Relationships among Alcohol Drinking Patterns, Macronutrient Composition, and Caloric Intake: National Health and Nutrition Examination Survey 2017-2018

Sex differences in the associations between prior weight loss and all-cause or cardiovascular mortality in non-elderly individuals with hyperuricemia: a mortality follow-up study

BACKGROUND

Hyperuricemia, a common metabolic condition, is strongly associated with obesity and represents as an independent risk factor for elevated risk of mortality. This observational study aimed to examine the sex-specific associations of prior long-term weight loss (LTWL), defined as a sustained reduction in body weight maintained for at least 12 months, with all-cause and cardiovascular disease (CVD) mortality in non-elderly individuals with hyperuricemia.

METHODS

Non-elderly individuals with hyperuricemia and a historical maximum body mass index ≥ 25 kg/m2 from the 1999-2018 US National Health and Nutrition Examination Survey were included. Sex-specific associations between prior LTWL (< 5%, 5-9.9%, 10-14.9%, and ≥ 15%) with all-cause and CVD mortality were investigated by weighted multivariable Cox proportional hazard regression analysis and stratified analysis.

RESULTS

Among 5,130 participants included, 505 all-cause (147 from CVD) deaths occurred during a median follow-up of 113 months. Compared with the LTWL < 5% reference group, the hazard ratios and 95% confidence intervals for the LTWL 5-9.9%, 10-14.9% and ≥ 15% groups were 1.11 (0.72-1.71), 1.34 (0.79-2.26) and 1.85 (1.14-2.92), respectively, for all-cause mortality (P for trend = 0.02) and 1.83 (0.76-4.43), 2.15 (0.76-6.10), and 3.76 (1.51-9.36), respectively, for CVD mortality (P for trend = 0.003). Significant associations between LTWL with all-cause and CVD mortality were observed exclusively in female, not male participants.

CONCLUSIONS

Prior LTWL ≥ 5% was associated with increased all-cause and CVD mortality in US non-elderly female participants with hyperuricemia. Additional prospective and longitudinal randomized clinical trials are necessary to further examine the current findings.

Alcohol Consumption and Risk of Age-Related Macular Degeneration and Geographic Atrophy Progression: Age-Related Eye Diseases Study 2 Report 34

PURPOSE

To examine potential relationships between alcohol consumption and age-related macular degeneration (AMD) progression, including progression to late AMD and geographic atrophy (GA) enlargement rate.

DESIGN

Post hoc analysis of cohorts within the Age-Related Eye Diseases Study 2.

PARTICIPANTS

A total of 6670 eyes (of 3673 participants) with no late AMD at baseline; 1143 eyes (of 841 participants) with GA at ≥2 consecutive visits.

METHODS

Color fundus photographs were collected at annual study visits and graded centrally for late AMD, GA area, and GA proximity. Alcohol consumption was calculated by food frequency questionnaire. Regression analyses of disease progression were performed according to alcohol consumption.

MAIN OUTCOME MEASURES

Progression to late AMD and its subtypes; GA area-based progression; GA proximity-based progression.

RESULTS

Over a mean follow-up of 4.5 years, 40.2% of eyes progressed to late AMD. In men, with alcohol tertile 1 (no regular consumption) as reference, hazard ratios for progression to late AMD were 0.69 (95% confidence interval [CI], 0.55-0.87; P = 0.0015) for tertile 2 and 0.85 (0.71-1.02; P = 0.079) for tertile 3. In women, hazard ratios were 1.12 (0.95-1.31, P = 0.17) and 0.85 (0.72-1.00, P = 0.046), respectively. Over a mean follow-up of 3.1 years, GA area-based progression was significantly faster in women than men, at 0.295 (95% CI, 0.278-0.311) and 0.260 mm/year (95% CI, 0.241-0.279), respectively (P = 0.007). In men, area-based progression differed significantly by alcohol tertile (P = 0.0001), at 0.275 (95% CI, 0.248-0.303), 0.183 (95% CI, 0.143-0.223), and 0.280 mm/year (0.254-0.306) in tertiles 1 to 3, respectively. In women, the area-based rate did not differ significantly by alcohol tertile (P = 0.11). In men only, Centers for Disease Control and Prevention-defined heavy drinking was associated with faster progression (P = 0.024), at 0.306 (95% CI, 0.262-0.349) versus 0.252 mm/year (95% CI, 0.233-0.270). In 808 eyes with noncentral GA, GA proximity-based progression did not differ significantly by alcohol tertile (P = 0.55).

CONCLUSIONS

Moderate alcohol consumption is associated with decreased risk of progression to late AMD in men. Geographic atrophy progression is faster in women, but its relationship with alcohol consumption is much stronger in men. In men, moderate consumption is associated with slower GA progression and higher consumption with faster progression. Although some of these associations may also relate to confounding, they might suggest that individuals with GA should avoid high alcohol consumption.

