participants) (all low-certainty evidence). 2) Compared to pharmacological intervention alone, combined pharmacological and psychosocial interventions may have little to no effect on: • the rate of abstinent days (MID 8%; MD -1.18, 95% CI -4.42 to 2.07; 2 studies, 1158 participants); and • dropouts from treatment (MID 10%; AD 1%, 95% CI -10 to 14%; RR 0.98, 95% CI 0.65 to 1.47; 3 studies, 1246 participants) (all low-certainty evidence). We are uncertain about their effect on: • continuous abstinent participants (MID 5%; AD 3%, 95% CI -5% to 18%; RR 1.22, 95% CI 0.62 to 2.40; 1 study, 241 participants); • the number of heavy drinkers (MID 2%; AD 2%, 95% CI -4% to 8%; RR 1.03, 95% CI 0.94 to 1.12; 1 study, 917 participants); • the number of drinks per drinking day (MID 1 drink; MD -2.40, 95% CI -3.98 to -0.82; 1 study, 241 participants); and • dropouts due to adverse events (MID 5%; AD -1%, 95% CI -3% to 6%; RR 0.61, 95% CI 0.14 to 2.72; 2 studies, 1165 participants) (all very low-certainty evidence). 3) We are uncertain about the effect of combined pharmacological and psychosocial interventions, when compared to TAU, on: • the number of heavy drinkers (MID 2%; AD -5%, 95% CI -13% to 2%; RR 0.93, 95% CI 0.83 to 1.03; 1 study, 616 participants); • the rate of abstinent days (MID 8%; MD 3.43, 95% CI -1.32 to 8.18; 1 study, 616 participants); • dropouts from treatment (MID 10%; AD 0%, 95% CI -10% to 15%; RR 0.98, 95% CI 0.58 to 1.65; 2 studies, 696 participants); and • dropouts due to adverse events (MID 5%; AD 3%, 95% CI 0% to 15%; RR 2.97, 95% CI 0.70 to 12.67; 1 study, 616 participants) (all very low-certainty evidence). The certainty of evidence ranged from moderate to very low, downgraded mainly due to risk of bias and imprecision.

AUTHORS' CONCLUSIONS

As implications for practice, our findings indicate that adding pharmacological to psychosocial interventions is safe and helps people with AUD recover. These conclusions are based on low- to moderate-certainty evidence. Given the few studies and very low-certainty evidence, any benefits of adding psychosocial to pharmacological interventions or comparing the combined intervention to TAU are less clear. As implications for research, further studies should investigate the effects of the combined intervention compared to pharmacotherapy or TAU.

Prognostic significance of myocardial fibrosis in men with alcoholic cardiomyopathy: insights from cardiac MRI

OBJECTIVES

Myocardial fibrosis significantly impacts prognosis in various cardiovascular diseases, yet its role in alcoholic cardiomyopathy (ACM) remains poorly understood. This study evaluates the prognostic value of myocardial fibrosis, as detected by cardiac magnetic resonance (CMR), in ACM patients.

METHODS

We conducted a retrospective analysis of consecutive ACM patients who underwent enhanced CMR from August 2015 to October 2023. Assessment of myocardial fibrosis was performed using late gadolinium enhancement (LGE), native T1, and extracellular volume (ECV) fraction. The primary outcome was a composite of cardiac-related mortality, heart transplantation, hospitalization for heart failure, life-threatening arrhythmias, and the need for implantable cardioverter-defibrillator or cardiac resynchronization therapy.

RESULTS

A total of 141 male patients were finally enrolled with 27.7% experiencing the primary outcome over a median follow-up of 30.6 months (IQR: 18.0-44.9). LGE was found in 55.3% of patients, with a median extent of 2.9%. Compared to DCM patients who didn't consume alcohol, ACM patients showed lower LGE, native T1, and ECV values. Multivariate analysis showed LGE (HR, 1.09 [1.04, 1.15]; p < 0.001), native T1 (per 10 ms increase, 1.06 [1.02, 1.10]; p = 0.003), and ECV (per 3% increase, 1.57 [1.22, 2.01]; p < 0.001) had significant prognostic associations with adverse outcomes. Including myocardial fibrosis parameters improved predictive accuracy beyond standard assessments. A nonlinear relationship was found between lifetime ethanol consumption and myocardial fibrosis, with a plateau at low exposures and a sharp increase at higher levels.

CONCLUSION

CMR-identified myocardial fibrosis has an association with major adverse cardiac events in ACM patients, underscoring its utility in risk stratification.

KEY POINTS

Question The prognostic role of myocardial fibrosis in alcoholic cardiomyopathy remains poorly understood. Findings Fibrosis detected by cardiac MRI has good incremental value for predictive models in assessing the risk of adverse cardiovascular events in patients with alcoholic cardiomyopathy. Clinical relevance Cardiac MRI may be a potential tool to identify high-risk alcoholic cardiomyopathy patients with cardiovascular adverse event, which is helpful for early clinical treatment, and improves patients prognosis.

Epidemiology characteristics of the drinking patterns and alcohol consumption among adults in Hainan Province, China

Background

Alcohol consumption is a significant risk factor for premature mortality and increased disease burden worldwide, especially among young and middle-aged individuals. This study aims to evaluate drinking patterns and alcohol consumption among adults in Hainan Province, while also identifying associated factors.

Methods

Analyses based on the 2022 "2 + 3" epidemiological survey in Hainan were conducted, and the drinking types, quantities, and frequencies among local residents were described. Chi-square tests and multiple linear regression were employed for the statistical analysis.

Results

A total of 32,857 adults participated, yielding an overall drinking rate of 42.8%. The drinking rate was significantly higher among men (64.4%) than women (18.9%). The highest drinking rates were found in the 30-59 age group, especially among individuals aged 30-39. Ethnic minorities had a higher drinking rate (70.1%) than Han individuals. Lower educational attainment was associated with lower drinking rates, although the prevalence of active drinkers was higher. Men preferred strong liquor and beer, whereas women favored beer and rice wine. The average weekly alcohol consumption was 59.8 mL for men and 10.9 mL for women, with 43.6% of men exceeding 100 mL weekly, compared to 12.7% of women.

Conclusion

This study emphasizes the complexity and diversity of drinking behaviors among adults in Hainan Province. Sociodemographic factors, including gender, age, ethnicity, education, marital status, occupation, and region, are closely linked to drinking behaviors. The findings provide a scientific basis for developing targeted public health strategies, highlighting the need for effective interventions to mitigate alcohol-related health issues among high-risk populations.

Identifying hazardous alcohol use in primary care using phosphatidylethanol: Timing of screening matters

BACKGROUND AND AIMS

Alcohol is a well-established risk factor for numerous health conditions, making screening for hazardous alcohol use in healthcare a critical task. While self-reported data suggest that alcohol consumption varies across seasons, this seasonal fluctuation has not yet been confirmed using objective biological markers. This study aimed to measure whether phosphatidylethanol (PEth) captures variations in hazardous alcohol use across two temporal resolutions: month of the year and day of the week.

DESIGN

Observational cross-sectional study based on data from medical records.

SETTING

Healthcare services, Region Dalarna, Sweden, between 2017 and 2023.

PARTICIPANTS/CASES

Adult patients (n = 62 431, 50% females) screened for hazardous alcohol use with PEth within primary care.

MEASUREMENTS

This study utilizes test results from PEth, with results >0.30 μmol/l defined as hazardous alcohol use. We compared the prevalence of hazardous alcohol use across months and weekdays using logistic regression while adjusting for sex, age, smoking status, the Charlson Comorbidity Index and psychiatric diagnoses.

FINDINGS

The prevalence of hazardous alcohol use increased between May and August, ranging from 13.2% to 15.9%, compared with 10.7% in November. This corresponds to a 48% relative increase in the peak month of July [prevalence ratio (PR) = 1.48, 95% confidence interval (CI) = 1.33-1.64]. Hazardous alcohol use was also more prevalent among patients tested on Mondays (13.0%) compared with Thursdays, with the lowest prevalence (12.0%). The difference was particularly pronounced among female patients, with a 14.0% higher relative prevalence on Mondays (PR = 1.14, 95% CI = 1.02-1.27).

CONCLUSIONS

In Sweden, the prevalence of hazardous alcohol use appears to fluctuate seasonally and, to a lesser extent, across weekdays, as measured by blood tests for phosphatidylethanol, a biomarker for hazardous alcohol use. November showed the lowest prevalence and July the highest, consistent across age, sex and the year of the observational period. Hazardous alcohol use showed a slight elevation of prevalence during Mondays compared with Tuesday to Friday.

Unhealthy alcohol use and risk of coronary heart disease among young and middle-aged adults

Objective

To examine the associations between unhealthy alcohol use and risk of coronary heart disease (CHD) among women and men aged 18-65 years.

Methods

An observational study in an integrated healthcare system with systematic alcohol screening. We identified 432,265 primary care patients aged 18-65 years who, in 2014-2015, reported weekly alcohol intake levels. Weekly alcohol intake, categorized into below (≤14/week men; ≤7/week women) and above limits (≥15/week men; ≥ 8/week women) per U.S. guidelines, and heavy episodic drinking (HED, ≥5/≥4 drinks any day in past 3 months for men/women, respectively). Main outcome was CHD during 4-year follow-up, based on inpatient ICD diagnoses of myocardial infarction and CHD. Cox proportional hazards models adjusted for age, sex, race/ethnicity, body mass index, physical activity, smoking, hypertension, diabetes, and hyperlipidemia.

