Short-term abstinence from alcohol and changes in cardiovascular risk factors, liver function tests and cancer-related growth factors: a prospective observational study

Response to semaglutide of non-drinker subjects with type 2 diabetes

BACKGROUND

Metabolic dysfunction-associated Steatotic Liver Disease (MASLD) displays a worse prognosis in subjects with type 2 diabetes (T2D); effective treatments are, so far, scanty. Semaglutide showed efficacy in improving steatohepatitis. We longitudinally observed a MASLD cohort of T2D subjects starting semaglutide, to detect an improvement of non-invasive surrogates of steatosis and fibro-inflammatory liver involvement, evaluating the role of mild alcohol consumption.

PATIENTS AND METHODS

In 62 overweight/obese T2D subjects with MASLD (36 non-drinker and 26 mild alcohol consumers), anthropometric, bio-humoral and transient elastography (TE) data were collected before (T0) and after an average time of 6.4 month (T1) from injective semaglutide prescription. Circulating levels of hormones (GIP, GLP-1, glucagon, insulin) and inflammatory markers (TNFα, MCP-1, IL-18, IL-10) were measured. Steatotic and necro-inflammatory liver involvement was evaluated with FibroScan controlled attenuation parameter (CAP) and liver stiffness (LS), respectively.

RESULTS

Significant (p < 0.006) T0-T1 reductions of BMI, waist circumference, fasting glucose, and HbA1c were observed. AST (-10 ± 3 IU/L), ALT (-18 ± 5 IU/L), GGT (-33 ± 15 IU/L), CAP (-25 ± 8 dB/m) and LS (-0.8 ± 0.4 kPa) were reduced, too. GLP-1 increased (+ 95.9 pM, p < 0.0001) and IL-18 was reduced (-46.6 pg/ml, p = 0.0002). After adjustment for confounders, CAP improving was only related to GLP-1 increase (ß=-0.437, p = 0.0122). Mild alcohol intake did not influence these relations.

CONCLUSION

Use of semaglutide in subjects with T2D and MASLD is associated with a significant decline of liver steatosis and necroinflammation proxies; mild alcohol assumption did not exert any influence. An independent effect of GLP-1 raise was observed on reduction of steatosis, irrespective of alcohol consumption.

Induction chemotherapy-based organ-preservation protocol improve the function preservation compared with immediate total laryngectomy for locally advanced hypopharyngeal cancer-Results of a matched-pair analysis

BACKGROUND

We performed a paired analysis to compare the therapeutic effect between the induction chemotherapy-based organ-preservation approach and immediate total laryngectomy in hypopharyngeal squamous cell carcinoma patients requiring total laryngectomy.

METHODS

351 patients who were treated with organ-preservation approach were compared with 110 patients who were treated with total laryngectomy. The main measures and outcomes were progression-free survival (PFS), overall survival (OS), and larynx function preservation survival (LFPS).

RESULTS

No statistical difference was observed for 3-, 5-, and 10-year PFS and OS in two groups. In the organ-preservation group, the 3-, 5-, and 10-year LFPS was 30.7%, 23.3%, and 16.6%, respectively. The LFPS of Stage III > Stage IV, N0 > N1 > N2 > N3, T2 > T3 > T4, CR > PR > SD > PD patients (all p values <0.05).

CONCLUSIONS

Survival outcomes did not significantly differ between the two groups. The organ-preservation approach allowed more than 70% of the survivors to retain their larynx function.

Temporary abstinence challenges: What do we need to know?

