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Shi J, Meng M, Sa R, Yu L, Lu Y, Gao B. Blood transfusion is correlated with elevated adult all-cause mortality and cardiovascular mortality in the United States: NHANES 1999 to 2018 population-based matched propensity score study. Clinics (Sao Paulo) 2024; 79:100379. [PMID: 38704877 PMCID: PMC11087911 DOI: 10.1016/j.clinsp.2024.100379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 03/28/2024] [Accepted: 04/22/2024] [Indexed: 05/07/2024] Open
Abstract
BACKGROUND AND AIMS The association of blood transfusion with an increase in medium- and short-term mortality in specific populations has been confirmed. However, the correlation between blood transfusion and long-term mortality in the general population remains unclear. This cohort study evaluated the correlation between blood transfusion and overall and cause-specific mortality in the general American adult population. METHODS The authors utilized 10 sets of 2-year cycle data (1999-2018) from the National Health and Nutrition Examination Survey on the outcomes of adults who did and did not receive blood transfusions. Propensity score-matching (1:1) was performed based on age, sex, race, education level, marital status, poverty-income ratio, arteriosclerotic cardiovascular disease, cancer, anemia, hypertension, and diabetes status. After controlling for demographic characteristics and clinical risk factors, Cox regression analysis was performed to evaluate the correlation between blood transfusion and all-cause and cause-specific mortality. RESULTS The study included 48,004 adult participants. The risk of all-cause mortality increased by 101 % with blood transfusion, and the risk of cardiovascular mortality increased by 165 %. After propensity score-matching, 6,116 pairs of cases were retained, and the risk of all-cause mortality increased by 84 % with blood transfusion, and the risk of cardiovascular mortality increased by 137 %. The sensitivity analysis results were robust. CONCLUSIONS In the general American population, blood transfusion significantly impacts long-term all-cause and cardiovascular mortality and may be an unacknowledged risk factor for death. Thus, the effective management of blood transfusion in the general population may be beneficial.
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Affiliation(s)
- Jie Shi
- Department of Blood Transfusion, The Second Hospital of Lanzhou University, Lanzhou, Gansu, China; School Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Min Meng
- Department of Medical, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Rina Sa
- Department of Pharmacy, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Lijun Yu
- Department of Pharmacy, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Yali Lu
- Department of Pharmacy, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Bei Gao
- Department of Pharmacy, Gansu Provincial Hospital, Lanzhou, Gansu, China.
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van den Ende MWJ, van der Maas HLJ, Epskamp S, Lees MH. Alcohol consumption as a socially contagious phenomenon in the Framingham Heart Study social network. Sci Rep 2024; 14:4499. [PMID: 38402289 PMCID: PMC11052543 DOI: 10.1038/s41598-024-54155-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 02/09/2024] [Indexed: 02/26/2024] Open
Abstract
We use longitudinal social network data from the Framingham Heart Study to examine the extent to which alcohol consumption is influenced by the network structure. We assess the spread of alcohol use in a three-state SIS-type model, classifying individuals as abstainers, moderate drinkers, and heavy drinkers. We find that the use of three-states improves on the more canonical two-state classification, as the data show that all three states are highly stable and have different social dynamics. We show that when modelling the spread of alcohol use, it is important to model the topology of social interactions by incorporating the network structure. The population is not homogeneously mixed, and clustering is high with abstainers and heavy drinkers. We find that both abstainers and heavy drinkers have a strong influence on their social environment; for every heavy drinker and abstainer connection, the probability of a moderate drinker adopting their drinking behaviour increases by [Formula: see text] and [Formula: see text], respectively. We also find that abstinent connections have a significant positive effect on heavy drinkers quitting drinking. Using simulations, we find that while both are effective, increasing the influence of abstainers appears to be the more effective intervention compared to reducing the influence of heavy drinkers.
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Affiliation(s)
- Maarten W J van den Ende
- Psychological Methods, University of Amsterdam, Amsterdam, 1001 NK, The Netherlands.
- Institute of Advanced Studies, University of Amsterdam, Amsterdam, 1012 GC, The Netherlands.
| | - Han L J van der Maas
- Psychological Methods, University of Amsterdam, Amsterdam, 1001 NK, The Netherlands
| | - Sacha Epskamp
- Psychological Methods, University of Amsterdam, Amsterdam, 1001 NK, The Netherlands
- Department of Psychology, National University of Singapore, Singapore, 117570, Singapore
| | - Mike H Lees
- Institute of Advanced Studies, University of Amsterdam, Amsterdam, 1012 GC, The Netherlands
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Chen X, Sun J, Zeng C, Jin F, Ma S, Song J, Chen Z. Association between life's essential 8 and periodontitis: a population-based study. BMC Oral Health 2024; 24:19. [PMID: 38178120 PMCID: PMC10768279 DOI: 10.1186/s12903-023-03816-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 12/21/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND The American Heart Association has developed a novel cardiovascular health indicator called Life's Essential 8 (LE8). However, no one has reported using LE8 to assess periodontitis. This study aimed to investigate the association between LE8 and periodontitis in American adults. METHODS Data from the National Health and Nutrition Examination Survey (NHANES) from 2009 to 2014 were used for this investigation. LE8 was the independent variable, and it is divided into three grades: high, moderate, and low. Periodontitis was the dependent variable, and the classification of periodontitis was based on the criteria of Eke in 2012. Multivariable logistic regression models were used to explore the relationship between LE8 and periodontitis. RESULTS A total of 9,039 participants with an average age of 52.16 ± 14.21 years were enrolled in this study, of whom 48.29% were male and 51.71% were female. The mean and standard deviation of LE8 was 66.29 ± 14.57, and the prevalence of periodontitis was 50.48% overall. The LE8 score and periodontitis in the fully adjusted logistic regression model showed a negative correlation (OR = 0.98; 95% CI, 0.98-0.99, p < 0.001). This result persisted when Life's Essential 8 was categorized into low, moderate, and high groups. Compared with those in the lowest group, those in the highest LE8 group had a 47% decreased risk of periodontitis (OR = 0.53; 95% CI, 0.46-0.66, P < 0.001). CONCLUSIONS This cross-sectional investigation revealed a negative relationship between the LE8 score and the likelihood of periodontitis.
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Affiliation(s)
- XingJin Chen
- School of Stomatology, Zunyi Medical University, Zunyi, China
- Department of Endodontics, Guiyang Stomatological Hospital, 253 Jiefang Road, Nanming District, Guiyang, 550005, China
| | - JiangLing Sun
- Department of Endodontics, Guiyang Stomatological Hospital, 253 Jiefang Road, Nanming District, Guiyang, 550005, China
| | - ChongWen Zeng
- School of Stomatology, Zunyi Medical University, Zunyi, China
- Department of Endodontics, Guiyang Stomatological Hospital, 253 Jiefang Road, Nanming District, Guiyang, 550005, China
| | - FuQian Jin
- Department of Endodontics, Guiyang Stomatological Hospital, 253 Jiefang Road, Nanming District, Guiyang, 550005, China
| | - Shu Ma
- Department of Endodontics, Guiyang Stomatological Hospital, 253 Jiefang Road, Nanming District, Guiyang, 550005, China
| | - Jukun Song
- Department of Oral and Maxillofacial Surgery, The Affiliated Stomatological Hospital of Guizhou Medical University, No. 9, Beijing Road, Yunyan District, Guiyang, 550002, China.
| | - Zhu Chen
- School of Stomatology, Zunyi Medical University, Zunyi, China.
- Department of Endodontics, Guiyang Stomatological Hospital, 253 Jiefang Road, Nanming District, Guiyang, 550005, China.
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Yogi TN, B.C. P, Bhusal A, Limbu S, Kafle R. Alcoholic pellagrous encephalopathy: a case report on atypical presentation and diagnostic dilemma in alcohol-related disorders. Ann Med Surg (Lond) 2024; 86:501-506. [PMID: 38222748 PMCID: PMC10783386 DOI: 10.1097/ms9.0000000000001497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 11/01/2023] [Indexed: 01/16/2024] Open
Abstract
Introduction Alcohol use disorder is a global health concern with various complications, including pellagra, often overlooked due to its rarity. This case explores the neurological presentation of pellagra in a long-term alcohol and substance abuser, emphasizing the diagnostic challenges in resource-constrained settings. Case presentation A 36-year-old male with a history of substance abuse presented with multiple symptoms, including hallucinations and neurological deficits. His complex clinical history included alcohol dependence, seizures, and relapses. Physical and neurological examinations revealed characteristic signs of pellagrous encephalopathy. Laboratory findings confirmed anemia and a fatty liver. Discussion Alcoholic pellagrous encephalopathy (APE) presents a diagnostic challenge due to its atypical symptoms, overlapping with other alcohol-related disorders. Niacin deficiency, central to its pathogenesis, affects neurotransmitter synthesis, contributing to neurological symptoms. Diagnosis relies on clinical presentation, but laboratory tests for niacin levels can aid in confirmation. Neuroimaging can exclude alternative causes. This case underscores the importance of considering pellagrous encephalopathy in alcohol-related disorders with neurological symptoms. Conclusion This case underscores the importance of recognizing atypical presentations of APE in chronic alcohol-dependent individuals. Prompt diagnosis, nutritional correction, and addressing alcohol use are vital for successful management. Healthcare providers must be aware of the diagnostic complexities and socioeconomic barriers hindering timely intervention in APE.
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Affiliation(s)
| | - Pooja B.C.
- Department of Psychiatry, BP Koirala Institute of Health Sciences (BPKIHS), Nepal
| | - Amrit Bhusal
- Department of Psychiatry, BP Koirala Institute of Health Sciences (BPKIHS), Nepal
| | - Suren Limbu
- Department of Psychiatry, BP Koirala Institute of Health Sciences (BPKIHS), Nepal
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Du W, Yang S, Zhou H, Wu Y, Cai Y, Meng H, Teng H, He AF. The association between constipation and stroke based on the NHANES and Mendelian randomization study. Front Neurosci 2023; 17:1276032. [PMID: 38027501 PMCID: PMC10661951 DOI: 10.3389/fnins.2023.1276032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Abstract
Background This study aimed to investigate putative causal effects between constipation and stroke using bidirectional Mendelian randomization (MR) analysis. Methods Based on the cross-sectional study, logistic regression models were developed to assess the association between constipation and stroke prevalence. Subsequently, genome-wide association studies statistics were employed to perform MR analysis between constipation and stroke, as well as its subtypes. The inverse variance weighting (IVW) method was the primary method, complemented by four additional methods, namely weighted median, weighted mode, simple mode, and MR-Egger regression. Cochran's Q test, MR-Egger intercept test, MR Pleiotropy RESidual Sum and Outlier, and MR Steiger test were performed to assess heterogeneity and pleiotropy effects. Results Constipation was associated with a greater risk of stroke even after adjusting for all covariates in logistic regression [odds ratio (OR) = 1.46, 95% confidence interval (CI) = 1.01-2.09, p = 0.042]. IVW MR analysis revealed that constipation affected large artery atherosclerosis (LAS; IVW OR = 1.5, 95% CI = 1.07-2.104, p = 0.019). No significant or suggestive association was observed with the risk of stroke or its various subtypes in MR analysis. Meanwhile, reverse MR analysis revealed no significant causal relationship between stroke or other stroke subtypes and constipation. The results of sensitivity analyses revealed no significant horizontal pleiotropy affecting causal estimates. Conclusion While cross-sectional studies have established that constipation increases the risk of stroke, this two-sample bidirectional MR analysis revealed a positive correlation between constipation and LAS. However, no such correlation was observed between constipation and stroke, including its various subtypes.
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Affiliation(s)
| | | | | | | | | | | | - Hongwei Teng
- Binhai County People's Hospital, Yancheng, China
| | - Ai Feng He
- Binhai County People's Hospital, Yancheng, China
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Lungwitz EA, Dzemidzic M, Shen YI, Plawecki MH, Oberlin BG. Brain response in heavy drinkers during cross-commodity alcohol and money discounting with potentially real rewards: A preliminary study. DRUG AND ALCOHOL DEPENDENCE REPORTS 2023; 8:100175. [PMID: 37753349 PMCID: PMC10518510 DOI: 10.1016/j.dadr.2023.100175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/09/2023] [Accepted: 06/12/2023] [Indexed: 09/28/2023]
Abstract
Background Alcohol use disorder (AUD) is associated with exaggerated preference for immediate rewards, a candidate endophenotype for use disorders. Addiction symptomology is often well-described by the preference for immediate intoxication over other delayed prosocial rewards. We measured brain activation in AUD-implicated regions during a cross-commodity delay discounting (CCD) task with choices for immediate alcohol and delayed money. Methods Heavy drinkers (n=24) experienced a brief intravenous alcohol infusion prime, regained sobriety, then chose between 'One Shot' and delayed money in an adjusting delay CCD task (sober and intoxicated); also during fMRI (sober). Participants also performed a behavioral sensation seeking task and completed self-report inventories of other risk factors. We assessed brain activation to choices representing immediate intoxication versus delayed money rewards in a priori regions of interest defined within the framework of Addictions NeuroImaging Assessment. Results Activation to CCD choice versus control trials activated paralimbic and ventral frontal cortical regions, including orbital and medial prefrontal cortex, posterior cingulate/retrosplenial cortex, angular and superior frontal gyri. We detected no differences between immediate or delayed choices. Left medial orbitofrontal cortex activation correlated with alcohol-induced wanting for alcohol; females showed greater activation than males. Behavioral sensation seeking correlated with right nucleus accumbens task engagement. Conclusions Alcohol decision-making elicited activation in regions governing reward, introspection, and executive decision-making in heavy drinkers, demonstrating the utility of laboratory tasks designed to better model real-world choice. Our findings suggest that the brain processes subserving immediate and delayed choices are mostly overlapping, even with varied commodities.
