Type of alcohol and drinking pattern in 56, 970 Danish men and women

Mediterranean Alcohol-Drinking Patterns and All-Cause Mortality in Women More Than 55 Years Old and Men More Than 50 Years Old in the "Seguimiento Universidad de Navarra" (SUN) Cohort

BACKGROUND

Most of the available epidemiological evidence on alcohol and chronic disease agrees on recommending alcohol abstention to young people, but some controversy exists about the most appropriate recommendation for alcohol abstention for people of older ages. A growing body of evidence suggests that the pattern of alcohol consumption is likely to be a strong effect modifier. The Mediterranean Alcohol Drinking Pattern (MADP) represents a score integrating several dimensions of drinking patterns (moderation, preference for red wine, drinking with meals, and avoiding binge drinking). Our aim was to clarify this issue and provide more precise recommendations on alcohol consumption.

METHODS

We prospectively followed-up 2226 participants (men older than 50 years and women older than 55 years at baseline) in the Seguimiento Universidad de Navarra (SUN) cohort. We classified participants into three categories of adherence to the MADP score (low, moderate, and high), and we added a fourth category for abstainers. Cox regression models estimated multivariable-adjusted hazard ratios (HR) of all-cause death and 95% confidence intervals (CI) using low MADP adherence as the reference category.

RESULTS

The strongest reduction in risk of mortality was observed for those with high adherence to the MADP, with an HR of 0.54 (95% CI: 0.37-0.80). The moderate adherence group (HR = 0.65, 95% CI: 0.44-0.96) and the abstention group (HR = 0.60, 95% CI: 0.36-0.98) also exhibited lower risks of mortality than the low MADP adherence group.

CONCLUSIONS

based on the available evidence, a public health message can be provided to people older than 50 years as follows: among those who drink alcohol, high adherence to the MADP score could substantially reduce their risk of all-cause mortality.

Alcohol, Drinking Pattern, and Chronic Disease

This review discusses the inconsistent recommendations on alcohol consumption and its association with chronic disease, highlighting the need for an evidence-based consensus. Alcohol is an addictive substance consumed worldwide, especially in European countries. Recommendations on alcohol consumption are controversial. On one hand, many nonrandomized studies defend that moderate consumption has a beneficial cardiovascular effect or a lower risk of all-cause mortality. On the other hand, alcohol is associated with an increased risk of cancer, neurological diseases, or injuries, among others. For years, efforts have been made to answer the question regarding the safe amount of alcohol intake, but controversies remain. Observational studies advocate moderate alcohol consumption following a Mediterranean pattern (red wine with meals avoiding binge drinking) as the best option for current drinkers. However, agencies such as the IARC recommend abstention from alcohol as it is a potent carcinogen. In this context, more randomized trial with larger sample size and hard clinical endpoints should be conducted to clarify the available evidence and provide clinicians with support for their clinical practice.

Changes in alcoholic beverage preference and consumption in Taiwan following accession to the World Trade Organization

BACKGROUND AND AIMS

Given the growing concerns that international trade agreements may increase the supply of health-harming commodities, including alcohol, this study aimed to investigate the changes in alcoholic beverage preference and consumption after Taiwan's accession to the World Trade Organization (WTO).

DESIGN

A before-and-after comparison analysis using data from two waves (1993-1996 and 2005-2008) of the Nutrition and Health Survey in Taiwan (NAHSIT), before and after Taiwan's accession to the WTO in 2002.

SETTING

Taiwan.

PARTICIPANTS

A total of 5031 and 2910 participants aged 19 years or older in NAHSIT 1993-1996 and 2005-2008, respectively.

MEASUREMENTS

Alcohol measures included beverage-specific preference, mean daily ethanol consumption, and heavy drinking. Logistic regression was used to estimate the prevalence rate ratios and rate differences of beverage preferences between the two waves and the risk ratios of heavy drinking associated with different beverage preferences.

