MEAS Research

MEAS Research http://www.meas.ie/news-and-research/critiques/ The lastest research papers and critiques from MEAS Critique 082: A statistical model attempting to estimate the level of alcohol consumption that is “optimal” for health http://www.meas.ie/news-and-research/critiques/2012/critique-082-a-statistical-model-attempting-to-estimate-the-level-of-alcohol-consumption-that-is-optimal-for-health/ Wed, 06 Jun 2012 00:00:00 +0100 <h3 style="text-align: center;">_____________________________________________________________________________________________</h3>
<h5 style="text-align: center;">Boston University School of Medicine Institute on Lifestyle & Health</h5>
<h3 style="text-align: center;">_____________________________________________________________________________________________</h3>
 
For full critique, click <a href="http://www.bu.edu/alcohol-forum/critique-082-a-statistical-model-attempting-to-estimate-the-level-of-alcohol-consumption-that-is-%E2%80%9Coptimal%E2%80%9D-for-health-6-june-2012/">here</a>.
6th June 2012
<h6>Contacts for Editors</h6>
Professor R Curtis Ellison: <a href="mailto:ellison@bu.edu">ellison@bu.edu</a>
Helena Conibear: <a href="https://xmail.bumc.bu.edu/owa/redir.aspx?C=74f80da44cfb445591d3eb16b66bd25e&URL=mailto%3ahelena%40alcohol-forum4profs.org">helena@alcohol-forum4profs.org</a>
Tel: +44 1300 320869 or +44 7876 593 345
 
Scientists from Australia and Oxford University have carried out a complex analysis in an attempt to determine the “optimal” level of alcohol consumption that is associated with the lowest rates of chronic disease in the UK. They conclude that the intake of about one-half of a typical drink per day would result in the healthiest outcomes, and the authors conclude that the recommended alcohol intake for the UK should be reduced from the current advised level of drinking. 
 There were a number of concerns by Forum members about the paper. It is based on an extremely complex statistical model that requires many assumptions, most of which cannot be validated. The parameters chosen to use in such a model determine the results, and a number of instances were identified where the values used in this analysis do not reflect current scientific knowledge. Further, the conclusions of the authors are based exclusively on the lowest point of the “J-shaped” curve for alcohol and disease, and disregard the findings that the risk of death, in comparison with non-drinkers, remains lower for drinkers of alcohol of up to several drinks per day.
 There were other aspects of the paper that were of particular concern: (1) focusing only on the average amount of alcohol consumed, while the pattern of drinking (regular moderate versus binge drinking) has the greatest effect on health outcomes; (2) giving a single recommended level of alcohol intake irrespective of age; the greatest risks and lowest expected benefits of alcohol intake are among the young, whereas most of the putative health benefits relate to the diseases of ageing; (3) giving a single value for both men and women, since women are known to react (both adversely and beneficially) to lower levels of alcohol than do men; (4) the use of their estimated value alone for making recommendations for the population; guidelines should be based on a large number of social and behavioral factors, not just on the results of one scientific study.
 The level of alcohol that is most likely to be associated with the lowest risk of adverse health outcomes and the most likely health benefits varies markedly among individuals. Middle-aged men and post-menopausal women are most likely to demonstrate enhanced health (e.g., lower risk of cardiovascular diseases, diabetes, dementia) from moderate drinking. For all ages, binge drinking is associated with predominantly adverse outcomes. In general, women should drink less than men. While the analyses presented in this paper are of scientific interest, they alone do not support changes in the current population recommendations for alcohol consumption.