Results

The cohort comprised 44 % women, mean age (standard deviation) of 43.5 years (±13.1). Weekly alcohol intake above limits was associated with higher prevalence of cardiovascular risk factors, and a 26 %, 19 % and 43 % higher risk on the overall, men- and women-specific risk of CHD after adjusting for these risk factors (hazard ratio [95 % confidence interval] = 1.26[1.13 -1.40], 1.19[1.04-1.35] and 1.43[1.20-1.71], respectively).

Conclusions

In a large, real-world, diverse population with a systematic alcohol screening program, having weekly alcohol intake above limits was associated with increased risk of CHD among young and middle-aged men and women. Increased CHD risk due to alcohol intake above limits warrants particular awareness and interventions.

Unveiling causal relationships between addiction phenotypes and inflammatory cytokines: insights from bidirectional mendelian randomization and bibliometric analysis

Observational studies have suggested associations between multiple inflammatory factors and tobacco and alcohol use, but establishing causation is challenging in epidemiological investigations. We employed genetic association data about the circulating levels of 41 cytokines obtained from the genome-wide association study (GWAS), which contained 8293 Finnish participants. Genetic data on 5 substance use phenotypes were obtained from the GWAS dataset containing 1.2 million European subjects. Then, we conducted a bidirectional mendelian randomization (MR) study. The forward results indicated that smoking cessation was positively correlated with hepatocyte growth factor (HGF), interleukin-10 (IL-10), and stem cell factor (SCF); cigarettes per day was a risk factor associated with high expression in stromal cell-derived factor 1α (SDF-1 A), interferon-γ (IFN-G), IL-4, and granulocyte colony-stimulating factor (G-CSF); drinks per week and smoking initiation were risk factors respectively correlated with reduced HGF and IL-2RA levels. During inverse MR analysis, the findings revealed that both IL-16 and IL-18 increased the risk of cigarettes per day; macrophage inflammatory protein-1β (MIP-1B) and tumor necrosis factor-β (TNF-B) inhibited and promoted smoking cessation, respectively; macrophage colony-stimulating factor (M-CSF) elevated the risk of drinks per week, while interferon inducible protein 10 (IP-10) had a contrary role; IL-7 and M-CSF respectively prolonged and shortened age of initiation of regular smoking. This study provides genetic proof supporting a causal relationship between various inflammatory factors and addiction phenotypes. Further comprehensive investigations are required to uncover underlying biological mechanisms. In addition, bibliometric studies have shown that oxidative stress is one of the most important orientations in alcohol and tobacco addiction research, where an in-depth investigation of its pro-inflammatory mechanisms would facilitate the development of potential therapeutic biological targets and drugs.

Smoking, and to a lesser extent non-combustible nicotine use, is associated with higher levels of alcohol consumption and risky drinking

This study aimed to estimate differences in alcohol consumption, receipt of alcohol brief intervention, and alcohol reduction attempts by smoking status and use of non-combustible nicotine (including e-cigarettes, nicotine replacement therapy, heated tobacco products, or nicotine pouches). Data were from a representative household survey of adults in England (n = 188,878). Participants who reported former or current smoking scored approximately 1 point higher, on average, on the AUDIT-C (which measures alcohol consumption) than those who had never regularly smoked (Badj=0.97 [95%CI 0.93-1.00] and 0.92 [0.87-0.96], respectively) and had double the odds of risky drinking (AUDIT-C ≥ 5: ORadj=2.04 [1.98-2.10] and 2.03 [1.97-2.10], respectively), while differences for those who did versus did not use non-combustible nicotine use were less pronounced (AUDIT-C: Badj=0.14 [0.08-0.21]; AUDIT-C ≥ 5: ORadj=1.09 [1.04-1.13]). Among participants who engaged in risky drinking, those who smoked (vs. not) were more likely to report receiving alcohol brief interventions, and those attempting to quit smoking (vs. not) were more likely to report alcohol reduction attempts. Overall, combustible and - less so - non-combustible nicotine use is associated with higher levels of alcohol consumption and risky drinking.

Predicting On-Road Air Pollution Coupling Street View Images and Machine Learning: A Quantitative Analysis of the Optimal Strategy

Integrating mobile monitoring data with street view images (SVIs) holds promise for predicting local air pollution. However, algorithms, sampling strategies, and image quality introduce extra errors due to a lack of reliable references that quantify their effects. To bridge this gap, we employed 314 taxis to monitor NO, NO2, PM2.5, and PM10, and extracted features from ∼382,000 SVIs at multiple angles (0°, 90°, 180°, 270°) and buffer radii (100-500 m). Additionally, three typical machine learning algorithms were compared with SVI-based land-used regression (LUR) model to explore their performances. Generally, machine learning methods outperform linear LUR, with the ranking: random forest > XGBoost > neural network > LUR. Averaging strategy is an effective method to avoid bias of insufficient feature capture. Therefore, the optimal sampling strategy is to integrating multiple viewing angles at a 100-m buffer, which achieved absolute errors mostly less than 2.5 μg/m3 or ppb. Besides, overexposure, blur, and underexposure led to image misjudgments and incorrect identifications, causing an overestimation of road features and underestimation of human-activity features. These findings enhance understanding and offer valuable support for developing image-based air quality models and other SVI-related research.

Sex disparity in the association between alcohol consumption and sarcopenia: a population-based study

Background

Previous studies have shown inconsistent findings regarding the association of alcohol consumption with sarcopenia. Therefore, this study comprehensively investigated the association of alcohol consumption with sarcopenia in a nationally representative sample of US adults.

Methods

This population-based study included adults aged 18 years and older from the National Health and Nutrition Examination Survey (NHANES) III. Alcohol exposure was defined as daily alcohol intake, alcohol drinking history, number of drinking days per week, and frequency of binge drinking days per month. Weighted logistic regressions were used to determine associations.

Results

Four cohorts were selected from the NHANES III: cohort 1 (n = 7,592), cohort 2 (n = 12,060), cohort 3 (n = 7,608), and cohort 4 (n = 7,649), corresponding to alcohol exposure categories of daily alcohol intake, drinking history, number of drinking days per week, and frequency of binge drinking days per month. In the full model, the risk of sarcopenia was significantly associated with mild (odds ratio [OR]: 1.65; 95% confidence interval [CI]: 1.08-2.51), moderate (OR: 2.04; 95% CI: 1.12-3.71), and heavy drinkers (OR: 2.42; 95% CI: 1.17-4.97) compared to nondrinkers. There was an association between the development of sarcopenia and current drinkers (OR: 1.69; 95% CI: 1.12-2.56) but not former drinkers (OR: 1.21; 95% CI: 0.88-1.66). Compared to nondrinkers, an increased risk of developing sarcopenia was observed in participants who consumed alcohol 2 days (OR: 2.36; 95% CI: 1.40-3.99) or > 2 days (OR: 1.84; 95% CI: 1.10-3.07) per week, and those who engaged in binge drinking for ≤1 day per month (OR: 1.68; 95% CI: 1.09-2.60) or > 1 day per month (OR: 2.10; 95% CI: 1.10-4.01). Sensitivity analyses based on different definitions of sarcopenia yielded similar results. Stratified analyses revealed that these associations were present in females but not males.

Conclusion

Alcohol intake was associated with an increased risk of sarcopenia in all individuals, with this association being primarily observed in females rather than males.

Increased mortality from alcohol use disorder, alcohol-associated liver disease, and liver cancer from alcohol among older adults in the United States: 2000 to 2021

BACKGROUND

To investigate the trends in alcohol-associated liver disease (ALD), liver cancer from alcohol, and alcohol use disorder (AUD) burden among older adults in the United States (US).

METHODS

We gathered the ALD, liver cancer from alcohol, and AUD prevalence, mortality, and age-standardized rates (ASRs) from the Global Burden of Disease (GBD) Study 2021 between 2010 and 2021. We estimated the annual percent change (APC) with confidence intervals (CIs) for the burden of ALD, liver cancer from alcohol, and AUD in older adults (>70 years) in the United States. The findings were contrasted with global estimates and categorized by sex and state.

RESULTS

In 2021, there were approximately 512,340 cases of AUD, 56,990 cases of ALD, and 4490 cases of primary liver cancer from alcohol among older adults in the United States. In contrast to declining ASRs of prevalence and mortality in the global burden, these parameters were increased in older adults in the United States. From 2000 to 2021, prevalence from AUD (APC: 0.54%, 95% CI 0.43% to 0.65%), ALD (APC + 0.54%, 95% CI 0.22% to 0.86%), and primary liver cancer from alcohol (APC 2.93%, 95% CI 2.76% to 3.11%) increased. Forty states in the United States exhibited a rise in the prevalence rates of ALD in older adults.

CONCLUSION

Our findings highlighted the increased prevalence and mortality of AUD, ALD, and primary liver cancer from alcohol among older adults in the United Sates, contrasting with the decline in global trends. Public health strategies on ALD, AUD, and primary liver cancer from alcohol, which targets older adults, are urgently needed.

Alcohol consumption and mortality among Canadian drinkers: A national population-based survival analysis (2000-2017)

INTRODUCTION

Alcohol contributes significantly to global disease burden. Over 50 countries, including Canada, have established low-risk drinking guidelines to reduce alcohol-related harm. Canada's Guidance on Alcohol and Health (CGAH) was released in 2023. This study examines the relationship between weekly alcohol consumption, CGAH risk zones and mortality patterns among Canadian drinkers aged 15 and older.

METHODS

A retrospective cohort study was conducted using data from three cycles of the national, population-based Canadian Community Health Survey (2000-2006) linked to mortality data up to 2017. The sample included 145,760 respondents aged 15 and older who reported alcohol consumption in the past week. Average weekly alcohol consumption was assessed using the Timeline Followback method (i.e., 7-day recall). Outcomes included all-cause mortality, alcohol-related mortality and mortality from conditions with an alcohol-attributable fraction ≥15%.