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Affiliation(s)
- Elizabeth A. Lungwitz
- Department of Psychiatry, Indiana University School of Medicine (IUSM); 355 W 16th St, Ste 4800; Indianapolis, IN 46202, USA
| | - Mario Dzemidzic
- Department of Neurology, IUSM; 355 W 16th St, Ste 4600; Indianapolis, IN 46202, USA
- Department of Radiology and Imaging Sciences, Center for Neuroimaging, IUSM; 355 W 16th St, Ste 4100; Indianapolis, IN 46202, USA
| | - Yitong I. Shen
- Department of Psychiatry, Indiana University School of Medicine (IUSM); 355 W 16th St, Ste 4800; Indianapolis, IN 46202, USA
| | - Martin H. Plawecki
- Department of Psychiatry, Indiana University School of Medicine (IUSM); 355 W 16th St, Ste 4800; Indianapolis, IN 46202, USA
| | - Brandon G. Oberlin
- Department of Psychiatry, Indiana University School of Medicine (IUSM); 355 W 16th St, Ste 4800; Indianapolis, IN 46202, USA
- Department of Neurology, IUSM; 355 W 16th St, Ste 4600; Indianapolis, IN 46202, USA
- Department of Psychology, Indiana University Purdue University Indianapolis; 402 N Blackford St, LD124; Indianapolis, IN 46202, USA
- Stark Neurosciences Research Institute, IUSM; 320 W 15th St, Ste 414; Indianapolis, IN 46202 USA
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Gao B, Bao Y, Meng M, Yu L, Lu Y, Sa R, Liang X, Shi J. Association of serum uric acid with risk of stroke in US adults: A cross-sectional study from NHANES 1999-2020. J Stroke Cerebrovasc Dis 2023; 32:107206. [PMID: 37276787 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/02/2023] [Accepted: 05/31/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND AND AIMS The validity of high uric acid levels as an independent cause of stroke remains controversial, and the association between its low concentration and stroke is unclear. This study determines how different serum uric acid (SUA) levels are associated with stroke risk. METHODS This cross-sectional study used continuous National Health and Nutrition Examination Survey data in the United States during 1999-2020. The SUA levels of 6.0, 6.8, and 9.0 mg/dL were all considered as cut-off points. Restricted cubic spline interpolation and logistic regression models were used to evaluate the different associations. Subgroup analyses and sensitivity analyses were conducted to evaluate the influence of multiple factors on the outcomes. RESULTS The study included 23,413 participants aged ≥ 20 years. A J-shaped curve existed between SUA and stroke risk, and the risk of stroke was positively correlated with SUA levels in the overall population. Subgroup analysis of all adults in the SUA 6.8-9.0 mg/dL group showed that stroke risk for non-Hispanic white, obese, ex-smoker, and heavy drinking groups was increased, but for the other Hispanic group was reduced. In the SUA < 6.0 mg/dL group, stroke risk for ex-smoker, heavy drinkers, and no chronic kidney disease groups was increased. CONCLUSION Our findings indicate a J-shaped relationship between SUA levels and stroke risk. Low and high SUA levels increased stroke risk for different populations, except in the other Hispanic population. Early SUA management is highly significant for stroke prevention in high-risk populations.
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Affiliation(s)
- Bei Gao
- Department of Pharmacy, Gansu Provincial Hospital, Lanzhou, China
| | - Yun Bao
- Institute of Clinical Research and Evidence Based Medicine, Gansu Provincial Hospital, Lanzhou, China
| | - Min Meng
- Department of Medical, Gansu Provincial Hospital, Lanzhou, China
| | - Lijun Yu
- Department of Pharmacy, Gansu Provincial Hospital, Lanzhou, China
| | - Yali Lu
- Department of Pharmacy, Gansu Provincial Hospital, Lanzhou, China
| | - Rina Sa
- Department of Pharmacy, Gansu Provincial Hospital, Lanzhou, China
| | - Xiaoyan Liang
- Department of Eye Optics Center, Gansu Provincial Hospital, Lanzhou, China
| | - Jie Shi
- Department of Blood Transfusion, The Second Hospital of Lanzhou University, Lanzhou, China; School Hospital of Lanzhou University, Lanzhou, China.
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Abstract
The medical disorders of alcoholism rank among the leading public health problems worldwide and the need for predictive and prognostic risk markers for assessing alcohol use disorders (AUD) has been widely acknowledged. Early-phase detection of problem drinking and associated tissue toxicity are important prerequisites for timely initiations of appropriate treatments and improving patient's committing to the objective of reducing drinking. Recent advances in clinical chemistry have provided novel approaches for a specific detection of heavy drinking through assays of unique ethanol metabolites, phosphatidylethanol (PEth) or ethyl glucuronide (EtG). Carbohydrate-deficient transferrin (CDT) measurements can be used to indicate severe alcohol problems. Hazardous drinking frequently manifests as heavy episodic drinking or in combinations with other unfavorable lifestyle factors, such as smoking, physical inactivity, poor diet or adiposity, which aggravate the metabolic consequences of alcohol intake in a supra-additive manner. Such interactions are also reflected in multiple disease outcomes and distinct abnormalities in biomarkers of liver function, inflammation and oxidative stress. Use of predictive biomarkers either alone or as part of specifically designed biological algorithms helps to predict both hepatic and extrahepatic morbidity in individuals with such risk factors. Novel approaches for assessing progression of fibrosis, a major determinant of prognosis in AUD, have also been made available. Predictive algorithms based on the combined use of biomarkers and clinical observations may prove to have a major impact on clinical decisions to detect AUD in early pre-symptomatic stages, stratify patients according to their substantially different disease risks and predict individual responses to treatment.
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Affiliation(s)
- Onni Niemelä
- Department of Laboratory Medicine and Medical Research Unit, Seinäjoki Central Hospital and Tampere University, Seinäjoki, Finland.
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Butts M, Sundaram VL, Murughiyan U, Borthakur A, Singh S. The Influence of Alcohol Consumption on Intestinal Nutrient Absorption: A Comprehensive Review. Nutrients 2023; 15:nu15071571. [PMID: 37049411 PMCID: PMC10096942 DOI: 10.3390/nu15071571] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 03/18/2023] [Accepted: 03/22/2023] [Indexed: 04/14/2023] Open
Abstract
Chronic alcohol use has been attributed to the development of malnutrition. This is in part due to the inhibitory effect of ethanol on the absorption of vital nutrients, including glucose, amino acids, lipids, water, vitamins, and minerals within the small intestine. Recent advances in research, along with new cutting-edge technologies, have advanced our understanding of the mechanism of ethanol's effect on intestinal nutrient absorption at the brush border membrane (BBM) of the small intestine. However, further studies are needed to delineate how ethanol consumption could have an impact on altered nutrient absorption under various disease conditions. Current research has elucidated the relationship of alcohol consumption on glucose, glutamine, vitamins B1 (thiamine), B2 (riboflavin), B9 (folate), C (ascorbic acid), selenium, iron, and zinc absorption within the small intestine. We conducted systematic computerized searches in PubMed using the following keywords: (1) "Alcohol effects on nutrient transport"; (2) "Alcohol mediated malabsorption of nutrients"; (3) "Alcohol effects on small intestinal nutrient transport"; and (4) "Alcohol mediated malabsorption of nutrients in small intestine". We included the relevant studies in this review. The main objective of this review is to marshal and analyze previously published research articles and discuss, in-depth, the understanding of ethanol's effect in modulating absorption of vital macro and micronutrients in health and disease conditions. This could ultimately provide great insights in the development of new therapeutic strategies to combat malnutrition associated with alcohol consumption.
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Affiliation(s)
- Molly Butts
- Department of Clinical and Translational Sciences, Marshall University, Huntington, WV 25755, USA
| | - Vijaya Lakshmi Sundaram
- Department of Clinical and Translational Sciences, Marshall University, Huntington, WV 25755, USA
| | - Usha Murughiyan
- Department of Clinical and Translational Sciences, Marshall University, Huntington, WV 25755, USA
| | - Alip Borthakur
- Department of Clinical and Translational Sciences, Marshall University, Huntington, WV 25755, USA
| | - Soudamani Singh
- Department of Clinical and Translational Sciences, Marshall University, Huntington, WV 25755, USA
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Kern LM, Ringel JB, Rajan M, Casalino LP, Colantonio LD, Pinheiro LC, Colvin CL, Safford MM. Ambulatory Care Fragmentation, Emergency Department Visits, and Race: a Nationwide Cohort Study in the U.S. J Gen Intern Med 2023; 38:873-880. [PMID: 36417133 PMCID: PMC10039160 DOI: 10.1007/s11606-022-07888-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 10/26/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND It is unclear whether highly fragmented ambulatory care (i.e., care spread across multiple providers without a dominant provider) increases the risk of an emergency department (ED) visit. Whether any such association varies with race is unknown. OBJECTIVE We sought to determine whether highly fragmented ambulatory care increases the risk of an ED visit, overall and by race. DESIGN AND PARTICIPANTS We analyzed data for 14,361 participants ≥ 65 years old from the nationwide prospective REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort study, linked to Medicare claims (2003-2016). MAIN MEASURES We defined high fragmentation as a reversed Bice-Boxerman Index ≥ 0.85 (≥ 75th percentile). We used Poisson models to determine the association between fragmentation (as a time-varying exposure) and ED visits, overall and stratified by race, adjusting for demographics, medical conditions, medications, health behaviors, psychosocial variables, and physiologic variables. KEY RESULTS The average participant was 70.5 years old; 53% were female, and 33% were Black individuals. Participants with high fragmentation had a median of 9 visits to 6 providers, with 29% of visits by the most frequently seen provider; participants with low fragmentation had a median of 7 visits to 3 providers, with 50% of visits by the most frequently seen provider. Overall, high fragmentation was associated with more ED visits than low fragmentation (adjusted risk ratio [aRR] 1.31, 95% confidence interval [CI] 1.29, 1.34). The magnitude of this association was larger among Black (aRR 1.48, 95% CI 1.44, 1.53) than White participants (aRR 1.23, 95% CI 1.20, 1.25). CONCLUSIONS Highly fragmented ambulatory care was an independent predictor of ED visits, especially among Black individuals.
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Affiliation(s)
- Lisa M Kern
- Weill Cornell Medicine, 420 East 70th Street, Box 331, New York, NY, 10021, USA.
| | - Joanna B Ringel
- Weill Cornell Medicine, 420 East 70th Street, Box 331, New York, NY, 10021, USA
| | - Mangala Rajan
- Weill Cornell Medicine, 420 East 70th Street, Box 331, New York, NY, 10021, USA
| | - Lawrence P Casalino
- Weill Cornell Medicine, 420 East 70th Street, Box 331, New York, NY, 10021, USA
| | | | - Laura C Pinheiro
- Weill Cornell Medicine, 420 East 70th Street, Box 331, New York, NY, 10021, USA
| | | | - Monika M Safford
- Weill Cornell Medicine, 420 East 70th Street, Box 331, New York, NY, 10021, USA
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Theofilis P, Oikonomou E, Lazaros G, Vogiatzi G, Niarchou P, Goliopoulou A, Anastasiou M, Mistakidi VC, Tsalamandris S, Fountoulakis P, Papamikroulis GA, Tousoulis D. The Association of Depression With QT Duration: A Comparison Between Individuals Younger or Older Than 65 Years. Psychosom Med 2023; 85:18-25. [PMID: 36516316 DOI: 10.1097/psy.0000000000001152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The electrocardiogram-derived corrected QT (QTc) interval is an indicator of cardiac autonomic activity that has been proposed as a biological measure to investigate the interplay between depression and cardiovascular diseases. This study assesses whether depression is associated with a longer QTc interval across age groups. METHODS Assessment of depressive symptoms was performed in 1637 participants of the cross-sectional Corinthia study with the Zung Self-Rating Depression Scale in those younger than 65 years (group 1) and with the Geriatric Depression Scale in elderly individuals (≥65 years, group 2). The QT interval was obtained from electrocardiogram recordings and corrected for heart rate (QTc). RESULTS Individuals in group 1 with depression were predominantly women and had a higher prevalence of coronary artery disease and diabetes mellitus. Group 1 individuals with depression had longer QTc duration (no depression versus depression, 389.3 [27.0] versus 401.1 [32.9] milliseconds; p < .001) and percentage of abnormal QTc (no depression versus depression, 2.0% versus 10.8%; p = .001) compared with those without depression. Elderly individuals (group 2) had similar values of QTc and percentage of abnormal QTc irrespective of depression status. Even after adjustment for known QT-prolonging factors, the presence of depression in younger individuals was associated with an increased QTc by 11.1 milliseconds and with an approximately 10.6-fold higher prevalence of abnormal QTc duration. CONCLUSIONS Depression was associated with a longer QTc interval especially in individuals younger than 65 years. These findings may indicate an interrelationship between depression and autonomic dysregulation as potential risk factors for cardiovascular disease and sudden cardiac death.
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Affiliation(s)
- Panagiotis Theofilis
- From the 1st Cardiology Clinic, Hippokration General Hospital, University of Athens Medical School, Athens, Greece
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Wine, beer and Chinese Baijiu in relation to cardiovascular health: the impact of moderate drinking. FOOD SCIENCE AND HUMAN WELLNESS 2023. [DOI: 10.1016/j.fshw.2022.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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13
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Hoek AG, van Oort S, Mukamal KJ, Beulens JWJ. Alcohol Consumption and Cardiovascular Disease Risk: Placing New Data in Context. Curr Atheroscler Rep 2022; 24:51-59. [PMID: 35129737 PMCID: PMC8924109 DOI: 10.1007/s11883-022-00992-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2021] [Indexed: 11/30/2022]
Abstract
Purpose of Review A clear link between excessive alcohol consumption and cardiovascular disease (CVD) has been established, but no consensus exists on the effects of moderate alcohol consumption on CVD. Recent Findings A lower risk of coronary heart disease and myocardial infarction among moderate drinkers compared to abstainers has been consistently observed in epidemiological studies and meta-analyses of these studies. However, ambiguity remains on the effect of alcohol on other CVDs and all-cause mortality. Short-term randomized controlled trials (RCT) have identified potentially beneficial effects of alcohol consumption on cardiovascular risk factors, but studies investigating genetic polymorphisms that influence alcohol consumption (i.e., Mendelian randomization) have yielded inconclusive results. To date, a long-term RCT providing causal evidence is lacking but urgently needed. Summary Triangulation of evidence from different study designs, including long-term RCTs, pragmatic trials and the evaluation of policy measures, combined will lead to the best available evidence.
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Affiliation(s)
- Anna G Hoek
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology & Data Science, Amsterdam Cardiovascular Sciences Research Institute, De Boelelaan 1117, Amsterdam, The Netherlands.
| | - Sabine van Oort
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology & Data Science, Amsterdam Cardiovascular Sciences Research Institute, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Kenneth J Mukamal
- Beth Israel Deaconess Medical Center, Harvard Medical School and Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Joline W J Beulens
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology & Data Science, Amsterdam Cardiovascular Sciences Research Institute, De Boelelaan 1117, Amsterdam, The Netherlands.,University Medical Centre Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht University, Utrecht, The Netherlands
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Blandino A, Cotroneo R, Tambuzzi S, Di Candia D, Genovese U, Zoja R. Driving under the influence of drugs: Correlation between blood psychoactive drug concentrations and cognitive impairment. A narrative review taking into account forensic issues. Forensic Sci Int Synerg 2022; 4:100224. [PMID: 35330981 PMCID: PMC8938866 DOI: 10.1016/j.fsisyn.2022.100224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 03/11/2022] [Accepted: 03/14/2022] [Indexed: 12/05/2022]
Abstract
Driving under the influence of alcohol has been shown to increase the risk of involvement in road traffic collisions (RTCs) however, less is known about the effects of illicit drugs, and a clear correlation between drug concentrations and RTC risk is still debated. The goal of this narrative review is to assess the current literature regarding the most detected psychoactive drugs in RTC (ethanol, amphetamines, cannabis, opioids and cocaine), in relation to driving performance. Evidence on impaired driving due to psychoactive substances, forensic issues relating to the assessment of the impact of drugs, blood cut-off values proposed to date as well as scientific basis for proposed legislative limits are discussed. At present there is no unequivocal evidence demonstrating a clear dose/concentration dependent impairment in many substances. Per se and zero tolerance approaches seem to have negative effect on drugged driving fatalities. However, the weight of these approaches needs further investigation. Driving under the influence of psychotropic substances has become a widespread phenomenon. Only a few substances have been reported to have a clear dose/concentration dependent impairment. Statistically significant differences should not be considered as clinically significant per se There is wide variability in legislative cut-offs. Detection limits seems to be the most public safety-oriented legislative approach.