FINDINGS

A reduced prevalence rate of drinkers who preferred rice spirits (prevalence rate ratio [PRR] = 0.47; 95% confidence interval [CI] = 0.24, 0.91) and Asian wine (PRR = 0.11; 95% CI = 0.04, 0.29) was found in contrast to an increase in the preference for fruit wine (PRR = 2.90; 95% CI = 1.75, 4.79); the preference for Asian spirits showed a non-significant increase (PRR = 1.63; 95% CI = 0.88, 3.02). Similarly, the mean daily ethanol consumption decreased for Asian wine and increased for Asian spirits. Compared with beer, an increased risk of heavy drinking was associated with rice spirits (adjusted risk ratio [aRR] = 3.30; 95% CI = 1.68, 6.47) and Asian spirits (aRR = 2.64; 95% CI = 1.38, 5.01).

CONCLUSIONS

After Taiwan became a member of the World Trade Organization and abolished its alcohol monopoly in 2002, the pattern of alcoholic beverage preference changed markedly, including a decrease in drinkers who preferred rice spirits and Asian wine (53% and 89% decrease, respectively) and an increase in drinkers who preferred fruit wine and Asian spirits (2.9-fold and 1.6-fold increase, respectively).

Correlates of Poor Self-Assessed Health Status among Socially Disadvantaged Populations in Poland

Self-assessment of health is recommended as valuable source of information about subjective health status. The present study was performed to evaluate the correlates of self-rated health status among beneficiaries of social care in Poland. This assessment could be crucial for the implementation of targeted preventive measures among this valuable population. The study population consisted of 1710 beneficiaries of social care from the Piotrkowski District. The relationship between self-rated health status and its correlates (sociodemographic, lifestyle factors, and health conditions) was examined using logistic regression, with a poor health rating as the outcome. Overall, 11% of respondents declared poor self-assessed health status. Men more often rated health status as poor (15%) as compared to women (8.5%) (p < 0.001). The odds of a poor assessment of health increased with age, being unemployed or disabled/retired (OR = 2.34 95%CI (1.34–4.19) or OR = 9.07 95%CI (3.68–22.37), respectively), and additionally with poor life satisfaction (OR = 5.14 95% CI (1.94–13.64)). Regarding lifestyle characteristics, only binge drinking was associated with poor health status assessment (OR = 12.62 95%CI (3.71–42.87)). In addition, having any illness or health problems decreased health status (OR = 4.26 95%CI (1.36–13.31)). Socially-disadvantaged populations, especially men who poorly rated their health status, still constituted a large percentage of the population, which is an important public health problem. Increasing knowledge about the correlates of health status will allow greater prevention strategies to be developed for the population.

Alcohol Consumption and Progression of Chronic Kidney Disease: Results From the Korean Cohort Study for Outcome in Patients with Chronic Kidney Disease

OBJECTIVE

To assess the association of alcohol consumption with chronic kidney disease (CKD) progression in patients with CKD.

PATIENTS AND METHODS

The KoreaN cohort study for Outcome in patients with CKD (KNOW-CKD) is a prospective observational study that included detailed questionnaires regarding alcohol consumption. The 1883 individuals with CKD were enrolled from April 1, 2011, through February 28, 2016, and followed until May 31, 2017. Using a questionnaire, alcohol consumption pattern was classified according to the amount of alcohol per occasion (none, moderate, or binge) or drinking frequency (none, occasional, or regular). The primary endpoint was a composite of 50% or greater decline in estimated glomerular filtration rate (eGFR) from the baseline level or end-stage renal disease.

RESULTS

During a follow-up of 5555 person-years (median, 2.95 years), the primary outcome occurred in 419 patients. Unadjusted cause-specific hazards model showed that the risk of the primary outcome was lower in drinkers than in non-drinkers. However, a fully adjusted model including eGFR and proteinuria yielded a reverse association. Compared with non-drinking, regular and occasional binge drinking were associated with a 2.2-fold (95% CI, 1.38-3.46) and a 2.0-fold (95% CI, 1.33-2.98) higher risk of CKD progression, respectively. This association was particularly evident in patients who had decreased kidney function and proteinuria. There was a significant interaction between alcohol consumption and eGFR for CKD progression. The slopes of eGFR decline were steeper in binge drinkers among patients with eGFR less than 60 mL/min/1.73 m².

CONCLUSIONS

Heavy alcohol consumption was associated with faster progression of CKD.

Alcoholic Beverage Preference and Dietary Habits: A Systematic Literature Review

INTRODUCTION

The aim of this review is to systematically and critically evaluate the existing literature into the association between alcoholic beverage preference and dietary habits in adults.