 Reference: Nichols M, Scarborough P, Allender S, Rayner M. What is the optimal level of population alcohol consumption for chronic disease prevention in England? Modelling the impact of changes in average consumption levels. BMJ Open 2012;2:e000957. doi:10.1136/bmjopen-2012-000957
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The following members of the International Scientific Forum on Alcohol Research have provided comments on this paper:
 Erik Skovenborg, MD, Scandinavian Medical Alcohol Board, Practitioner, Aarhus, Denmark
Yuqing Zhang, MD, DSc, Epidemiology, Boston University School of Medicine, Boston, MA, USA
Giovanni de Gaetano, MD, PhD, Research Laboratories, Catholic University, Campobasso, Italy
Andrew L. Waterhouse, PhD, Marvin Sands Professor, Department of Viticulture and Enology, University of California, Davis; Davis, CA, USA
Ulrich Keil, MD, PhD, Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
Harvey Finkel, MD, Hematology/Oncology, Boston University Medical Center, Boston, MA, USA
Fulvio Ursini, MD, Dept. of Biological Chemistry, University of Padova, Padova, Italy
Arne Svilaas, MD, PhD, general practice and lipidology, Oslo University Hospital, Oslo, Norway
Francesco Orlandi, MD, Dept. of Gastroenterology, Università degli Studi di Ancona. Italy
Gordon Troup, MSc, DSc, School of Physics, Monash University, Victoria, Australia
R. Curtis Ellison, MD, Section of Preventive Medicine & Epidemiology, Boston University School of Medicine, Boston, MA, USA
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For the detailed critique of this paper by the International Scientific Forum on Alcohol Research and a listing of references, go to <a href="http://www.bu.edu/alcohol-forum">www.bu.edu/alcohol-forum</a>, click on <a href="http://www.bu.edu/alcohol-forum/critique-082-a-statistical-model-attempting-to-estimate-the-level-of-alcohol-consumption-that-is-%e2%80%9coptimal%e2%80%9d-for-health-6-june-2012/">http://www.bu.edu/alcohol-forum/critique-082-a-statistical-model-attempting-to-estimate-the-level-of-alcohol-consumption-that-is-%e2%80%9coptimal%e2%80%9d-for-health-6-june-2012/</a>
The specialists who are members of the Forum are happy to respond to questions from Health Editors regarding emerging research on alcohol and health and will offer an independent opinion in context with other research on the subject.
Helena Conibear co Director The International Scientific Forum on Alcohol Research <a href="mailto:helena@alcoholforum4profs.org">helena@alcoholforum4profs.org</a>
Professor R Curtis Ellison co Director The International Scientific Forum on Alcohol Research <a href="mailto:ellison@bu.edu">ellison@bu.edu</a>
<a href="http://www.alcoholforum4profs.org">www.alcoholforum4profs.org</a> <a href="http://www.alcoholforum4profs.com/">www.bu.edu/alcohol-forum</a>
Tel UK: + 44 1300 320869 http://www.meas.ie/news-and-research/critiques/2012/critique-082-a-statistical-model-attempting-to-estimate-the-level-of-alcohol-consumption-that-is-optimal-for-health/ Critique 081: Alcohol intake in the elderly affects risk of cognitive decline and dementia http://www.meas.ie/news-and-research/critiques/2012/critique-081-alcohol-intake-in-the-elderly-affects-risk-of-cognitive-decline-and-dementia/ Tue, 22 May 2012 00:00:00 +0100 <h3 style="text-align: center;">_____________________________________________________________________________________________</h3>
<h5 style="text-align: center;">Boston University School of Medicine Institute on Lifestyle & Health</h5>
<h3 style="text-align: center;">___________________________________________________________________________________</h3>
 