RESULTS

Alcohol consumption was significantly positively associated with increased risks of all-cause (hazard ratio = 1.01, p < 0.001), alcohol-related (hazard ratio = 1.01, p = 0.001) and alcohol-attributable fraction-related mortality (hazard ratio = 1.02, p < 0.001). Each additional standard drink per week raised mortality risk, with women experiencing a greater increase in risk compared to men.

DISCUSSION AND CONCLUSION

The findings support the CGAH recommendations, highlighting the importance of lower alcohol consumption limits to reduce health risks. Public health efforts should focus on increasing awareness and adherence to these guidelines, particularly among women who face greater mortality risks at higher consumption levels. Ongoing monitoring of alcohol consumption is critical for tracking and evaluating low-risk drinking guideline effectiveness in reducing alcohol-related harm.

Changes in socio-economic inequality in alcohol-attributable mortality in periods of increasing and decreasing alcohol affordability

INTRODUCTION

Reducing alcohol affordability reduces alcohol-related harm but its impact on socio-economic inequalities requires further study. We examine changes in alcohol-attributable mortality inequalities in Finland during periods of sharply rising (2000-2007) and falling (2008-2017) alcohol affordability.

METHODS

Linking individual-level register data on causes of death and socio-demographics for the Finnish population aged ≥25 in 2000-2017 (68 million person-years), we analysed age-standardised monthly alcohol-attributable mortality rates by sex and income quintile (n = 32,699 alcohol-attributable deaths). Regression models were used to analyse mortality trends in the two periods, contrasting high- and low-income groups.

RESULTS

Inequalities in alcohol-attributable mortality between low- and high-income groups were large throughout the study period. During the period of rising alcohol affordability, mortality increased among high-income men with an average monthly increase of 0.17% (p = 0.046). This rate was even higher among low-income men, increasing by 0.55% per month, that is, +0.38 percentage points more than the rate for high-income men (p = 0.002). Among women, mortality increased at similar rates in both income groups. During the period of falling alcohol affordability, mortality decreased among high-income men with an average monthly decrease of -0.21% (p < 0.001), and it decreased even more among low-income men (-0.40%, i.e., -0.19 percentage points more, p = 0.030). Among women, the decreases were not statistically significant.

DISCUSSION AND CONCLUSIONS

The results indicate that increased alcohol affordability was associated with widening socio-economic inequalities while reduced affordability was linked with narrowing inequalities among men. Reducing alcohol affordability is thus a recommendable policy for reducing socio-economic inequality in alcohol-related harm.

The prevalence of mandated and voluntary health information on alcohol products in Australia

OBJECTIVE

Regulations to restrict alcohol promotion and requirements for mandatory display of information about health risks associated with alcohol use have been minimal and hard-won in Australia. This study (i) outlines an approach to monitoring alcohol industry use of health messages on alcohol products and (ii) reports prevalence and nature of government-mandated health-related information and voluntary health messages on alcohol products.

METHODS

Images of 5,923 alcohol products sold in four large alcohol stores in Sydney were captured. Data were collected in-store and via web-scraping. Label content was extracted from the images.

RESULTS

There was high compliance (97%-99%) with government-mandated requirements other than the pregnancy warning label (63%). Presence of voluntary health-related messages was common (65%), but typically present in the form of DrinkWise (an industry-led social aspects/public relations organisation) statements that are unlikely to be effective.

CONCLUSIONS

This study provides a unique and systematic approach to examining alcohol industry compliance with government-mandated on-product information requirements and voluntary inclusion of other health-related messages.

IMPLICATIONS FOR PUBLIC HEALTH

The results demonstrate the need for ongoing monitoring to enforce alcohol industry compliance with Australia's existing and future labelling regulations and to assess the industry's voluntary use of other forms of health messaging.

Effects of Chronic Alcohol Intake on the Composition of the Ensemble of Drug-Metabolizing Enzymes and Transporters in the Human Liver

In this study, to better understand the mechanisms of the profound impact of alcohol consumption on drug pharmacokinetics, efficacy, and toxicity, we characterized the alcohol-induced changes in the ensemble of drug-metabolizing enzymes and transporters (DMETs) in the human liver by performing global proteomic analysis of human liver microsomes from 94 donors. DMET protein levels were analyzed concerning alcohol consumption, smoking history, and sex using non-parametric tests, which were further strengthened by correlational analysis. To this end, we used a provisional index of alcohol exposure formulated based on the relative abundances of four marker proteins best correlating with the level of alcohol consumption. Alcohol-induced changes in the cytochrome P450 pool include significant increases in CYP2E1, CYP2B6, CYP2J2, and NADPH-cytochrome P450 reductase levels and the lowering of CYP1A2, CYP2C8, CYP2C9, CYP4A11, and cytochrome b5. Changes in UDP-glucuronosyltransferase (UGT) abundances comprise elevated UGT1A6, UGT1A9, and UGT2A1, and reduced UGT1A3, UGT1A4, UGT2B7, UGT2B10, and UGT2B15 levels. Tobacco smokers showed elevated CYP1A2, UGT1A6, and UGT2B4 and reduced FMO3, FMO4, and FMO5 levels, while in females, CYP1A2, UGT2B17, and UGT2B15 levels were lower, and UGT2A3 and STS were higher compared to males. The alcohol-induced changes in the DMET ensemble at the protein level reported herein provide deep insights into how alcohol impacts drug and xenobiotic metabolism.

Association Between GABRG2 and Self-Rating of the Effects of Alcohol in a French Young Adult Sample

Purpose

Alcohol use is a leading risk factor for preventable death, injury, and disease globally. Low sensitivity to the effects of alcohol is influenced by genes and predicts risk for harmful alcohol use and alcohol use disorder (AUD). Alcohol induces effects partly by modulation of gamma-aminobutyric acid receptors type A (GABAARs). This study investigates the relationship between genetic variation in GABAAR subunit genes and individual alcohol sensitivity among French university students.

Patients and Methods

The study involved 1,409 French university students (34.5% women; mean age 20.3 years). Alcohol sensitivity was measured by the Self-Rating of the Effects of Alcohol Scale (SRE). SRE-scores from initial drinking, regular drinking, and heavy drinking were investigated for correlations with alcohol consumption and for associations with single nucleotide polymorphisms (SNPs) in GABAAR subunit genes (GABRA2, GABRG2, GABRA6).

Results

We replicated correlations between low alcohol sensitivity and high alcohol consumption. We further found an association between the minor allele in rs211014 (GABRG2) and higher SRE-scores, linked to dizziness and motor incoordination. Genetic variation in GABRG2 has previously been associated with processes involving motor coordination (alcohol withdrawal, febrile- and epileptic seizures).

Conclusion

The results from our study suggest that genetic variation in GABRG2 may influence alcohol sensitivity, which could inform strategies for assessing risk for harmful alcohol use and AUD.

Building Connections and Striving to Build Better Futures: A Qualitative Interview Study of Alcohol Recovery Navigators' Practice in the North East of England, UK

To address the holistic and continuity of care needs of people who attend North East hospitals frequently for alcohol-related reasons, Recovery Navigator (Navigator) roles were introduced into Alcohol Care Teams in six hospitals in the North East of England, UK, in 2022. The Navigators aimed to provide dedicated holistic support to patients experiencing alcohol harms, starting whilst in the hospital with the potential to continue this beyond discharge. This qualitative study explores the contributions that the Navigators make towards integrated alcohol care. Twenty-five semi-structured interviews were undertaken with 7 patients, 1 carer, and 17 staff. We used reflexive thematic analysis and applied the concept of continuity of care and Self-Determination Theory. The findings suggest that all of the participants value Navigators having dedicated time to work with patients to address their social needs, that patients benefit from having someone who provides relational support and is 'gently persistent', and that most of the Navigators have good relationships with community providers and have supported the transition of patients to these services. Staff recognise the challenges of holistic alcohol care in hospitals, and the support of the Alcohol Care Teams and Navigators is seen as invaluable. Navigators help to address gaps in the provision of holistic support for patients who experience significant health inequalities.

Chronic low back pain causal risk factors identified by Mendelian randomization: a cross-sectional cohort analysis

BACKGROUND CONTEXT

There are a number of risk factors- from biological, psychological, and social domains- for nonspecific chronic low back pain (cLBP). Many cLBP treatments target risk factors on the assumption that the targeted factor is not just associated with cLBP but is also a cause (i.e., a causal risk factor). In most cases this is a strong assumption, primarily due to the possibility of confounding variables. False assumptions about the causal relationships between risk factors and cLBP likely contribute to the generally marginal results from cLBP treatments.

PURPOSE

The objectives of this study were to a) using rigorous confounding control compare associations between modifiable causal risk factors identified by Mendelian randomization (MR) studies with associations in a cLBP population and b) estimate the association of these risk factors with cLBP outcomes.

STUDY DESIGN/SETTING

Cross sectional analysis of a longitudinal, online, observational study.

PATIENT SAMPLE

1,376 participants in BACKHOME, a longitudinal observational e-Cohort of U.S. adults with cLBP that is part of the NIH Back Pain Consortium (BACPAC) Research Program.

OUTCOME MEASURES

Pain, Enjoyment of Life, and General Activity (PEG) Scale.

