Moderate alcohol consumption, types of beverages and drinking pattern with cardiometabolic biomarkers in three cohorts of US men and women

Underlying mechanisms of the inverse relationship between moderate alcohol consumption and cardiometabolic disorders are unclear. Modification by types of alcoholic beverages consumed and drinking pattern remains understudied. We aimed to provide insight into the mechanisms by examining 14 insulinemic/glycemic, inflammatory and lipid markers. We used cross-sectional data from 15,436 women in the Nurses' Health Study, 19,318 women in the Nurses' Health Study II, and 6872 men in the Health Professionals Follow-up Study. Multivariable linear regression was used to estimate the percentage differences in biomarker concentrations according to alcohol intakes. The average alcohol intake in the combined cohort was 3.3 servings/week. We found a 1 serving/d increment in alcohol intake (14 g ethanol, 44 ml liquor or 355 ml beer or 118 ml wine per day) was associated with a 0.6% lower level of HbA1c, 1.7-3.6% lower proinflammatory markers and 4.2% higher adiponectin, as well as 7.1% higher HDL-cholesterol and 2.1% lower triglyceride with a significant linear trend. Wine, especially red wine, was associated with lower inflammation in particular. Beer had weaker favorable to null associations with blood lipids and adiponectin. Liquor was associated with higher C-peptide and interleukin-6, yet equally associated with lower HbA1c and higher HDL-cholesterol as other beverages. Drinking 3 days or more per week was related to a better biomarker profile than nonregular drinking independent of intake levels. Drinking appeared to have similar associations irrespective whether done with meals or not. Our data indicated moderate alcohol intake, especially if consumed from wine and done regularly, was associated with favorable profiles of insulinemic/glycemic and inflammatory markers and blood lipids.

Heavy drinkers and the contexts of drinking among adults in Norway

BACKGROUND

There is little knowledge about characteristics of the heaviest drinkers. This study aimed at exploring 1) socio-demographic characteristics and 2) drinking patterns and drinking contexts of heavy drinkers and other drinkers in Norway, applying various criteria for heavy drinking.

METHODS

Data from cross-sectional population surveys among adults in Norway (aged 16 +) in 2015 through 2018 (current drinkers, n = 6 940) were analysed. Two measures were applied to categorize heavy drinkers: 1) AUDIT score (10 +), and 2) annual consumption volume (445 + units) (both above 90th percentile). Social contexts of drinking included location (private homes, licensed premises); social company (partner/family, work mates, friends, no one); and weekend versus weekdays.

RESULTS

Heavy drinkers accounted for 10% of the sample and up to half of the total consumption. Heavy drinkers differed significantly from other drinkers with regard to age, education level and criterion; by AUDIT score, the prevalence of heavy drinkers decreased with increasing age and education level, whereas the opposite was the case for by volume. Compared to other drinkers, heavy drinkers drank relatively more often on weekdays and relatively more often alone, and more frequently at licenced premises.

CONCLUSIONS

In Norway, the distribution of alcohol consumption is heavily skewed, and the heaviest drinkers differ from the rest of the population in several aspects. This group of drinkers represent an important target for public policy, and there is a need for further knowledge of this group enabling more targeted interventions in addition to policies aimed at reducing the per-capita consumption.

[Binge drinking: the challenges of definition and its impact on health.]