Participation in temporary abstinence challenges (TAC) continues to increase with campaigns established in several countries. Temporarily abstaining from alcohol as part of such challenges is associated with ongoing benefits including reductions to alcohol consumption after the TAC. We identified three research priorities regarding TACs which are outlined in this paper. First, the role of temporary abstinence itself is unclear with post-TAC reductions in alcohol consumption still apparent among participants who do not remain fully abstinent throughout the challenge. It is necessary to establish to what degree temporary abstinence itself, rather than the combination of abstinence and the additional supports provided by TAC organisers (e.g., mobile applications, online support groups), contributes to changes in consumption after the TAC. Second, little is known about the psychological changes underlying these changes in alcohol consumption, with conflicting evidence as to whether increases in someone's belief in their ability to avoid drinking mediates the association between participation in a TAC and reductions in consumption afterwards. Other potential psychological and social mechanisms of change have been subjected to little, if any, scrutiny. Third, evidence of increased consumption post-TAC among a minority of participants indicates a need to establish for whom or in what circumstances participation in a TAC may result in unintended negative consequences. Focussing research in these areas would increase the confidence with which participation could be encouraged. It would also enable campaign messaging and additional supports to be prioritised and tailored to be as effective as possible in facilitating long-term change.

Exploring changes in temporary abstinence in increasing and higher risk drinkers in England and Dry January participation in users of the Try Dry app in the UK between 2020 and 2021

BACKGROUND

We looked at changes in the prevalence of increasing and higher risk drinkers reporting a reduction attempt motivated by temporary abstinence and changes in prevalence of use of the official app accompanying Dry January between 2020 vs 2021, following the onset of the COVID-19 pandemic. We also explored potential shifts in the sociodemographic composition of both groups.

METHODS

We analysed data from: i) 1863 increasing and higher risk drinkers (defined as ≥ 8 on the AUDIT) responding to a nationally representative survey of adults in England in January and February 2020 and 2021, and ii) 104,598 users of the 'Try Dry' app, the official aid to those participating in Dry January 2020 and 2021 in the UK. We used logistic regression to examine shifts in the prevalence of increasing and higher risk drinkers reporting a reduction attempt motivated by temporary abstinence and explored whether there were shifts in the characteristics of this group in terms of AUDIT score, number of last year reduction attempts, smoking status, living alone, living with children, reducing alcohol consumption due to future health motives, age, sex, and occupational social grade between 2020 and 2021. We used t-tests and chi-squared tests to compare the prevalence of users of the 'Try Dry' app in 2020 and 2021 and examine whether the two groups differed in terms of age and sex.

RESULTS

The proportion of increasing and higher risk drinkers reporting a reduction attempt motivated by temporary abstinence increased from 4% in 2020 to 8% in 2021 (OR = 2.07, 95% CI = 1.38-3.11, p < .001) with no changes detected in sociodemographic composition. The number of Try Dry app users in 2021 increased by 34.8% relative to 2020. App users in 2021 were two years older on average [p < .001, d = .02], with a 2% increase in the proportion of female app users [p < .001, vs. < .01].

CONCLUSIONS

Higher participation in Dry January 2021 relative to 2020 indicates increased engagement with a period of temporary abstinence following the COVID-19 related lockdowns in England and the UK, which is positive in the wider context of increasing alcohol consumption throughout the pandemic.

Evaluation of high-risk factors and the diagnostic value of alpha-fetoprotein in the stratification of primary liver cancer

BACKGROUND

Alpha-fetoprotein (AFP) is one of the diagnostic standards for primary liver cancer (PLC); however, AFP exhibits insufficient sensitivity and specificity for diagnosing PLC.

AIM

To evaluate the effects of high-risk factors and the diagnostic value of AFP in stratified PLC.

METHODS

In total, 289 PLC cases from 2013 to 2019 were selected for analysis. First, the contributions of high-risk factors in stratifying PLC were compared according to the following criteria: Child–Pugh score, clinical stage of liver cirrhosis, tumor size, and Barcelona Clinic Liver Cancer (BCLC) stage. Then, the diagnostic value of AFP was evaluated in different stratifications of PLC by receiver operating characteristic curves. For PLC cases in which AFP played little role, the diagnostic values of carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA 19-9), gamma-glutamyl transferase (GGT), and AFP were analyzed.