FINANCIAL DISCLOSURE(S)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Lifestyle-Related Factors for Improving Diet Quality

Background/Objectives: Diet quality is important for the prevention of non-communicable diseases (NCDs), which are now responsible for leading causes of death worldwide. Although health professionals often recommend diet improvement for the treatment and management of many NCDs, patients continually struggle to make dietary changes and maintain them long-term. This may be due to an interplay of many factors that affect dietary quality. This paper discusses some lifestyle-related factors that may offer additional points of intervention for health professionals to use to increase diet quality. Methods: This review examines the effects of exercise, sleep, mindfulness practice, meal socialization, social media use, and tobacco and alcohol use on diet quality. Studies examining the effects of these factors on diet were found by searching PubMed, CINAHL, and Google Scholar. Results: Evidence suggests that a positive relationship between exercise, adequate sleep, and all forms of mindfulness have positive effects on diet quality. Meal socialization's effects on diet quality were nuanced. Individuals tend to eat similarly to those they share a meal with. However, food quantity intake may be affected by the physical characteristics of individuals with whom people share a meal. Social media use was found to have negative effects on diet quality in those who used it excessively and was found to promote disordered eating patterns. Both tobacco and alcohol use were found to have negative impacts on diet quality. Conclusions: Using these findings, health professionals may be able to educate people about lifestyle-related factors that can improve diet quality.

SE, Toledo-Corral CM, Farias AJ. Alcohol and Cannabis Use Associated with Cardiometabolic Biomarkers among "All of Us" Cancer Survivors

BACKGROUND

Cancer survivors are at increased risk for cardiometabolic comorbidities following cancer treatment, which may be further exacerbated by cannabis and alcohol use. We aimed to examine the direct relationships of cannabis, alcohol, and the co-use of both substances with cardiometabolic risk factors and to explore disparities by race/ethnicity and sex.

METHODS

Cross-sectional data were extracted from adult cancer survivors in the "All of Us" from 2018 to 2022. Cannabis use was defined as occasional or frequent/regular cannabis use (vs. never) in the past 3 months and hazardous alcohol intake (AUDIT-C >3 for females; AUDIT-C >4 for males) versus nonhazardous in the past year, respectively. Co-use was defined as participants who engaged in regular cannabis and hazardous alcohol intake. We identified binary cardiovascular, immune, and metabolic system biomarkers, with high values defined by clinically established cutoffs or >75th percentile. We used multivariable logistic regression adjusting for sociodemographic and clinical factors.

RESULTS

In our sample (N = 7,054), 7.6% were Hispanic, 6.2% were Black, and 86.2% were White cancer survivors. Less than 5% of Hispanic and White survivors reported substance co-use compared with 7% of Black survivors. Compared with never-users, co-users were 1.58 (95% confidence interval, 1.14-2.19) more likely to have high blood pressure. No significant associations were found between co-use and immune biomarkers or sex differences.

CONCLUSIONS

Co-use of cannabis and hazardous alcohol may worsen high blood pressure in survivors, who are at higher risk for cardiometabolic comorbidities.

IMPACT

The study investigates substance use and cardiometabolic biomarkers, urging much research on their effects on cancer survivors.

The Postmortem Pathology of Sudden Death in Chronic Alcohol Exposure and Acute Alcohol Intoxication: A Review of Medicolegal Considerations, Traumatic and Systemic Pathology, and Biochemical Mechanisms

ABSTRACT

Chronic alcohol exposure is common in all societies and is seen at high rates during coronial (medicolegal) postmortem examinations. In both setting of acute alcohol intoxication and chronic misuse, a wide range of pathologies and mechanisms of death may be encountered, particularly with regard to sudden, unexpected or violent deaths. These warrant special attention. In this review, we examine the approach to postmortem examination where alcohol is likely to have played a key role in death. Attention is given to the scene of death, patterns of traumatic injury, systemic pathology (particularly of chronic alcohol exposure), seizures related to alcohol, and appropriate biochemical investigations.

Food inequity and insecurity and MASLD: burden, challenges, and interventions

Liver disease prevalence, severity, outcomes and hepatic risk factors (for example, unhealthy diet) are heavily affected by socioeconomic status and food insecurity. Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent liver disease globally and is likely to co-occur with other liver diseases associated with food insecurity. Though weight reduction and adopting a healthy diet can reverse the course of MASLD, gaps between recommendations and practice transcend individual responsibility and preference. Broader sociocultural determinants of food choices (social nutrition) include food insecurity, community and social norms and the local environment, including commercial pressures that target people experiencing poverty, ethnic minorities and children. Food insecurity is a barrier to a healthy diet, as a low-quality diet is often less expensive than a healthy one. Consequently, food insecurity is an 'upstream' risk factor for MASLD, advanced fibrosis and greater all-cause mortality among patients with liver disease. Intervening on food insecurity at four major levels (environment, policy, community and health care) can reduce the burden of liver disease, thereby reducing social and health inequities. In this Review, we report on the current research in the field, the need for implementing proven interventions, and the role liver specialists can have.