METHODS

A literature search was conducted in the databases of Medline (PubMed), ISI Web of Knowledge, and PsycINFO for studies published up to March 2013. From a total of 4,345 unique hits, 16 articles were included in this systematic review. Two independent reviewers extracted relevant data for each study and assessed study quality.

RESULTS

14 cross-sectional and two ecological studies from the United States and several European countries were included. Across different study populations and countries, persons with a beer preference displayed in general less healthy dietary habits. A preference for wine was strongly associated with healthier dietary habits in Western study populations, whereas studies in Mediterranean populations did not observe this. Dietary habits of persons with another preference or who were abstinent were less reported.

CONCLUSION

This review has shown that the preference for a specific alcoholic beverage is associated with diet. Thus, it might not be the alcoholic beverage but the underlying dietary patterns that are related to health outcomes.

Drinking pattern of wine and effects on human health: why should we drink moderately and with meals?

Epidemiological studies examining the effects of alcoholic beverages on human health may be unclear if they do not take into account drinking pattern parameters such as beverage type, regular moderateversusbinge drinking and drinking with meals.

Mediterranean alcohol-drinking pattern and mortality in the SUN (Seguimiento Universidad de Navarra) Project: a prospective cohort study

Moderate alcohol intake has been related to lower mortality. However, alcohol use includes other dimensions beyond the amount of alcohol consumed. These aspects have not been sufficiently studied as a comprehensive entity. We aimed to test the relationship between an overall alcohol-drinking pattern and all-cause mortality. In a Mediterranean cohort study, we followed 18 394 Spanish participants up to 12 years. A validated 136-item FFQ was used to assess baseline alcohol intake. We developed a score assessing simultaneously seven aspects of alcohol consumption to capture the conformity to a traditional Mediterranean alcohol-drinking pattern (MADP). It positively scored moderate alcohol intake, alcohol intake spread out over the week, low spirit consumption, wine preference, red wine consumption, wine consumed during meals and avoidance of binge drinking. During the follow-up, 206 deaths were identified. For each 2-point increment in a 0-9 score of adherence to the MADP, we observed a 25% relative risk reduction in mortality (95% CI 11, 38%). Within each category of alcohol intake, a higher adherence to the MADP was associated with lower mortality. Abstainers (excluded from the calculations of the MADP) exhibited higher mortality (hazard ratio 1·82, 95% CI 1·14, 2·90) than participants highly adherent to the MADP. In conclusion, better adherence to an overall healthy alcohol-drinking pattern was associated with reduced mortality when compared with abstention or departure from this pattern. This reduction goes beyond the inverse association usually observed for moderate alcohol drinking. Even moderate drinkers can benefit from the advice to follow a traditional MADP.

Different types of alcoholic beverages and incidence of metabolic syndrome and its components in a Mediterranean cohort

BACKGROUND & AIMS

We prospectively assessed the association between alcohol consumption and the incidence of Metabolic Syndrome (MS) in a Mediterranean cohort.

METHODS

We included 8103 (mean age: 35.4 years) University graduates free of any MS criteria and followed-up during ≥6 years. Alcohol consumption was collected with a validated 136-item food frequency questionnaire. New-onset cases of MS were defined according to the updated harmonizing criteria.

RESULTS

We observed 341 incident cases of MS. Consumers of ≥7 drinks/wk presented a significantly higher risk of developing MS (aOR: 1.80; 95% CI: 1.22-2.66; p < 0.001) compared with non-drinkers. In addition, alcohol drinkers (≥7 drinks/wk) had higher risk of hypertriglyceridemia (aOR: 2.07; 95% CI: 1.46-2.93) and impaired fasting glucose (aOR: 1.54; 95% CI: 1.16-2.04). Beer consumption was associated with higher risk for MS (p for trend = 0.027) and higher risk of hypertriglyceridemia (aOR: 1.81; 95% CI: 1.02-3.20), but with lower risk of low HDL-cholesterol criterion (aOR: 0.21; 95% CI: 0.05-0.89) for ≥7 drinks/wk versus no consumption. Non-significant association was observed between wine or liquor consumption and MS.

