Drinking patterns, drinking contexts and alcohol-related aggression among late adolescent and young adult drinkers

AIMS: The main objectives of this study were to determine: (1) the relative roles of heavy episodic drinking (HED), drinking frequency and drinking volume in explaining alcohol-related aggression and (2) whether drinking context variables (i.e. usual drinking locations, typical drinking companions and extent of peer drinking) confound or modify the relationship between HED and alcohol-related aggression or whether they predict alcohol-related aggression independently. DESIGN: A secondary analysis of the US National Longitudinal Survey of Youth was conducted. Alcohol-related aggression (denoted fights after drinking) was measured based on self-reports of arguments or fights that occurred during or after drinking in the previous 12 months. PARTICIPANTS: A composite sample of drinkers, ages 17-21, from the 1994, 1996 and 1998 Young Adult surveys (n = 738) was used. FINDINGS: Frequency of drinking and drinking volume largely confounded the association between HED and fights after drinking. Usually drinking in public locations away from home versus private locations was found to be significantly associated with a greater likelihood of fights after drinking among females. Among males, usual drinking location modified the relationship between drinking frequency and alcohol-related aggression, with the greatest risk of aggression for males who drank frequently and usually drank in public locations away from home. CONCLUSIONS: Programs designed to reduce drinking frequency in this population and to increase the safety of drinking locations in public places away from home may prove to be beneficial in reducing alcohol-related aggression.     

Binge drinking: Burden of liver disease and beyond

The consumption of alcoholic beverages is harmful to human health. In recent years, consumption patterns of alcoholic beverages have changed in our society, and binge drinking has generalized. It is considered to be a socio-sanitary problem with few known consequences in terms of individual and third-party social impacts (in the form of violence or traffic accidents) and its organic impact (affects the liver and other organs and systems, such as the nervous and cardiovascular systems) and represents an important financial burden due to its increasing economic impact. This review provides a global approach to binge drinking and emphasizes its epidemiological character, the effect of this type of consumption and the possible management of a problem with an increasing tendency in our society.     

The importance of drinking frequency in evaluating individuals' drinking patterns: implications for the development of national drinking guidelines

Aims   This paper examines the relationship between frequency of drinking, usual daily consumption and frequency of binge drinking, taking into consideration possible age and gender differences.
Participants and design   Subjects were 10 466 current drinkers (5743 women and 4723 men) aged between 18 and 76 years, who participated in the GENACIS Canada (GENder Alcohol and Culture: an International Study) study.
Setting   Canada.
Measurements   The independent variable was the annual drinking frequency. The dependent variables were the usual daily quantity consumed, annual, monthly and weekly frequency of binge drinking (five drinks or more on one occasion).
Findings   Logistic regressions show (i) that those who drink less than once a week are less likely than weekly drinkers to take more than two drinks when they do drink; (ii) that the usual daily quantity consumed by weekly drinkers is not related to their frequency of drinking; but that (iii) the risk and frequency of binge drinking increase with the frequency of drinking.
Conclusions   Given that risk and frequency of binge drinking among Canadians increases with their frequency of drinking, any public recommendation to drink moderately should be made with great caution.     

Volume of alcohol consumption, patterns of drinking and burden of disease in the European region 2002

AIMS: To describe the volume of alcohol consumption and patterns of drinking in the World Health Organization (WHO) European regions in 2002 and to estimate quantitatively the burden of disease attributable to alcohol in that year. METHODS: Secondary data analysis. Exposure data were taken from the WHO Comparative Risk Assessment, outcome data from the WHO Measurement and Health Information department, and used to derive three outcome measures: deaths, years of life lost (YLL) and disability adjusted life years (DALY) for 2002. All calculations were conducted according to age, sex and region. RESULTS: Alcohol consumption in the WHO regions for Europe was high, with 12.1 litres pure alcohol per capita, on average more than 100% above the global consumption. Alcohol consumption caused a considerable disease burden: 6.1% of all the deaths, 12.3% of all YLL and 10.7% of all DALY in all European regions in 2002 could be attributed to this exposure. Intentional and unintentional injuries accounted for almost 50% of all alcohol-attributable deaths and almost 44% of alcohol-attributable disease burden. Young people and men were affected the most. Geographically, the most eastern region around Russia had the highest alcohol-attributable disease burden. CONCLUSIONS: Interventions should be implemented to reduce the high burden of alcohol-attributable disease in the European regions. Given the epidemiological structure of the burden, injury prevention, including but not restricted to the prevention of traffic injuries, and specific prevention for young people should play the most important role in a comprehensive plan to reduce alcohol-attributable burden.     