For full critique, click <a href="http://www.bu.edu/alcohol-forum/critique-081-alcohol-intake-in-the-elderly-affects-risk-of-cognitive-decline-and-dementia-22-may-2012/">here</a>.
22 May 2012
<h5>Contacts for Editors</h5>
Professor R Curtis Ellison: <a href="https://xmail.bumc.bu.edu/owa/redir.aspx?C=74f80da44cfb445591d3eb16b66bd25e&URL=mailto%3aellison%40bu.edu">ellison@bu.edu</a>
Helena Conibear: <a href="https://xmail.bumc.bu.edu/owa/redir.aspx?C=74f80da44cfb445591d3eb16b66bd25e&URL=mailto%3ahelena%40alcohol-forum4profs.org">helena@alcohol-forum4profs.org</a>
Tel: +44 1300 320665 or +44 7876 593 345
 
Alzheimer’s disease (AD) and other types of dementia are most common in the very elderly, and are associated with huge health costs. With a rapidly ageing population throughout the world, factors that affect the risk of cognitive decline and dementia are of great importance. A review paper by Kim JW et al published in Psychiatry Investig 2012;9:8-16 on the association between alcohol consumption and cognition in the elderly provides an excellent summary of the potential ways in which alcohol may affect cognitive function and the risk of dementia, both adversely and favourably, as alcohol may have both a neuro toxic and neuro protective effect, depending on the dose and drinking pattern. Longitudinal and brain imaging studies in the elderly show that excessive alcohol consumption may increase the risk of cognitive dysfunction and dementia, but regular low to moderate alcohol intake may protect against cognitive decline and dementia and provide cardiovascular benefits.
 Studies published from 1971 to 2011 related to alcohol and cognition in the elderly were reviewed using a PubMed search. At present, there are no proven agents to prevent cognitive decline or dementia, although a number of prospective epidemiologic studies have shown a lower risk of such conditions among light to moderate drinkers in comparison with non-drinkers. Other studies have found that beneficial effects are seen only among certain sub-groups of subjects. A recent meta-analysis by Peters et al of subjects over the age of 65 in longitudinal studies concluded that light-to-moderate alcohol consumption, in comparison with abstinence, was associated with approximately 35-45% lower risk of cognitive decline or dementia.
 This paper provides a summary of what is known about the mechanisms by which alcohol consumption, especially heavy drinking, can be neurotoxic, and how light-to-moderate drinking may help protect against cognitive decline and dementia. The authors state that their intent is to determine if there is an “optimal pattern of drinking” that may protect the elderly against such conditions.
 At present, the mechanisms by which the moderate intake of wine and other alcoholic beverages reduces the risk of cardiovascular diseases are much better defined than they are for cognition. Forum members agree with the authors that further research is needed to evaluate a potential role that alcohol may play in reducing the risk of dementia. 
 Forum members also agree that, at present, the specific mechanisms of such putative protection are not well defined, and it would be premature to recommend light-to-moderate drinking for reducing the risk of dementia. On the other hand, current biomedical data supports the concept that regular, moderate intake of ethanol is not simply less dangerous for cognitive function, but is positively protective. This is the same conclusion reached by epidemiologic studies.
 Reference: Kim JW, Lee DY, Lee BC, Jung MH, Kim H, Choi YS, Choi I-G. Alcohol and Cognition in the Elderly: A Review. Psychiatry Investig 2012;9:8-16; On-line: <a href="http://dx.doi.org/10.4306/pi.2012.9.1.8">http://dx.doi.org/10.4306/pi.2012.9.1.8</a>
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 The following members of the International Scientific Forum on Alcohol Research provided comments on the present paper:
Harvey Finkel, MD, Hematology/Oncology, Boston University Medical Center, Boston, MA, USA
Creina Stockley, MSc, MBA, Clinical Pharmacology, Health and Regulatory Information Manager, AWRI, Glen Osmond, South Australia, Australia
Andrew L. Waterhouse, PhD, Marvin Sands Professor, University of California, Davis; Davis, CA, USA
David Vauzour, PhD, Senior Research Associate, Department of Nutrition, Norwich Medical School, University of East Anglia, Norwich, UK
R. Curtis Ellison, MD, Section of Preventive Medicine & Epidemiology, Boston University School of Medicine, Boston, MA, USA
Erik Skovenborg, MD, Scandinavian Medical Alcohol Board, Practitioner, Aarhus, Denmark
Pierre-Louis Teissedre, PhD,, University Victor Segalen Bordeaux 2, Bordeaux, France
Arne Svilaas, MD, PhD, general practice and lipidology, Oslo University Hospital, Oslo, Norway
Fulvio Ursini, MD, Dept. of Biological Chemistry, University of Padova, Padova, Italy
 
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For the detailed critique of this paper by the International Scientific Forum on Alcohol Research and a listing of references, go to <a href="http://www.bu.edu/alcohol-forum">www.bu.edu/alcohol-forum</a>, click on <a href="http://www.bu.edu/alcohol-forum/critique-081-alcohol-intake-in-the-elderly-affects-risk-of-cognitive-decline-and-dementia-22-may-2012/">http://www.bu.edu/alcohol-forum/critique-081-alcohol-intake-in-the-elderly-affects-risk-of-cognitive-decline-and-dementia-22-may-2012/</a> 
 
The specialists who are members of the Forum are happy to respond to questions from Health Editors regarding emerging research on alcohol and health and will offer an independent opinion in context with other research on the subject.
 
Helena Conibear co Director The International Scientific Forum on Alcohol Research <a href="mailto:helena@alcoholforum4profs.org">helena@alcoholforum4profs.org</a>
Professor R Curtis Ellison co Director The International Scientific Forum on Alcohol Research <a href="mailto:ellison@bu.edu">ellison@bu.edu</a>
<a href="http://www.alcoholforum4profs.org">www.alcoholforum4profs.org</a> <a href="http://www.alcoholforum4profs.com/">www.bu.edu/alcohol-forum</a>
Tel UK: + 44 1300 320869 http://www.meas.ie/news-and-research/critiques/2012/critique-081-alcohol-intake-in-the-elderly-affects-risk-of-cognitive-decline-and-dementia/ Critique 080: Modest alcohol intake is associated with less inflammation among patients with the most common type of liver disease, non-alcoholic fatty liver disease (NAFLD) http://www.meas.ie/news-and-research/critiques/2012/critique-080-modest-alcohol-intake-is-associated-with-less-inflammation-among-patients-with-the-most-common-type-of-liver-disease-non-alcoholic-fatty-liver-disease-nafld/ Tue, 15 May 2012 00:00:00 +0100 <h3 style="text-align: center;">_____________________________________________________________________________________________</h3>
<h5 style="text-align: center;">Boston University School of Medicine Institute on Lifestyle & Health</h5>
<h3 style="text-align: center;">_____________________________________________________________________________________________</h3>
 