CONCLUSIONS

Consumption of at least seven alcoholic drinks per week was associated with a higher risk of developing MS among subjects initially free of any MS criteria.

A bottle of beer, a glass of wine or a shot of whiskey? Can the rate of alcohol-induced harm be affected by altering the population's beverage choices?

This article summarizes and puts into context the findings from the five articles contained in this thematic issue. The question of interest has been the connection between different beverage types and alcohol-induced harm. The key question is whether policy makers can affect rates of harm by affecting beverage choice. In the discussion, four different potential pathways for such an effect are differentiated. The first is the direct effect of the beverage over and above the effect of the ethanol it contains. The review of results suggests that the size of this effect may be modest, and it is clearly overmatched by cultural factors relating to who chooses to drink which beverage and how. However, even more relevant than the direct effect may be the other three mechanisms, which potentially affect the amounts of alcohol drunk or allow the influencing of drinker groups of interest.

The positive and negative health effects of alcohol- and the public health implications

In this paper, the negative and the positive effects of alcohol on health are reviewed. It is first of all established facts that a high alcohol intake implies an increased risk of a large number of health outcomes, such as dementia, breast cancer, colorectal cancer, cirrhosis, upper digestive tract cancer and alcohol dependency. Second, it is justified that alcohol has beneficial effects for some individuals, especially with regard to prevention of thrombosis of the heart. The public health relevance of these results is considered. The sensible drinking limits, used in both the UK and Denmark, of a maximum of 21 drinks per week for men and 14 drinks per week for women seem valid. A broader public health message of the beneficial effects of alcohol does not seem to be of interest in Western societies, where only a very small fraction of the population are non drinkers and may have very good reasons therefore.

Alcohol and self-rated health in a Mediterranean country: the role of average volume, drinking pattern, and alcohol dependence

BACKGROUND

The association between average alcohol consumption and self-rated ill-health is "J-shaped" in Scandinavian and Anglo-Saxon countries, but it has shown an inverse linear relationship in the few studies conducted in Mediterranean countries, based on average volume solely.

OBJECTIVE

To examine the relationship between alcohol and self-rated health in the general population of a Mediterranean country, by simultaneously taking into account average volume, drinking pattern, and alcohol abuse.

METHODS

From 2000 to 2005, we conducted telephone interviews on 12,037 persons, representative of the population aged 18 to 64 years in Madrid, Spain. The drinking pattern encompassed binge drinking, beverage preference, and drinking at mealtimes. Alcohol abuse was estimated by the CAGE test. The association between each alcohol-related variable and self-rated suboptimal (fair, poor, or very poor) health was estimated from logistic regression, with adjustment for the remaining alcohol-related variables and other potential confounders.

RESULTS

In comparison with never-drinkers, suboptimal health was less frequent among occasional drinkers [odds ratio (OR) 0.72; 95% confidence interval (CI): 0.61 to 0.86], average moderate drinkers (OR 0.57; 95% CI: 0.48 to 0.69), and excessive drinkers (OR 0.51; 95% CI: 0.36 to 0.72), but more frequent among former drinkers with > or =1 year of abstinence (OR 1.30; 95% CI: 1.03 to 1.64). Frequency of suboptimal health was likewise higher in subjects with > or =3 episodes of binge drinking (OR 1.55; 95% CI: 1.12 to 2.14) or alcohol abuse (OR 1.47; 95% CI: 1.22 to 1.76). No differences were observed in suboptimal health according to beverage preference or drinking at mealtimes. RESULTS in each gender were similar to those for total study participants.

CONCLUSIONS

Occasional, moderate, and excessive consumption of alcohol are associated with better self-rated health, even after adjustment for drinking pattern and alcohol abuse. In contrast, former-drinking, frequent binge drinking, and alcohol abuse are all associated with suboptimal self-rated health.