METHODS

Five risk factors were selected based on evidence from MR randomization studies: sleep disturbance, depression, BMI, alcohol use, and smoking status. Confounders were identified using the ESC-DAG approach, a rigorous method for building directed acyclic graphs based on causal criteria. Strong evidence for confounding was found for age, female sex, education, relationship status, financial strain, anxiety, fear avoidance and catastrophizing. These variables were used to determine the adjustment sets for the primary analysis. Potential confounders with weaker evidence were used for a sensitivity analysis.

RESULTS

Participants had the following characteristics: age 54.9±14.4 years, 67.4% female, 60% never smokers, 29.9% overweight, 39.5% obese, PROMIS sleep disturbance T-score 54.8±8.0, PROMIS depression T-score 52.6±10.1, Fear-avoidance Beliefs Questionnaire 11.6±5.9, Patient Catastrophizing Scale 4.5±2.6, PEG 4.4±2.2. In the adjusted models, alcohol use, sleep disturbance, depression, and obesity were associated with PEG, after adjusting for confounding variables identified via a DAG constructed using a rigorous protocol. The adjusted effect estimates- the expected change in the PEG outcome for every standard deviation increase or decrease in the exposure (or category shift for categorical exposures) were the largest for sleep disturbance and obesity. Each SD increase in the PROMIS sleep disturbance T-score resulted in a mean 0.77 (95% CI: 0.66, 0.88) point increase in baseline PEG score. Compared to participants with normal BMI, adjusted mean PEG score was slightly higher by 0.37 points (95% CI: 0.09, 0.65) for overweight participants, about 0.8 to 0.9 points higher for those in obesity classes I and II, and 1.39 (95% CI: 0.98, 1.80) points higher for the most obese participants. Each SD increase in the PROMIS depression T-score was associated with a mean 0.28 (95% CI: 0.17, 0.40) point increase in baseline PEG score, while each SD decrease in number of alcoholic drinks per week resulted in a mean 0.12 (95% CI: 0.01, 0.23) increase in baseline PEG score in the adjusted model.

CONCLUSIONS

Several modifiable causal risk factors for cLBP - alcohol use, sleep disturbance, depression, and obesity- are associated with PEG, after adjusting for confounding variables identified via a DAG constructed using a rigorous protocol. Convergence of our findings for sleep disturbance, depression, and obesity with the results from MR studies, which have different designs and biases, strengthens the evidence for causal relationships between these risk factors and cLBP. The estimated effect of change in a risk factor on change in PEG were the largest for sleep disturbance and obesity. Future analyses will evaluate these relationships with longitudinal data.

Quantifying the portrayal of alcohol-related A&E attendances and prevention in the British medical documentary series '24 hours in A&E'

BACKGROUND

Alcohol misuse is linked to numerous health and socioeconomic harms. Edutainment and docutainment television programmes can act as health promotion tools, influencing health perceptions and behaviours. Inaccurate portrayals can engender misinformation. Limited research has assessed alcohol-related illnesses and prevention in edutainment/docutainment, with none examining British medical documentaries.

METHODS

A quantitative content analysis assessed the portrayal of alcohol-related attendances (ARAs), behaviours, and prevention in the series 24 hours in A&E. Main series episodes broadcast 2011-2022, depicting ARAs, were coded. Descriptive statistics and a Fisher's exact were then undertaken.

RESULTS

ARAs featured 38 patients in 23 episodes (8.3% episodes total). Significantly more ARA episodes were broadcast from 2011 to 2016 than 2017-2022 (P = 0.002). ARAs were mainly portrayed in males (63.2%), young adults (73.7%) and White ethnic groups (78.9%). Binge drinking and pubs/bar/nightclubs/'nights out' were the main behaviours and settings depicted. ARAs encompassed predominantly accidents/injuries (72.7%). Prevention featured infrequently (15.8% patients) and involved secondary (50.0%) or tertiary prevention (50.0%) for alcohol-use disorders (AUDs).

CONCLUSION

ARAs were under-portrayed. While prevention portrayals and demographics were largely consistent with reality, ethnic minority groups, AUDs and chronic alcohol-related illnesses were underrepresented. Binge drinking and night-time economy settings were over-portrayed. Inaccurate depictions could lead to misperceptions of alcohol-related health harms.

Antioxidative Therapy of Alcoholic Liver Injury by Amorphous Two-Dimensional Cobalt Hydroxide Nanocatalyst

The intake of excessive ethanol will activate an alternative ethanol metabolic pathway in the liver, resulting in the overproduction of reactive oxygen species (ROS), which further leads to alcoholic liver injury (ALI). Although several molecular antioxidants have been utilized in clinics for treating ALI, their efficacies are still less satisfactory. In this work, a nanocatalytic antioxidation therapeutic strategy is proposed for ALI treatment by constructing amorphous Co(OH)2 nanosheets with catalytic antioxidative property. The bis(μ-hydroxo)CoIICoII dinuclear active sites of Co(OH)2 nanosheets are capable of coordinating with hydrogen peroxide (H2O2) with significantly reduced thermodynamic barrier to form a dihydroxyl adduct bis(μ-hydroxo)CoIII(OH)CoIII(OH) favorable for catalytic H2O2 disproportionation, while amorphous and ultrathin structure further facilitates the reaction, resulting in a high catalytic efficiency (Km=59.31 mM). Thanks to the inherent hepatic passive targeting ability of nanomaterials, the antioxidative nanosheets can accumulate in liver region efficiently after intravenous administration (35.5 % ID/g accumulation efficiency), enabling efficient catalytic antioxidation in the liver to mitigate hepatic oxidative stress, protect hepatocytes from apoptosis/ferroptosis. This study provides a new methodology of nanocatalytic antioxidation for treating ALI and other hepatic diseases related to oxidative stress.

Effect of a small increase in off-premises trading hours on alcohol sales in Norway: A stepped-wedge cluster-randomized controlled trial

BACKGROUND AND AIMS

Evidence of the effect of limiting off-premises alcohol trading hours is still scarce. This study tested the effect of a small extension in trading hours on alcohol sales in alcohol monopoly outlets in Norway.

DESIGN

The extension of trading hours was implemented within a stepped-wedge cluster-randomized trial design. Eligible state monopoly outlets (n = 229) were clustered into trade districts (n = 62), which were block-randomized to one of three sequences regarding date of implementation: 1 September 2020 (n = 21 districts, 82 outlets), 1 December 2020 (n = 21 districts, 73 outlets) and 1 March 2021 (n = 20 districts, 74 outlets). Outcomes were followed-up for a 1-year period.

SETTING AND PARTICIPANTS

Study participants were state monopoly outlets in urban and rural trade districts in all parts of Norway.

MEASUREMENTS

Monthly alcohol sales in litres of pure alcohol per trade district and per outlet were measured from March 2020 to March 2022 (primary outcome). We applied a linear mixed-effect model with two-way fixed effects within a difference-in-difference framework. As a robustness check we considered the effects of cross-border trade and effects in subgroups of outlets. Trading hours in monopoly outlets were extended by 1 hour on Saturdays. The extension was permanent. Pre-intervention periods and not-yet-treated units served as control conditions.

FINDINGS

We did not find a statistically significant effect of the small extension in trading hours on monthly alcohol sales (i) per trade district [average treatment effect: -185.5 litres, 95% confidence interval (CI) = -1159.9, 788.9] and (ii) per outlet (-35.3 litres, 95% CI = -142.1, 72.0). These findings were consistent across estimation methods and model specifications.

CONCLUSION

There is no clear evidence that a small extension in off-premises trading hours affected alcohol sales in monopoly outlets in Norway.

Alcohol-attributable deaths in Thai people from 2015 to 2021 using the comparative risk assessment approach

BACKGROUND

The alcohol-attributable mortality rate is an important health indicator for surveillance of health-related impacts of alcohol consumption. This study aimed to estimate the annual number and rate of alcohol-attributable deaths among the Thai population aged 15 years and over during 2015-2021.

METHODS

Mortality data were drawn from the National Death Registry based on ICD-10. We used the standard methodology of comparative risk assessments for alcohol within the general framework of the Global Burden of Disease Studies and used alcohol-attributable fractions, derived from exposure, and relative risk compared to lifetime abstainers as the counterfactual. Age-standardization was used to adjust mortality rates which were calculated by cause, age group, and sex.

RESULTS

The estimated annual number of alcohol-attributable deaths was 20,039 (men: 17,726 [6.50% of total annual deaths of the Thai population] and women: 2312 [1.11%]). The age-standardized alcohol-attributable mortality rates continuously increased from 33.8 to 37.5 deaths per 100,000 population from 2015 to 2019 and slightly decreased to 34.5 and 35.3 in 2020 and 2021, respectively. The three leading causes of death attributed to alcohol consumption were road injuries, cirrhosis and other liver diseases, and other unintentional injuries.

CONCLUSION

Alcohol remains an important preventable cause of death among Thais. The alcohol-attributable mortality rate increased from 2015 to 2019 but declined in 2020 and 2021, possibly due to the coronavirus pandemic and lockdown measures. Culturally appropriate, cost-effective interventions should be used to control alcohol accessibility, particularly among young people who frequently sustain injuries from external causes and have high mortality rates.

A global review of the impact on women from men's alcohol drinking: the need for responding with a gendered lens

BACKGROUND

Global evidence shows that men's harmful alcohol use contributes to intimate partner violence (IPV) and other harms. Yet, interventions that target alcohol-related harms to women are scarce. Quantitative analyses demonstrate links with physical and verbal aggression; however, the specific harms to women from men's drinking have not been well articulated, particularly from an international perspective.

AIM

To document the breadth and nature of harms and impact of men's drinking on women.