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Fankhänel T, Panic BJ, Schwarz M, Schulz K, Frese T. Treating Excessive Consumers With Brief Intervention to Reduce Their Alcohol Consumption. EUROPEAN JOURNAL OF HEALTH PSYCHOLOGY 2021. [DOI: 10.1027/2512-8442/a000079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. Background: General Practitioners’ (GP) readiness to implement screening and brief intervention to reduce alcohol consumption of excessive consumers is low. Although several barriers were identified by past research, improving these conditions has not led to improved implementation. Based on Expectancy Value Theory of Achievement Motivation we assume that low seriousness of the health problem in association with the treatment of excessive alcohol consumers may be considered as a crucial barrier too. Aims: By our study, we tested for the influence of the seriousness of the health problem on the GP’s readiness to implement brief intervention (BI) in comparison to crucial barriers such as insufficient financial reimbursement and low patient adherence. Method: In order to manipulate the seriousness of the health problem GPs were confronted with three different situations each introducing a fictitious patient with either excessive alcohol consumption, or binge drinking, or harmful alcohol consumption. Results: Questionnaires of 185 GPs were analyzed. As hypothesized GPs were less ready to treat patients with excessive consumption in comparison to patients with harmful consumption, t(184) = 5.51, p < .001, d = .40, and binge drinking, t(184) = 6.14, p < .001, d = .43. Their readiness was higher in case of high adherence, F(1, 181) = 17.35, p < .001, η2 = .09. Limitations: Recruitment of GPs was based on voluntary participation. GPs had to assess their readiness in the artificial context of case vignettes. Conclusion: GPs’ readiness to implement a BI was influenced by the seriousness of the health problem and expected patient adherence. No such effect was found for financial reimbursement.
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Affiliation(s)
- Thomas Fankhänel
- Institute for General Practice and Family Medicine, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Halle, Germany
- Department of Health Psychology, SRH University of Applied Health Science, Gera, Germany
| | - Benjamin Jovan Panic
- Department of Health Psychology, SRH University of Applied Health Science, Gera, Germany
| | - Marcus Schwarz
- Department of Health Psychology, SRH University of Applied Health Science, Gera, Germany
| | - Katrin Schulz
- Department of Health Psychology, SRH University of Applied Health Science, Gera, Germany
| | - Thomas Frese
- Institute for General Practice and Family Medicine, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Halle, Germany
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Kern LM, Ringel JB, Rajan M, Colantonio LD, Casalino LP, Reshetnyak E, Pinheiro LC, Safford MM. Ambulatory Care Fragmentation and Incident Stroke. J Am Heart Assoc 2021; 10:e019036. [PMID: 33899495 PMCID: PMC8200753 DOI: 10.1161/jaha.120.019036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 02/16/2021] [Indexed: 11/16/2022]
Abstract
Background More fragmented ambulatory care (ie, care spread across many providers without a dominant provider) has been associated with excess emergency department and inpatient care. We sought to determine whether more fragmented ambulatory care is associated with an increase in the hazard of incident stroke, overall and stratified by health status and by race. Methods and Results We conducted a secondary analysis of data from the REGARDS (Reasons for Geographic and Racial Differences in Stroke) study (2003-2016), including participants aged ≥65 years who had linked Medicare fee-for-service claims and no history of stroke (N=12 510). We measured fragmentation of care with the reversed Bice-Boxerman index. We used Poisson models to determine the association between fragmentation and adjudicated incident stroke. The average age of participants was 70.5 years; 53% were women, 32% were Black participants, and 16% were participants with fair or poor health. Overall, the adjusted rate of incident stroke was similar for high versus low fragmentation (8.2 versus 8.1 per 1000 person-years, respectively; P=0.89). Among participants with fair or poor self-rated health, having high versus low fragmentation was associated with a trend toward a higher adjusted rate of incident strokes (14.8 versus 10.4 per 1000 person-years, respectively; P=0.067). Among Black participants with fair or poor self-rated health, having high versus low fragmentation was associated with a higher adjusted rate of strokes (19.3 versus 10.3 per 1000 person-years, respectively; P=0.02). Conclusions Highly fragmented ambulatory care is independently associated with incident stroke among Black individuals with fair or poor health.
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Kern LM, Ringel JB, Rajan M, Colantonio LD, Casalino LP, Pinheiro LC, Reshetnyak E, Safford MM. Ambulatory Care Fragmentation and Subsequent Hospitalization: Evidence From the REGARDS Study. Med Care 2021; 59:334-340. [PMID: 33273294 PMCID: PMC7954814 DOI: 10.1097/mlr.0000000000001470] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Previous studies have suggested that highly fragmented ambulatory care increases the risk of subsequent hospitalization, but those studies used claims only and were not able to adjust for many clinical potential confounders. OBJECTIVE The objective of this study was to determine the association between fragmented ambulatory care and subsequent hospitalization, adjusting for demographics, medical conditions, medications, health behaviors, psychosocial variables, and physiological variables. DESIGN Longitudinal analysis of data (2003-2016) from the nationwide REasons for Geographic And Racial Differences in Stroke (REGARDS) study, linked to Medicare fee-for-service claims. SUBJECTS A total of 12,693 Medicare beneficiaries 65 years and older from the REGARDS study who had at least 4 ambulatory visits in the first year of observation and did not have a hospitalization in the prior year. MEASURES We defined high fragmentation as a reversed Bice-Boxerman score above the 75th percentile. We used Cox proportional hazards models to determine the association between fragmentation as a time-varying exposure and incident hospitalization in the 3 months following each exposure period. RESULTS The mean age was 70.4 years; 54% were women, and 33% were African American. During the first year of observation, participants with high fragmentation had a median of 8 ambulatory visits with 6 providers, whereas participants with low fragmentation had a median of 7 visits with 3 providers. Over 11.8 years of follow-up, 6947 participants (55%) had a hospitalization. High fragmentation was associated with an increased hazard of hospitalization (adjusted hazard ratio=1.18; 95% confidence interval: 1.12, 1.24). CONCLUSION Highly fragmented ambulatory care is an independent risk factor for hospitalization.
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Kern LM, Rajan M, Colantonio LD, Reshetnyak E, Ringel JB, Muntner PM, Casalino LP, Pinheiro LC, Safford MM. Differences in ambulatory care fragmentation by race. BMC Health Serv Res 2021; 21:154. [PMID: 33596897 PMCID: PMC7890852 DOI: 10.1186/s12913-021-06133-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 01/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND More fragmented ambulatory care (i.e., care spread across many providers without a dominant provider) has been associated with more subsequent healthcare utilization (such as more tests, procedures, emergency department visits, and hospitalizations) than less fragmented ambulatory care. It is not known if race and socioeconomic status are associated with fragmented ambulatory care. METHODS We conducted a longitudinal analysis of data from the REasons for Geographic and Racial Differences in Stroke (REGARDS) study, using the REGARDS baseline visit plus the first year of follow-up. We included participants ≥65 years old, who had linked fee-for-service Medicare claims, and ≥ 4 ambulatory visits in the first year of follow-up. We used Tobit regression to determine the associations between race, annual household income, and educational attainment at baseline and fragmentation score in the subsequent year (as measured with the reversed Bice-Boxerman Index). Covariates included other demographic characteristics, medical conditions, medication use, health behaviors, and psychosocial variables. Additional analyses categorized visits by the type of provider (primary care vs. specialist). RESULTS The study participants (N = 6799) had an average age of 73.0 years, 53% were female, and 30% were black. Nearly half had low annual household income (<$35,000) and 41% had a high school education or less. Overall, participants had a median of 10 ambulatory visits to 4 providers in the 12 months following their baseline study visit. Participants in the highest quintile of fragmentation scores had a median of 11 visits to 7 providers. Black race was associated with an absolute adjusted 3% lower fragmentation score compared to white race (95% confidence interval (2% lower to 4% lower; p < 0.001). This difference was explained by blacks seeing fewer specialists than whites. Income and education were not independent predictors of fragmentation scores. CONCLUSIONS Among Medicare beneficiaries, blacks had less fragmented ambulatory care than whites, due to lower utilization of specialty care. Future research is needed to determine the effect of fragmented care on health outcomes for blacks and whites.
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Affiliation(s)
- Lisa M Kern
- Weill Cornell Medicine, 420 East 70th Street, Box 331, New York, NY, 10021, USA.
| | - Mangala Rajan
- Weill Cornell Medicine, 420 East 70th Street, Box 331, New York, NY, 10021, USA
| | | | - Evgeniya Reshetnyak
- Weill Cornell Medicine, 420 East 70th Street, Box 331, New York, NY, 10021, USA
| | - Joanna Bryan Ringel
- Weill Cornell Medicine, 420 East 70th Street, Box 331, New York, NY, 10021, USA
| | - Paul M Muntner
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Lawrence P Casalino
- Weill Cornell Medicine, 420 East 70th Street, Box 331, New York, NY, 10021, USA
| | - Laura C Pinheiro
- Weill Cornell Medicine, 420 East 70th Street, Box 331, New York, NY, 10021, USA
| | - Monika M Safford
- Weill Cornell Medicine, 420 East 70th Street, Box 331, New York, NY, 10021, USA
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Kern LM, Rajan M, Ringel JB, Colantonio LD, Muntner PM, Casalino LP, Pesko M, Reshetnyak E, Pinheiro LC, Safford MM. Healthcare Fragmentation and Incident Acute Coronary Heart Disease Events: a Cohort Study. J Gen Intern Med 2021; 36:422-429. [PMID: 33140281 PMCID: PMC7878592 DOI: 10.1007/s11606-020-06305-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 10/07/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND Highly fragmented ambulatory care (i.e., care spread across many providers without a dominant provider) has been associated with excess tests, procedures, emergency department visits, and hospitalizations. Whether fragmented care is associated with worse health outcomes, or whether any association varies with health status, is unclear. OBJECTIVE To determine whether fragmented care is associated with the risk of incident coronary heart disease (CHD) events, overall and stratified by self-rated general health. DESIGN AND PARTICIPANTS We conducted a secondary analysis of the nationwide prospective Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort study (2003-2016). We included participants who were ≥ 65 years old, had linked Medicare fee-for-service claims, and had no history of CHD (N = 10,556). MAIN MEASURES We measured fragmentation with the reversed Bice-Boxerman Index. We used Cox proportional hazards models to determine the association between fragmentation as a time-varying exposure and adjudicated incident CHD events in the 3 months following each exposure period. KEY RESULTS The mean age was 70 years; 57% were women, and 34% were African-American. Over 11.8 years of follow-up, 569 participants had CHD events. Overall, the adjusted hazard ratio (HR) for the association between high fragmentation and incident CHD events was 1.14 (95% confidence interval (CI) 0.92, 1.39). Among those with very good or good self-rated health, high fragmentation was associated with an increased hazard of CHD events (adjusted HR 1.35; 95% CI 1.06, 1.73; p = 0.01). Among those with fair or poor self-rated health, high fragmentation was associated with a trend toward a decreased hazard of CHD events (adjusted HR 0.54; 95% CI 0.29, 1.01; p = 0.052). There was no association among those with excellent self-rated health. CONCLUSION High fragmentation was associated with an increased independent risk of incident CHD events among those with very good or good self-rated health.
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Affiliation(s)
| | | | | | | | - Paul M Muntner
- University of Alabama at Birmingham, Birmingham, AL, USA
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Yang M, Barrios J, Yan J, Zhao W, Yuan S, Dong E, Ai X. Causal roles of stress kinase JNK2 in DNA methylation and binge alcohol withdrawal-evoked behavioral deficits. Pharmacol Res 2021; 164:105375. [PMID: 33316384 PMCID: PMC7867628 DOI: 10.1016/j.phrs.2020.105375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/20/2020] [Accepted: 12/06/2020] [Indexed: 11/27/2022]
Abstract
Excessive binge alcohol intake is a common drinking pattern in humans, especially during holidays. Cessation of the binge drinking often leads to aberrant withdrawal behaviors, as well as serious heart rhythm abnormalities (clinically diagnosed as Holiday Heart Syndrome (HHS)). In our HHS mouse model with well-characterized binge alcohol withdrawal (BAW)-induced heart phenotypes, BAW leads to anxiety-like behaviors and cognitive impairment. We have previously reported that stress-activated c-Jun NH(2)-terminal kinase (JNK) plays a causal role in BAW-induced heart phenotypes. In the HHS brain, we found that activation of JNK2 (but not JNK1 and JNK3) in the prefrontal cortex (PFC), but not hippocampus and amygdala, led to anxiety-like behaviors and impaired cognition. DNA methylation mediated by a crucial DNA methylation enzyme, DNA methyltransferase1 (DNMT1), is known to be critical in alcohol-associated behavioral deficits. In HHS mice, JNK2 in the PFC (but not hippocampus and amygdala) causally enhanced total genomic DNA methylation via increased DNMT1 expression, which was regulated by enhanced binding of JNK downstream transcriptional factor c-JUN to the DNMT1 promoter. JNK2-specific inhibition either by an inhibitor JNK2I or JNK2 knockout completely offset c-JUN-regulated DNMT1 upregulation and restored the level of DNA methylation in HHS PFC to the baseline levels seen in sham controls. Strikingly, either JNK2-specific inhibition or genetic JNK2 depletion or DNMT1 inhibition (by an inhibitor 5-Azacytidine) completely abolished BAW-evoked behavioral deficits. In conclusion, our studies revealed a novel mechanism by which JNK2 drives BAW-evoked behavioral deficits through a DNMT1-regulated DNA hypermethylation. JNK2 could be a novel therapeutic target for alcohol withdrawal treatment and/or prevention.
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Affiliation(s)
- Mei Yang
- Department of Physiology & Biophysics, Rush University Medical Center, Chicago, IL, 60607, USA
| | - Jasson Barrios
- Department of Physiology & Biophysics, Rush University Medical Center, Chicago, IL, 60607, USA
| | - Jiajie Yan
- Department of Physiology & Biophysics, Rush University Medical Center, Chicago, IL, 60607, USA
| | - Weiwei Zhao
- Department of Physiology & Biophysics, Rush University Medical Center, Chicago, IL, 60607, USA
| | - Shengtao Yuan
- Jiangsu Key Laboratory of Drug Screening, China Pharmaceutical University, Nanjing, 210009, China
| | - Erbo Dong
- Center for Alcohol Research in Epigenetics, Department of Psychiatry, College of Medicine, University of Illinois at Chicago, IL, 60612, USA.
| | - Xun Ai
- Department of Physiology & Biophysics, Rush University Medical Center, Chicago, IL, 60607, USA.