Drinking behaviour among men and women in China: the 2007 China Chronic Disease and Risk Factor Surveillance

Aim To obtain information on drinking behaviour and to examine the associations between frequency of drinking, usual daily drinking quantity and binge drinking behaviour among Chinese residents aged 15–69 years. Design A multi‐stage clustering sampling method was used to select a nationally representative sample and data were collected as part of the China Chronic Disease and Risk Factor Surveillance by face‐to‐face interview. Setting Respondents were selected randomly from 160 counties/districts scattered over 31 provinces/autonomous regions/municipalities between August and October, 2007. Participants Weighted analyses included 49 527 Chinese residents (aged 15–69 years). Measurements Prevalence of current drinking and usual daily quantity, median number of annual binge drinking episodes, proportions of excessive drinking, frequent drinking and binge drinking among current drinkers were the main measurements. Results The prevalence of male, female and total current drinking was 55.6%, 15.0% and 35.7%, respectively. On average, male drinkers consumed 47.8 g alcohol per drinking day, whereas females consumed 19.1 g. The median numbers of annual binge drinking episodes were 5.6 for male drinkers and 2.4 for females. Among the current drinkers, proportions of excessive drinking, frequent dinking and binge drinking were 62.7%, 26.3%, 57.3% for men and 51.0%, 7.8%, 26.6% for women, respectively. Logistic regressions showed that binge drinking was associated strongly with drinking frequency and drinking quantity increased with drinking frequency for both genders. Conclusions Excessive drinking, frequent drinking and binge drinking behaviour have reached epidemic proportions among current drinkers in China, and culturally appropriate public health strategies to reduce hazardous drinking behaviour are needed.     

The relationship of average volume of alcohol consumption and patterns of drinking to burden of disease: an overview

Aims As part of a larger study to estimate the global burden of disease attributable to alcohol:

• ? to quantify the relationships between average volume of alcohol consumption, patterns of drinking and disease and injury outcomes, and
• ? to combine exposure and risk estimates to determine regional and global alcohol‐attributable fractions (AAFs) for major disease and injury categories.

Design, methods, setting Systematic literature reviews were used to select diseases related to alcohol consumption. Meta‐analyses of the relationship between alcohol consumption and disease and multi‐level analyses of aggregate data to fill alcohol–disease relationships not currently covered by individual‐level data were used to determine the risk relationships between alcohol and disease. AAFs were estimated as a function of prevalence of exposure and relative risk, or from combining the aggregate multi‐level analyses with prevalence data. Findings Average volume of alcohol consumption was found to increase risk for the following major chronic diseases: mouth and oropharyngeal cancer; oesophageal cancer; liver cancer; breast cancer; unipolar major depression; epilepsy; alcohol use disorders; hypertensive disease; hemorrhagic stroke; and cirrhosis of the liver. Coronary heart disease (CHD), unintentional and intentional injuries were found to depend on patterns of drinking in addition to average volume of alcohol consumption. Most effects of alcohol on disease were detrimental, but for certain patterns of drinking, a beneficial influence on CHD, stroke and diabetes mellitus was observed. Conclusions Alcohol is related to many major disease outcomes, mainly in a detrimental fashion. While average volume of consumption was related to all disease and injury categories under consideration, pattern of drinking was found to be an additional influencing factor for CHD and injury. The influence of patterns of drinking may be underestimated because pattern measures have not been included in many epidemiologic studies. Generalizability of the results is limited by methodological problems of the underlying studies used in the present analyses. Future studies need to address these methodological issues in order to obtain more accurate risk estimates.     

Risky drinking and alcohol use patterns in a national sample of women of childbearing age

AIMS: We examined risky drinking and alcohol use patterns associated with prenatal effects of alcohol exposure in women of childbearing age, using various definitions of low-risk drinking. DESIGN: Computer-assisted telephone interview (CATI) methodology was used to gather information in a cross-sectional survey on alcohol use and problems, pregnancy and likelihood of future pregnancy. SETTING: Participants were respondents in the 2000 National Alcohol Survey (NAS, N10, response rate 58%) which includes men and women from all 50 states of the United States and the District of Columbia. PARTICIPANTS: A total of 1504 women aged 18-39 years were included; 72 were pregnant, 511 were currently not pregnant but reported being likely to be pregnant in the next 5 years, and 921 women were neither pregnant nor likely to be in the next 5 years. MEASUREMENTS: Various alcohol use patterns in the past 12 months including average volume, amount per session, drinking with food and time spent drinking were assessed. FINDINGS: Seven per cent of childbearing age women exceeded guidelines used to classify women as risky drinkers in the past month. Thirty per cent were classified as risky drinkers when these guidelines were extended to past-year drinking. Examination of specific alcohol use patterns revealed that while under 10% of risky drinkers reported past-month heavy episodic drinking, 30% or more reported heavy episodic drinking and exceeding daily limits for alcohol consumption in the past year. CONCLUSIONS: Public health professionals should note that past-year drinking in a significant proportion of women of childbearing age exceeds guidelines for alcohol use. When targeting such prevention efforts, they should thus include assessment of past-year alcohol use patterns.     

