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Alcohol and Health: TABLE of CONTENTS Current Evidence Alcohol and Health: TABLE OF CONTENTS Current Evidence JAN-FEB 2006 \ALCOHOL AND HEALTH OUTCOMES Alcohol and Health Outcomes Alcohol Likely Worsens Adher- ence to Diabetes Preventive Care, Alcohol Likely Worsens Adherence to Diabetes Preventive Care 1 In addition to its effects on morbidity and mor- have had a provider visit for diabetes in Withdrawal May Trigger Alcoholic tality, alcohol use influences the self- the past year (odds ratios 1.3 and 1.8, Pancreatitis, 1 management of chronic illness. Using data from respectively). a national survey, researchers examined • Annual self-reported hemoglobin A1c Alcohol Consumption and Lung whether alcohol use worsens adherence to monitoring, annual foot exams, and for- Cancer: Are They Connected?, 2 diabetes care. Analyses were adjusted for po- mal diabetes education did not signifi- tential confounders (e.g., age, race, diabetes Alcohol Use Decreases Platelet cantly differ by levels of alcohol con- Activation and Aggregation in duration, insulin use). sumption. Men, 2 • Among 10,980 adults with self-reported Comments: Though unable to prove causality, Drinking Frequency, Mediating diabetes, 70% were current nondrinkers, this cross-sectional study illustrates that alco- Biomarkers, and Myocardial In- 28% were moderate drinkers (average hol use is associated with less self-care among farction, 3 <=1 drinks per day for women, <= 2 adults with diabetes. Subsequently, these pa- drinks for men) and 2% were heavy drink- tients likely increase their risk of adverse out- Heart and Mind: Is Moderate Alcohol Consumption Good for ers (average >1 drink per day for women, comes. Clinicians should assess alcohol use in Your Brain, Too?, 3 >2 drinks for men). patients with diabetes and inform them of the • Heavy drinkers were significantly more many ways alcohol can harm their health. Does Alcohol Use Increase Hepa- likely than nondrinkers to not perform Joseph Conigliaro, MD, MPH titis C Virus Replication?, 4 daily glucose self-monitoring and to not have had an eye exam in the past year Reference: Chew LD, et al. Association be- (odds ratios 1.8 and 2.2, respectively). tween alcohol consumption and diabetes pre- ventive practices. Fam Med. 2005;37(8):589– INTERVENTIONS • Moderate drinkers were significantly more likely than nondrinkers to not perform 594. daily glucose self-monitoring and to not Vitamin K May Reduce Risk of Alcohol Dependence, 4 AA: Attend Early and Often, 4 Withdrawal May Trigger Alcoholic Pancreatitis Topiramate May Help People It is generally assumed that ethanol toxicity is symptoms before they consumed their With Alcohol Dependence to entirely responsible for alcoholic pancreatitis. last drink; 36 (43%) had developed symp- Quit Smoking, 5 However, withdrawal may also play a role toms on the first day they stopped drink- given that few patients hospitalized for pan- ing and the remainder developed symp- creatitis are intoxicated and that pancreatitis- toms later (usually the second or third ASSESSMENTS associated protein appears in the serum after day). drinking stops. To investigate this possibility, Finnish researchers studied 100 patients with a Comments: This study cannot answer The Validity of Biomarkers in first episode of acute alcoholic pancreatitis. whether direct toxicity or withdrawal from Detecting Alcohol Dependence, 5 alcohol causes pancreatitis because serum Do PCPs Use Lab Tests and the • Most patients had already stopped drink- alcohol levels were likely greater than zero in AUDIT to Screen for Unhealthy ing before they began to feel nausea or to most patients when symptoms developed. Alcohol Use?, 6 vomit (69 of 76 patients [91%] with nausea And perhaps patients chose to drink less as and vomiting) or to feel abdominal pain they became ill but before they recognized (54 of 79 [68%] with abdominal pain). specific pancreatitis symptoms. • Of 83 patients able to be assessed, only 24 (continued on page 2) (29%) had developed some pancreatitis Alcohol and Health: Current Evidence is a project of the Boston Medical Center, supported by the National Institute on Alcohol Abuse and Alcoholism, and produced in cooperation with the Boston University Schools of Medicine and Public Health. PAGE 2 Withdrawal May Trigger Alcoholic Pancreatitis (continued from page 1) Nonetheless, it is interesting that most patients Reference: Nordback I, et al. Is it long-term Editorial Board with acute pancreatitis stopped drinking before, continuous drinking or the post-drinking and not after, developing symptoms. This obser- withdrawal period that triggers the first Editor vation suggests that there may be a window of acute alcoholic pancreatitis? Scand J Richard Saitz, MD, MPH, FASAM, FACP time during which an episode of alcoholic pan- Gastroenterol. 