Heavy episodic drinking, or binge drinking, is a drinking pattern characterized by the intake of large amounts of alcohol in a short period of time, which often leads to alcohol intoxication. There is no consensus on its operational definition, finding large methodological differences between studies in estimating the amount of alcohol consumed, as well as in defining the occasion of drinking and the reference time period. Keep in mind that most drinkers with this pattern have a low risk total average alcohol consumption. Therefore, actively detecting binge drinking is essential to be able to identify and classify all risk drinkers and characterize the global impact of alcohol consumption on health, society or the economy. Its negative effects affect the drinker himself (intoxication, cardiovascular diseases, dependence, neurocognitive and developmental disorders, among others), but also causes harm to others (accidents, violence, harmful effects on fetal and perinatal neuronal development). These effects can be acute or chronic, even among those who adopt binge drinking sporadically. Different thresholds or ways of characterizing this pattern of alcohol consumption could more adequately predict each of the associated acute and chronic effects, especially if we consider the intensity and frequency of the episodes. However, the absence of a safe threshold for alcohol consumption, both regularly and occasionally, is clear; Any intake with a binge drinking pattern, regardless of the threshold we establish, carries significant risks, not only for the health of the drinker, but also for the people around them.

Letting wine polyphenols functional: Estimation of wine polyphenols bioaccessibility under different drinking amount and drinking patterns

Effects of drinking amount and patterns of wine on the digestive characteristics and bioaccessibility of wine polyphenols under in vitro gastrointestinal digestion were investigated. Wine polyphenols released well during mouth and stomach digestion, and the release rates in the "serum-available" fraction, "colon-available" fraction, and after the colon were much lower. Red wine showed a higher biological activity than white wine, but white wine had a better bioaccessibility than red wine, especially under binge drinking. The bioaccessibility of most polyphenols decreased as the drinking amount increased, indicating that drinking larger volumes of wine did not increase the bioaccessibility of polyphenols. Additionally, the relevant biological activities did not increase as the drinking amount increased. Drinking after a meal showed significantly better results than drinking before a meal in most of the tests. Hence, in order to let wine polyphenols play its functional for human health, there still need a moderate consumption amount of wine and drinking after meal is better.

Liver enzymes in alcohol consumers with or without binge drinking

BACKGROUND

While alcohol use is linked with a wide variety of health problems, the question of whether differences in drinking patterns could yield different outcomes has remained unclear.

PATIENTS AND METHODS

We measured liver enzymes (ALT, GGT) from alcohol consumers with or without binge drinking from a population-based sample in Finland, where binge-type drinking is common. Data on alcohol use, diet, body weight, lifestyle (smoking, coffee consumption, physical activity), and health status were collected from 19225 subjects (9492 men, 9733 women), aged 25-74 years. The participants were subsequently classified to subgroups, both according to the frequencies of binge drinking and the amounts of regular alcohol intake (low-, medium-, and high-risk drinking).

RESULTS

The quantity of regular alcohol use was roughly linearly related with GGT and ALT activities. ANOVA analyses of the trends according to the frequency of binge drinking showed a significant GGT increase in both men (p < 0.0005) and women (p < 0.0005), and a significant increase of ALT in men (p < 0.0005). In those with low-risk overall consumption, markedly higher GGT (p < 0.0005) and ALT (p < 0.0005) occurred in those with binge drinking more than once a month, compared with those with no such occasions. Binge drinking occurring ≤1/month also resulted in higher GGT (p < 0.0005) and ALT (p < 0.05) activities.

CONCLUSIONS

These results emphasize possible adverse consequences of binge drinking on hepatic function even in those with low-risk overall consumption. The pattern of drinking should be more systematically implicated in clinical recommendations for drinking reduction.

[Research advances in risk factors for alcoholic liver disease]

Only a small number of people may develop severe alcoholic liver disease after continuous or excessive drinking, which is different from the harm caused by smoking, and some people may even develop alcoholic liver disease associated with inflammation, liver cirrhosis, or primary liver cancer. There are complex risk factors for liver injury in these people; besides ethnic and genetic factors, drinking volume, and drinking duration, more important factors are involved in the pathophysiological changes of the liver, such as the type and quality of alcohol, drinking pattern, socioeconomic status, and government public policy, which may be the determining factors for the development of alcoholic liver disease. On the basis of literature review, this article proposes the concept that "liquor does not equal to alcohol" , which has important guiding significance for healthy drinking and the prevention of alcoholic liver disease.