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Oberlin BG, Carron CR, Ramer NE, Plawecki MH, O'Connor SJ, Kareken DA. Intoxication Effects on Impulsive Alcohol Choice in Heavy Drinkers: Correlation With Sensation Seeking and Differential Effects by Commodity. Alcohol Clin Exp Res 2021; 45:204-214. [PMID: 33119917 PMCID: PMC7855750 DOI: 10.1111/acer.14497] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 10/21/2020] [Accepted: 10/21/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND The preference for immediate rewards and high sensation seeking are both potent risk factors for alcohol use disorder (AUD), but how they interact during intoxication is poorly understood. To model decision making linked to AUD risk, we tested heavy drinkers for impulsive choice (delay discounting with alcohol:money or money:money) and behavioral sensation seeking using a novel odor choice task. Laboratory tasks measured actual behavior with real contingencies. Our goals were to determine, in heavy drinkers, (i) alcohol's effects on delay discounting, and (ii) how AUD risk factors relate to delay discounting, and (iii) how delay discounting with alcohol choices compares with strictly monetary choices. METHODS Thirty-five heavy drinkers (≥2 binges per month; age = 22.8 ± 2.2; 20 male; 5.8 ± 2.3 drinks/drinking day) performed cross-commodity discounting (CCD) of immediate alcohol vs. delayed money, a monetary delay discounting (DD), and behavioral sensation-seeking tasks. CCD and DD were performed while sober and during controlled alcohol infusion targeting 0.08 g/dl. The behavioral sensation-seeking task presented binary choices of odorants varying in intensity and novelty, and the risk of exposure to a malodorant. RESULTS CCD and DD behaviors were highly correlated across conditions, mean r = 0.64. Alcohol increased delayed reward preference in DD, p = 0.001, but did not alter mean CCD, p > 0.16. However, alcohol-induced changes in CCD correlated with behavioral sensation seeking, such that higher sensation seekers' immediate alcohol preference increased when intoxicated, p = 0.042; self-reported sensation seeking was uncorrelated, ps > 0.08. Behavioral sensation seeking also correlated with "want" alcohol following a priming dose targeting 0.035 g/dl, p = 0.021. CCD and DD did not correlate with self-reported drinking problems or other personality risk traits. CONCLUSIONS Alcohol increased impulsive alcohol choice in high sensation seekers, suggesting an interaction that may underlie impaired control of drinking, at least in a subset of heavy drinkers-consistent with models highlighting high novelty/sensation-seeking AUD subtypes. Discounting behavior overall appears to be a generalized process, and relatively stable across methods, repeated testing, and intoxication. These findings further support the utility of behavioral tasks in uncovering key behavioral phenotypes in AUD.
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Affiliation(s)
- Brandon G Oberlin
- Department of Psychiatry (BGO, MHP, SJO, DAK), Indiana University School of Medicine (IUSM), Indianapolis, Indiana, USA
- Department of Neurology (BGO, CRC, DAK), IUSM, Indianapolis, Indiana, USA
- Department of Psychology (BGO, NER), Indiana University Purdue University Indianapolis, Indianapolis, Indiana, USA
- Stark Neurosciences Research Institute (BGO, DAK), IUSM, Indianapolis, Indiana, USA
| | - Claire R Carron
- Department of Neurology (BGO, CRC, DAK), IUSM, Indianapolis, Indiana, USA
| | - Nolan E Ramer
- Department of Psychology (BGO, NER), Indiana University Purdue University Indianapolis, Indianapolis, Indiana, USA
| | - Martin H Plawecki
- Department of Psychiatry (BGO, MHP, SJO, DAK), Indiana University School of Medicine (IUSM), Indianapolis, Indiana, USA
| | - Sean J O'Connor
- Department of Psychiatry (BGO, MHP, SJO, DAK), Indiana University School of Medicine (IUSM), Indianapolis, Indiana, USA
| | - David A Kareken
- Department of Psychiatry (BGO, MHP, SJO, DAK), Indiana University School of Medicine (IUSM), Indianapolis, Indiana, USA
- Department of Neurology (BGO, CRC, DAK), IUSM, Indianapolis, Indiana, USA
- Stark Neurosciences Research Institute (BGO, DAK), IUSM, Indianapolis, Indiana, USA
- Department of Radiology and Imaging Sciences (DAK), Center for Neuroimaging, IUSM, Indianapolis, Indiana, USA
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Monyeki KD, Siweya HJ, Kemper HCG, Kengne AP, Musinguzi G, Nkwana MR, Mothiba T, Malatji T, Baloyi SMA, Malema R, Leach L, Matshipi M, Sebati RB, Seloka MA, Sibuyi E, Monyeki SM. The Relationship between Binge Drinking and Metabolic Syndrome Components amongst Young Adults Aged 21 to 31 Years: Ellisras Longitudinal Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E7484. [PMID: 33076216 PMCID: PMC7650754 DOI: 10.3390/ijerph17207484] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 09/07/2020] [Accepted: 09/09/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND Evidence is lacking on the effects of binge alcohol consumption on metabolic syndrome in the rural South African population. The purpose of this study was to investigate the association between binge drinking and components of metabolic syndrome (MetS) amongst Ellisras rural young adults aged 21 to 31 years who are part of the Ellisras Longitudinal Study. METHODS Logistic regression analysis was applied to a total of 624 participants (306 males and 318 females) aged 21 to 31 years who took part in the Ellisras Longitudinal Study (ELS). The model was adjusted for covariates, including smoking, age, and gender. Binge alcohol consumption was assessed using a standardised questionnaire that was validated for the Ellisras rural community. A standardised method of determining the components MetS was used after fasting blood samples were collected from all the participants. RESULTS Binge drinking remained significantly associated with low levels of high-density lipoprotein cholesterol (HDL-C) (OR = 2.64, 95% CI = 1.23-5.65), after being adjusted for smoking, age, and gender. Other MetS components were not predicted. Instead, gender remained significantly associated with all MetS components, except triglycerides, at multivariate analysis. Age retained significance at multivariate analysis with waist girth (OR = 2.13, 95% CI = 1.37-3.34), triglycerides (OR = 2.30, 95% CI = 1.05-5.02), and the MetS composite (OR = 1.65, 95% CI = 1.12-2.41). CONCLUSION Binge drinking was significantly associated with lower levels of HDL-C. Future studies should investigate the relationship between alcohol abuse and the components of incident MetS in this population.
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Affiliation(s)
- Kotsedi Daniel Monyeki
- Department of Physiology and Environmental Health, University of Limpopo, Sovenga 0727, South Africa; (M.R.N.); (M.M.); (R.B.S.); (M.A.S.); (E.S.); (S.M.M.)
| | - Hlengani James Siweya
- Executive Dean Faculty of Science and Agriculture, University of Limpopo, Sovenga 0727, South Africa;
| | - Han C. G. Kemper
- Amsterdam Public Health Research Institute, Amsterdam UMC, 1218 HD Amsterdam, The Netherlands;
| | - Andre P. Kengne
- South African Medical Research Council, Francie van Zijl Drive, Parow Valley, Cape Town 7505, South Africa;
| | - Geofrey Musinguzi
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University, Kampala 7072, Uganda;
- Department of Primary and Interdisciplinary Care, University of Antwerp, 2610 Antwerpen, Belgium
| | - Mbelegem Rosina Nkwana
- Department of Physiology and Environmental Health, University of Limpopo, Sovenga 0727, South Africa; (M.R.N.); (M.M.); (R.B.S.); (M.A.S.); (E.S.); (S.M.M.)
| | - Tebogo Mothiba
- Faculty of Health Science, University of Limpopo, Sovenga 0727, South Africa;
| | - Tumiso Malatji
- Department of Health, Polokwane Provincial Hospital, Polokwane 0700, South Africa;
| | - Shisana M.-A. Baloyi
- Obstetrics and Gynecology, Faculty of Health Sciences, Posbus 339, Bloemfontein 9300, South Africa;
| | - Rambelani Malema
- Department of Psychology, University of Limpopo, Polokwane 0700, South Africa;
| | - Lloyd Leach
- Department of Sport, Recreation and Exercise Science, University of the Western Cape, Private Bag X17, Bellville, Cape Town 7535, South Africa;
| | - Moloko Matshipi
- Department of Physiology and Environmental Health, University of Limpopo, Sovenga 0727, South Africa; (M.R.N.); (M.M.); (R.B.S.); (M.A.S.); (E.S.); (S.M.M.)
| | - Ramakgahlela Betty Sebati
- Department of Physiology and Environmental Health, University of Limpopo, Sovenga 0727, South Africa; (M.R.N.); (M.M.); (R.B.S.); (M.A.S.); (E.S.); (S.M.M.)
| | - Mohlago Ablonia Seloka
- Department of Physiology and Environmental Health, University of Limpopo, Sovenga 0727, South Africa; (M.R.N.); (M.M.); (R.B.S.); (M.A.S.); (E.S.); (S.M.M.)
| | - Eliot Sibuyi
- Department of Physiology and Environmental Health, University of Limpopo, Sovenga 0727, South Africa; (M.R.N.); (M.M.); (R.B.S.); (M.A.S.); (E.S.); (S.M.M.)
| | - Suzan Mafoloa Monyeki
- Department of Physiology and Environmental Health, University of Limpopo, Sovenga 0727, South Africa; (M.R.N.); (M.M.); (R.B.S.); (M.A.S.); (E.S.); (S.M.M.)
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Olusanya OA, Barry AE. Dissemination of Prenatal Drinking Guidelines: A Preliminary Study Examining Personal Alcohol Use Among Midwives in a Southwestern US State. J Midwifery Womens Health 2020; 65:634-642. [PMID: 32844544 DOI: 10.1111/jmwh.13146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 05/30/2020] [Accepted: 06/09/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The constellation of birth defects seen in fetuses exposed to alcohol in utero have been described as fetal alcohol spectrum disorders. Evidence suggests that health care providers' communication practices regarding prenatal alcohol use could have beneficial outcomes. There is a paucity of investigations, however, that have examined the health professionals' personal alcohol use and prenatal alcohol recommendations they provide. METHODS This study sought to examine and compare midwives' personal alcohol use and communication practices regarding prenatal alcohol consumption. Certified nurse-midwives (CNMs) and certified professional midwives (CPMs) in a southwestern US state participated. Inclusion criteria included training in prenatal care, labor, birth, and membership in a midwife professional organization. Personal drinking behaviors were assessed with Alcohol Use Disorder Identification Test-Consumption (AUDIT-C). RESULTS All midwives (N = 61; 100%) reported they typically screened a patient for alcohol use during an initial prenatal visit. However, 5 (8.2%) respondents opted for recommendations that advised patients to drink once in a while. Similarly, 4 (6.6%) midwives counseled no more than one drink per day. In the cohort of participants (n = 40) with AUDIT-C scores, 25 (62.5%) engaged in nonrisky drinking (AUDIT-C scores <3). Most respondents (n = 39 of 40; 97.5%) typically consumed 1 to 2 standard drinks on the day they drank. There was no statistically significant difference in mean overall AUDIT-C scores between CNMs and CPMs (P = .42). When examining midwives' (1) responses on the AUDIT-C questionnaire, (2) nonrisky or risky drinking behaviors, and 3) communication practices regarding prenatal alcohol use, Fisher's exact test showed no statistically significant differences between CNMs and CPMs. DISCUSSION Results of this study highlight the importance of advocating healthy lifestyles among health care professionals while also promoting communication practices that align with national alcohol guidelines. Future investigations that examine associations between health care professionals' personal alcohol use and type or effectiveness of services offered to patients may be beneficial.
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Affiliation(s)
| | - Adam E Barry
- Department of Health and Kinesiology, Texas A&M University, College Station, Texas
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24
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Fankhaenel T, Schulz K, Petersen LE, Klement A, Frese T. Financial reimbursement - irrelevant for GPs' readiness to implement brief intervention to reduce alcohol consumption? A cross-sectional vignette study. BMC FAMILY PRACTICE 2020; 21:170. [PMID: 32814561 PMCID: PMC7439686 DOI: 10.1186/s12875-020-01231-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 07/22/2020] [Indexed: 11/14/2022]
Abstract
Background General Practitioners’ (GPs) readiness to implement screening and brief intervention (SBI) to treat patients with excessive alcohol consumption is low. Several studies identified crucial barriers such as insufficient financial reimbursement. In contrast to the barriers-account, we assume that low implementation readiness of GPs may be less attributed to external barriers but rather more so to inherent characteristics of SBI. To test our assumption, we conducted a vignette study assessing the GPs’ readiness to implement SBI in comparison to a pharmacological intervention also designed for the treatment of excessive drinkers in relation to standard or above-standard financial reimbursement. According to our hypothesis GPs should be less ready to implement SBI regardless of financial reimbursement. Methods A convenience sample of GPs was recruited to answer the questionnaire. To assess the GPs’ implementation readiness a 4-item 6-point Likert scale was developed and pretested. Results One hundred forty GPs completed the questionnaire. GPs were more ready to implement the pharmacological intervention than SBI, F(1,132) = 27.58, p > .001 (main effect). We found no effect for financial reimbursement, F(1,132) = 3.60, ns, and no interaction effect, F(1,132) = 2.20, ns. Conclusions Further research should investigate more thoroughly the crucial characteristics of SBI to initiate a modification process finally leading to more effective primary care dependency prevention.
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Affiliation(s)
- Thomas Fankhaenel
- University of Halle-Wittenberg, Halle, Germany. .,SRH University of Applied Health Sciences, Gera, Germany.
| | - Katrin Schulz
- SRH University of Applied Health Sciences, Gera, Germany
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25
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Kim SM, Kim AS, Ko HJ, Moon H, Choi HI, Song J. Association between Bone Mineral Density and Serum Iron Indices in Premenopausal Women in South Korea. Korean J Fam Med 2020; 41:175-182. [PMID: 32456385 PMCID: PMC7272370 DOI: 10.4082/kjfm.18.0142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 01/09/2019] [Indexed: 01/11/2023] Open
Abstract
Background Osteoporosis is characterized by a decrease in bone mineral density (BMD) and increased risk of fragility fractures. Serum iron level may interact with bone health status. This study investigated the correlations of BMD with serum iron level, hemoglobin level, and total iron-binding capacity (TIBC). Methods We performed a retrospective analysis of data from the medical records of premenopausal women in South Korea. The women’s BMDs and the Z scores of the BMDs were verified using dual-energy X-ray absorption. The participants were stratified into quartiles for analyses of the associations of BMD with serum iron level, TIBC, and hemoglobin level. Results A simple linear regression analysis revealed associations of changes in BMD with iron level (β=-0.001, standard error [SE]=0.001, P<0.001), hemoglobin level (β=0.015, SE=0.003, P<0.001), and TIBC (β=0.001, SE=0.001, P<0.001). This pattern was also observed in a multiple linear regression analysis. A multivariate logistic regression analysis of iron level and TIBC for low BMD revealed odds ratios of 1.005 (P<0.001) and 0.995 (P<0.001), respectively. Conclusion This study demonstrated clear relationships of changes in BMD with serum iron level and TIBC, and thus confirms the usefulness of these markers in the clinical evaluation of iron storage and BMD in younger women.