Effect of oral health status and oral function on malnutrition in community-dwelling older adult dental patients: A two-year prospective cohort study

OBJECTIVES

To survey oral status in detail and clarify the factors associated with nutritional status as evaluated by the Mini Nutritional Assessment.

BACKGROUND

Malnutrition is common in older adults and increases the risk of frailty, sarcopenia, and mortality. However, few longitudinal studies have been performed to investigate the causal effect of oral status on malnutrition in detail, and the information reported in those longitudinal studies has been limited to dentition status and swallowing ability.

MATERIALS AND METHODS

The participants in this prospective cohort study were patients who visited the Preventive Dentistry Clinic at Okayama University Hospital from November 2017 to January 2021. The number of teeth, periodontal condition, oral function (oral diadochokinesis, masticatory ability, number of bacteria in tongue coating, occlusal force, oral moisture, tongue pressure, swallowing function), nutritional status, the number of comorbidities, and mental health status were examined. These variables were analysed using structural equation modelling (SEM).

RESULTS

The final analysis included 141 participants (40 males and 101 females; mean age, 73.5 ± 6.3 years; follow-up rate: 79.7%). The results of the SEM revealed that oral status (number of teeth present and swallowing function) was positively associated with nutritional status 2 years later. In addition, age was negatively associated with oral status.

CONCLUSION

In community-dwelling older adult dental patients (age ≥60 years), oral function at baseline was associated with nutritional status two years later.

Effects of Ketogenic Diet on Increased Ethanol Consumption Induced by Social Stress in Female Mice

Stress is a critical factor in the development of mental disorders such as addiction, underscoring the importance of stress resilience strategies. While the ketogenic diet (KD) has shown efficacy in reducing alcohol consumption in male mice without cognitive impairment, its impact on the stress response and addiction development, especially in females, remains unclear. This study examined the KD's effect on increasing ethanol intake due to vicarious social defeat (VSD) in female mice. Sixty-four female OF1 mice were divided into two dietary groups: standard diet (n = 32) and KD (n = 32). These were further split based on exposure to four VSD or exploration sessions, creating four groups: EXP-STD (n = 16), VSD-STD (n = 16), EXP-KD (n = 16), and VSD-KD (n = 16). KD-fed mice maintained ketosis from adolescence until the fourth VSD/EXP session, after which they switched to a standard diet. The Social Interaction Test was performed 24 h after the last VSD session. Three weeks post-VSD, the Drinking in the Dark test and Oral Ethanol Self-Administration assessed ethanol consumption. The results showed that the KD blocked the increase in ethanol consumption induced by VSD in females. Moreover, among other changes, the KD increased the expression of the ADORA1 and CNR1 genes, which are associated with mechanisms modulating neurotransmission. Our results point to the KD as a useful tool to increase resilience to social stress in female mice.

Peripheral blood transcriptomic profiling of molecular mechanisms commonly regulated by binge drinking and placebo effects

Molecular responses to alcohol consumption are dynamic, context-dependent, and arise from a complex interplay of biological and external factors. While many have studied genetic risk associated with drinking patterns, comprehensive studies identifying dynamic responses to pharmacologic and psychological/placebo effects underlying binge drinking are lacking. We investigated transcriptome-wide response to binge, medium, and placebo alcohol consumption by 17 healthy heavy social drinkers enrolled in a controlled, in-house, longitudinal study of up to 12 days. Using RNA-seq, we identified 251 and 13 differentially expressed genes (DEGs) in response to binge drinking and placebo, respectively. Eleven protein-coding DEGs had very large effect sizes in response to binge drinking (Cohen's d > 1). Furthermore, binge dose significantly impacted the Cytokine-cytokine receptor interaction pathway (KEGG: hsa04060) across all experimental sequences. Placebo also impacted hsa04060, but only when administered following regular alcohol drinking sessions. Similarly, medium-dose and placebo commonly impacted KEGG pathways of Systemic lupus erythematosus, Neutrophil extracellular trap formation, and Alcoholism based on the sequence of drinking sessions. These findings together indicate the "dose-extending effects" of placebo at a molecular level. Furthermore, besides supporting alcohol dose-specific molecular changes, results suggest that the placebo effects may induce molecular responses within the same pathways regulated by alcohol.