The amounts and contributions of total drinking fluids and water from food to total water intake of young adults in Baoding, China

PURPOSE

To investigate the amounts and contributions of total drinking fluids and water from food to total water intake (TWI), to explore the drinking pattern, and to compare the amount of TWI with the recommendations of China and EFSA among young adults.

METHODS

A cross-sectional study was implemented with 159 young adults aged 18-23 years from Hebei, China. Total drinking fluids and water from food were assessed by 7-day 24-h fluid intake questionnaire and the duplicate portion method, respectively. Differences between groups stratified according to the distribution of TWI were compared using one-way ANOVA and Kruskal-Wallis H test. General linear models were used to identify the variations in TWI due to total drinking fluids and water from food.

RESULTS

In total, 156 subjects (80 males and 76 females) completed the study. Approximately 80.1% of them did not meet the TWI recommended by China, while 50.0% did not meet that recommended by the EFSA. Participants with higher TWI had greater amounts of total drinking fluids, water rom food and water than their counterparts with lower TWI. The regression between total drinking fluids and TWI was R² = 0.8526 (P < 0.05) and that between water from food and TWI was R² = 0.4650 (P < 0.05).

CONCLUSIONS

A large proportion of young adults have insufficient TWI. Participants with lower TWI would not compensate with water from food. The variances in TWI among participants were mainly due to differences in total drinking fluids. There is an urgent need to improve the fluids intake behaviors of young adults.

Frequency and intensity of alcohol consumption: new evidence from Sweden

There is an increasing body of evidence that the intensity in which alcohol is drunk is of greater concern than the frequency or overall quantity consumed. This paper provides an extensive analysis of the demand for alcohol as measured by total quantity, frequency, and intensity. A unique large sample of cross-sectional data from Sweden 2004-2011 allows reduced-form alcohol demand equations to be estimated for beer, wine, and spirits, split by alcohol drinking pattern (average vs. binge drinkers) and gender. Results find a negative beer excise rate effect for participation and frequency, and positive effect for intensity. The effect was stronger for binge drinkers. Generally, the results also show a positive socioeconomic (income and education) gradient in frequency demand and a negative gradient in the intensity demand. Female wine drinkers show a positive socioeconomic gradient in both frequency and intensity. The findings highlight the complexity of this policy space. Tax increases appear to reduce frequency but raise intensity consumed. The more educated and higher earners drink more in total, but less intensely when they do and this is likely to explain in part why poor health is concentrated amongst lower socioeconomic status individuals.

Chronic plus binge ethanol exposure causes more severe pancreatic injury and inflammation

Alcohol abuse increases the risk for pancreatitis. The pattern of alcohol drinking may impact its effect. We tested a hypothesis that chronic ethanol consumption in combination with binge exposure imposes more severe damage to the pancreas. C57BL/6 mice were divided into four groups: control, chronic ethanol exposure, binge ethanol exposure and chronic plus binge ethanol exposure. For the control group, mice were fed with a liquid diet for two weeks. For the chronic ethanol exposure group, mice were fed with a liquid diet containing 5% ethanol for two weeks. In the binge ethanol exposure group, mice were treated with ethanol by gavage (5g/kg, 25% ethanol w/v) daily for 3days. For the chronic plus binge exposure group, mice were fed with a liquid diet containing 5% ethanol for two weeks and exposed to ethanol by gavage during the last 3days. Chronic and binge exposure alone caused minimal pancreatic injury. However, chronic plus binge ethanol exposure induced significant apoptotic cell death. Chronic plus binge ethanol exposure altered the levels of alpha-amylase, glucose and insulin. Chronic plus binge ethanol exposure caused pancreatic inflammation which was shown by the macrophages infiltration and the increase of cytokines and chemokines. Chronic plus binge ethanol exposure increased the expression of ADH1 and CYP2E1. It also induced endoplasmic reticulum stress which was demonstrated by the unfolded protein response. In addition, chronic plus binge ethanol exposure increased protein oxidation and lipid peroxidation, indicating oxidative stress. Therefore, chronic plus binge ethanol exposure is more detrimental to the pancreas.