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Affiliation(s)
- Sung-Min Kim
- Department of Family Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - A-Sol Kim
- Department of Family Medicine, School of Medicine, Kyungpook National University, Daegu, Korea.,Department of Family Medicine, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Hae-Jin Ko
- Department of Family Medicine, Kyungpook National University Hospital, Daegu, Korea.,Department of Family Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Hana Moon
- Department of Family Medicine, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Hye-In Choi
- Department of Family Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Jieun Song
- Department of Family Medicine, Kyungpook National University Hospital, Daegu, Korea
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26
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Spiegelman D, Lovato LC, Khudyakov P, Wilkens TL, Adebamowo CA, Adebamowo SN, Appel LJ, Beulens JW, Coughlin JW, Dragsted LO, Edenberg HJ, Eriksen JN, Estruch R, Grobbee DE, Gulayin PE, Irazola V, Krystal JH, Lazo M, Murray MM, Rimm EB, Schrieks IC, Williamson JD, Mukamal KJ. The Moderate Alcohol and Cardiovascular Health Trial (MACH15): Design and methods for a randomized trial of moderate alcohol consumption and cardiometabolic risk. Eur J Prev Cardiol 2020; 27:1967-1982. [PMID: 32250171 DOI: 10.1177/2047487320912376] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Observational studies have documented lower risks of coronary heart disease and diabetes among moderate alcohol consumers relative to abstainers, but only a randomized clinical trial can provide conclusive evidence for or against these associations. AIM The purpose of this study was to describe the rationale and design of the Moderate Alcohol and Cardiovascular Health Trial, aimed to assess the cardiometabolic effects of one alcoholic drink daily over an average of six years among adults 50 years or older. METHODS This multicenter, parallel-arm randomized trial was designed to compare the effects of one standard serving (∼11-15 g) daily of a preferred alcoholic beverage to abstention. The trial aimed to enroll 7800 people at high risk of cardiovascular disease. The primary composite endpoint comprised time to the first occurrence of non-fatal myocardial infarction, non-fatal ischemic stroke, hospitalized angina, coronary/carotid revascularization, or total mortality. The trial was designed to provide >80% power to detect a 15% reduction in the risk of the primary outcome. Secondary outcomes included diabetes. Adverse effects of special interest included injuries, congestive heart failure, alcohol use disorders, and cancer. RESULTS We describe the design, governance, masking issues, and data handling. In three months of field center activity until termination by the funder, the trial randomized 32 participants, successfully screened another 70, and identified ∼400 additional interested individuals. CONCLUSIONS We describe a feasible design for a long-term randomized trial of moderate alcohol consumption. Such a study will provide the highest level of evidence for the effects of moderate alcohol consumption on cardiovascular disease and diabetes, and will directly inform clinical and public health guidelines.
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Affiliation(s)
| | - Laura C Lovato
- Wake Forest School of Medicine, USA.,Department of Internal Medicine, Hospital Clínic, IDIBAPS August Pi i Sunyer Biomedical Research Institute, University of Barcelona, Spain
| | - Polyna Khudyakov
- Harvard TH Chan School of Public Health, USA.,Department of Internal Medicine, Hospital Clínic, IDIBAPS August Pi i Sunyer Biomedical Research Institute, University of Barcelona, Spain
| | | | - Clement A Adebamowo
- Department of Epidemiology and Public Health, Greenebaum Comprehensive Cancer Center, University of Maryland, School of Medicine, USA
| | - Sally N Adebamowo
- Department of Epidemiology and Public Health, Greenebaum Comprehensive Cancer Center, University of Maryland, School of Medicine, USA
| | - Lawrence J Appel
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins ProHealth Clinical Research Center, USA
| | - Joline Wj Beulens
- Amsterdam UMC - location VUmc, Amsterdam Cardiovascular Sciences Research Institute, Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Netherlands
| | - Janelle W Coughlin
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins ProHealth Clinical Research Center, USA
| | | | | | | | - Ramon Estruch
- CIBER de Fisiopatología de la Obesidad y la Nutricion (CIBEROBN), Instituto de Salud Carlos III, Spain.,Department of Internal Medicine, Hospital Clínic, IDIBAPS August Pi i Sunyer Biomedical Research Institute, University of Barcelona, Spain
| | | | | | | | | | - Mariana Lazo
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins ProHealth Clinical Research Center, USA
| | | | - Eric B Rimm
- Harvard TH Chan School of Public Health, USA.,National Institute on Alcohol Abuse and Alcoholism, U.S. National Institutes of Health, USA
| | - Ilse C Schrieks
- Department of Internal Medicine, Hospital Clínic, IDIBAPS August Pi i Sunyer Biomedical Research Institute, University of Barcelona, Spain
| | | | - Kenneth J Mukamal
- Channing Laboratory, Brigham and Women's Hospital, Harvard Medical School, USA
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27
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Butts M, Singh S, Haynes J, Arthur S, Sundaram U. Moderate Alcohol Consumption Uniquely Regulates Sodium-Dependent Glucose Co-Transport in Rat Intestinal Epithelial Cells In Vitro and In Vivo. J Nutr 2020; 150:747-755. [PMID: 31769840 PMCID: PMC7138678 DOI: 10.1093/jn/nxz277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 07/31/2019] [Accepted: 10/15/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Chronic alcohol use often leads to malnutrition. However, how the intestinal absorption of nutrients such as glucose may be affected during moderate ethanol use has not been investigated. Glucose is absorbed via sodium (Na)-dependent glucose co-transport (SGLT1; SLC5A1) along the brush border membrane (BBM) of intestinal absorptive villus cells. OBJECTIVE The aim of this study was to investigate how moderate alcohol consumption affects the absorption of glucose via SGLT1. METHODS Intestinal epithelial cells (IEC-18; rat) were exposed to 8.64 mM ethanol over 1, 3, 6, and 12 h. Rats (16-wk-old, male, Sprague-Dawley) were administered 2 g/kg ethanol over 1, 3, and 6 h. Na-dependent 3H-O-methyl-d-glucose uptake was measured to assess SGLT1 activity. Na-K-ATPase activity was measured as a function of inorganic phosphate release. Protein expression was analyzed by Western blot analysis and immunohistochemical staining. RESULTS Ethanol significantly decreased Na-dependent glucose absorption in enterocytes in vitro (ethanol treatment: 48.4% of controls at 1 h; P < 0.01) and in vivo (ethanol treatment: 60.0% of controls at 1 h; P < 0.01). Na-K-ATPase activity was significantly inhibited in vitro (ethanol treatment: 36.9% of controls at 1 h; P < 0.01) and in vivo (ethanol treatment: 42.1% of controls at 1 h; P < 0.01). Kinetic studies showed that the mechanism of inhibition of Na-glucose co-transport was secondary to a decrease in the affinity (1/Km) of the co-transporter for glucose both in vitro and in vivo. Western blots and immunohistochemistry further demonstrated unaltered amounts of SGLT1 after ethanol treatment. CONCLUSIONS Moderate ethanol significantly decreases glucose absorption in IEC-18 cells and in villus cells of Sprague-Dawley rats. The inhibition of SGLT1 is secondary to an altered Na gradient at the cellular level and secondary to diminished affinity of the co-transporter for glucose at the protein level in the BBM. These observations may, at least in part, explain 1 possible mechanism of the onset of malnutrition associated with alcohol consumption.
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Affiliation(s)
- Molly Butts
- Department of Clinical and Translational Sciences, Marshall University, Huntington, WV, USA
| | - Soudamani Singh
- Department of Clinical and Translational Sciences, Marshall University, Huntington, WV, USA
| | - Jennifer Haynes
- Department of Clinical and Translational Sciences, Marshall University, Huntington, WV, USA
| | - Subha Arthur
- Department of Clinical and Translational Sciences, Marshall University, Huntington, WV, USA
| | - Uma Sundaram
- Department of Clinical and Translational Sciences, Marshall University, Huntington, WV, USA,Address correspondence to US (e-mail: )
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28
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Miller LM, Anderson CAM, Ix JH. Editorial: From MACH15 to MACH0 – a missed opportunity to understand the health effects of moderate alcohol intake. Eur J Prev Cardiol 2020; 28:e23-e24. [PMID: 33611395 DOI: 10.1177/2047487320904230] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Lindsay M Miller
- Division of Nephrology-Hypertension, Department of Medicine, University of California San Diego, San Diego, CA, USA
| | - Cheryl AM Anderson
- Department of Family Medicine and Public Health, University of California San Diego, San Diego, CA, USA
| | - Joachim H Ix
- Division of Nephrology-Hypertension, Department of Medicine, University of California San Diego, San Diego, CA, USA
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Latanioti M, Schuster JP, Rosselet Amoussou J, Strippoli MPF, von Gunten A, Ebbing K, Verloo H. Epidemiology of at-risk alcohol use and associated comorbidities of interest among community-dwelling older adults: a protocol for a systematic review. BMJ Open 2020; 10:e035481. [PMID: 31924642 PMCID: PMC6955484 DOI: 10.1136/bmjopen-2019-035481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 11/28/2019] [Accepted: 12/04/2019] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION There is little epidemiological evidence and knowledge about at-risk alcohol use among community-dwelling older adults and their chronic and acute alcohol-related comorbidities of interest. This systematic review will summarise and examine relevant studies about the epidemiology of at-risk alcohol use and associated comorbidities of interest in this population. METHODS We will search the following databases, without language or date restrictions, from inception to 31 August 2019: Embase.com, Medline Ovid SP, Pubmed (NOT medline[sb]), CINAHL EBSCO, PsycINFO Ovid SP, Central-Cochrane Library Wiley and Web of Science (Core Collection). Search strategies will be developed in collaboration with a librarian. We will use predefined search terms for alcoholism, epidemiology, the elderly, living place and comorbidities of interest, as well as terms related to the identification of "measurements", "tools" or "instruments" for measuring harm from alcohol use. At-risk status will be determined by the amount of alcohol consumed and any comorbidities of interest associated with at-risk alcohol use, with the latter being documented separately or using an assessment tool for at-risk drinking. We will also examine the bibliographies of all the relevant articles found and search for unpublished studies. We will consider publications in all languages. ETHICS AND DISSEMINATION No ethical approval is necessary. Results will be presented in national and international conferences on addiction and published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42018099965.
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Affiliation(s)
- Maria Latanioti
- Department of Psychiatry, Lausanne University Hospital, Service of Old Age Psychiatry, Prilly, Switzerland
| | - Jean-Pierre Schuster
- Department of Psychiatry, Lausanne University Hospital, Service of Old Age Psychiatry, Prilly, Switzerland
| | - Joelle Rosselet Amoussou
- Department of Psychiatry, Lausanne University Hospital, Education and Research Department, University of Lausanne, Prilly, Switzerland
| | - Marie-Pierre F Strippoli
- University of Lausanne, Centre for Psychiatric Epidemiology and Psychopathology (CEPP), Lausanne, Switzerland
| | - Armin von Gunten
- Department of Psychiatry Lausanne University Hospital, Service of Old Age Psychiatry, Prilly, Switzerland
| | - Karsten Ebbing
- Department of Psychiatry, Lausanne University Hospital, Service of Old Age Psychiatry, Prilly, Switzerland
| | - Henk Verloo
- Nursing Sciences, School of Health Sciences HES-SO Valais/Wallis, Sion, Switzerland
- Department of Psychiatry, Lausanne University Hospital, Service of Old Age Psychiatry, Prilly, Switzerland
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30
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Association Between Alcohol Use and Angina Symptoms Among Outpatients From the Veterans Health Administration. J Addict Med 2019; 12:143-149. [PMID: 29334512 DOI: 10.1097/adm.0000000000000379] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Alcohol use is associated with angina incidence, but associations between alcohol use and experience of angina among patients with coronary artery disease (CAD) have not been described. METHODS Outpatients with CAD from 7 clinics in the Veterans Health Administration were surveyed; alcohol use was measured using the validated Alcohol Use Disorders Identification Test-Consumption scores categorized into 6 groups: nondrinking, low-risk drinking, and mild, moderate, severe, and very severe unhealthy alcohol use. Three domains of self-reported angina symptoms (frequency, stability, and physical function) were measured with the Seattle Angina Questionnaire. Linear regression models evaluated associations between alcohol use groups and angina symptoms. Models were adjusted first for age and then additionally for smoking, comorbidities, and depression. RESULTS Patients (n = 8303) had a mean age of 66 years. In age-adjusted analyses, a U-shaped association was observed between alcohol use groups and all angina outcomes, with patients in nondrinking and severe unhealthy alcohol groups reporting the greatest angina symptoms and lowest functioning. After full adjustment, no clinically important and few statistically important differences were observed across alcohol use in angina stability or frequency. Patients in the nondrinking group had statistically greater functional limitation from angina than those in all groups of unhealthy alcohol use, though differences were small. Patients in all groups of unhealthy alcohol use did not differ significantly from those with low-risk drinking. CONCLUSIONS Alcohol use was associated with some small statistically but no clinically important differences in angina symptoms among patients with CAD. This cross-sectional study does not support a protective effect of low-level drinking on self-reported angina.
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The Use of Alcohol and Knowledge of Cardiovascular Diseases among Ellisras Rural Children Aged 14-22 Years: Ellisras Longitudinal Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16152650. [PMID: 31344981 PMCID: PMC6695915 DOI: 10.3390/ijerph16152650] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 07/22/2019] [Accepted: 07/22/2019] [Indexed: 01/07/2023]
Abstract
The harm alcohol abuse does to physical and mental health is well established. The perception of cardiovascular disease risk factors and alcohol use requires attention. This study aims to investigate the association between alcohol usage and knowledge of cardiovascular diseases (CVDs) risk factors among Ellisras rural adolescents and young adults aged 14–22 years. In this cross-sectional study a total of 1409 subjects (736 boys and 673 girls), aged 14–22 years, from the Ellisras Longitudinal Study, South Africa completed a validated alcohol use and CVDs knowledge questionnaire. Logistic regression was used to estimate the association. The prevalence of alcohol intake increased with increasing age among girls (13.6% to 17.7%) and boys (10.3% to 16.9%) and reached a statistically significant difference (p < 0.024) at an older age category (20–22 years). There was a significant (p < 0.05) association between alcohol use and a positive response on the following knowledge statements: The fact that cardiovascular disease attacked all age groups and mostly elderly people (the odds ratio (OR) ranged between 0.5 95% confidence interval (CI) = 0.33–0.74 and OR = 2.86 95% CI = 1.27–6.42). Medical doctors can help to diagnose somebody with cardiovascular diseases (OR ranged between 2.25 95% CI = 1.49–3.39 and OR = 0.75 95% CI = 0.65–0.87). The condition for cardiovascular diseases developed over a long period (OR ranged between 1.75 95% CI = 1.16–2.64 and OR = 2.23 95% CI = 1.34–4.07). The prevalence of alcohol use in Ellisras rural adolescents and young adults begins between the ages of 14 and 16 years and increases with age. Binge drinking was more evident on Fridays and Saturdays among the Ellisras rural adolescents and young adults with girls showing a significantly higher prevalence of binge drinking compared to boys on a Friday.