RESULTS

The roles of high-risk factors differed in stratified PLC. The incidence of smoking and drinking history was higher in PLC with Child–Pugh scores of C (P < 0.0167). The hepatitis B virus (HBV) infection rate in PLC with cirrhosis was more than in PLC without cirrhosis (P < 0.0167). Small tumors were more prone to cirrhosis than large tumors (P < 0.005). BCLC stage D PLC was more likely to be associated with HBV infection and cirrhosis (P < 0.0083). AFP levels were higher in PLC with cirrhosis, diffuse tumors, and BCLC stage D disease. In diagnosing PLC defined as Child–Pugh A, B, and C, massive hepatoma, diffuse hepatoma, BCLC stage B, C, and D, and AFP showed significant diagnostic value [all area under the curve (AUC) > 0.700]. However, these measures were meaningless (AUC < 0.600) in small hepatomas and BCLC A stage PLC, but could be replaced by the combined detection of CEA, CA 19-9, GGT, and AFP (AUC = 0.810 and 0.846, respectively).

CONCLUSION

Stratification of PLC was essential for precise diagnoses and benefited from evaluating AFP levels.

Development and validation of a model to predict incident chronic liver disease in the general population: The CLivD score

BACKGROUND & AIMS

Current screening strategies for chronic liver disease focus on detection of subclinical advanced liver fibrosis but cannot identify those at high future risk of severe liver disease. Our aim was to develop and validate a risk prediction model for incident chronic liver disease in the general population based on widely available factors.

METHODS

Multivariable Cox regression analyses were used to develop prediction models for liver-related outcomes with and without laboratory measures (Model_lab and Model_non-lab) in 25,760 individuals aged 40-70 years. Their data were sourced from the Finnish population-based health examination surveys FINRISK 1992-2012 and Health 2000 (derivation cohort). The models were externally validated in the Whitehall II (n = 5,058) and Copenhagen City Heart Study (CCHS) (n = 3,049) cohorts.

RESULTS

The absolute rate of incident liver outcomes per 100,000 person-years ranged from 53 to 144. The final prediction model included age, sex, alcohol use (drinks/week), waist-hip ratio, diabetes, and smoking, and Model_lab also included gamma-glutamyltransferase values. Internally validated Wolbers' C-statistics were 0.77 for Model_lab and 0.75 for Model_non-lab, while apparent 15-year AUCs were 0.84 (95% CI 0.75-0.93) and 0.82 (95% CI 0.74-0.91). The models identified a small proportion (<2%) of the population with >10% absolute 15-year risk for liver events. Of all liver events, only 10% occurred in participants in the lowest risk category. In the validation cohorts, 15-year AUCs were 0.78 (Model_lab) and 0.65 (Model_non-lab) in the CCHS cohort, and 0.78 (Model_non-lab) in the Whitehall II cohort.

CONCLUSIONS

Based on widely available risk factors, the Chronic Liver Disease (CLivD) score can be used to predict risk of future advanced liver disease in the general population.

LAY SUMMARY

Liver disease often progresses silently without symptoms and thus the diagnosis is often delayed until severe complications occur and prognosis becomes poor. In order to identify individuals in the general population who have a high risk of developing severe liver disease in the future, we developed and validated a Chronic Liver Disease (CLivD) risk prediction score, based on age, sex, alcohol use, waist-hip ratio, diabetes, and smoking, with or without measurement of the liver enzyme gamma-glutamyltransferase. The CLivD score can be used as part of health counseling, and for planning further liver investigations and follow-up.

One-month alcohol abstinence national campaigns: a scoping review of the harm reduction benefits

Over the last decade, one-month alcohol abstinence campaigns (OMACs) have been implemented within the general population in an increasing number of countries. We identified the published studies reporting data on OMACs to explore the following aspects: profile of participants, rates and factors associated with the completion of the abstinence challenge, and outcomes and harm reduction benefits in participating in the challenges. We screened 322 records, including those found in the grey literature, and reviewed 6 studies and 7 Dry July Annual Reports. Compared to non-participating alcohol users, participants were more likely to be female, have a higher income, and a higher level of education. They were heavier drinkers and were more concerned by the consequences of alcohol on health and by their health in general. Participants who achieved the one-month abstinence challenge were lower drinkers and more likely to have registered on the campaign-related Internet communities. Both successful and unsuccessful participants frequently reported health benefits, including sleep improvement and weight loss. Successful participants were more likely to durably change their alcohol drinking habits. Overall, OMACs provide short- or mid-term harm reduction benefits for both successful and unsuccessful participants. Findings were limited by the paucity of studies, their observational nature, and heterogeneity in the features of the different national campaigns, which would probably gain in enhanced internationalization.