Binge drinking and subsequent depressive symptoms in young women in Australia

BACKGROUND

The long-term impact of binge drinking on subsequent depressive symptoms is unclear. The aims were to identify longitudinal patterns of binge drinking and whether binge drinking preceded depressive symptoms in the short-term (1-6 years) and long-term (10-15 years).

METHODS

Longitudinal data from 1996, 2000 and 2009 mailed surveys of 8,197 women in the 1973-78 cohort of the Australian Longitudinal Study on Women's Health. Latent class analysis was used to identify binge drinking patterns and logistic regression to estimate associations with subsequent depressive symptoms.

RESULTS

Five binge drinking trajectories were identified with predicted proportions of women who were very infrequent (24%), fluctuating infrequent (17%), frequent (17%), very frequent (26%) or extremely frequent binge drinkers (16%) between 16 and 21 years. At 22-27 years, depressive symptoms were significantly higher for extremely frequent binge drinkers (31% versus 21% in the short-term; 22% versus 16%-18% in the long-term) than for less frequent bingers. Unadjusted odds of depressive symptoms were 1.70 (95%CI:1.38;2.08) times for extremely frequent binge drinkers than very infrequent bingers and were 1.30 (95%CI:1.04;1.63) after adjusting for demographics, relationships and experience of violence. At 31-36 years, the odds of depressive symptoms were 1.34 (95%CI:1.09-1.64) times for extremely frequent than very infrequent binge drinkers, but were not significant after adjusting for relationships and violence.

CONCLUSIONS

Extremely frequent binge drinking (more than weekly) in late adolescence appears to elevate the risk of subsequent depressive symptoms in young women in their early twenties and thirties, emphasising the need for preventive strategies to curb binge drinking.

Drinking patterns of alcohol intoxicated adolescents in the emergency department: A latent class analysis

INTRODUCTION

The increasing number of children and adolescents in need of emergency medical treatment following acute alcohol intoxication has been a major public health concern in Europe in recent years. However, little is known about drinking habits and associated risks in this population. To our knowledge, this is the first study to examine drinking patterns and associated risks in adolescent emergency department patients following alcohol intoxication. The aim of this study is to establish a classification system for admitted adolescents

METHODS

Latent class analysis was used to identify subgroups of adolescents with distinct patterns of habitual drinking as defined by the quantity of consumed alcohol on a typical drinking occasion, frequency of binge drinking and drunkenness, alcohol-related problems, prior alcohol-related hospitalizations and alcohol-related risk behaviors. Subgroup characteristics were examined with regard to sociodemographics, other substance use and psychosocial problems using analysis of variance (ANOVA) and chi-square tests.

RESULTS

A total of 316 adolescents aged 12-17 treated in 6 urban emergency departments in Germany were analyzed. Five classes of drinking patterns were identified: one class representing low-risk drinking (class 1 "low-risk" (61.2%)), two classes representing risky drinking (class 2 "moderate-risk" (5.7%) and class 3 "frequent drunk" (15.8%)), as well as two classes representing high-risk drinking (class 4 "alcohol-related problems" (11.4%) and class 5 "excessive drinking" (5.1%)). Membership of classes 4 and 5 was associated with the most severe psychosocial problems, especially with regard to aggressive-dissocial behaviors. The CRAFFT-d and brief RAPI screening tools allowed identifying the two risky drinking classes and two high-risk drinking classes.

CONCLUSIONS

Our findings provide the first in-depth analysis of habitual drinking in this study population and may help practitioners to better tailor interventions to patients' needs by using the identified classes as a form of classification system for admitted adolescents.