饮酒、肥胖与脂肪肝关系的流行病学调查

目的探讨饮酒、肥胖与脂肪肝的关系。方法通过随机多级分层整群抽样,对上海市成人进行问卷调查、体检、血糖、血脂和B超检查。结果3175名调查对象中月饮酒率、肥胖、脂肪肝检出率分别为7.62%、41.9%和20.82%。661例脂肪肝中,非酒精性占92.43%、酒精性仅占3.48%。与对照组相比,过量饮酒和肥胖分别增加脂肪肝患病风险3.6倍(95%CI,1.1～11.7)和11.6倍(95%CI,8.2～16.5),而过量饮酒合并肥胖则增加脂肪肝患病风险17.1倍(95%CI,9.1～32.4);肥胖增加过量饮酒者脂肪肝患病风险4.8倍(95%CI,1.4～16.6),而过量饮酒并不能显著增加肥胖患者脂肪肝患病风险(OR=1.5,95%CI,0.9～2.6)。结论上海市成人脂肪肝患病率高且以非酒精性为主,肥胖与脂肪肝的关系较过量饮酒与脂肪肝的关系更为密切。     

Alcohol drinking patterns and biomarkers of coronary risk in the Spanish population

Background and aimsTo estimate the association between patterns of alcohol consumption and biomarkers of coronary heart disease (CHD) risk.Methods and resultsCross-sectional study among 10,793 individuals representative of the Spanish population aged ≥18 years. The threshold between moderate and heavy drinking was 40 g of alcohol/day in men and 24 g/day in women. Binge drinking was defined as intake of ≥80 g of alcohol in men and ≥60 g in women at any drinking occasion in the preceding 30 days. Analyses were performed with generalized linear models with adjustment for the main confounders, and results were expressed as the percentage change in the geometric mean (PCGM). Compared to non-drinkers, moderate and heavy drinkers had progressively higher serum HDL-cholesterol, with a PCGM ranging from 4.8% (95% CI: 3.7–6.0%) in moderate drinkers without binge drinking (MNB) to 9.6% (5.1–14.2%) in heavy drinkers with binge drinking (HB). Fibrinogen decreased progressively with alcohol intake, from −2.2% (−3.1 to −1.3%) in MNB to −5.8% (−9.4 to −2.0%) in HB. Leptin, glycated hemoglobin and the HOMA-index also decreased with increasing alcohol intake, and particularly with binge drinking.ConclusionsModerate alcohol intake is associated with improved HDL-cholesterol, fibrinogen and markers of glucose metabolism, which is consistent with the reduced CHD risk of moderate drinkers in many studies. Heavy and binge drinking were also associated with favorable levels of CHD biomarkers; since these drinking patterns produce substantial health harms, our results should not be used to promote alcohol consumption.     

Socio‐economic status predicts drinking patterns but not alcohol‐related consequences independently

Aim To identify independent relationships between socio‐economic status and drinking patterns and related consequences and to identify socio‐economic groups at risk for heavier consumption. Design and setting Three comparable national telephone surveys were utilized: 1995, 2000 and 2004. The respondents were aged 18–65 years. Contextual information includes that a number of liberalized alcohol policy changes occurred over the time of the surveys. Results Educational qualification, income and occupation were associated independently with alcohol consumption. There were indications that the different dimensions of drinking (quantity and frequency) had different relationships with socio‐economic status (SES). For example, lower SES groups drank heavier quantities while higher SES groups drank more frequently. SES, however, did not play a major role predicting drinking consequences once drinking patterns were controlled for, although there were some exceptions. It was the lower‐to‐average SES groups that were at greater risk for drinking heavier quantities compared to other SES groups in the population (as they had sustained increases in the quantities they consumed over time where other SES groups did not). Conclusion Socio‐economic status was related independently to drinking patterns and there were indications that SES interacted differently with the different dimensions of drinking (quantity and frequency). For the most part, socio‐economic status was not related independently to the experience of alcohol‐related consequences once drinking patterns were accounted for. It was the lower‐to‐average SES groups that were at greater risk for drinking heavier quantities compared to other SES groups in the population.     