The ALT upper reference interval debate: Blame it on the alcohol

BACKGROUND

In 2017, the American College of Gastroenterology (ACG) and the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition published clinical guidelines recommending the use of alanine aminotransferase (ALT) upper reference limits (URL) of 33, 25, 26, and 22 U/l for men, women, boys, and girls, respectively. This was opposed by laboratory experts who advocated for the use of higher URL of 59, 41, 33, and 24 U/l instead. We suspected that the variable inclusion of individuals who consumed alcohol to be a major contributing source of URL variability and debate.

METHODS

Outpatient ALT data (n = 7379) were collected from unique individuals ≥13 y with BMIs of ≥19 and ≤25. A total of 222 (3%) were excluded due to suspected liver disease. Patients were split into a pediatric group (age 13-17 y), an alcohol-restricted adult group (age 18-20 y), and adults with access to alcohol by decade (i.e., age 21-29, 30-39, 40-49, 50-59, 60-69, 70-79, and ≥ 80 y). All ALT values were measured on Roche Cobas 8000 with pyridoxal phosphate and traceable to the IFCC-reference measurement procedure.

RESULTS

We derived URL similar to CALIPER for our pediatric population, but closer to ACG-proposed URL in our alcohol-restricted adult group. The URL increased significantly in men and women for all other age groups.

CONCLUSIONS

The discrepancy in ALT URL in clinical laboratories may be attributable in part due to the variable inclusion of individuals who recently consumed alcohol in local population derivation studies.

Alcohol and Metabolic-associated Fatty Liver Disease

The diagnosis of metabolic-associated fatty liver disease is based on the detection of liver steatosis together with the presence of metabolic dysfunction. According to this new definition, the diagnosis of metabolic-associated fatty liver disease is independent of the amount of alcohol consumed. Actually, alcohol and its metabolites have various effects on metabolic-associated abnormalities during the process of alcohol metabolism. Studies have shown improved metabolic function in light to moderate alcohol drinkers. There are several studies focusing on the role of light to moderate alcohol intake on metabolic dysfunction. However, the results from studies are diverse, and the conclusions are often controversial. This review systematically discusses the effects of alcohol consumption, focusing on light to moderate alcohol consumption, obesity, lipid and glucose metabolism, and blood pressure.

New Indications for Liver Transplantation

Liver transplantation (LT) is an important therapeutic option for the treatment of several liver diseases. Modern LT is characterized by remarkable improvements in post-transplant patient survival, graft survival, and quality of life. Thanks to these great improvements, indications for LT are expanding. Nowadays, clinical conditions historically considered exclusion criteria for LT, have been considered new indications for LT, showing survival advantages for patients. In this review, we provide an updated overview of the principal newer indications for LT, with particular attention to alcoholic hepatitis, acute-on-chronic liver failure (ACLF), cholangiocarcinoma and colorectal cancer metastases.

Lactobacillus acidophilus and vitamin C attenuate ethanol-induced intestinal and liver injury in mice