Drinking pattern during midlife and risk of developing depression during 28 years of follow-up: A prospective cohort study

BACKGROUND

The long-term impact of alcohol intake in midlife on developing depression is not clear. We aimed to investigate drinking pattern during midlife as a risk factor for developing depression during 28 years of follow-up.

METHODS

We used data from a well characterised prospective cohort study (the Whitehall II study) of 7478 men and women (70% male) aged 35 to 55 years, and free from depression in 1985-1988, followed up regularly until 2013. Drinking pattern was defined in terms of usual and maximum amounts consumed within a single drinking session, total weekly volume of alcohol consumed and drinking frequency. Depression was assessed using the General Health Questionnaire Depression Subscale at multiple follow-up occasions (up to eight times in total). Associations between different drinking pattern components during midlife and depression were estimated using flexible parametric survival models.

RESULTS

After adjustment for confounding factors only abstaining from alcohol during midlife was associated with an increased risk of developing depression during long-term observation. However, this association became non-significant after adjusting for baseline self-reported health.

CONCLUSIONS

In this community dwelling population, drinking pattern during midlife was not associated with an increased risk of developing depression.

Microstructural analysis of rat ethanol and water drinking patterns using a modified operant self-administration model

BACKGROUND

Ethanol drinking pattern has emerged as an important factor in the development, maintenance, and health consequences of alcohol use disorders in humans. The goal of these studies was to further our understanding of this important factor through refinement of an operant rodent model of ethanol consumption capable of drinking pattern microstructural analysis. We evaluated measures of total consumption, appetitive behavior, and drinking microstructure for ethanol and water at baseline and assessed alterations induced by two treatments previously shown to significantly alter gross ethanol appetitive and consummatory behaviors in opposing directions.

METHODS

Male Long-Evans rats were trained on an FR1 operant paradigm which allowed for continuous liquid access until an 8 second pause in consumption resulted in termination of liquid access. Total appetitive and consummatory behaviors were assessed in addition to microstructural drinking pattern for both ethanol and water during a five day baseline drinking period, after chronic intermittent ethanol vapor exposure, and following administration of a cannabinoid receptor antagonist SR141716a.

RESULTS

As in previous operant studies, ethanol vapor exposure resulted in increases in ethanol-directed responding, total consumption, and rate of intake. Further, striking differential alterations to ethanol and water bout size, duration, and lick pattern occurred consistent with alterations in hedonic evaluation. Vapor additionally specifically reduced the number of ethanol-directed lever presses which did not result in subsequent consumption. SR141716a administration reversed many of these effects.

CONCLUSIONS

The addition of microstructural analysis to operant self-administration by rodents provides a powerful and translational tool for the detection of specific alterations in ethanol drinking pattern which may enable insights into neural mechanisms underlying specific components of drug consumption.

Alcohol drinking pattern and risk of alcoholic liver cirrhosis: a prospective cohort study

BACKGROUND & AIMS

Alcohol is the main contributing factor of alcoholic cirrhosis, but less is known about the significance of drinking pattern.

METHODS

We investigated the risk of alcoholic cirrhosis among 55,917 participants (aged 50-64 years) in the Danish Cancer, Diet, and Health study (1993-2011). Baseline information on alcohol intake, drinking pattern, and confounders was obtained from a questionnaire. Follow-up information came from national registers. We calculated hazard ratios (HRs) for alcoholic cirrhosis in relation to drinking frequency, lifetime alcohol amount, and beverage type.

RESULTS

We observed 257 and 85 incident cases of alcoholic cirrhosis among men and women, respectively, none among lifetime abstainers. In men, HR for alcoholic cirrhosis among daily drinkers was 3.65 (95% CI: 2.39; 5.55) compared to drinking 2-4 days/week. Alcohol amount in recent age periods (40-49 and 50-59 years) was associated with an increased risk, whereas the amount in 20-29 and 30-39 years was not. In men drinking 14-28 drinks/week, HR was 7.47 (95% CI: 1.68; 33.12), 3.12 (95% CI: 1.53; 6.39), and 1.69 (95% CI: 0.79; 3.65) in drinkers of little (<1% of weekly amount), some (1-15%), and mostly wine (50-100%), compared to drinking <14 drinks/week. In general, results were similar for women.