Alcohol and atherosclerosis: recent insights

Light to moderate alcohol intake is known to have cardioprotective properties; however, the magnitude of protection depends on other factors and may be confined to some subsets of the population. This review focuses on factors that modify the relationship between alcohol and coronary heart disease (CHD). The cardioprotective effect of alcohol seems to be larger among middle-aged and elderly adults than among young adults, who do not have a net beneficial effect of a light to moderate alcohol intake in terms of reduced all-cause mortality. The levels of alcohol at which the risk of CHD is lowest and the levels of alcohol at which the risk of CHD exceeds the risk among abstainers are lower for women than for men. The pattern of drinking seems important for the apparent cardioprotective effect of alcohol, and the risk of CHD is generally lower for steady versus binge drinking. Finally, there is some evidence that wine may have more beneficial effects than beer and distilled spirits; however, these results are still controversial and may be confounded by personal characteristics and other lifestyle factors such as diet. The inverse association between alcohol intake and CHD is influenced by age, gender, drinking pattern, and possibly by type of alcohol.

Alcoholic beverage preference and dietary pattern in Spanish university graduates: the SUN cohort study

OBJECTIVE

To describe the association between alcohol beverage preference and dietary habits comparing wine drinkers with other alcoholic beverage drinkers and with nondrinkers in Spanish university graduates.

SUBJECTS

A total of 10 526 men and women, who were recruited using mailed questionnaires, participated in this study.

METHODS

A semiquantitative food frequency questionnaire previously validated in Spain was used together with other questionnaires designed to collect lifestyle characteristics.

RESULTS

Wine drinkers reported higher intake of fibre and olive oil, and lower consumption of fat (only men), dairy products, sugared soda drinks and fast food as compared with other alcoholic beverage groups and nondrinkers. Men nondrinkers were more likely to be physically active during their leisure time than wine drinkers. No relevant differences were found in adherence to the Mediterranean food pattern according to alcoholic beverage preference.

CONCLUSION

This similarity in dietary patterns between wine drinkers and other groups suggests that the positive cardiovascular effects reported for wine should not be attributed to an overall healthier dietary pattern of wine drinkers. .

Prospective study of alcohol drinking patterns and coronary heart disease in women and men

OBJECTIVE

To determine the association between alcohol drinking patterns and risk of coronary heart disease in women and men.

DESIGN

Population based cohort study.

SETTING

Denmark, 1993-2002.

PARTICIPANTS

28 448 women and 25 052 men aged 50-65 years, who were free of cardiovascular disease at entry to the study.

MAIN OUTCOME MEASURES

Incidence of coronary heart disease occurring during a median follow-up period of 5.7 years.

RESULTS

749 and 1283 coronary heart disease events occurred among women and men. Women who drank alcohol on at least one day a week had a lower risk of coronary heart disease than women who drank alcohol on less than one day a week. Little difference was found, however, between drinking frequency: one day a week (hazard ratio 0.64, 95% confidence interval 0.51 to 0.81), 2-4 days a week (0.63, 0.52 to 0.77), five or six days a week (0.79, 0.61 to 1.03), and seven days a week (0.65, 0.51 to 0.84). For men an inverse association was found between drinking frequency and risk of coronary heart disease across the entire range of drinking frequencies. The lowest risk was observed among men who drank daily (0.59, 0.48 to 0.71) compared with men who drank alcohol on less than one day a week.

CONCLUSIONS

Among women alcohol intake may be the primary determinant of the inverse association between drinking alcohol and risk of coronary heart disease whereas among men, drinking frequency, not alcohol intake, seems more important.

Factors influencing the relation between alcohol and cardiovascular disease

PURPOSE OF REVIEW

Light-to-moderate alcohol intake is known to have cardioprotective properties in some subsets of the population. This review focuses on factors that modify the relation between alcohol and cardiovascular disease.

RECENT FINDINGS

Several large American studies have shown that the J-shaped relation is influenced by age and coronary heart disease risk-factor status since only middle-aged and elderly and those already at risk of developing coronary heart disease seem protected by drinking alcohol. It has also been suggested that only those who have a steady - in contrast to a binge - intake of alcohol have benefits with regard to cardiovascular disease. Prospective studies from the UK, Sweden and Denmark have further suggested that wine drinkers have a lower mortality than beer and spirits drinkers.

SUMMARY

The J-shaped relation between alcohol intake and cardiovascular disease seems to be influenced by age, gender, drinking pattern and type of alcohol.