For full critique, click <a href="http://www.bu.edu/alcohol-forum/critique-080-modest-alcohol-intake-is-associated-with-less-inflammation-among-patients-with-the-most-common-type-of-liver-disease-non-alcoholic-fatty-liver-disease-nafld-15-may-2012/">here</a>.
15 May 2012
 
<h5>Contacts for Editors</h5>
Professor R Curtis Ellison: <a href="https://xmail.bumc.bu.edu/owa/redir.aspx?C=74f80da44cfb445591d3eb16b66bd25e&URL=mailto%3aellison%40bu.edu">ellison@bu.edu</a>
Helena Conibear: <a href="https://xmail.bumc.bu.edu/owa/redir.aspx?C=74f80da44cfb445591d3eb16b66bd25e&URL=mailto%3ahelena%40alcohol-forum4profs.org">helena@alcohol-forum4profs.org</a>
Tel: +44 1300 341601 or +44 7876 593 345
 
NAFLD (non-alcoholic fatty liver disease) is the most common type of liver disease in the developed world, affecting up to one-third of the US population. NAFLD is often associated with obesity and other parameters of the so-called “metabolic syndrome,” which is a major risk factor for the development of cardiovascular disease. In a well-done study among subjects with NAFLD, the investigators have demonstrated that modest alcohol consumption (an average of up to 20 grams of alcohol per day and no binge drinking) is associated with less evidence of inflammation of the liver (steatohepatitis), a condition known to markedly increase the risk of progression of liver disease to cirrhosis. 
 
Given that NAFLD and other conditions associated with the metabolic syndrome are so common, and are major risk factors for developing cardiovascular disease, the results of the present study are important. They show that modest drinking is associated with decreased, not increased, inflammation of the liver. Further, even among subjects with NAFLD, cardiovascular disease is a much more common cause of death than liver disease. The authors suggest that intervention studies should be done to support their findings; if confirmed, subjects with NAFLD should not be advised to avoid all alcohol, which is the current advice usually given to such patients.
Reference: Dunn W, Sanyal AJ, Brunt EM, Unalp-Arida A, Donohue M, McCullough AJ, Schwimmer JB. Modest alcohol consumption is associated with decreased prevalence of steatohepatitis in patients with non-alcoholic fatty liver disease (NAFLD). 
Journal of Hepatology 2012 (pre-publication release)
 
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Comments on this paper were provided by the following members of the International Scientific Forum on Alcohol Research:
 
Francesco Orlandi, MD, Dept. of Gastroenterology, Università degli Studi di Ancona. Italy.
 
Erik Skovenborg, MD, Scandinavian Medical Alcohol Board, Practitioner, Aarhus, Denmark.
 
R. Curtis Ellison, MD, Section of Preventive Medicine & Epidemiology, Boston University School of Medicine, Boston, MA, USA.
 
Arne Svilaas, MD, PhD, general practice and lipidology, Oslo University Hospital, Oslo, Norway.
 
Tedd Goldfinger, DO, FACC, Desert Cardiology of Tucson Heart Center, Dept. of Cardiology, University of Arizona School of Medicine, Tucson, Arizona, USA
 
Harvey Finkel, MD, Hematology/Oncology, Boston University Medical Center, Boston, MA, USA.
 
Gordon Troup, MSc, DSc, School of Physics, Monash University, Victoria, Australia.
 
David Vauzour, PhD, Senior Research Associate, Department of Nutrition, Norwich Medical School, University of East Anglia, Norwich, UK.
 
David Van Velden, MD, Dept. of Pathology, Stellenbosch University, Stellenbosch, South Africa.
 
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For the detailed critique of this paper by the International Scientific Forum on Alcohol Research and a listing of references, go to <a href="http://www.bu.edu/alcohol-forum">www.bu.edu/alcohol-forum</a>, click on Recent Reviews and select Critique 080 – 15 May 2012.
 
The specialists who are members of the Forum are happy to respond to questions from Health Editors regarding emerging research on alcohol and health and will offer an independent opinion in context with other research on the subject. 
 