Ethanol exposure frequently induces intestinal and liver injury, dysbiosis of the gut microbiota and vitamin C (VC) deficiency. Gut microbiota-targeted therapy is emerging as an important adjuvant method for protecting the body against ethanol-induced injury, particularly probiotics containing Lactobacillus acidophilus (LA). However, the feasibility and efficiency of using synbiotics containing LA and VC against ethanol-induced injury remained largely undetermined. To examine the advantages of LA+VC, their effect was evaluated in an ethanol-fed mouse model. The results suggested that LA+VC restored gut microbiota homeostasis and reinstated the immune balance of colonic T-regulatory cells (CD4⁺CD45⁺forkhead box p3⁺). In addition, intestinal barrier disorders were improved via upregulating tight junction proteins (claudin-2, zona occludens-1 and occludin) and mucus secretion, which prevented the translocation of lipopolysaccharide into circulatory systems and subsequently reduced the expression of Toll-like receptor 4 in liver tissues. In this context, LA+VC treatment reduced the inflammatory response in the liver, which was likely responsible for the improved liver function in ethanol-challenged mice. Collectively, these results indicated that LA+VC treatment significantly protected the intestine and liver from ethanol damage by enhancing intestinal barrier function and reducing systemic inflammation. The present study paved the way for further exploration of synbiotics based on Lactobacillus species and VC.

Natural Recovery by the Liver and Other Organs after Chronic Alcohol Use

Chronic, heavy alcohol consumption disrupts normal organ function and causes structural damage in virtually every tissue of the body. Current diagnostic terminology states that a person who drinks alcohol excessively has alcohol use disorder. The liver is especially susceptible to alcohol-induced damage. This review summarizes and describes the effects of chronic alcohol use not only on the liver, but also on other selected organs and systems affected by continual heavy drinking—including the gastrointestinal tract, pancreas, heart, and bone. Most significantly, the recovery process after cessation of alcohol consumption (abstinence) is explored. Depending on the organ and whether there is relapse, functional recovery is possible. Even after years of heavy alcohol use, the liver has a remarkable regenerative capacity and, following alcohol removal, can recover a significant portion of its original mass and function. Other organs show recovery after abstinence as well. Data on studies of both heavy alcohol use among humans and animal models of chronic ethanol feeding are discussed. This review describes how (or whether) each organ/tissue metabolizes ethanol, as metabolism influences the organ’s degree of injury. Damage sustained by the organ/tissue is reviewed, and evidence for recovery during abstinence is presented.

Clinical application of thioredoxin reductase as a novel biomarker in liver cancer

Hepatic cancer is often amenable to surgery, including percutaneous ablation, trans-arterial chemoembolization. However, in metastatic cases, surgery is often not an effective option. Chemotherapy as a conventional clinical method for treatment of malignant diseases may be useful in such cases, but it is likewise not always able to slow or halt progression, therefore novel approaches for treatment of hepatic cancer are needed. Current research suggests that molecular tumor markers (TM) can play a crucial role for diagnosis and prognostic evaluation of malignancies, and TM such as AFP, CEA, CA19-9 have been reported in many malignant diseases. Thioredoxin reductase (TrxR), a type of anti-oxidant biomarker, has become a TM of significant interest. However, little is known about the above TM and TrxR activity in liver cancer. Therefore, this paper aimed to assess these TM with regards to diagnosis and and monitoring treatment efficacy in both primary and metastatic liver cancer. Our results showed TrxR had superior performance for discriminating between liver cancer patients and healthy controls than AFP, CEA, and CA19-9. TrxR also exhibited superior performance for assessing benefits of chemotherapy regardless if patients had PLC or MLC. Meanwhile, due to diagnostic efficiency of unresponsive chemotherapy patients, TrxR also showed a higher activity levels than other general markers in liver metastasis patients. Our results suggest that application of TrxR in combination with other tumor markers may maximize the efficiency of diagnosis and assessment of therapeutic efficiency, and provide new insights for the clinical application of TrxR as a candidate biomarker for liver cancer.

From Nonalcoholic Fatty Liver Disease (NAFLD) to Metabolic Dysfunction-Associated Fatty Liver Disease (MAFLD)-New Terminology in Pediatric Patients as a Step in Good Scientific Direction?

Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in the world, which predispose to more serious hepatic conditions. It ranges from simple liver steatosis to nonalcoholic steatohepatitis (NASH), which may progress to cirrhosis, and even end-stage liver disease. Since obesity became one of the most important health concerns wordwide, a considerable increase in the prevalance of NAFLD and other metabolic implications has been observed, both in adults and children. Due to the coexistence of visceral obesity, insulin resistance, dyslipidemia, NAFLD is considered to be the hepatic manifestation of metabolic syndrome (MetS). These relationships between NAFLD and MetS led to the set up in adults of a new term combining both of these conditions, called metabolic dysfunction-associated fatty liver disease (MAFLD). Based on these findings, we propose a set of criteria, which may be useful to diagnose MAFLD in children and adolescents.

BNP worsens 12 days after alcohol cessation while other cardiovascular risk biomarkers improve: An observational study

Subjects with alcohol use disorder (AUD) display a high prevalence of cardiovascular risk factors (CRFs), and a high incidence of cardiovascular diseases associated with an earlier mortality. Abstinence has long-term cardiovascular and global health benefits. However, few studies have examined the short-term effect of alcohol cessation on cardiac function and key CRFs. The aim of the study was to assess brain natriuretic peptide (BNP) and other CRFs on admission for alcohol cessation and 12 days later, in inpatients with AUD. A retrospective chart review of inpatients hospitalized for alcohol cessation was conducted. Patients who did not relapse at day 12 were included. We compared, at entry and at day 12, BNP and other CRFs: hemodynamic and electromyographic variables, lipid, homocysteine level, and liver enzymes at entry and at day 12. Wilcoxon, Student tests, and repeated-measures ANOVA were conducted. Fifty-five patients were included (38 males, mean age 50.5 years, alcohol per day 60 g-750 g, 44 current tobacco smokers). BNP was significantly increased (11.8 pg/mL [±16.2] to 35.5 pg/mL [±47.6], p < 0.001). Repeated-measure ANOVA showed a significant between-subject effect (p = 0.024), but no significant interaction between BNP variation and having a BNP at entry >10 pg/mL (p = 0.092). In contrast, a significant improvement on 8 of 13 other CRFs and liver enzymes measures was observed (p ≤ 0.05). A rapid improvement of several CRFs was confirmed. However, the increase of BNP at day 12 supports its investigation as a possible relevant biomarker of cardiac function in alcohol withdrawal.

Short- and Longer-Term Benefits of Temporary Alcohol Abstinence During ‘Dry January’ Are Not Also Observed Among Adult Drinkers in the General Population: Prospective Cohort Study

Aims

The alcohol abstinence challenge ‘Dry January’ continues to grow, but there is a lack of knowledge of how Dry January participants compare to the general population. There is also a need to determine whether benefits experienced by Dry January participants are unique to that group or are also observed among other people.

Methods

We conducted a prospective cohort study using online questionnaires in early January, February and August 2019. We compared 1192 Dry January participants and 1549 adult drinkers who did not attempt to abstain from alcohol. Key outcomes were self-rated physical health, psychological well-being (Warwick–Edinburgh Mental Well-Being Scale), control over drinking (Drink Refusal Self-Efficacy Scale (DRSE)) and alcohol intake (Alcohol Use Disorders Identification Test–Consumption (AUDIT-C) subscale). Baseline differences in demographic and alcohol consumption variables were included as covariates in between-group analyses.

Results

Dry January participants had higher SES, poorer well-being, higher AUDIT-C scores and less control over their drinking than the general population. Beneficial changes in health, WEMWBS, DRSE and AUDIT-C observed among people completing Dry January were not observed among other adult drinkers.

Conclusions

Dry January appears to attract people who are heavier drinkers than the general population and who are more concerned about their alcohol intake. Completion of Dry January is associated with short- and longer-term benefits to well-being that are not observed in the general population.

Risk Factors of Cardiovascular Disease according to Alcohol Behavioral Change after Cancer Diagnosis

Background

Problem drinking increases the incidence of all-cause mortality and specific cancers, and persistent drinking is associated with cardiovascular disease in certain cancer survivors. This study analyzed the cardiovascular risk factors before and after diagnosis in Korean cancer survivors.