METHODS

A narrative review, using inductive analysis, was conducted of peer-reviewed qualitative studies that: (a) focused on alcohol (men's drinking), (b) featured women as primary victims, (c) encompassed direct/indirect harms, and (d) explicitly featured alcohol in the qualitative results. Papers were selected following a non-time-limited systematic search of key scholarly databases.

RESULTS

Thirty papers were included in this review. The majority of studies were conducted in low- to middle-income countries. The harms in the studies were collated and organised under three main themes: (i) harmful alcohol-related actions by men (e.g. violence, sexual coercion, economic abuse), (ii) impact on women (e.g. physical and mental health harm, relationship functioning, social harm), and (iii) how partner alcohol use was framed by women in the studies.

CONCLUSION

Men's drinking results in a multitude of direct, indirect and hidden harms to women that are cumulative, intersecting and entrench women's disempowerment. An explicit gendered lens is needed in prevention efforts to target men's drinking and the impact on women, to improve health and social outcomes for women worldwide.

Bidirectional Associations Between Alcohol Drinking and Depressive Symptoms Among US Adults Aged 50 to 75: The US Health and Retirement Study

Background/Objectives: Low or moderate alcohol drinking may reduce the risk of depression, but depression may induce alcohol drinking. However, the bidirectional associations between alcohol drinking and depression were inconsistent, and many prior analyses were not properly conducted. This study explored the within-individual bidirectional associations between alcohol drinking and depressive symptoms under a causal analytic framework. Methods: Using data for the baby boomer cohorts (born between 1948 and 1965) from the Health and Retirement Study (HRS), we employed the unit fixed-effect models with lagged measures to examine the within-individual bidirectional associations between the number of alcohol drinks per week and the changes in the eight-item Center for Epidemiological Studies-Depression (CES-D) scores. Results: Among 11,057 participants at baseline, about 48% were drinkers and 19% had a CES-D ≥4, i.e., at a high risk of depression. Among male low/moderate drinkers, increasing alcohol drinking between consecutive visits was significantly associated with a decrease in depression scores after adjusting for prior alcohol drinking (-0.15 points per 7 drinks/week increase, p = 0.009). Conversely, among male drinkers and female heavy drinkers, increasing depression scores between visits increased alcohol drinking after adjusting for prior depression scores (ranging from 0.22 to 0.79 drinks/week per 1 point increase of depression score, all p values < 0.01). Conclusions: The bidirectional associations between alcohol drinking and depressive symptoms were evident only among male drinkers, and alcohol drinking should not be recommended as a solution for preventing or relieving depressive symptoms. Limitations: Measures of alcohol drinking and depression were coarse, and the study cohorts were limited to the US baby boomer generation. Generalizing findings to other populations should be cautious.

The burden of generational harm due to alcohol use in Tanzania: A mixed method study of pregnant women

BACKGROUND

Rates of prenatal alcohol use in Sub-Saharan Africa (SSA) are increasing despite regulatory bodies urging pregnant women to abstain from alcohol. Tanzania has minimal policies, interventions, and educational programs addressing prenatal alcohol exposure. Consequently, a considerable number of mothers and their fetuses are exposed to alcohol, leading to serious health consequences like fetal alcohol spectrum disorder (FASD). Our study aims to understand the alcohol use practices of pregnant women, the knowledge and attitudes related to prenatal alcohol exposure among different genders and generations, and how these may be influenced by community perceptions and cultural beliefs among patients at Kilimanjaro Christian Medical Center (KCMC).

METHODS

A total of 676 individuals seeking care at the KCMC Emergency Department (ED) or Reproductive Health Center (RHC) met our inclusion criteria, were approached for participation using a systematic random sampling method, and were enrolled. Of those, 541 women and 114 men completed the survey. The quantitative analysis focused exclusively on survey data from 533 women who reported their pregnancy status and age. Descriptive frequencies were used to compare sociodemographic factors and alcohol use practices across three female groups stratified by pregnancy status and age. Nineteen survey participants-both men and women-were purposively selected for qualitative semi-structured in-depth interviews (IDIs) exploring knowledge, attitudes, and cultural beliefs surrounding alcohol use during pregnancy. A grounded theory approach was used to analyze IDIs in NVivo.

RESULTS

A large percentage of pregnant women reported consuming alcohol at least once per week (42.2%). Older non-pregnant women exhibited the highest rate of alcohol use per week (66.0%). Many older non-pregnant women (28.7%) perceived alcohol use as acceptable during pregnancy. Younger non-pregnant women had the highest prevalence of harmful or hazardous drinking (HHD) at 16.4%. This group also reported the highest weekly alcohol expenses, with 18.1% spending over 10,000 Tanzanian shillings (TZS) per week. Median [IQR] DrInC scores were 0 [0-0] for pregnant women, 0 [0-7] for younger non-pregnant women, and 0 [0-1] for older non-pregnant women. Older non-pregnant women exhibited the highest prevalence of depression (31.4%). Median [IQR] PHQ-9 scores were 4 [3-6.25] for pregnant women, 5 [2-8] for younger non-pregnant women, and 6 [3-10] for older non-pregnant women. Qualitative analyses demonstrated that (1) cultural beliefs are intricately tied to perceived benefits of prenatal alcohol exposure, (2) a history of alcohol use preceding pregnancy largely influences prenatal alcohol use, and (3) community views of PWCA are negative.

CONCLUSIONS

Our findings demonstrate high rates of prenatal alcohol use in Moshi, Tanzania, with pre-pregnancy alcohol use as a significant predictor. Despite generally negative views of pregnant women who consume alcohol (PWCA), some sociocultural beliefs and limited knowledge about the dangers of prenatal alcohol exposure encouraged alcohol use during pregnancy. To improve health outcomes and reduce alcohol-related pregnancy complications for current and future generations, community-wide health messaging and pre-pregnancy interventions may prove beneficial for pregnant women and women of reproductive age who consume alcohol.

The role of alcohol control policies in the reversal of alcohol consumption levels and resulting attributable harms in China

Yearly adult per capita consumption of alcohol in China between 2016 and 2019 decreased by 2.4 L of pure alcohol, or 33%. According to the World Health Organization, this decrease in consumption was accompanied by reductions in alcohol-attributable mortality of 23% between 2015 and 2019. This paper examines the contribution of alcohol control policies in China to these public health gains. A systematic search of the literature was conducted on alcohol control policies and their effectiveness in China as part of a larger search of all countries in WHO Western Pacific Region. In addition to articles on empirical evidence on the impact of such alcohol control policies, we also searched for reviews. The plausibility of changes of traditional alcohol control policies (taxation increases, availability restrictions, restriction on advertisement and marketing, drink-driving laws, screening and brief interventions) in explaining reductions of consumption levels and attributable mortality rates was explored. There was some progress in the successful implementation of strict drink-driving policies, which could explain reductions in traffic injuries, including fatalities. Other traditional alcohol control policies seem to have played a minimal role in reducing alcohol consumption and attributable harms during the time period 2016-2019. However, an anti-corruption campaign was extensive enough to have substantially contributed to these reductions. The campaign prohibited the consumption of alcoholic beverages in everyday life of government officials and thus contributed to a de-normalization of alcohol. While this anti-corruption campaign was the only policy to potentially explain marked decreases in levels of alcohol consumption and attributable mortality, more detailed research is required to determine exactly how the campaign achieved these decreases.

Prevalence and psycho-social factors associated with alcohol use among primary school-going children aged 6 to 13 years in Mbale district, Uganda: a cross-sectional study

BACKGROUND

Alcohol use among children in low-resource settings has received limited attention. This study investigated the prevalence of and biopsychosocial factors associated with alcohol use among children aged 6 to 13 years enrolled in primary education in Uganda.

METHODS

This cross-sectional study conducted in primary schools within Mbale district, employed stratified random sampling to select 470 child-parent dyads. Screening for child alcohol consumption utilized the validated Ugandan (Lumasaaba) version of the Car, Relax, Alone, Forget, Family/Friends, Trouble (CRAFFT) tool. Alcohol Use Disorder (AUD) was diagnosed using the AUD module of the Mini International Neuropsychiatric Interview for children and adolescents (MINI KID). Logistic regression analysis explored associations between alcohol consumption (CRAFFT cut-off score: 1 or more) and biopsychosocial factors (age, sex, nutrition, family dynamics, socioeconomic indicators, and school environment). Data analysis utilized STATA-17 statistical software.

RESULTS

The median age of the participants was 11 years, with an interquartile range (IQR) of 9 to 12 years and a male to female ratio of 1:1.3. The screened prevalence of alcohol consumption among the children in the past 12 months was 25.2% (95% CI: 21.4-29.4) and 7.2% (95% CI: 5.1-10.0) were diagnosed with AUD. The study found a comparable prevalence of alcohol use between boys (25.0%, 95% CI: 19.4-31.5) and girls (25.4%, 95% CI: 20.0-31.1). Age-specific variations indicated that early adolescents (10 to 13 years), were more likely to consume alcohol 28.1% (95% CI: 23.5-33.3) compared to pre-adolescent children (6 to 9 years) 17.6% (95% CI: 11.9-25.1) in the past 12 months. Factors associated with alcohol use included single-parent households, lower caregiver education, low socioeconomic status, maternal drinking, food insecurity, under-weight, physical discipline by parents, peer influence, rural school attendance, and the school environment.

CONCLUSION

The prevalence of alcohol consumption among children in Mbale district, eastern Uganda was high with one-in-four primary-school-children aged 6 to 13 years consuming alcohol in the past year, and no significant gender differences. It highlights various interconnected factors associated with alcohol use among school-aged children. We recommend awareness campaigns at all levels, stricter implementation of alcohol policies, school prevention programs, and family-focused and socio-economic interventions. Nationwide school surveys should target pre-adolescent alcohol use.