CONCLUSIONS

In men, daily drinking was associated with an increased risk of alcoholic cirrhosis. Recent alcohol consumption rather than earlier in life was associated with risk of alcoholic cirrhosis. Compared to beer and liquor, wine might be associated with a lower risk of alcoholic cirrhosis.

Roles of alcohol consumption in fatty liver: a longitudinal study

BACKGROUND & AIMS

Roles of alcohol consumption in non-alcoholic fatty liver disease are still controversial, although several cross-sectional studies have suggested the beneficial effect of light to moderate drinking on fatty liver. We analyzed the longitudinal relationship between drinking pattern and fatty liver.

METHODS

We included 5297 Japanese individuals (3773 men and 1524 women) who underwent a baseline study in 2003 and follow-up at least once from 2004 to 2006. Generalized estimating equation was used to estimate any association between drinking pattern and fatty liver assessed by ultrasonography.

RESULTS

At baseline, 1179 men (31.2%) and 235 women (15.4%) had fatty liver; 2802 men (74.2%) and 436 women (28.6%) reported alcohol consumption. At the latest follow-up, 348 of 2594 men (13.4%) and 101 of 1289 women (7.8%) had newly developed fatty liver; 285 of 1179 men (24.2%) and 70 of 235 women (29.8%) demonstrated a remission of fatty liver. In men, drinking 0.1-69.9 g/week (odds ratio, 0.79 [95% confidence interval, 0.68-0.90]), drinking 70.0-139.9 g/week (0.73 [0.63-0.84]), drinking 140.0-279.9 g/week (0.69 [0.60-0.79]), and drinking ⩾280.0 g/week (0.68 [0.58-0.79]) were inversely associated with fatty liver after adjusting for obesity, exercise, and smoking. In women, drinking 0.1-69.9 g/week (0.71 [0.52-0.96]) and drinking 70.0-139.9 g/week (0.67 [0.45-0.98]) were inversely associated with fatty liver after the adjustment.

CONCLUSIONS

Light to moderate alcohol consumption, or even somewhat excessive amounts especially in men, was likely to protect most individuals against fatty liver over time.

Wistar and Sprague Dawley rats

Alcohol-preferring (P) rats develop high ethanol intake over several weeks of water/10% ethanol (10E) choice drinking. However, it is not yet clear precisely what components of drinking behavior undergo modification to achieve higher intake. Our concurrent report compared precisely measured daily intake in P vs. non-selected Wistar and Sprague Dawley (SD) rats. Here we analyze their drinking patterns and bouts to clarify microbehavioral components that are common to rats of different genetic backgrounds, vs. features that are unique to each. Under sole-fluid conditions P, Wistar and SD rats all consumed water at a high initial rate followed by a slow maintenance phase, but 10E - in a distinctly different step-like pattern of evenly distributed bouts. During choice period, 10E vs. water patterns for P rat appeared as an overlap of sole-fluid patterns. The SD rat choice patterns resembled sole-fluid patterns but were less regular. Choice patterns in Wistar differed from both P and SD rats, by consisting of intermixed small frequent episodes of drinking both 10E and water. Wistar and SD rats increased choice ethanol intake by elevating the number of bouts. A key finding was that P rat increased choice ethanol intake through a gradual increase of the bout size and duration, but kept bout number constant. This supports the hypothesis that genetic selection modifies microbehavioral machinery controlling drinking bout initiation, duration, and other pattern features. Precision analysis of drinking patterns and bouts allows differentiation between genetic lines, and provides a venue for study of localized circuit and transmitter influences mediating mesolimbic control over ethanol consumption.