Methods

Data for the period between 2002 and 2013 were collected from the National Health Insurance Service Health-Examinee Cohort Database. Among the 27,835 patients included, those with moderate alcohol consumption before and after cancer diagnosis were excluded. Problem drinking was defined as males under 65 years consuming over 14 glasses a week, and males over 65 years or females consuming over seven glasses a week. A t-test, chi-square test, and linear regression analysis were performed for differences in cardiovascular risk factors and differences according to cancer types.

Results

There was a difference in the body mass index, systolic and diastolic blood pressure, and total cholesterol among patients who became moderate drinkers after diagnosis, but fasting blood glucose did not show any significant changes. Risk factors for cardiovascular disease were analyzed in patients with liver, stomach, rectal, and breast cancer with improved drinking behavior, and there were significant differences in body mass index, systolic and diastolic blood pressure, fasting blood glucose, and total cholesterol in stomach cancer patients.

Conclusion

Moderate drinking can lower cardiovascular risk in cancer survivors, and among the many drinking-related cancers, stomach cancer patients demonstrated significantly reduced cardiovascular risk factors.

Chronic Stress and Cardiovascular Disease among Individuals Exposed to Lead: A Pilot Study

Chronic stress and cardiovascular disease risk were explored in a predominately middle-aged adult population exposed to elevated lead levels in this cross-sectional study using data from the National Health and Nutrition Examination Survey (NHANES) from the period 2007-2010. Elevated lead exposure was defined using the epidemiological threshold of a blood lead level (BLL) > 5 μg/dL as defined by the U.S. Centers for Disease Control and Prevention (CDC). Allostatic load (AL), a measure of chronic stress, was operationalized using 10 clinical markers. The geometric mean values for clinical cardiovascular disease risk markers of interest (a) Gamma glutamyl-transferase (GGT) (a marker of oxidative stress), and (b) non-HDL cholesterol (non-HDL-c) (a marker of cardiovascular disease risk) were explored among lead-exposed and less lead-exposed individuals with differential chronic stress (AL) levels. Associations between AL and GGT/non-HDL-C were analyzed using linear regression models. The likelihood of increased clinical markers in lead-exposed individuals with high compared to low AL was explored using binary logistic regression models. In analyzing lead-exposed as compared to less lead-exposed populations, the geometric mean of the variables of interest showed significant elevations among lead-exposed individuals as compared to less lead-exposed individuals. Simple linear regression revealed that AL was positively associated with the variables of interest among the lead-exposed. In binary logistic regression among the lead-exposed, those with high AL, as compared to those with low AL, had significantly higher odds of having elevated non-HDL-C. This study submits that those exposed to lead with increasing AL may experience adverse cardiovascular health outcomes.

Benefits of temporary alcohol restriction: a feasibility randomized trial

BACKGROUND

Participation in temporary alcohol abstinence campaigns such as 'Dry January' may prompt enduring reductions in alcohol consumption. A randomized controlled trial (RCT) is required to establish any long-term benefits or negative consequences of temporary abstinence. In the present study, we randomized heavy drinkers to complete or intermittent alcohol abstinence for 4 weeks, in order to evaluate the feasibility of conducting a large-scale RCT.

METHODS

This was a mixed methods feasibility study in which we explored recruitment and retention to a randomized trial, compliance with alcohol abstinence instructions and barriers to compliance, and acceptability of study procedures (primary feasibility outcomes). A community sample of women aged between 40 and 60 who drank in excess of 28 alcohol units per week were randomized to abstain from alcohol for 4 weeks either completely or intermittently (at least four abstinent days per week). To monitor compliance, both groups provided regular breath samples on a cellular breathalyser. A subsample completed a semi-structured interview that probed barriers to compliance with abstinence instructions and acceptability of study procedures.

RESULTS

Within 5 months, we recruited, screened and randomized 25 participants (20% of participants who responded to advertisements: 14 in the complete abstinence group, 11 in the intermittent abstinence group), 24 of whom were retained throughout the 28-day intervention period. Participants in both groups tended to comply with the instructions: the median number of breathalyser-verified abstinent days was 24 (IQR = 15.5-25.0; 86% of target) in the complete abstinence group versus 12 (IQR = 10-15; 75% of target) in the intermittent abstinence group. Semi-structured interviews identified some barriers to compliance and methodological issues that should be considered in future research. No adverse events were reported.