Helena Conibear co Director The International Scientific Forum on Alcohol Research <a href="mailto:helena@alcoholforum4profs.org">helena@alcoholforum4profs.org</a>
Professor R Curtis Ellison co Director The International Scientific Forum on Alcohol Research <a href="mailto:ellison@bu.edu">ellison@bu.edu</a>
<a href="http://www.alcoholforum4profs.org">www.alcoholforum4profs.org</a> <a href="http://www.alcoholforum4profs.com/">www.bu.edu/alcohol-forum</a>
Tel UK: + 44 1300 320869 http://www.meas.ie/news-and-research/critiques/2012/critique-080-modest-alcohol-intake-is-associated-with-less-inflammation-among-patients-with-the-most-common-type-of-liver-disease-non-alcoholic-fatty-liver-disease-nafld/ Critique 079: Moderate alcohol consumption before, and following, a heart attack is associated with lower risk of mortality for men http://www.meas.ie/news-and-research/critiques/2012/critique-079-moderate-alcohol-consumption-before-and-following-a-heart-attack-is-associated-with-lower-risk-of-mortality-for-men/ Wed, 18 Apr 2012 00:00:00 +0100 <h5 style="text-align: center;"/>
<h3 style="text-align: center;">__________________________________________________________________________</h3>
<h5 style="text-align: center;">Boston University School of Medicine Institute on Lifestyle & Health</h5>
<h3 style="text-align: center;"> _________________________________________________________________________</h3>
 
For full critique, click <a href="http://www.bu.edu/alcohol-forum/critique-079-moderate-alcohol-consumption-both-prior-to-and-following-a-myocardial-infarction-is-associated-with-lower-risk-of-mortality-17-april-2012/ ">here</a>.
17 April 2012
<h2> </h2>
<h5>Contacts for Editors</h5>
Professor R Curtis Ellison <a href="https://xmail.bumc.bu.edu/owa/redir.aspx?C=74f80da44cfb445591d3eb16b66bd25e&URL=mailto%3aellison%40bu.edu">ellison@bu.edu</a>
Helena Conibear <a href="https://xmail.bumc.bu.edu/owa/redir.aspx?C=74f80da44cfb445591d3eb16b66bd25e&URL=mailto%3ahelena%40alcohol-forum4profs.org">helena@alcohol-forum4profs.org</a>
Tel: +44 1300 320869 or +44 7876 593 345
 
The Health Professionals Follow-up Study (HPFS) is a prospective cohort study of 51,529 US male health professionals. During the follow up of these men between 1986 to 2006, published in the European Heart Journal, 1,818 men were confirmed with incident non-fatal myocardial infarction (MI) – a non-fatal heart attack. Among heart attack survivors, 468 deaths were documented during up to 20 years of follow up. Repeated reports were obtained on alcohol consumption every four years. Average alcohol consumption was calculated prior to and then following the MI. 
 
The overall results show that, in comparison with no alcohol consumption, the pre-MI and the post-MI intakes of light (0.1-9.9g/day of alcohol, or up to one small typical drink) and moderate (10.0-29.9g/d, or up to about 2 ½ to 3 drinks) amounts of alcohol were both associated with lower risk of all-cause mortality and cardiovascular morality among these men. 
 
The significant reductions in all-cause mortality risk (22% lower for 0.1-9.9g/day and 34% lower for 10.0 – 29.9g/day, in comparison with non-drinkers) were no longer present for those who drank more than 30g/day; for this highest consumer group, the adjusted hazard ratio was 0.87 with 95% CI of 0.61-1.25. 
 
There are a number of other informative and interesting results described from this study. First, there was little change in reported alcohol intake prior to and following the MI: drinkers tended to remain drinkers of similar amounts. Few non-drinkers began to drink after their heart attack; among heavier drinkers, there was a tendency to reduce drinking (but very few stopped drinking completely). Further there were no significant differences in outcome according to type of beverage consumed although, interestingly, lower hazard ratios were seen for consumers of beer and liquor than of wine. While the authors state that the effects of alcohol were stronger for the association with non-anterior MI’s, the relative risk (versus non-drinkers) for all-cause mortality were little different: among the moderately drinking men the relative risks were 0.58 for anterior MI and 0.51 for other types of MI.
 
Even though exposures (such as alcohol) for cardiovascular events (such as MI) may be different after a person has an event than it was before the event, in this study the reductions in risk were almost the same. For example, both for alcohol intake reported prior to a MI, and that after a non-fatal MI, the risk of mortality was about 30% lower for moderate drinkers than it was for abstainers. This suggests that, in terms of reducing cardiovascular disease, alcohol may have relatively short-term effects, suggesting that frequent but moderate consumption (of under 30g a day for men) may result in the best health outcomes.
 