Rational Design of a Tandem Activatable Fluorescent Probe for Differential Diagnosis and Therapeutic Assessment of Hepatocellular Carcinoma

Hepatocellular carcinoma (HCC) is a formidable disease, distinguished by its high aggressiveness and dismal outcomes. Although leucine aminopeptidase (LAP) has been widely employed as a biomarker in biological imaging of HCC, it is still susceptible to interference from false-positive signals activated in injured liver tissues. In this study, based on the significant difference of GSH levels in alcohol-damaged liver tissues and tumor tissues, a dual-tandem activatable probe (PCLT) was designed for differential diagnosis and treatment guidance of HCC by near-infrared fluorescence (NIRF) imaging. This probe comprised a dual-locked hemicyanine dye decorated with a tetraethylene glycol chain and dual-recognition unit of glutathione (GSH) and LAP, which could be sequentially cleaved by GSH and LAP to restore its NIRF signal. PCLT excellently discriminated orthotopic HCC from ALI far earlier (7 days) than histological analysis (28 days) and exhibited higher specificity toward early orthotopic HCC than the single-locked probe (PCL). In addition, PCLT is capable of accurately delineating the tumor contour, assisting in surgical resection of HCC tumors under fluorescence visualization, and noninvasively assessing the antitumor effect of HCC chemotherapy during ferroptosis, thereby presenting promising clinical implications for clinical diagnosis and therapy of HCC.

Hepatocytes and mitochondria dual-targeted astaxanthin WPI-SCP nanoparticles for the alleviation of alcoholic liver injury

Alcoholic liver injury is one of the most frequent liver diseases around the world, and nutritional intervention has been considered as an effective way to alleviate alcohol liver injury. To alleviate the liver damage caused by alcohol, a type of astaxanthin (AXT) loaded nanoparticles were designed for dual targeting of hepatocytes and mitochondria. Firstly, galactooligosaccharides (GOS) were conjugated to whey protein isolate (WPI) and sea cucumber peptide (SCP) via the Maillard reaction, achieving a grafting degree of 29 %, then triphenylphosphonium (TPP) was linked by amide reaction. Secondly, AXT was loaded into the complex of SCP-WPI-GOS-TPP (SWGT) to form AXT@SCP-WPI-GOS-TPP(AXT@SWGT) nanoparticles. The Pearson coefficient increased from 0.69 to 0.76 after introducing TPP targeting moiety. In vivo experiments showed that AXT@SWGT significantly alleviated liver injury caused by alcohol. The vacuolation and fat accumulation associated with alcoholic liver injury was alleviated. The alcohol dehydrogenase and aldehyde dehydrogenase activity were improved by 296.88 % and 34.19 %, respectively. AXT@SWGT significantly enhanced the biological activities of glutathione by 76.86 %, catalase by 145.42 %, and superoxide dismutase by 33.48 %, thereby alleviating oxidative stress. The results indicated that the AXT@SWGT might have the potential to intervene alcoholic liver injury via the dual targeting strategy.

Probiotics alleviate chronic ethanol exposure-induced anxiety-like behavior and hippocampal neuroinflammation in male mice through gut microbiota-derived extracellular vesicles

BACKGROUND

Probiotics can colonize both the human and animal bodies and consist of active microorganisms that are beneficial to health. The use of probiotics has been shown to alleviate certain neurological diseases and disturbances in gut microbiota resulting from chronic ethanol exposure. Research indicates that probiotics can influence the nervous system via the microbial-gut-brain axis, wherein extracellular vesicles secreted by the gut microbiota play a significant role in this process.

RESULTS

In this study, we first established a 30-day ethanol exposure and probiotic gavage mouse model, both of which influenced behavior and the composition of gut microbiota. We then extracted gut microbiota-derived extracellular vesicles from the feces of these model mice and injected them into new mice via the tail vein to assess the role of each set of extracellular vesicles. The results indicated that the extracellular vesicles derived from the intestinal microbiota in the ethanol group induced anxiety-like behavior and hippocampal neuroinflammation in the recipient mice. In contrast, the extracellular vesicles secreted by the gut microbiota from the probiotic group mitigated the anxiety-like behavior and neuroinflammation induced by ethanol-influenced extracellular vesicles.

CONCLUSIONS

Our study demonstrates that extracellular vesicles secreted by the gut microbiota can influence the nervous system via the microbial-gut-brain axis. Furthermore, we found that the extracellular vesicles secreted by the gut microbiota from the probiotic group exert a beneficial therapeutic effect on anxiety and hippocampal neuroinflammation.

Screening and Following Up Harmful Alcohol Use "… is Not Necessarily Your Primary Focus": A Qualitative Study Exploring Health Professionals' Experiences Addressing Harmful Alcohol Use in a Norwegian Hospital

Introduction

Alcohol use remains a leading cause of excess mortality and morbidity worldwide, and identifying and following up harmful alcohol use represents a key component of alcohol harm reduction policies. This article explores health professionals' experiences implementing these policies in a Norwegian hospital.

Aim

To explore health professionals' views and experiences of systematic screening and tailored follow-up of harmful and hazardous alcohol use in a Norwegian hospital.

Methods

We conducted semi-structured interviews with 13 specialty registrars and nurses working in the emergency department and observation ward of a hospital in Oslo, Norway. Interviews were carried out between May and December 2022, coded using NVivo v.14 and analyzed thematically.

Results

We identified three themes: (i) standardized and clinical assessment, referring to tensions between standardized and clinical alcohol risk assessment; (ii) formal and informal treatment guidelines, encompassing the informal patient care practices enacted in the emergency department and on the wards, and; (iii) training delivery and barriers to implementation, referring to the training penetration rate and identified need for "clear and simple" alcohol treatment guidelines.

Conclusion

This study highlights tensions between alcohol-related harm and alcohol-related norms as these pertain to screening and following up harmful and hazardous alcohol use in a Norwegian hospital. Results suggest training should focus on zero alcohol recommendations, the use of assessment tools, the acceptability of screening to patients and "clear and simple" patient follow-up procedures.

Gut microbiota modulates depressive-like behaviors induced by chronic ethanol exposure through short-chain fatty acids

BACKGROUND

Chronic ethanol exposure (CEE) is recognized as an important risk factor for depression, and the gut-brain axis has emerged as a key mechanism underlying chronic ethanol exposure-induced anxiety and depression-like behaviors. Short-chain fatty acids (SCFAs), which are the key metabolites generated by gut microbiota from insoluble dietary fiber, exert protective roles on the central nervous system, including the reduction of neuroinflammation. However, the link between gut microbial disturbances caused by chronic ethanol exposure, production of SCFAs, and anxiety and depression-like behaviors remains unclear.

METHODS

Initially, a 90-day chronic ethanol exposure model was established, followed by fecal microbiota transplantation model, which was supplemented with SCFAs via gavage. Anxiety and depression-like behaviors were determined by open field test, forced swim test, and elevated plus-maze. Serum and intestinal SCFAs levels were quantified using GC-MS. Changes in related indicators, including the intestinal barrier, intestinal inflammation, neuroinflammation, neurotrophy, and nerve damage, were detected using Western blotting, immunofluorescence, and Nissl staining.

RESULTS

Chronic ethanol exposure disrupted with gut microbial homeostasis, reduced the production of SCFAs, and led to anxiety and depression-like behaviors. Recipient mice transplanted with fecal microbiota that had been affected by chronic ethanol exposure exhibited impaired intestinal structure and function, low levels of SCFAs, intestinal inflammation, activation of neuroinflammation, a compromised blood-brain barrier, neurotrophic defects, alterations in the GABA system, anxiety and depression-like behaviors. Notably, the negative effects observed in these recipient mice were significantly alleviated through the supplementation of SCFAs.

CONCLUSION

SCFAs not only mitigate damage to intestinal structure and function but also alleviate various lesions in the central nervous system, such as neuroinflammation, and reduce anxiety and depression-like behaviors, which were triggered by transplantation with fecal microbiota that had been affected by chronic ethanol exposure, adding more support that SCFAs serve as a bridge between the gut and the brain.

The alcohol harm paradox: is it valid for self-reported alcohol harms and does hazardous drinking pattern matter?

BACKGROUND

The alcohol harm paradox (APH) posits that alcohol harms are more prevalent in low socioeconomic position (SEP) groups compared to high SEP groups, when adjusted for alcohol consumption volume.

AIM

We explored whether APH is valid for self-reported alcohol harms and whether SEP differences in hazardous drinking patterns may explain SEP differences in alcohol harms, accounting for consumption volume.

DATA AND METHODS

We applied cross-sectional data from national population surveys in Norway, restricted to a subsample of past month drinkers aged 25-79 years (n = 8 171). Two binary outcome measures of self-reported alcohol-related harms were constructed from the AUDIT-10 items 4 through 10; alcohol dependence symptoms and alcohol related consequences. We separated two SEP groups based on education level: low versus high. Employing logistic regression models, we examined the extent to which SEP differences in alcohol-related harms were attributable to a more hazardous drinking pattern in terms of: (i) heavy episodic drinking and (ii) proportion of consumption volume by spirits, adjusting for consumption volume and demographic characteristics.

RESULTS

In the low SEP group, alcohol-related harms were significantly more prevalent as compared to the high SEP group when adjusted for gender and age, and more so after adjustment for consumption volume. Measures of hazardous drinking pattern and having a spouse could only to a minor extent account for the elevated risk of alcohol-related harm in the low SEP group. The findings were robust across various sensitivity analyses.

CONCLUSION

Low SEP was associated with alcohol-related harm and a more hazardous drinking pattern but also with lower consumption volume. The findings support the validity of the alcohol harm paradox for self-reported alcohol harms.