CONCLUSIONS

It is feasible to recruit heavy drinking women from community settings and randomize them to either complete or intermittent abstinence from alcohol for 4 weeks. The majority of participants were retained in the study and compliance with the abstinence instructions was good, albeit imperfect. A comprehensive RCT to compare temporary alcohol abstinence with other alcohol reduction strategies on long-term alcohol consumption is feasible. Findings from such a trial would inform implementation of alcohol campaigns and interventions.

Lead Exposure and Cardiovascular Disease among Young and Middle-Aged Adults

Lead and its effects on cardiovascular-related markers were explored in this cross-sectional study of young adults (18–44 years) and middle-aged adults (45–65 years) from the United States using the National Health and Nutrition Examination Survey (NHANES), 2009–2016. Degrees of exposure were created using blood lead level (BLL) as the biomarker of exposure based on the epidemiologically relevant threshold of BLL > 5 μg/dL. The mean values, in addition to the percentages of people represented for the markers of interest (systolic blood pressure [SBP], diastolic blood pressure [DBP], gamma-glutamyl transferase [GGT], non-high-density lipoprotein cholesterol [non-HDL-C]) were explored. Among those exposed to lead, the likelihood of elevated clinical markers (as defined by clinically relevant thresholds of above normal) were examined using binary logistic regression. In exploring exposure at the 5 μg/dL levels, there were significant differences in all the mean variables of interest between young and middle-aged adults. The binary logistic regression showed young and middle-aged adults exposed to lead were significantly more likely to have elevated markers (apart from DBP). In all, lead affects cardiovascular-related markers in young and middle-aged U.S. adults and thus we must continue to monitor lead exposure to promote health.

Changes in behaviors after diagnosis of type 2 diabetes and 10-year incidence of cardiovascular disease and mortality

Background

Large changes in health behaviors achieved through intensive lifestyle intervention programs improve cardiovascular disease (CVD) risk factors among adults with type 2 diabetes. However, such interventions are not widely available, and there is limited evidence as to whether changes in behaviors affect risk of CVD events.

Methods

Among 852 adults with screen-detected type 2 diabetes in the ADDITION-Cambridge study, we assessed changes in diet, physical activity, and alcohol use in the year following diabetes diagnosis. Participants were recruited from 49 general practices in Eastern England from 2002 to 2006, and were followed through 2014 for incidence of CVD events (n = 116) and all-cause mortality (n = 127). We used Cox proportional hazards regression to estimate hazard ratios (HR) for the associations of changes in behaviors with CVD and all-cause mortality. We estimated associations with CVD risk factors using linear regression. We considered changes in individual behaviors and overall number of healthy changes. Models adjusted for demographic factors, bodyweight, smoking, baseline value of the health behavior, and cardio-protective medication use.

Results

Decreasing alcohol intake by ≥ 2 units/week was associated with lower hazard of CVD vs maintenance [HR: 0.56, 95% CI 0.36, 0.87]. Decreasing daily calorie intake by ≥ 300 kcal was associated with lower hazard of all-cause mortality vs maintenance [HR: 0.56, 95% CI 0.34, 0.92]. Achieving ≥ 2 healthy behavior changes was associated with lower hazard of CVD vs no healthy changes [HR: 0.39, 95% CI 0.18, 0.82].

Conclusions

In the year following diabetes diagnosis, small reductions in alcohol use were associated with lower hazard of CVD and small reductions in calorie intake were associated with lower hazard of all-cause mortality in a population-based sample. Where insufficient resources exist for specialist-led interventions, achievement of moderate behavior change targets is possible outside of treatment programs and may reduce long-term risk of CVD complications.

Trial registration This trial is registered as ISRCTN86769081. Retrospectively registered 15 December 2006

Electronic supplementary material

The online version of this article (10.1186/s12933-019-0902-5) contains supplementary material, which is available to authorized users.