Reference: Pai JK, Mukamal KJ, Rimm EB. Long-term alcohol consumption in relation to all-cause and cardiovascular mortality among survivors of myocardial infarction: the Health Professionals Follow-up Study. European Heart Journal 2012; doi:10.1093/eurheartj/ehs047
 
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Contributions to this critique were provided by the following members of the International Scientific Forum on Alcohol Research:
 
Yuqing Zhang, MD, DSc, Epidemiology, Boston University School of Medicine, Boston, MA, USA
 
David Van Velden, MD, Dept. of Pathology, Stellenbosch University, Stellenbosch, South Africa
 
Harvey Finkel, MD, Hematology/Oncology, Boston University Medical Center, Boston, MA, USA
 
Gordon Troup, MSc, DSc, School of Physics, Monash University, Victoria, Australia
 
Arne Svilaas, MD, PhD, general practice and lipidology, Oslo University Hospital, Oslo, Norway
 
R. Curtis Ellison, MD, Section of Preventive Medicine & Epidemiology, Boston University School of Medicine, Boston, MA, USA
 
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For the detailed critique of this paper by the International Scientific Forum on Alcohol Research and a listing of references, go to <a href="http://www.bu.edu/alcohol-forum">www.bu.edu/alcohol-forum</a> or <a href="http://www.bu.edu/alcohol-forum/critique-079-moderate-alcohol-consumption-both-prior-to-and-following-a-myocardial-infarction-is-associated-with-lower-risk-of-mortality-17-april-2012/">http://www.bu.edu/alcohol-forum/critique-079-moderate-alcohol-consumption-both-prior-to-and-following-a-myocardial-infarction-is-associated-with-lower-risk-of-mortality-17-april-2012/</a> 
 
The specialists who are members of the Forum are happy to respond to questions from Health Editors regarding emerging research on alcohol and health and will offer an independent opinion in context with other research on the subject.
Helena Conibear co Director The International Scientific Forum on Alcohol Research <a href="mailto:helena@alcoholforum4profs.org">helena@alcoholforum4profs.org</a>
Professor R Curtis Ellison co Director The International Scientific Forum on Alcohol Research <a href="mailto:ellison@bu.edu">ellison@bu.edu</a>
<a href="http://www.alcoholforum4profs.org/">www.alcoholforum4profs.org</a> <a href="http://www.alcoholforum4profs.com/">www.bu.edu/alcohol-forum</a>
Tel UK: + 44 1300 320869
 http://www.meas.ie/news-and-research/critiques/2012/critique-079-moderate-alcohol-consumption-before-and-following-a-heart-attack-is-associated-with-lower-risk-of-mortality-for-men/ Critique 077: Swedish study supports a “U-shaped” association of alcohol consumption with risk of pre-diabetes and diabetes mellitus http://www.meas.ie/news-and-research/critiques/2012/critique-077-swedish-study-supports-a-u-shaped-association-of-alcohol-consumption-with-risk-of-pre-diabetes-and-diabetes-mellitus/ Thu, 29 Mar 2012 00:00:00 +0100 <h5 style="text-align: center;">______________________________________________________________________________________________________</h5>
<h5 style="text-align: center;">Boston University School of Medicine Institute on Lifestyle & Health</h5>
<h5 style="text-align: center;">______________________________________________________________________________________________________</h5>
 
For full critique, click <a href="http://www.bu.edu/alcohol-forum/critique-077-swedish-study-supports-a-%E2%80%9Cu-shaped%E2%80%9D-association-of-alcohol-consumption-with-risk-of-pre-diabetes-and-diabetes-mellitus-29-march-2012/">here</a>.
 
29 March 2012
<h5>Contacts for Editors</h5>
Professor R Curtis Ellison: <a href="https://xmail.bumc.bu.edu/owa/redir.aspx?C=74f80da44cfb445591d3eb16b66bd25e&URL=mailto%3aellison%40bu.edu">ellison@bu.edu</a>
Helena Conibear: <a href="https://xmail.bumc.bu.edu/owa/redir.aspx?C=74f80da44cfb445591d3eb16b66bd25e&URL=mailto%3ahelena%40alcohol-forum4profs.org">helena@alcohol-forum4profs.org</a>
Tel: +44 1300 320869 or +44 7876 593 345
 
Subjects in a cohort in Sweden, some of whom had been exposed to a community intervention program to prevent diabetes, were evaluated 8-10 years after baseline for the presence of diabetes mellitus or impaired glucose metabolism (“pre-diabetes”) in relation to a baseline report of alcohol consumption. Approximately 2,000 men and 3,000 women had a normal glucose tolerance test at baseline; of these 105 men and 57 women developed type II diabetes. Of subjects with pre-diabetes at baseline, 175 men and 98 women progressed to diabetes. The authors report that total alcohol consumption and binge drinking increased the risk of pre-diabetes and diabetes in men, while low consumption decreased diabetes risk in women. However, the authors did not discuss the findings in their cohort that in essentially all comparisons, the highest risk of diabetes or pre-diabetes was among non-drinkers.
 