Weekend effects on binge drinking and homicide: the social connection between alcohol and violence in Russia

AIMS AND DESIGN: This study employs unique newly available Russian mortality data to examine the social connection between binge drinking and homicide in the country. SETTING, PARTICIPANTS AND MEASUREMENTS: All death certificates of those aged 20-64 years in the Udmurt Republic, Russia, were analyzed according to day and cause of death for the years 1994-98. Deaths due to alcohol poisoning were used as a proxy for binge drinking. FINDINGS: There was a high bivariate correlation (r = 0.75) between the daily distribution of deaths due to alcohol and homicide. The number of alcohol deaths was significantly higher on Saturdays and Sundays (presumably as a result of drinking on Friday and Saturday nights) and the number of homicide deaths was significantly higher on Fridays and Saturdays. CONCLUSIONS: The levels of alcohol consumption and homicide in Russia are among the highest in the world, and there is mounting evidence that the two are related. Binge drinking, preference for distilled spirits and a high social tolerance for heavy drinking may act as social and cultural contextual factors that might increase the risk of violent outcomes. The high correspondence between the daily distribution of alcohol and homicide deaths provides indirect evidence for the social connection between them. While these findings do not represent a causal connection, when placed in the context of the growing literature on this topic they provide further support of an association between alcohol consumption and homicide rates in Russia and preliminary evidence for the intermediate role in this relationship played by social context.     

Drinking habits as cofactors of risk for alcohol induced liver damage

Background—The Dionysos Study is a cohort studyof the prevalence of chronic liver disease in the general population oftwo northern Italian communities. It included 6917 subjects, aged 12-65 (69% of the total population).
Aims—The aim of this part of the study was toexamine the relationship of daily alcohol intake, type of alcoholicbeverage consumed, and drinking patterns to the presence of alcoholinduced liver damage in an open population.
Patients and methods—6534 subjects, free of virusrelated chronic liver disease and participating in the firstcross-sectional part of the study, were fully examined. Each subjectunderwent: (a) medical history and physical examination, (b) evaluationof alcohol intake using an illustrated dietary questionnaire, and (c)routine blood tests. More invasive diagnostic procedures were performedwhen indicated.
Results—Multivariate analysis showed that therisk threshold for developing either cirrhosis or non-cirrhotic liverdamage (NCLD) was ingestion of more than 30 g alcohol per day in both sexes. Using this definition, 1349 individuals (21% of the population studied) were at risk. Of these, only 74 (5.5% of the individuals atrisk) showed signs of liver damage. The prevalence of "pure" alcoholic cirrhosis was 0.43% (30 of 6917), representing 2.2% of theindividuals at risk, with a ratio of men to women of 9:1, while 44 (3.3% of the individuals at risk) showed persistent signs of NCLD.After 50 years of age, the cumulative risk of developing both NCLD andcirrhosis was significantly higher (p<0.0001) for those individualswho regularly drank alcohol both with and without food than for thosewho drank only at mealtimes.
Conclusions—Our data show that in an openpopulation the risk threshold for developing cirrhosis and NCLD is 30 gethanol/day, and this risk increases with increasing daily intake.Drinking alcohol outside mealtimes and drinking multiple differentalcoholic beverages both increase the risk of developing alcoholinduced liver damage.

Keywords:alcohol; liver disease; cirrhosis

     

脂肪性肝病与原发性肝癌

脂肪性肝病是隐原性肝硬化的主要原因之一,其经过肝硬化进展至原发性肝癌的过程已被认可,但是近年来越来越多的研究证实脂肪性肝病本身存在有促肿瘤形成的机制,它可以不经过肝硬化而直接进展成原发性肝癌,两者之间的具体机制还未明确.此文就脂肪性肝病向原发性肝癌进展的可能机制作一综述.     

Oxidative stress in alcohol-related liver disease

Alcohol consumption is one of the leading causes of the global burden of disease and results in high healthcare and economic costs. Heavy alcohol misuse leads to alcohol-related liver disease, which is responsible for a significant proportion of alcohol-attributable deaths globally. Other than reducing alcohol consumption, there are currently no effective treatments for alcohol-related liver disease. Oxidative stress refers to an imbalance in the production and elimination of reactive oxygen species and antioxidants. It plays important roles in several aspects of alcohol-related liver disease pathogenesis. Here, we review how chronic alcohol use results in oxidative stress through increased metabolism via the cytochrome P4502E1 system producing reactive oxygen species, acetaldehyde and protein and DNA adducts. These trigger inflammatory signaling pathways within the liver leading to expression of pro-inflammatory mediators causing hepatocyte apoptosis and necrosis. Reactive oxygen species exposure also results in mitochondrial stress within hepatocytes causing structural and functional dysregulation of mitochondria and upregulating apoptotic signaling. There is also evidence that oxidative stress as well as the direct effect of alcohol influences epigenetic regulation. Increased global histone methylation and acetylation and specific histone acetylation inhibits antioxidant responses and promotes expression of key pro-inflammatory genes. This review highlights aspects of the role of oxidative stress in disease pathogenesis that warrant further study including mitochondrial stress and epigenetic regulation. Improved understanding of these processes may identify novel targets for therapy.