Trends in alcohol expenditure among risky drinkers: A population study in England, 2014-2023

BACKGROUND

This study aimed to estimate time trends in alcohol expenditure among risky drinkers in England over the past decade, to understand whether these trends are driven by changes in prices paid or volumes purchased, and to explore differences between population subgroups.

METHODS

Nationally-representative monthly cross-sectional survey. Participants were 44,382 adults (≥18y) drinking at risky levels (AUDIT-C ≥ 5; 'risky drinkers'). Linear regression modelled trends between March-2014 and October-2023 in (i) mean weekly inflation-adjusted expenditure on alcohol, (ii) mean weekly alcohol consumption in units, and (iii) mean inflation-adjusted expenditure per unit of alcohol, overall and by age, gender, social grade, region, and smoking status.

RESULTS

There was an uncertain decrease in mean weekly expenditure from £18.90 [95 %CI=£18.30-£19.50] in March-2014 to £17.90 [£17.60-£18.30] in May-2016, then an uncertain increase to £18.60 [£18.30-£18.90] between May-2016 and June-2018. This was followed by a further decline to £16.90 [£16.60-£17.30] by April-2021 and subsequent rise to £18.60 [£17.90-£19.40] by October-2023. Changes in weekly alcohol expenditure were more closely mirrored by changes in mean expenditure per unit of alcohol than by changes in mean weekly alcohol consumption in units. Notable subgroup differences included sharp rises in weekly alcohol expenditure since 2021 among younger ages (driven by a rise in expenditure per unit of alcohol) and current smokers (driven by a rise in weekly units of alcohol consumed).

CONCLUSIONS

In England, the average amount adult risky drinkers reported spending on alcohol each week has fluctuated since 2014, with a notable decrease around the start of the COVID-19 pandemic in 2020 and a subsequent rise since restrictions were lifted and since the cost-of-living crisis has led to high rates of inflation. Except for current smokers, this pattern appears to have been driven predominantly by changes in the price paid per unit rather than changes in consumption.

Alcohol-Specific Inpatient Diagnoses in Germany: A Retrospective Cross-Sectional Analysis of Primary and Secondary Diagnoses from 2012 to 2021

AIMS

Our study aimed to a) describe the distribution of hospital discharges with primary and secondary alcohol-specific diagnoses by sex and age group, and b) describe how the number of hospital discharges with primary and secondary alcohol-specific diagnoses have changed across different diagnostic groups (categorized by primary International Classification of Diseases, 10th Revision [ICD-10] diagnosis) over time.

DESIGN

Retrospective cross-sectional analysis.

SETTING

German hospital settings between 2012 and 2021.

PARTICIPANTS

All persons aged 15-69 admitted to hospitals as registered in a nationwide data set.

MEASUREMENTS

We counted a) the number of all hospital discharges and b) the number of hospital discharges with at least one alcohol-specific secondary diagnosis (secondary alcohol-specific diagnosis) by year, sex, age group, and diagnostic group. One diagnostic group included all primary alcohol-specific diagnoses, while 13 additional groups aligned with ICD-10 chapters (e.g., neoplasms). Alcohol-involvement was defined as either a primary or secondary alcohol-specific diagnosis.

FINDINGS

Of 95 417 204 recorded hospital discharges between 2012 and 2021, 3 828 917 discharges (4.0%; 2 913 903 men (6.4%); 915 014 women (1.8%)) involved either a primary or at least one secondary diagnosis related to alcohol. Of all alcohol-involved hospital discharges, 56.8% (1 654 736 discharges) had no primary but only a secondary alcohol-specific diagnosis. Secondary alcohol-specific diagnoses were particularly prevalent in hospital discharges due to injuries. With rising age, alcohol-involvement in hospital discharges due to digestive or cardiovascular diseases increased. Between 2012 and 2021, the rate of alcohol-involved hospital discharges has decreased more in younger as compared with older adults (average change between 2012 and 2021: 15-24: -55%; 25-34: -41%; 35-44: -23%; 45-54: -31%; 55-64: -21%; 65-69: -8%).

CONCLUSIONS

The number of alcohol-involved hospital discharges in Germany from 2012 to 2021 more than doubles (from 1 654 736 to 3 828 917) when including secondary alcohol-specific diagnoses. More pronounced declines among younger adults may be attributed to unequal changes in alcohol consumption patterns across the population and to the hazardous effects of long-term alcohol use.

Trends in alcohol-attributable morbidity and mortality in Germany from 2000 to 2021: A modelling study

INTRODUCTION

We aimed to assess: (i) trends in alcohol-specific - that is, fully attributable - morbidity and mortality in the German adult population aged 15-69 between 2000 and 2021; and (ii) changes in alcohol-attributable disease burden - that is, fully and partially alcohol-attributable categories - for 2006, 2012, 2018 and 2021.

METHODS

Morbidity data was pulled from hospitalisation and rehabilitation statistics and mortality data was pulled from the causes of death registry. Alcohol use, adjusted for unrecorded consumption, was estimated using the Epidemiological Survey of Substance Abuse and triangulated with per capita consumption from annual sales data. For major disease categories, alcohol-attributable fractions were estimated for males and females by age groups (15-29, 30-49, 50-69 years) using the comparative risk assessment methodology.

RESULTS

For males and females, the age-standardised rate of alcohol-specific morbidity peaked in 2012 and decreased thereafter showing a steep decline from 2019 to 2021. The rates of alcohol-specific mortality decreased constantly from 2000 to 2019 but increased from 2019 to 2021. Compared to 2006 the age-standardised alcohol-attributable morbidity and mortality rates in males and females were lower in 2021. For both sexes, the age-standardised alcohol-attributable morbidity and mortality rates and the proportions of morbidity/mortality rates relative to all-cause morbidity/mortality decreased between 2006 and 2021.

DISCUSSION

The declines in alcohol-attributable morbidity and mortality are in line with decreases in consumption and signal that the importance of alcohol in health service utilisation and mortality has weakened. Sex ratios in morbidity and mortality do not indicate a strong converging trend.

Alcohol and mortality in Mexico: prospective study of 150 000 adults

BACKGROUND

Alcohol consumption is a leading cause of premature death globally, but there is no large-scale prospective evidence from Mexico.

METHODS

The Mexico City Prospective Study recruited 150 000 adults aged 35 years or older between 1998 and 2004. Participants were followed up until Oct 1, 2022 for cause-specific mortality. Cox regression in those with no self-reported chronic disease at entry (adjusted for age, sex, district, education, physical activity, smoking, and diabetes) was used to relate baseline-reported alcohol consumption (never, former, occasional [less than monthly], and regular [at least monthly, split into <70, ≥70 to <140, ≥140 to <210, and ≥210 g/week]) to mortality at ages 35-74 from all causes, and from a pre-specified alcohol-related set of underlying causes. Heavy episodic drinking (normally consuming >5 [men] or >4 [women] drinks on a single occasion) and type of preferred drink were also examined.

FINDINGS

Among 138 413 participants aged 35-74 years at recruitment, 21 136 (15%) were regular alcohol drinkers (14 863 [33%] men, 6273 [7%] women), of whom 13 383 (63%) favoured spirits and 6580 (31%) favoured beer. During follow-up, there were 13 889 deaths at ages 35-74 years, including 3067 deaths from the pre-specified alcohol-related causes. Overall, J-shaped associations with mortality were observed. Compared with occasional drinkers, those with baseline-reported consumption ≥210 g/week had 43% higher all-cause mortality (rate ratio [RR] 1·43 [95% CI 1·30-1·56]) and nearly three times the mortality from the pre-specified alcohol-related causes (2·77 [2·39-3·20]). Death from liver disease was strongly related to alcohol consumption; the RR comparing regular drinkers of ≥140 g/week with occasional drinkers was 4·03 (3·36-4·83). Compared with occasional light drinking, occasional heavy episodic drinking was associated with 20% higher alcohol-related mortality (1·20 [1·06-1·35]), and regular heavy episodic drinking was associated with 89% higher alcohol-related mortality (1·89 [1·67-2·15]). Drinks with alcohol percentages higher than spirits were associated with the greatest increased mortality risk, even after accounting for the total alcohol consumed.

INTERPRETATION

In this Mexican population, higher alcohol consumption, episodic drinking, and very high percentage alcoholic products were all associated with increased mortality.

FUNDING

Wellcome Trust, the Mexican Health Ministry, the National Council of Science and Technology for Mexico, Cancer Research UK, British Heart Foundation, and the UK Medical Research Council.

TRANSLATION

For the Spanish translation of the abstract see Supplementary Materials section.

Computational algorithm based on health and lifestyle traits to categorize lifemetabotypes in the NUTRiMDEA cohort

Classifying individuals based on metabotypes and lifestyle phenotypes using exploratory factor analyses, cluster definition, and machine-learning algorithms is promising for precision chronic disease prevention and management. This study analyzed data from the NUTRiMDEA online cohort (baseline: n = 17332 and 62 questions) to develop a clustering tool based on 32 accessible questions using machine-learning strategies. Participants ranged from 18 to over 70 years old, with 64.1% female and 35.5% male. Five clusters were identified, combining metabolic, lifestyle, and personal data: Cluster 1 ("Westernized Millennial", n = 967) included healthy young individuals with fair lifestyle habits; Cluster 2 ("Healthy", n = 10616) consisted of healthy adults; Cluster 3 ("Mediterranean Young Adult", n = 2013) represented healthy young adults with a healthy lifestyle and showed the highest adherence to the Mediterranean diet; Cluster 4 ("Pre-morbid", n = 600) was characterized by healthy adults with declined mood; Cluster 5 ("Pro-morbid", n = 312) comprised older individuals (47% >55 years) with poorer lifestyle habits, worse health, and a lower health-related quality of life. A computational algorithm was elicited, which allowed quick cluster assignment based on responses ("lifemetabotypes"). This machine-learning approach facilitates personalized interventions and precision lifestyle recommendations, supporting online methods for targeted health maintenance and chronic disease prevention.