Forum reviewers had some concerns about the study. For example, the study included some subjects who had been exposed to an intervention trial to prevent diabetes, yet no information is given on potential effects of the intervention. It was not a population-based group. Also, the sample was “enriched” with subjects who had a positive family history of diabetes, which may make it more difficult to judge the effects of environmental factors. Ex-drinkers and never drinkers were included in the abstainer group. 
 
It appears that the authors focused only on the “statistically significant” results rather than commenting on the overall pattern of association (lower risk of developing diabetes for moderate drinkers than for abstainers and heavier drinkers). Further, the number of subjects in many of the sub-groups was very small, making it difficult to define specific cut-points for effects of alcohol on risk. 
 
Nevertheless, reviewers considered that, overall, these analyses support the usual findings from previous research of a “U-shaped curve” for alcohol and diabetes for both men and women. There appears to be a reduction in risk with moderate alcohol intake and possibly an increased risk for heavier drinking. 
 
Reference: Cullmann M, Hilding A, Östenson CG. Alcohol consumption and risk of pre-diabetes and type 2 diabetes development in a Swedish population. Diabet Med 2012;29:441–452. DOI: 10.1111/j.1464-5491.2011.03450.x
 
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Comments on this paper were provided by the following members of the International Scientific Forum on Alcohol Research:
 
Luc Djoussé, MD, DSc, Dept. of Medicine, Division of Aging, Brigham & Women’s Hospital and Harvard Medical School, Boston, MA, USA
 
David Van Velden, MD, Dept. of Pathology, Stellenbosch University, Stellenbosch, South Africa
 
Harvey Finkel, MD, Hematology/Oncology, Boston University Medical Center, Boston, MA, USA
 
Tedd Goldfinger, DO, FACC, Desert Cardiology of Tucson Heart Center, Dept. of Cardiology, University of Arizona School of Medicine, Tucson, Arizona, USA
 
Giovanni de Gaetano, MD, PhD, Research Laboratories, Catholic University, Campobasso, Italy
 
Arne Svilaas, MD, PhD, general practice and lipidology, Oslo University Hospital, Oslo, Norway
 
Andrew L. Waterhouse, PhD, Marvin Sands Professor, University of California, Davis; Davis, CA, USA
 
David Vauzour, PhD, Senior Research Associate, Department of Nutrition, Norwich Medical School, University of East Anglia, Norwich, UK
 
Yuqing Zhang, MD, DSc, Epidemiology, Boston University School of Medicine, Boston, MA, USA
 
Erik Skovenborg, MD, Scandinavian Medical Alcohol Board, Practitioner, Aarhus, Denmark
 
Fulvio Ursini, MD, Dept. of Biological Chemistry, University of Padova, Padova, Italy
 
R. Curtis Ellison, MD, Section of Preventive Medicine & Epidemiology, Boston University School of Medicine, Boston, MA, USA
 
Ulrich Keil, MD, PhD, Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
 
Creina Stockley, MSc, MBA, Clinical Pharmacology, Health and Regulatory Information Manager, Australian Wine Research Institute, Glen Osmond, South Australia, Australia
 
* * *
 
For the detailed critique of this paper by the International Scientific Forum on Alcohol Research and a listing of references, go to <a href="http://www.bu.edu/alcohol-forum">www.bu.edu/alcohol-forum</a>, click on Recent Reports, and select Critique 077 – 29 March 2012.
 
The specialists who are members of the Forum are happy to respond to questions from Health Editors regarding emerging research on alcohol and health and will offer an independent opinion in context with other research on the subject.
Helena Conibear co Director The International Scientific Forum on Alcohol Research <a href="mailto:helena@alcoholforum4profs.org">helena@alcoholforum4profs.org</a>
Professor R Curtis Ellison co Director The International Scientific Forum on Alcohol Research <a href="mailto:ellison@bu.edu">ellison@bu.edu</a>
<a href="http://www.alcoholforum4profs.org/">www.alcoholforum4profs.org</a> <a href="http://www.alcoholforum4profs.com/">www.bu.edu/alcohol-forum</a>
Tel UK: + 44 1300 320869 http://www.meas.ie/news-and-research/critiques/2012/critique-077-swedish-study-supports-a-u-shaped-association-of-alcohol-consumption-with-risk-of-pre-diabetes-and-diabetes-mellitus/ Critique 075: Moderate drinking associated with lower risk of stroke in women http://www.meas.ie/news-and-research/critiques/2012/critique-075-moderate-drinking-associated-with-lower-risk-of-stroke-in-women/ Thu, 15 Mar 2012 00:00:00 +0000 <h5>____________________________________________________________________________________________________</h5>
<h5 style="text-align: center;">Boston University School of Medicine Institute on Lifestyle & Health</h5>
<h3 style="text-align: center;">____________________________________________________________________________________________</h3>
 
For full critique, click <a href="http://www.bu.edu/alcohol-forum/2011/12/19/critique-053-an-extensive-review-of-the-effects-of-alcohol-consumption-on-the-risk-of-cognitive-impairment-and-dementia-25-august-2011/">here</a>.
 