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Kudela MA, Dzemidzic M, Oberlin BG, Lin Z, Goñi J, Kareken DA, Harezlak J. Semiparametric Estimation of Task-Based Dynamic Functional Connectivity on the Population Level. Front Neurosci 2019; 13:583. [PMID: 31293367 PMCID: PMC6598619 DOI: 10.3389/fnins.2019.00583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 05/23/2019] [Indexed: 12/13/2022] Open
Abstract
Dynamic functional connectivity (dFC) estimates time-dependent associations between pairs of brain region time series as typically acquired during functional MRI. dFC changes are most commonly quantified by pairwise correlation coefficients between the time series within a sliding window. Here, we applied a recently developed bootstrap-based technique (Kudela et al., 2017) to robustly estimate subject-level dFC and its confidence intervals in a task-based fMRI study (24 subjects who tasted their most frequently consumed beer and Gatorade as an appetitive control). We then combined information across subjects and scans utilizing semiparametric mixed models to obtain a group-level dFC estimate for each pair of brain regions, flavor, and the difference between flavors. The proposed approach relies on the estimated group-level dFC accounting for complex correlation structures of the fMRI data, multiple repeated observations per subject, experimental design, and subject-specific variability. It also provides condition-specific dFC and confidence intervals for the whole brain at the group level. As a summary dFC metric, we used the proportion of time when the estimated associations were either significantly positive or negative. For both flavors, our fully-data driven approach yielded regional associations that reflected known, biologically meaningful brain organization as shown in prior work, as well as closely resembled resting state networks (RSNs). Specifically, beer flavor-potentiated associations were detected between several reward-related regions, including the right ventral striatum (VST), lateral orbitofrontal cortex, and ventral anterior insular cortex (vAIC). The enhancement of right VST-vAIC association by a taste of beer independently validated the main activation-based finding (Oberlin et al., 2016). Most notably, our novel dFC methodology uncovered numerous associations undetected by the traditional static FC analysis. The data-driven, novel dFC methodology presented here can be used for a wide range of task-based fMRI designs to estimate the dFC at multiple levels—group-, individual-, and task-specific, utilizing a combination of well-established statistical methods.
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Affiliation(s)
- Maria A Kudela
- Safety and Observational Statistics, Takeda R&D Data Science Institute, Takeda Pharmaceuticals, Cambridge, MA, United States
| | - Mario Dzemidzic
- Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, United States.,Department of Radiology, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Brandon G Oberlin
- Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, United States.,Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Zikai Lin
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Joaquín Goñi
- School of Industrial Engineering, Purdue University, West Lafayette, IN, United States.,Purdue Institute for Integrative Neuroscience, Purdue University, West Lafayette, IN, United States.,Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States
| | - David A Kareken
- Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, United States.,Department of Radiology, Indiana University School of Medicine, Indianapolis, IN, United States.,Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Jaroslaw Harezlak
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington, IN, United States
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Oikonomou E, Lazaros G, Tsalamandris S, Vogiatzi G, Christoforatou E, Papakonstantinou M, Goliopoulou A, Tousouli M, Chasikidis C, Tousoulis D. Alcohol Consumption and Aortic Root Dilatation: Insights from the Corinthia Study. Angiology 2019; 70:969-977. [DOI: 10.1177/0003319719848172] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Aortic diameter and progression to thoracic aortic aneurysm are influenced by several factors. In this study, we investigated the association of alcohol consumption with aortic root and ascending aorta dilatation. In the context of the Corinthia study, we examined 1751 patients with echocardiography. Several demographic and clinical characteristics were recorded. Alcohol consumption was assessed based on a questionnaire of frequency, type, and quantity. Accordingly, patients were categorized as everyday alcohol consumers (EDACs) and as social drinkers (SoD). Everyday alcohol consumers were further categorized to group 1: 0 to 1 drink/d; group 2: 1 to 2 drinks/d; and group 3: ≥3 drinks/d. From the study population, 40% were categorized as EDAC and had an increased aortic root diameter (AoRD) and an elevated AoRD index compared with SoD. Interestingly, there was a stepwise increase in aortic root and ascending aorta diameter according to daily alcohol consumption. Specifically, patients consuming ≥3 drinks of alcohol/d had increased indexed aortic by 1.4 mm/m2 compared with SoD even after adjustment for possible confounders. Daily alcohol consumption is associated with increased aortic root diameter. These findings may have important clinical implications, especially in patients with borderline or dilated aortic root, and merit further investigation.
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Affiliation(s)
- Evangelos Oikonomou
- First Cardiology Clinic, ‘Hippokration’ General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - George Lazaros
- First Cardiology Clinic, ‘Hippokration’ General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Sotirios Tsalamandris
- First Cardiology Clinic, ‘Hippokration’ General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Georgia Vogiatzi
- First Cardiology Clinic, ‘Hippokration’ General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Evangelia Christoforatou
- First Cardiology Clinic, ‘Hippokration’ General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Margenti Papakonstantinou
- First Cardiology Clinic, ‘Hippokration’ General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Athina Goliopoulou
- First Cardiology Clinic, ‘Hippokration’ General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Maria Tousouli
- First Cardiology Clinic, ‘Hippokration’ General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Christos Chasikidis
- First Cardiology Clinic, ‘Hippokration’ General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Dimitris Tousoulis
- First Cardiology Clinic, ‘Hippokration’ General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
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Clusters of risk behaviors for noncommunicable diseases in the Brazilian adult population. Int J Public Health 2019; 64:821-830. [PMID: 31062035 DOI: 10.1007/s00038-019-01242-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 04/01/2019] [Accepted: 04/05/2019] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES To identify clusters of risk behaviors among Brazilian adults, by sex, and to associate clusters with sociodemographic factors and self-perception of health. METHODS We assessed 46,785 adults from the Brazilian National Health Survey. The risk behaviors were low consumption of fruits and vegetables-LFV (< 5 times/week), physical inactivity-PI (< 150 min/week), smoking (yes/no) and excessive consumption of alcohol-EA (5 doses for male, 4 doses for female). We used Venn diagram, cluster analysis and multinomial regression models. RESULTS We found 9 clusters. The cluster of four risk behaviors was more common in males (3.2% vs. 0.83%). Despite a greater potential for aggregation of behaviors in females (O/E = 2.48) than in males (O/E = 1.62), the women were less likely to have all risk behaviors jointly (OR 0.24, 95% CI 0.19; 0.31), and this was found for the other clusters. In general, Brazilian black/brown, younger, with low education level and who had a self-perception of bad health, were more likely to engage in clusters of risk behaviors. CONCLUSIONS The prevalence of Brazilian adults engaging in clusters of risk behaviors is high, mainly among males, those who reported a bad health and with low socioeconomic status.
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Sanchez-Alavez M, Nguyen W, Mori S, Wills DN, Otero D, Ehlers CL, Conti B. Time course of microglia activation and brain and blood cytokine/chemokine levels following chronic ethanol exposure and protracted withdrawal in rats. Alcohol 2019; 76:37-45. [PMID: 30554034 DOI: 10.1016/j.alcohol.2018.07.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 05/30/2018] [Accepted: 07/11/2018] [Indexed: 12/12/2022]
Abstract
Alcohol produces complex effects on the immune system. Moderate alcohol use (1-2 drinks per day) has been shown to produce anti-inflammatory responses in human blood monocytes, whereas, the post mortem brains of severe alcoholics show increased immune gene expression and activated microglial markers. The present study was conducted to evaluate the time course of alcohol effects during exposure and after withdrawal, and to determine the relationship between microglial and cytokine responses in brain and blood. Forty-eight adult, male Wistar rats were exposed to chronic ethanol vapors, or air control, for 5 weeks. Following ethanol/air exposure blood and brains were collected at three time points: 1) while intoxicated, following 35 days of air/vapor exposure; 2) following 24 h of withdrawal from exposure, and 3) 28 days after withdrawal. One hemisphere of the brain was flash-frozen for cytokine analysis, and the other was fixed for immunohistochemical analysis. The ionized calcium-binding adapter molecule 1 (Iba-1) was used to evaluate microglia activation at the three time points, and rat cytokine/chemokine Magnetic Bead Panels (Millipore) were used to analyze frontal cortex tissue lysate and serum. Ethanol induced a significant increase in Iba-1 that peaked at day 35, remained significant after 1 day of withdrawal, and was elevated at day 28 in frontal cortex, amygdala, and substantia nigra. Ethanol exposure was associated with a transient reduction of the serum level of the major pro- and anti-inflammatory cytokines and chemokines and a transient increase of effectors of sterile inflammation. Little or no changes in these molecules were seen in the frontal cortex except for HMG1 and fractalkine that were reduced and elevated, respectively, at day 28 following withdrawal. These data show that ethanol exposure produces robust microglial activation; however, measures of inflammation in the blood differ from those in the brain over a protracted time course.
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Affiliation(s)
- Manuel Sanchez-Alavez
- Department of Neuroscience, The Scripps Research Institute, 10550 North Torrey Pines Road, La Jolla, CA 92037, United States
| | - William Nguyen
- Department of Neuroscience, The Scripps Research Institute, 10550 North Torrey Pines Road, La Jolla, CA 92037, United States
| | - Simone Mori
- Department of Neuroscience, The Scripps Research Institute, 10550 North Torrey Pines Road, La Jolla, CA 92037, United States
| | - Derek N Wills
- Department of Neuroscience, The Scripps Research Institute, 10550 North Torrey Pines Road, La Jolla, CA 92037, United States
| | - Dennis Otero
- Infectious and Inflammatory Disease Center and National Cancer Institute (NCI)-Designated Cancer Center, Sanford Burnham Prebys Medical Discovery Research Institute, La Jolla, CA 92037, United States
| | - Cindy L Ehlers
- Department of Neuroscience, The Scripps Research Institute, 10550 North Torrey Pines Road, La Jolla, CA 92037, United States.
| | - Bruno Conti
- Department of Neuroscience, The Scripps Research Institute, 10550 North Torrey Pines Road, La Jolla, CA 92037, United States; Department of Molecular Medicine, The Scripps Research Institute, 10550 North Torrey Pines Road, La Jolla, CA 92037, United States; Dorris Neuroscience Center, The Scripps Research Institute, 10550 North Torrey Pines Road, La Jolla, CA 92037, United States
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Perceived harmfulness of various alcohol- and cannabis use modes: Secular trends, differences, and associations with actual substance use behaviors among Norwegian adolescents, 2007-2015. Drug Alcohol Depend 2019; 197:280-287. [PMID: 30875649 DOI: 10.1016/j.drugalcdep.2019.02.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 01/31/2019] [Accepted: 02/03/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND How youth perceive harmfulness of risk behaviors such as substance use relates to their engagement in those behaviors. Yet, little is known about how different substance use modes (i.e., variations in amounts and use frequencies) are perceived. We investigated how adolescent perceptions of harmfulness of various alcohol- and cannabis use modes changed over time, compared to one another, and related to actual substance use behaviors. METHODS We examined nationally-representative repeated cross-sectional samples of 16-year olds in Norway, assessed in 2007, 2011, and 2015 (NTotal = 9296) as part of the European School Survey Project on Alcohol and Other Drugs (ESPAD). Adolescents reported their: 1) lifetime alcohol- and cannabis use, and 2) perceived harmfulness of various alcohol- and cannabis use modes. RESULTS Prevalence estimates for perceived harmfulness: 1) remained high and stable, or increased for alcohol use modes, and 2) declined for all cannabis use modes (i.e., using 1-2 times, occasionally, and regularly) since 2007-cohort. High quantity daily drinking was more commonly perceived as harmful than minimal or occasional cannabis use. Even though culturally-relevant use modes (i.e., weekend heavy drinking and experimental cannabis use) were not most commonly endorsed as harmful, only perceptions of those use modes as harmful were inversely associated with actual substance use. CONCLUSIONS How adolescents from Norway perceived harmfulness of alcohol- and cannabis use depended on the specific substance, its use modes, and secular cohort. Perceived harmfulness was associated with measures of actual substance use predominantly along the culturally- and adolescent-relevant modes of use.
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Choi HI, Ko HJ, Kim AS, Moon H. The Association between Mineral and Trace Element Concentrations in Hair and the 10-Year Risk of Atherosclerotic Cardiovascular Disease in Healthy Community-Dwelling Elderly Individuals. Nutrients 2019; 11:E637. [PMID: 30884739 PMCID: PMC6471722 DOI: 10.3390/nu11030637] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 03/05/2019] [Accepted: 03/12/2019] [Indexed: 12/25/2022] Open
Abstract
This cross-sectional analysis included 137 Korean subjects aged 60⁻79 years. All subjects underwent anthropometric measurements and laboratory tests. Scalp hair samples were obtained from each individual, the concentrations of 36 minerals and trace elements were analyzed, and 16 ratios of elements were calculated. ASCVD risk was estimated using pooled cohort ASCVD risk assessment equations for 10-year risk profiles. The 137 subjects were divided into three risk groups: low (<5%, n = 28), intermediate (5% to <7.5%, n = 21), and high (≥7.5%, n = 88) risk groups. After adjusting for obesity (BMI ≥ 25 kg/m²) and sex, Na concentration (mg%) in hair was significantly lower in the low-risk (13.91 ± 7.02) than in the intermediate-risk (47.18 ± 8.08) and high-risk (36.76 ± 3.95) groups (p for trend = 0.024). The concentration of K (mg%) in hair was also positively associated with the severity of ASCVD risk (10.50 ± 8.37, 23.62 ± 9.63, 33.31 ± 4.71, respectively; p for trend = 0.017), but their differences were not statistically significant (p = 0.059). By contrast, the levels of Co, U, and Hg, and the Ca/P and Ca/Mg ratios, were negatively correlated with the severity of ASCVD risk (p for trend < 0.05). Mean Na concentration in hair was significantly lower in the low-risk than in the other risk groups. By contrast, Co, U, and Hg concentrations showed significant negative associations with risk severity. Further studies are needed to assess whether dietary modification for trace elements could lower the risk of ASCVD.