Gut Hormones: Possible Mediators of Addictive Disorders?

BACKGROUND

Alcohol and drug dependence are major health and economic burdens to society. One of the major challenges to reducing this burden will be to develop more effective and better tolerated medications that target alternative mechanisms in the brain. While the dopamine system has been well characterized for mediating the reward value of drugs, there is evidence that the endocrine system also conveys signals to the same neural systems using gut hormones.

SUMMARY

These gut hormones, produced in the stomach and intestine and that regulate food intake, have also been shown to control the use of other substances, such as alcohol and drugs of abuse. Examples of such hormones are ghrelin and glucagon-like peptide-1, which exert their effects on dopamine transmission in parts of the brain known to be involved in some of the core features of addiction, such as reward sensitivity.

KEY MESSAGES

This raises the possibility that gut hormone systems may play a pivotal role in addictive disorders. This review will briefly outline emerging evidence that the ghrelin and glucagon-like peptide-1 hormones are contrasting mediators of alcohol and drug use and may present a promising alternative target for treatment intervention in addictive disorders.

Addressing India's alcohol misuse crisis: The urgent need for screening and brief intervention to bridge the healthcare gap

India faces a significant challenge with alcohol misuse, as evidenced by the national survey revealing that 57 million out of 160 million persons with alcohol use exhibit harmful or dependent patterns, necessitating professional assistance. The Global Status Report on Alcohol and Health (2018) indicates a rising per capita alcohol consumption in the Southeast Asian Region, with India contributing substantially. To address this, implementing policies and programs to curb hazardous alcohol use is crucial. Despite a shortage of mental health professionals in India, they remain the primary caregivers for those with alcohol-related issues. Only one in five individuals with problematic alcohol use can access professional help. I argue for adopting Screening and Brief Intervention (SBI) to bridge this healthcare gap. SBI is a concise, structured counseling approach that proves effective and scalable. It can be delivered by various healthcare providers, including doctors, nurses, counselors, and paramedics. Hence, it can be seamlessly integrated into primary care, emergency, and nonclinical settings. The efficacy of SBI extends to electronic formats, providing a scope of expansion through telehealth. The WHO advocates SBI by its SAFER initiative aimed at reducing negative alcohol-associated health and social consequences. SBI is effective across age groups, including adolescents and young adults, constituting most of India's population. Emerging evidence suggests that SBI is acceptable, feasible, and effective in the Indian context. Universal or targeted SBI can be a pivotal tool in achieving the Sustainable Development Goals (2030) and global commitments for noncommunicable diseases, fortifying efforts to prevent and treat alcohol misuse.

Drunk in China? The Imperative for Effective Interventions Against Alcohol Abuse

BACKGROUND

Alcohol use and abuse remain prevalent in China, though mounting evidence shows that even drinking in moderation is detrimental to health. While many countries' intake is on the decline, China's alcohol consumption is rising fast and is on the path to overtaking countries like the United States, even on a per capita level.

OBJECTIVES

This paper aims to analyze the danger of lax enforcement of laws and regulations against alcohol use and abuse and underscores the imperative for effective health interventions to curb problematic alcohol consumption in China.

RESULTS

Different from their Western counterparts, Chinese drinkers often consume more spirit with a high percentage of alcohol in social settings that encourage the "ganbei culture"-making toasts with alcohol filled to the brim and downed in one go to show respect-which perpetuates excessive drinking at a fast pace. Though the country has various laws and regulations in place to curb problematic alcohol consumption, like workplace drinking, their impacts are dismal. Considering that China has 1.4 billion people, the country's uncurbed alcohol consumption trend could have a detrimental effect on national strategic objectives like "Healthy China 2030" and international ones like the Sustainable Development Goals. To further compound the situation, prevalent campaigns promoted by liquor companies-like alcohol-infused coffee, chocolate, and ice cream-may groom young people to develop alcohol consumption habits, if not addictions, for generations to come.

CONCLUSIONS

We developed the Framework of 5Vs of China's "Ganbei Culture to shed light on the issue, with the hope that it, along with the overarching insights of this paper, can assist health professionals and policymakers in better guarding and improving public health against the harms of alcohol use and abuse in China and beyond.

Exploring the impact of inflammatory cytokines on alcoholic liver disease: a Mendelian randomization study with bioinformatics insights into potential biological mechanisms

Background: Alcoholic liver disease (ALD) significantly contributes to global morbidity and mortality. The role of inflammatory cytokines in alcohol-induced liver injury is pivotal yet not fully elucidated.Objectives: To establish a causal link between inflammatory cytokines and ALD using a Mendelian Randomization (MR) framework.Methods: This MR study utilized genome-wide significant variants as instrumental variables (IVs) for assessing the relationship between inflammatory cytokines and ALD risk, focusing on individuals of European descent. The approach was supported by comprehensive sensitivity analyses and augmented by bioinformatics tools including differential gene expression, protein-protein interactions (PPI), Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis, and analysis of immune cell infiltration.Results: Our findings reveal that increased levels of stem cell growth factor beta (SCGF-β, beta = 0.141, p = .032) and interleukin-7 (IL-7, beta = 0.311, p = .002) are associated with heightened ALD risk, whereas higher levels of macrophage inflammatory protein-1α (MIP-1α, beta = -0.396, p = .004) and basic fibroblast growth factor (bFGF, beta = -0.628, p = .008) are linked to reduced risk. The sensitivity analyses support these robust causal relationships. Bioinformatics analyses around inflammatory cytokine-associated SNP loci suggest multiple pathways through which cytokines influence ALD.Conclusion: The genetic evidence from this study convincingly demonstrates that certain inflammatory cytokines play directional roles in ALD pathogenesis. These findings provide insights into the complex biological pathways involved and underscore the potential for developing targeted therapies that modulate these inflammatory responses, ultimately improving clinical outcomes for ALD patients.

Harm from others' drinking among young adults in Taiwan: Predictors and deteriorating quality of life

INTRODUCTION

This study aimed to investigate the prevalence of different forms of harm from others' drinking (HFOD), predictors and the relationship with multi-dimensional quality of life among young adults in an emerging alcohol market in Asia-Taiwan.

METHODS

Data were extracted from a 2018 household survey with national representativeness on substance use experiences. The analytic sample comprised 4901 participants aged 18-34. Eight items were used to measure HFOD experiences. Five-dimensional quality of life was assessed by the EQ-5D-5L. Multivariable regressions with complex survey analyses were performed to estimate the prevalence and risk association.

RESULTS

Almost 4.2% of young adults experienced any form of HFOD; psychological harm occurred more prevalently than physical harm (3.7% and 1.5%, respectively). Those aged 25-29 and 30-34 had a two- to three-fold risk of HFOD compared with those aged 18-24. Both non-drunk drinking and drunk drinking were associated with an increased risk of psychological HFOD (adjusted odds ratio 2.36 and 5.89, respectively), whereas the risk of physical HFOD was related only to drunk drinking (adjusted odds ratio 7.8). Psychological HFOD victimisation emerged as the strongest predictor for deteriorated quality of life (adjusted b -0.14; 95% confidence interval -0.24, -0.04), especially in the dimensions of pain/discomfort and anxiety/depression. Among HFOD victims, only 33% sought help.

DISCUSSION AND CONCLUSIONS

The HFOD among young adults, commonly exhibited in psychological form, was linked with deteriorated quality of life; nonetheless, young HFOD victims are under-recognised. When devising interventions for alcohol harm, developmental perspectives should be integrated into policies implemented in healthcare and community settings.

Alcohol Drinking Impacts on Adiposity and Steatotic Liver Disease: Concurrent Effects on Metabolic Pathways and Cardiovascular Risks

PURPOSE OF REVIEW

This integrative search aimed to provide a scoping overview of the relationships between the benefits and harms of alcohol drinking with cardiovascular events as associated to body fat mass and fatty liver diseases, as well as offering critical insights for precision nutrition research and personalized medicine implementation concerning cardiovascular risk management associated to ethanol consumption.

RECENT FINDINGS

Frequent alcohol intake could contribute to a sustained rise in adiposity over time. Body fat distribution patterns (abdominal/gluteus-femoral) and intrahepatic accumulation of lipids have been linked to adverse cardiovascular clinical outcomes depending on ethanol intake. Therefore, there is a need to understand the complex interplay between alcohol consumption, adipose store distribution, metabolic dysfunction-associated steatotic liver disease (MASLD), and cardiovascular events in adult individuals. The current narrative review deals with underconsidered and apparently conflicting benefits concerning the amount of alcohol intake, ranging from abstention to moderation, and highlights the requirements for additional robust methodological studies and trials to interpret undertrained and existing controversies. The conclusion of this review emphasizes the need of newer multifaceted clinical approaches for precision medicine implementation, considering epidemiological strategies and pathophysiological mechanistic. Newer investigations and trials should be derived and performed particularly focusing both on alcohol's objective consequences as putatively mediated by fat deposition, including associated roles in fatty liver disease as well as to differentiate the impact of different levels of alcohol consumption (absence or moderation) concerning cardiovascular risks and accompanying clinical manifestations. Indeed, the threshold for the safe consumption of alcoholic drinks remains to be fully elucidated.