15 March 2012
<h5>Contacts for Editors</h5>
Professor R Curtis Ellison: ellison@bu.edu
Helena Conibear: helena@alcohol-forum4profs.org
Tel: +44 1300 320869 or +44 7876 593 345
 
Light-to-moderate alcohol consumption has been consistently associated with lower risk of heart disease, but data for stroke are less certain, especially among women.
 
A total of 83,578 female participants of the Nurses’ Health Study who were free of diagnosed cardiovascular disease and cancer at baseline were followed-up from 1980 to 2006. Data on self-reported alcohol consumption were assessed at baseline and updated approximately every 4 years, whereas stroke and potential confounder data were updated at baseline and biennially. Strokes were classified according to the National Survey of Stroke criteria.
 
The authors found that the risk of total stroke is significantly lower among light-to-moderate consumers of alcohol than among subjects reporting no alcohol intake. In comparison with non-drinkers, the estimated risk was 17-21% lower for women averaging up to 15 grams of alcohol per day (one drink/day by US definitions of approximately 14 grams of alcohol, or two UK units of 8g). For consumers of larger amounts of alcohol, the risk of stroke increased at levels of consumption above 38g.
 
Data on the pattern of drinking (regularly, binge, etc.) were not reported. Among these predominantly light drinkers, there were no differences between effects on the risk of the most common type of stroke, ischemic stroke (due to atherosclerotic obstruction of a artery or an embolic clot) or the less-common hemorrhagic stroke (bleeding into the brain).
 
The results, with full adjustment for other factors that may affect risk, suggest a “J-shaped” curve for total stroke, with reductions in risk for light-to-moderate drinking and possibly an increase with greater amounts. In this study, the point at which the risk of women having a stroke exceeding that of non-drinkers was about 38 grams of alcohol per day (about 3 typical “drinks”).
 
The study supports many previous reports from observational epidemiologic studies that have shown a slight reduction in risk of the ischemic type of stroke from moderate alcohol intake. Some, but not all previous studies, show an increase in hemorrhagic stroke for any amounts of alcohol, but that was not seen in this study, possibly because there were few heavy drinkers in this group of nurses.
 
Reference: Jimenez M, Chiuve SE, Glynn RJ, Stampfer MJ, Camargo Jr CA, Willett WC, Manson JE, Rexrode KM. Alcohol Consumption and Risk of Stroke in Women. Stroke 2012, pre-publication. http://stroke.ahajournals.org.
 
DOI: 10.1161/STROKEAHA.111.639435
 
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Comments on this paper were provided by the following members of the International Scientific Forum on Alcohol Research:
 
 
 
Harvey Finkel, MD, Hematology/Oncology, Boston University Medical Center, Boston, MA, USA
 
 
 
Erik Skovenborg, MD, Scandinavian Medical Alcohol Board, Practitioner, Aarhus, Denmark
 
Tedd Goldfinger, DO, FACC, Desert Cardiology of Tucson Heart Center, Dept. of Cardiology, University of Arizona School of Medicine, Tucson, Arizona, USA
Gordon Troup, MSc, DSc, School of Physics, Monash University, Victoria, Australia
Giovanni de Gaetano, MD, PhD, Research Laboratories, Catholic University, Campobasso, Italy
R. Curtis Ellison, MD, Section of Preventive Medicine & Epidemiology, Boston University School of Medicine, Boston, MA, USA
Arne Svilaas, MD, PhD, general practice and lipidology, Oslo University Hospital, Oslo, Norway
Ulrich Keil, MD, PhD, Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
* * *
For the detailed critique of this paper by the International Scientific Forum on Alcohol Research and a listing of references, go to www.bu.edu/alcohol-forum, click on Recent Reports, and select Critique 075 – 15 March 2012.
The specialists who are members of the Forum are happy to respond to questions from Health Editors regarding emerging research on alcohol and health and will offer an independent opinion in context with other research on the subject.
 
<h5>Helena Conibear co Director</h5>
The International Scientific Forum on Alcohol Research
helena@alcoholforum4profs.org
<h5/>
<h5>Professor R Curtis Ellison co Director</h5>
The International Scientific Forum on Alcohol Research
ellison@bu.edu
 
www.alcoholforum4profs.org www.bu.edu/alcohol-forum
 
Tel UK: + 44 1300 320869
 http://www.meas.ie/news-and-research/critiques/2012/critique-075-moderate-drinking-associated-with-lower-risk-of-stroke-in-women/