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Affiliation(s)
- Hye-In Choi
- Department of Family Medicine, Kyungpook National University Hospital, Daegu 41944, Korea.
| | - Hae-Jin Ko
- Department of Family Medicine, Kyungpook National University Hospital, Daegu 41944, Korea.
- Department of Family Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Korea.
| | - A-Sol Kim
- Department of Family Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Korea.
- Department of Family Medicine, Kyungpook National University Chilgok Hospital, Daegu 41404, Korea.
| | - Hana Moon
- Department of Family Medicine, Kyungpook National University Chilgok Hospital, Daegu 41404, Korea.
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Jensen KP, Lieberman R, Kranzler HR, Gelernter J, Clinton K, Covault J. Alcohol-responsive genes identified in human iPSC-derived neural cultures. Transl Psychiatry 2019; 9:96. [PMID: 30862775 PMCID: PMC6414668 DOI: 10.1038/s41398-019-0426-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 01/22/2019] [Accepted: 01/26/2019] [Indexed: 01/04/2023] Open
Abstract
Alcohol use contributes to numerous diseases and injuries. The nervous system is affected by alcohol in diverse ways, though the molecular mechanisms of these effects are not clearly understood. Using human-induced pluripotent stem cells (iPSCs), we developed a neural cell culture model to identify the mechanisms of alcohol's effects. iPSCs were generated from fibroblasts and differentiated into forebrain neural cells cultures that were treated with 50 mM alcohol or sham conditions (same media lacking alcohol) for 7 days. We analyzed gene expression using total RNA sequencing (RNA-seq) for 34 samples derived from 10 subjects and for 10 samples from 5 subjects in an independent experiment that had intermittent exposure to the same dose of alcohol. We also analyzed genetic effects on gene expression and conducted a weighted correlation network analysis. We found that differentiated neural cell cultures have the capacity to recapitulate gene regulatory effects previously observed in specific primary neural tissues and identified 226 genes that were differentially expressed (FDR < 0.1) after alcohol treatment. The effects on expression included decreases in INSIG1 and LDLR, two genes involved in cholesterol homeostasis. We also identified a module of 58 co-expressed genes that were uniformly decreased following alcohol exposure. The majority of these effects were supported in independent alcohol exposure experiments. Enrichment analysis linked the alcohol responsive genes to cell cycle, notch signaling, and cholesterol biosynthesis pathways, which are disrupted in several neurological disorders. Our findings suggest that there is convergence between these disorders and the effects of alcohol exposure.
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Affiliation(s)
- Kevin P. Jensen
- 0000000419368710grid.47100.32Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06511 USA ,0000 0004 0419 3073grid.281208.1VA Connecticut Healthcare System, West Haven, CT 06516 USA
| | - Richard Lieberman
- 0000000419370394grid.208078.5Alcohol Research Center, Department of Psychiatry, University of Connecticut School of Medicine, Farmington, CT 06030–1410 USA
| | - Henry R. Kranzler
- 0000 0004 1936 8972grid.25879.31Center for Studies of Addiction, Department of Psychiatry, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA 19104 USA ,VISN4 MIRECC, Crescenz VAMC, Philadelphia, PA 19104 USA
| | - Joel Gelernter
- 0000000419368710grid.47100.32Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06511 USA ,0000 0004 0419 3073grid.281208.1VA Connecticut Healthcare System, West Haven, CT 06516 USA
| | - Kaitlin Clinton
- 0000000419370394grid.208078.5Alcohol Research Center, Department of Psychiatry, University of Connecticut School of Medicine, Farmington, CT 06030–1410 USA
| | - Jonathan Covault
- Alcohol Research Center, Department of Psychiatry, University of Connecticut School of Medicine, Farmington, CT, 06030-1410, USA. .,Institute for Systems Genomics, University of Connecticut, Storrs, CT, 06269, USA.
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Wu Y, Fan Z, Chen Y, Ni J, Liu J, Han J, Ren L, Tu J, Ning X, Wang J. Determinants of Developing Stroke Among Low-Income, Rural Residents: A 27-Year Population-Based, Prospective Cohort Study in Northern China. Front Neurol 2019; 10:57. [PMID: 30804876 PMCID: PMC6370670 DOI: 10.3389/fneur.2019.00057] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 01/16/2019] [Indexed: 11/13/2022] Open
Abstract
Although strokes are the leading cause of death and disability in many countries, China still lacks long-term monitoring data on stroke incidence and risk factors. This study explored stroke risk factors in a low-income, rural population in China. The study population was derived from the Tianjin Brain Study, a population-based stroke monitoring study that began in 1985. This study documented the demographic characteristics, past medical histories, and personal lifestyles of the study participants. In addition, physical examinations, including measurements of blood pressure (BP), height, and weight, were performed. Hazard ratios (HRs) were estimated for the risk factors for all subtypes of stroke using multivariate Cox regression analyses. During the study with mean following-up time of 23.16 years, 3906 individuals were recruited at baseline, and during 27 years of follow-up, 638 strokes were documented. The multivariate Cox regression analyses revealed a positive correlation between age and stroke incidence. Limited education was associated with a 1.9-fold increase in stroke risk (lowest vs. highest education level). Stroke risk was higher among former smokers than among current smokers (HR, 1.8 vs. 1.6; both, P < 0.05). Moreover, stroke risk was significantly associated with sex (HR, 1.8), former alcohol drinking (HR, 2.7), baseline hypertension (HR, 3.1), and overweight (HR, 1.3). In conclusion, this study identified uncontrollable (sex and age) and controllable (education, smoking, alcohol drinking, hypertension, and overweight) risk factors for stroke in a low-income, rural population in China. Therefore, it is critical to control BP and weight effectively, advocate cessation of smoking/alcohol drinking, and enhance the education level in this population to prevent increase in the burden of stroke in China.
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Affiliation(s)
- Yanan Wu
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China.,Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, China.,Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Tianjin Neurological Institute, Ministry of Education and Tianjin City, Tianjin, China
| | - Zhenqian Fan
- Department of Endocrinology and Metabolism, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Yu Chen
- Department of Endocrinology and Metabolism, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Jingxian Ni
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China.,Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, China.,Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Tianjin Neurological Institute, Ministry of Education and Tianjin City, Tianjin, China
| | - Jie Liu
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China.,Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, China.,Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Tianjin Neurological Institute, Ministry of Education and Tianjin City, Tianjin, China
| | - Jing Han
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
| | - Li Ren
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
| | - Jun Tu
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China.,Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, China.,Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Tianjin Neurological Institute, Ministry of Education and Tianjin City, Tianjin, China
| | - Xianjia Ning
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China.,Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, China.,Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Tianjin Neurological Institute, Ministry of Education and Tianjin City, Tianjin, China
| | - Jinghua Wang
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China.,Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, China.,Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Tianjin Neurological Institute, Ministry of Education and Tianjin City, Tianjin, China
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Kim AS, Ko HJ. Atrophic Gastritis as a Risk Factor for Bone Loss in Premenopausal Women in Their 40s: A Retrospective Cohort Study. Calcif Tissue Int 2019; 104:34-41. [PMID: 30191283 DOI: 10.1007/s00223-018-0473-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 09/03/2018] [Indexed: 12/18/2022]
Abstract
This study assessed the effects of atrophic gastritis on bone mineral density (BMD) in premenopausal women in their 40s. We performed a retrospective analysis of medical records of premenopausal women in their 40s who underwent a health checkup, esophagogastroduodenoscopy, and bone densitometry at least thrice, 24 months apart, between January 2006 and December 2016. Based on first-visit esophagogastroduodenoscopy results, patients were divided into atrophic and non-atrophic gastritis groups; BMD changes over time were analyzed. Patients were further divided into subgroups depending on atrophic gastritis persistence; differences and absolute changes in BMD were assessed. BMD in both groups exhibited group-by-time interaction (p < 0.001). After adjusting for confounding factors, the mean BMD was significantly different at the 24-month and the 48-month follow-up (p = 0.049, p < 0.001, respectively). Subgroup analysis after adjusting for confounding factors showed a mean BMD of 1.128 and 1.104 at baseline, 1.110 and 1.100 at the 24-month follow-up, and 1.106 and 1.065 at the 48-month follow-up for persistent atrophic and non-atrophic gastritis groups, respectively. The difference between mean BMD was not significant at baseline (p = 0.171), but was significant at the 24-month and 48-month follow-ups (p = 0.044 and p < 0.001, respectively). Absolute changes in BMD over 48 months were - 0.010 and - 0.051 for the two subgroups, which was significantly different (p < 0.001). Atrophic gastritis reduces BMD in premenopausal women in their 40s. Patients with atrophic gastritis exhibited lower BMD than patients without, and patients with persistent atrophic gastritis exhibited a greater decrease in BMD.
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Affiliation(s)
- A-Sol Kim
- Department of Family Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, 807 Hoguk-ro, Buk-gu, Daegu, 41404, South Korea
| | - Hae-Jin Ko
- Department of Family Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongduk-ro, Jung-gu, Daegu, 41944, South Korea.
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Linden-Carmichael AN, Lanza ST. Drinking Patterns of College- and Non-College-Attending Young Adults: Is High-Intensity Drinking Only a College Phenomenon? Subst Use Misuse 2018; 53:2157-2164. [PMID: 29671683 PMCID: PMC6105386 DOI: 10.1080/10826084.2018.1461224] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Young adults report the heaviest drinking of any age group, and many are at risk for experiencing an alcohol use disorder. Most research investigating young adult drinking has focused on single indicators of use. Using multiple dimensions of consumption, such as federal guidelines for daily/weekly drinking and engagement in drinking at twice the binge threshold ("high-intensity drinking") to characterize drinking behavior could illuminate drinking patterns linked with harms. OBJECTIVES We used a person-centered approach to examine latent classes of drinkers from a national sample of young adults. Further, we compared classes on college status. METHODS We used 2012-2013 data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC)-III. We included past-year drinkers aged 18-22 years (n = 2213). Latent classes were estimated based on drinking frequency, daily/weekly drinking, frequency of heavy episodic drinking (4+/5+ drinks for women/men), frequency of high-intensity drinking (8+/10+ drinks), and intoxication frequency. RESULTS Five latent classes were identified: Occasional, Light Drinkers (30%), Regular Drinkers (6%), Infrequent Drinkers with Occasional Binging (10%), Frequent Drinkers with Occasional Binging (22%), and High-Intensity Drinkers (32%). Although membership in the two riskiest classes were more common among college-attenders, odds of being a High-Intensity Drinker relative to the second riskiest class was not significantly different for college- and non-college-attending young adults. Conclusions/Importance: As high-intensity drinking does not appear to be a drinking pattern unique to college-attenders and non-college-attenders are less likely to mature out of heavy drinking patterns, intervention efforts are needed for this at-risk age group.
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Affiliation(s)
- Ashley N Linden-Carmichael
- a Department of Biobehavioral Health and The Edna Bennett Pierce Prevention Research Center , The Pennsylvania State University , University Park , Pennsylvania , USA
| | - Stephanie T Lanza
- a Department of Biobehavioral Health and The Edna Bennett Pierce Prevention Research Center , The Pennsylvania State University , University Park , Pennsylvania , USA
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Oberlin BG, Dzemidzic M, Eiler WJA, Carron CR, Soeurt CM, Plawecki MH, Grahame NJ, O'Connor SJ, Kareken DA. Pairing neutral cues with alcohol intoxication: new findings in executive and attention networks. Psychopharmacology (Berl) 2018; 235:2725-2737. [PMID: 30066136 PMCID: PMC6119082 DOI: 10.1007/s00213-018-4968-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 07/05/2018] [Indexed: 12/27/2022]
Abstract
RATIONALE Alcohol-associated stimuli capture attention, yet drinkers differ in the precise stimuli that become paired with intoxication. OBJECTIVES Extending our prior work to examine the influence of alcoholism risk factors, we paired abstract visual stimuli with intravenous alcohol delivered covertly and examined brain responses to these Pavlovian-conditioned stimuli in fMRI when subjects were not intoxicated. METHODS Sixty healthy drinkers performed task-irrelevant alcohol conditioning that presented geometric shapes as conditioned stimuli. Shapes were paired with a rapidly rising alcohol limb (conditioned stimulus; CS+) using intravenous alcohol infusion targeting a final peak breath alcohol concentration of 0.045 g/dL or saline (CS-) infusion at matched rates. On day 2, subjects performed monetary delay discounting outside the scanner to assess delay tolerance and then underwent event-related fMRI while performing the same task with CS+, CS-, and an irrelevant symbol. RESULTS CS+ elicited stronger activation than CS- in frontoparietal executive/attention and orbitofrontal reward-associated networks. Risk factors including family history, recent drinking, sex, and age of drinking onset did not relate to the [CS+ > CS-] activation. Delay-tolerant choice and [CS+ > CS-] activation in right inferior parietal cortex were positively related. CONCLUSIONS Networks governing executive attention and reward showed enhanced responses to stimuli experimentally paired with intoxication, with the right parietal cortex implicated in both alcohol cue pairing and intertemporal choice. While different from our previous study results in 14 men, we believe this paradigm in a large sample of male and female drinkers offers novel insights into Pavlovian processes less affected by idiosyncratic drug associations.
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Affiliation(s)
- Brandon G Oberlin
- Department of Psychiatry, School of Medicine, Indiana University, 355 W. 16th Street (GH 4800), Indianapolis, IN, 46202, USA.
- Department of Neurology, School of Medicine, Indiana University, Indianapolis, IN, USA.
- Stark Neurosciences Institute, School of Medicine, Indiana University, Indianapolis, IN, USA.