Perspective: Nutrition Health Disparities Framework: A Model to Advance Health Equity

Disparities in nutrition, such as poor diet quality and inadequate nutrient intake, arise from multiple factors and are related to adverse health outcomes such as obesity, diabetes, cardiovascular disease, and some cancers. The aim of the current perspective is to present a nutrition-centric socioecological framework that delineates determinants and factors that contribute to diet and nutrition-related disparities among disadvantaged populations. The Nutrition Health Disparities Framework (NHDF) describes the domains (biological, behavioral, physical/built environment, sociocultural environment, and healthcare system) that influence nutrition-related health disparities through the lens of each level of influence (that is, individual, interpersonal, community, and societal). On the basis of the scientific literature, the authors engaged in consensus decision making in selecting nutrition-related determinants of health within each domain and socioecological level when creating the NHDF. The framework identifies how neighborhood food availability and access (individual/built environment) intersect with cultural norms and practices (interpersonal/sociocultural environment) to influence dietary behaviors, exposures, and risk of diet-related diseases. In addition, the NHDF shows how factors such as genetic predisposition (individual/biology), family dietary practices (interpersonal/behavioral), and food marketing policies (societal) may impact the consumption of unhealthy foods and beverages and increase chronic disease risk. Family and peer norms (interpersonal/behavior) related to breastfeeding and early childhood nutrition interact with resource-poor environments such as lack of access to preventive healthcare settings (societal/healthcare system) and low usage of federal nutrition programs (societal/behavioral), which may increase risk of poor nutrition during childhood and food insecurity. The NHDF describes the synergistic interrelationships among factors at different levels of the socioecological model that influence nutrition-related outcomes and exacerbate health disparities. The framework is a useful resource for nutrition researchers, practitioners, food industry leaders, and policymakers interested in improving diet-related health outcomes and promoting health equity in diverse populations.

National Nutrition Surveys Applying Dietary Records or 24-h Dietary Recalls with Questionnaires: A Scoping Review

Development of an accurate and efficient dietary method is required for national nutrition surveys. Some countries conduct dietary surveys and combine 24-h dietary records or 24-h dietary recalls with dietary questionnaires. This scoping review aimed to summarize studies that used results from national surveys that combined detailed dietary surveys (dietary records or 24-h dietary recall) and dietary questionnaires and identify the purpose of combining the two methods. The PubMed database and manual searches were used for the literature review. We extracted 58 articles from 16 national nutrition surveys from 14 countries. Most studies used 24-h dietary recall for detailed dietary surveys and the food frequency questionnaire (FFQ) or food propensity questionnaire (FPQ) for questionnaire surveys. Among 37 studies from eight countries, the purpose of combining the two dietary survey methods was to estimate energy and nutrient intakes from detailed dietary surveys and habitual food intake from questionnaires. These findings are useful as a reference when introducing new dietary survey methods in future national nutrition surveys.

Peripheral blood transcriptomic profiling indicates molecular mechanisms commonly regulated by binge-drinking and placebo-effects

Molecular changes associated with alcohol consumption arise from complex interactions between pharmacological effects of alcohol, psychological/placebo context surrounding drinking, and other environmental and biological factors. The goal of this study was to tease apart molecular mechanisms regulated by pharmacological effects of alcohol - particularly at binge-drinking, from underlying placebo effects. Transcriptome-wide RNA-seq analyses were performed on peripheral blood samples collected from healthy heavy social drinkers (N=16) enrolled in a 12-day randomized, double-blind, cross-over human laboratory trial testing three alcohol doses: Placebo, moderate (0.05g/kg (men), 0.04g/kg (women)), and binge (1g/kg (men), 0.9g/kg (women)), administered in three 4-day experiments, separated by minimum of 7-day washout periods. Effects of beverage doses on the normalized gene expression counts were analyzed within each experiment compared to its own baseline using paired-t-tests. Differential expression of genes (DEGs) across experimental sequences in which each beverage dose was administered, as well as responsiveness to regular alcohol compared to placebo (i.e., pharmacological effects), were analyzed using generalized linear mixed-effects models. The 10% False discovery rate-adjusted DEGs varied across experimental sequences in response to all three beverage doses. We identified and validated 22 protein coding DEGs potentially responsive to pharmacological effects of binge and medium doses, of which 11 were selectively responsive to binge dose. Binge-dose significantly impacted the Cytokine-cytokine receptor interaction pathway (KEGG: hsa04060) across all experimental-sequences that it was administered in, and during dose-extending placebo. Medium dose and placebo impacted pathways hsa05322, hsa04613, and hsa05034, in the first two and last experimental sequences, respectively. In summary, our findings add novel, and confirm previously reported data supporting dose-dependent effects of alcohol on molecular mechanisms and suggest that the placebo effects may induce molecular responses within the same pathways regulated by alcohol. Innovative study designs are required to validate molecular correlates of placebo effects underlying drinking.