Epidemiologic evidence for the cardioprotective effects associated with consumption of alcoholic beverages

The impact of alcohol intake on mortality from all causes has been described in a large number of prospective population studies from many countries. Most have shown a J-shaped relation between alcohol intake and subsequent mortality, indicating that there are both beneficial and harmful effects of ethanol on health. The risk of death from ischemic heart disease is seen to be significantly increased, and highest among abstainers, but not significantly increased among heavy drinkers. Some studies have found plausible mechanisms for the beneficial effect of light to moderate drinking. Subjects with a moderate alcohol intake have a higher level of high density lipoprotein than abstainers. Further, moderate drinkers are seen to have a lower low density lipoprotein. Also, alcohol has a beneficial effect on platelet aggregation, and thrombin level in blood is higher among drinkers than among non-drinkers. In the other end of the range of intake, the ascending leg of the U-shaped curve has been explained by the increased risk of cirrhosis, pancreatitis, and development oropharynx, oesophagus, and breast cancer. In exploring the French paradox, it has been suggested that wine may have beneficial effects additional to that of ethanol. Recently, several prospective population studies have supported this idea. It is, however, also likely that the apparent additional beneficial effect of wine on health in addition to the effect of ethanol itself is a consequence of confounding.

Alcoholic beverage preference and characteristics of drinkers and nondrinkers in western New York (United States)

BACKGROUND AND AIM

Dietary and lifestyle characteristics may differ for drinkers of specific alcoholic beverages and nondrinkers which would have important implications for studies of alcohol and disease. Our aim in this study was to describe differences in dietary and lifestyle characteristics associated with alcoholic beverage preference in a population-based sample of healthy study participants.

METHODS AND RESULTS

Data were collected as part of a series of case-control studies of alcohol use, myocardial infarction, and lung, breast and prostate cancer in western New York from 1846 men and 1910 women aged 35 to 79, randomly selected from the general population of Erie and Niagara Counties. Beverage preference was defined for noncurrent vs current drinkers, and drinkers of beer, wine, liquor, and mixed beverages. Generalized linear models for continuous variables and Cochran-Mantel-Haenszel statistics for categorical variables were computed for the entire sample and stratified by gender. Participant characteristics differed by alcoholic beverage preference and drinking status. In general, wine drinkers had higher education and household incomes, lower prevalence of current smoking, higher intakes of dietary fiber, potassium, vitamin E, and total carotenoids, lower total fat intakes and higher amounts of fruits, vegetables, and grain products than consumers of other beverages. Conversely, beer and liquor drinkers had somewhat lower education and household incomes, higher rates of current smoking, higher energy and total fat intakes and consumed lower amounts of fruits, vegetables, and grain products. Finally, current nondrinkers were more likely to be older, less educated, have lower household incomes, and consume diets less consistent with dietary guidelines than current drinkers.

CONCLUSIONS

These results suggest that usual beverage preference may encompass other health-related behaviors and underline the importance of accurate exposure measurement and use of statistical methods to accommodate these interrelationships.

Alcoholic beverage preference, diet, and health habits in the UNC Alumni Heart Study

BACKGROUND

Moderate alcohol intake is related to better health, and additional benefits may be associated with wine. However, beverage preference may be confounded by lifestyle factors related to health.

OBJECTIVE

The goal was to describe the associations between alcoholic-beverage preferences and indicators of a healthy diet and other health habits.

DESIGN

This cross-sectional study included data from 2864 men and 1571 women enrolled in the UNC Alumni Heart Study. Self-reports of drinking habits were used as predictors of health behaviors and of intakes of nutrients and food groups.

RESULTS

Subjects who preferred wine had healthier diets than did those who preferred beer or spirits or had no preference. Wine drinkers reported eating more servings of fruit and vegetables and fewer servings of red or fried meats. The diets of wine drinkers contained less cholesterol, saturated fat, and alcohol and more fiber. Wine drinkers were less likely to smoke. Compared with all drinkers, those who drank no alcohol consumed fewer vegetables but more fiber. Nondrinkers were less likely to exercise regularly and had a higher mean body mass index. Controlling for income and education had little effect on these associations.

CONCLUSIONS

The apparent health benefits of wine compared with other alcoholic beverages, as described by others, may be a result of confounding by dietary habits and other lifestyle factors. Confounding by lifestyle variables could also be a factor in the previously observed health differences between drinkers and nondrinkers, although the evidence for this association is not as strong.