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA.
| | - Mario Dzemidzic
- Department of Neurology, School of Medicine, Indiana University, Indianapolis, IN, USA
- Department of Radiology and Imaging Sciences, School of Medicine, Indiana University, Indianapolis, IN, USA
| | - William J A Eiler
- Department of Neurology, School of Medicine, Indiana University, Indianapolis, IN, USA
| | - Claire R Carron
- Department of Neurology, School of Medicine, Indiana University, Indianapolis, IN, USA
| | - Christina M Soeurt
- Department of Neurology, School of Medicine, Indiana University, Indianapolis, IN, USA
| | - Martin H Plawecki
- Department of Psychiatry, School of Medicine, Indiana University, 355 W. 16th Street (GH 4800), Indianapolis, IN, 46202, USA
| | - Nicholas J Grahame
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Sean J O'Connor
- Department of Psychiatry, School of Medicine, Indiana University, 355 W. 16th Street (GH 4800), Indianapolis, IN, 46202, USA
- Roudebush Veteran's Administration Medical Center, Indianapolis, IN, USA
| | - David A Kareken
- Department of Psychiatry, School of Medicine, Indiana University, 355 W. 16th Street (GH 4800), Indianapolis, IN, 46202, USA
- Department of Neurology, School of Medicine, Indiana University, Indianapolis, IN, USA
- Stark Neurosciences Institute, School of Medicine, Indiana University, Indianapolis, IN, USA
- Department of Radiology and Imaging Sciences, School of Medicine, Indiana University, Indianapolis, IN, USA
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Alcohol consumption and incidence of proteinuria: a retrospective cohort study. Clin Exp Nephrol 2018; 22:1133-1142. [PMID: 29600409 DOI: 10.1007/s10157-018-1568-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 03/21/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND Previous studies report conflicting results of a dose-dependent association between alcohol consumption and incidence of chronic kidney disease. Only a few studies have assessed the clinical impact of > 45-65 g/day of critically high alcohol consumption. METHODS This retrospective cohort study included 88,647 males and 88,925 females with dipstick urinary protein ≤ ± and estimated glomerular filtration rate ≥ 60 mL/min/1.73 m2 at their first annual health examinations between April 2008 and March 2010 in Japan. The exposure was the self-reported alcohol consumption. The outcome was proteinuria defined as dipstick urinary protein ≥ 1 + or ≥ 2 +. RESULTS During median 1.8 years (interquartile range 1.0-2.1) of the observational period, 5416 (6.1%) males and 3262 (3.7%) females developed proteinuria defined as dipstick urinary protein ≥ 1 +. In males, a U-shape association between alcohol consumption and proteinuria was observed in a multivariable-adjusted Poisson regression model [incidence rate ratio (95% confidence interval) of rare, occasional, and daily drinkers with ≤ 19, 20-39, 40-59, and ≥ 60 g/day: 1.00 (reference), 0.86 (0.79-0.94), 0.70 (0.64-0.78), 0.82 (0.75-0.90), 1.00 (0.90-1.11), and 1.00 (0.85-1.17), respectively], whereas a J-shape association was observed in females [1.00 (reference), 0.81 (0.75-0.87), 0.74 (0.64-0.85), 0.93 (0.78-1.11), 1.09 (0.83-1.44), and 1.45 (1.02-2.08), respectively]. Similar associations with dipstick urinary protein ≥ 2 + were shown in males and females. CONCLUSIONS Moderate alcohol consumption was associated with lower risk of proteinuria in both males and females. Females with ≥ 60 g/day of high alcohol consumption were at higher risk of proteinuria, whereas males were not. Females were more vulnerable to high alcohol consumption, than males.
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Abstract
PURPOSE OF REVIEW This review aims to discuss the effect of alcohol consumption on various cardiovascular (CV) diseases and CV mortality. RECENT FINDINGS Alcohol intake has consistently shown a J- or U-shaped relationship with several cardiovascular diseases. Light to moderate alcohol intake has been associated with lower risk of coronary artery disease, heart failure (HF), as well as CV mortality. On the other hand, heavy consumption has been associated with deleterious CV outcomes including increased mortality. However, the evidence is based from observational and population-based studies where risk of confounding cannot be excluded even after meticulous methodological approaches. This is compounded by conflicting data such as higher risk of certain CV diseases like HF in former drinkers compared to abstainers. Further, Mendelian randomization studies using genetic polymorphisms in enzymes have recently questioned the beneficial association of low-moderate drinking with CV system. There has been substantial and consistent evidence that light to moderate alcohol consumption have beneficial effect on overall cardiovascular profile and mortality. However, there are considerable limitations in the reported literature to determine a strong causality of a protective effect of moderate alcohol consumption by itself. Further robust studies or possibly a well-structured randomized controlled could bring an end to this debate.
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Affiliation(s)
- Sunny Goel
- Division of Cardiovascular Medicine, Maimonides Medical Center, Brooklyn, NY, USA
| | - Abhishek Sharma
- Division of Cardiovascular Medicine, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
- Institute of Cardiovascular Research and Technology, Brooklyn, NY, USA.
| | - Aakash Garg
- Rutgers Robert Wood Johnson Medical School, 69 Duke Street, New Brunswick, NJ, USA
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Gonçalves PD, Schuckit MA, Smith TL. Drinking Status Between Ages 50 and 55 for Men From the San Diego Prospective Study Who Developed DSM-IV Alcohol Abuse or Dependence in Prior Follow-Ups. J Stud Alcohol Drugs 2018; 78:512-520. [PMID: 28728633 DOI: 10.15288/jsad.2017.78.512] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE Although alcohol use disorders (AUDs) are prevalent among older individuals, few studies have examined the course and predictors of AUDs from their onset into the person's 50s. This study describes the AUD course from ages 50 to 55 in participants who developed AUDs according to criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), during the San Diego Prospective Study (SDPS). METHOD Among the 397 university students in the SDPS who were followed about every 5 years from age 20 (before AUD onset), 165 developed AUDs, 156 of whom were interviewed at age 55. Age 50-55 outcomes were compared regarding age 20-50 characteristics. Variables that differed significantly across outcome groups were evaluated using binary logistic regression analyses predicting each outcome type. RESULTS Between ages 50 and 55, 16% had low-risk drinking, 36% had high-risk drinking, 38% met DSM-5 AUD criteria, and 10% were abstinent. Baseline predictors of outcome at ages 50-55 included earlier low levels of response to alcohol predicting DSM-5 AUDs and abstinence, higher drinking frequency predicting DSM-5 diagnoses and lower predicting low-risk drinking, higher participation in treatment and/or self-help groups predicting abstinence and lower predicting DSM-5 AUDs, later ages of AUD onset predicting high-risk drinking, and cannabis use disorders predicting abstinent outcomes. CONCLUSIONS Despite the high functioning of these men, few were abstinent or maintained low-risk drinking during the recent 5 years, and 38% met DSM-5 AUD criteria. The data may be helpful to both clinicians and researchers predicting the future course of AUDs in their older patients and research participants.
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Affiliation(s)
- Priscila Dib Gonçalves
- Department of Psychiatry, University of California, San Diego, La Jolla, California.,Institute of Psychiatry, Psychology and Neuropsychology Service and Institute of Psychiatry, Interdisciplinary Group of Studies on Alcohol and Drugs (GREA), University of São Paulo, São Paulo, Brazil
| | - Marc A Schuckit
- Department of Psychiatry, University of California, San Diego, La Jolla, California
| | - Tom L Smith
- Department of Psychiatry, University of California, San Diego, La Jolla, California
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Holahan CJ, Brennan PL, Schutte KK, Holahan CK, Hixon JG, Moos RH. Drinking Level Versus Drinking Pattern and Cigarette Smoking Among Older Adults. Alcohol Clin Exp Res 2018; 42:795-802. [PMID: 29417610 DOI: 10.1111/acer.13607] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 01/30/2018] [Indexed: 01/30/2023]
Abstract
BACKGROUND There is a lack of research on the role of alcohol consumption in cigarette smoking among older adults, and the few studies on alcohol use and smoking with older adults have failed to distinguish between average level and pattern of drinking as predictors of smoking. The main purpose of this study was to examine the independent contributions of average level versus pattern of drinking as predictors of cigarette smoking among older adults. A subsidiary purpose was to examine the link between continued smoking and mortality among older smokers. METHODS We investigated average level and pattern of drinking as predictors of current smoking among 1,151 older adults at baseline and of continued smoking and mortality among the subset of 276 baseline smokers tracked across 20 years. We used multiple linear and logistic regression analyses and, to test mediation, bias-corrected bootstrap confidence intervals. RESULTS A high level of average drinking and a pattern of episodic heavy drinking were concurrently associated with smoking at baseline. However, only episodic heavy drinking was prospectively linked to continued smoking among baseline smokers. Continued smoking among baseline smokers increased the odds of 20-year mortality and provided an indirect pathway through which heavy episodic drinking related to mortality. CONCLUSIONS Smokers who misuse alcohol are a challenging population for smoking cessation efforts. Older adults who concurrently misuse alcohol and smoke cigarettes provide a unique target for public health interventions.
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Affiliation(s)
- Charles J Holahan
- Department of Psychology , University of Texas at Austin, Austin, Texas
| | - Penny L Brennan
- Institute for Health and Aging , University of California, San Francisco, San Francisco, California
| | - Kathleen K Schutte
- Center for Health Care Evaluation , VA Palo Alto Health Care System, Palo Alto, California
| | - Carole K Holahan
- Department of Kinesiology and Health Education , University of Texas at Austin, Austin, Texas
| | - J Gregory Hixon
- Department of Psychology , University of Texas at Austin, Austin, Texas
| | - Rudolf H Moos
- Department of Psychiatry and Behavioral Sciences , Stanford University School of Medicine, Stanford, California
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Barclay GA, Barbour J, Stewart S, Day CP, Gilvarry E. Adverse physical effects of alcohol misuse. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/apt.bp.105.001263] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This article outlines the majority of the adverse physical effects that have been described secondary to the consumption of alcohol at levels above recommended sensible limits. These conditions are cited according to the organ system they belong to. Only brief descriptions are provided because of the vastness of this topic. The underlying pathophysiology of tolerance and withdrawal is touched upon as this is of relevance to the psychiatrist. Definitions of the terms used describing alcohol misuse, and sensible upper limits of alcohol consumption are also mentioned.
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Where should the safe limits of alcohol consumption stand in light of liver enzyme abnormalities in alcohol consumers? PLoS One 2017; 12:e0188574. [PMID: 29206836 PMCID: PMC5716536 DOI: 10.1371/journal.pone.0188574] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 11/09/2017] [Indexed: 12/12/2022] Open
Abstract
Objectives To estimate the prevalence and risk factors for abnormal liver enzymes in a large age- and gender stratified population-based sample of apparently healthy individuals with or without alcohol consumption and other health-related risk factors (adiposity, physical inactivity, smoking). Methods Data on alcohol use, smoking, diet and physical activity were recorded using structured questionnaires from 13,976 subjects (6513 men, 7463 women, aged 25–74 years) in the national FINRISK studies. Alcohol data was used to categorize the participants into abstainers, light drinkers, moderate drinkers and heavy drinkers. Serum gamma-glutamyltransferase (GGT) and alanine aminotransferase (ALT) activities were measured using standard kinetic methods. Results Male light drinkers, moderate drinkers and heavy drinkers showed significantly higher relative risks of abnormal GGT than abstainers: 1.37 (95% confidence interval 1.11 to 1.71, p < 0.01), 2.72 (2.08 to 3.56, p < 0.0005), and 6.10 (4.55 to 7.17, p < 0.0005), respectively. Corresponding values for women were 1.22 (0.99 to 1.51, p = 0.065), 1.90 (1.44 to 2.51, p < 0.0005), and 5.91 (3.80 to 9.17, p < 0.0005). Estimated threshold doses for a significant GGT elevation was 14 standard weekly alcohol doses for men and 7 for women. Excess body weight and age over 40 years modulated the thresholds towards smaller quantities of alcohol. The risk of abnormal GGT was also significantly influenced by physical inactivity and smoking. The relative risks of abnormal ALT activities were increased in male heavy drinkers, especially in those presenting with adiposity and sedentary lifestyle. Conclusions Alcohol use markedly increases the risk for abnormal liver enzyme activities in those presenting with age over 40 years, obesity, smoking or sedentary lifestyle. The data should be considered in public health recommendations and in the definitions of safe limits of alcohol use.
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Holahan CJ, Brennan PL, Schutte KK, Holahan CK, Hixon JG, Moos RH. Late-Life Drinking Problems: The Predictive Roles of Drinking Level vs. Drinking Pattern. J Stud Alcohol Drugs 2017; 78:435-441. [PMID: 28499111 DOI: 10.15288/jsad.2017.78.435] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Research on late-middle-aged and older adults has focused primarily on average level of alcohol consumption, overlooking variability in underlying drinking patterns. The purpose of the present study was to examine the independent contributions of an episodic heavy pattern of drinking versus a high average level of drinking as prospective predictors of drinking problems. METHOD The sample comprised 1,107 adults ages 55-65 years at baseline. Alcohol consumption was assessed at baseline, and drinking problems were indexed across 20 years. We used prospective negative binomial regression analyses controlling for baseline drinking problems, as well as for demographic and health factors, to predict the number of drinking problems at each of four follow-up waves (1, 4, 10, and 20 years). RESULTS Across waves where the effects were significant, a high average level of drinking (coefficients of 1.56, 95% CI [1.24, 1.95]; 1.48, 95% CI [1.11, 1.98]; and 1.85, 95% CI [1.23, 2.79] at 1, 10, and 20 years) and an episodic heavy pattern of drinking (coefficients of 1.61, 95% CI [1.30, 1.99]; 1.61, 95% CI [1.28, 2.03]; and 1.43, 95% CI [1.08, 1.90] at 1, 4, and 10 years) each independently increased the number of drinking problems by more than 50%. CONCLUSIONS Information based only on average consumption underestimates the risk of drinking problems among older adults. Both a high average level of drinking and an episodic heavy pattern of drinking pose prospective risks of later drinking problems among older adults.
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Affiliation(s)
- Charles J Holahan
- Department of Psychology, University of Texas at Austin, Austin, Texas
| | - Penny L Brennan
- Institute for Health and Aging, University of California, San Francisco, San Francisco, California
| | - Kathleen K Schutte
- Center for Health Care Evaluation, VA Palo Alto Health Care System, Palo Alto, California
| | - Carole K Holahan
- Department of Kinesiology and Health Education, University of Texas at Austin, Austin, Texas
| | - J Gregory Hixon
- Department of Psychology, University of Texas at Austin, Austin, Texas
| | - Rudolf H Moos
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
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Dwyer-Clonts M, Frates E, Suzuki J. Managing Problem Drinking: Screening Tools and Brief Interventions for Primary Care Physicians. Am J Lifestyle Med 2017; 11:424-429. [PMID: 30202365 PMCID: PMC6125007 DOI: 10.1177/1559827616629929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 01/11/2016] [Indexed: 11/16/2022] Open
Abstract
A high percentage of patients seen in primary care clinics partake in excessive alcohol consumption. It leads to numerous health problems and remains one of the leading risk factors for chronic disease. Despite the health concerns, screening for and intervening in patients' alcohol misuse has yet to become standard practice in many primary care settings. There is well-established empirical evidence that brief doctor-patient interactions reduce alcohol consumption among excessive drinkers in primary care settings. This article draws on randomized controlled trials and literature on screening techniques, motivational interviewing, the transtheoretical model of behavior change, and medication-assisted treatments to enhance brief intervention methodology. Through this review, evidence-based practical strategies are presented to primary care doctors that reduce alcohol consumption in patients screened as problem drinkers. Referral information for those individuals with severe drinking problems is included. We propose that short, multicomponent interventions are most effective when they include interventions that utilize the lifestyle medicine philosophy, a nonjudgmental therapeutic alliance, and account for patient concerns more directly.
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Affiliation(s)
- Michael Dwyer-Clonts
- Michael Dwyer-Clonts, AA, Harvard University, 28 Myrtle Street, Medford, MA 02155; e-mail:
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