2005;40(10):1235–1239. Professor of Medicine & Epidemiology creatitis can be predicted and perhaps pre- Associate Director, Youth Alcohol Prevention Center vented. Director, Clinical Addiction Research & Education Unit Richard Saitz, MD, MPH Section of General Internal Medicine Boston Medical Center Boston University Schools of Medicine & Public Health Alcohol Consumption and Lung Cancer: Are They Connected? Co-Editor Few studies have explored whether alcohol • There were no significant findings for R. Curtis Ellison, MD independently increases the risk of lung cancer women who never smoked. Professor of Medicine & Public Health or modifies the risk conferred by smoking. To Chief, Section of Preventive Medicine & Epidemiology examine these possibilities, researchers con- Comments: This study is notable for its Evans Department of Medicine ducted a pooled analysis of data from 7 pro- analysis of a large number of subjects. How- Director, Institute on Lifestyle & Health spective studies of diet and cancer. Of 399,767 ever, the diversity of cohorts examined and Boston University School of Medicine subjects, 3137 developed lung cancer. Analyses difficulty adjusting for smoking (since smok- were adjusted for potential confounders (e.g., ing is common in drinkers) make drawing smoking, education). clear conclusions challenging. Nonetheless, Associate Editors this study, like others, suggests a weak, posi- Joseph Conigliaro, MD, MPH, FACP • The risk of lung cancer was slightly greater tive association between consuming larger Director, Program for Quality, Safety and Patient Rights in subjects who consumed >=30 g of alco- amounts of alcohol (>2 drinks a day) and University of Kentucky Medical Center hol (approximately 2 drinks) per day than in lung cancer risk. Notably, the association those who abstained (pooled relative risk was limited in subgroup analyses to non- Peter D. Friedmann, MD, MPH [RR] 1.2; P for trend=0.03). smokers and relatively small amounts of Associate Professor of Medicine & Community Health • Among smokers, risk did not significantly alcohol, though these findings need to be Division of General Internal Medicine differ between those who drank and those replicated before they can be definitively Rhode Island Hospital who did not drink (e.g., RR 1.0 for men interpreted. Brown Medical School drinking 5 to <15 grams per day). R. Curtis Ellison, MD • However, among men who never smoked, Kevin L. Kraemer, MD, MSc those who drank had a significantly greater Reference: Freudenheim JL, et al. Alcohol Associate Professor of Medicine & Health Policy & risk of lung cancer than those who did not consumption and risk of lung cancer: a Management drink (RR 2.5 for 5 to <15 g per day; RR pooled analysis of cohort studies. Am J Clin Director, General Internal Medicine Fellowship Program 6.4 for >=15 g per day). Nutr. 2005;82(3):657–667. Division of General Internal Medicine University of Pittsburgh Schools of Medicine & Public Health Jeffrey H. Samet, MD, MA, MPH Alcohol Use Decreases Platelet Activation and Aggregation in Men Professor of Medicine & Public Health The lower risk of myocardial infarction in mod- women without cardiovascular disease who Chief, Section of General Internal Medicine erate drinkers may be partially due to alcohol’s were enrolled in a prospective study of Boston Medical Center positive effects on platelet activity and high- cardiovascular disease risk factors. They Boston University Schools of Medicine & Public Health density lipoprotein cholesterol. Large-scale stud- measured platelet activation (i.e., response ies examining these possibilities, however, have to adenosine diphosphate [ADP] ) in 1037 not included women and have not evaluated subjects and platelet aggregability (i.e., re- Managing Editor how alcohol consumption affects measures of sponses to ADP, epinephrine, and collagen) Rosanne T. Guerriero, MPH platelet function. in 2013 subjects. Analyses were adjusted Boston Medical Center for potential confounders (e.g., age, body Boston University Schools of Medicine & Public Health Investigators examined alcohol use, platelet mass index, smoking). activation, and platelet aggregability in men and (continued on page 3) Alcohol and Health: Current Evidence, Jan-Feb 2006 Alcohol Use Decreases Platelet Activation and Aggregation in Men (continued from page 2) PAGE 3 As alcohol consumption increased from 0 drinks to >=20 drinks Comments: Alcohol use appears to decrease platelet activa- per week, tion (in men) and aggregation (in both men and women). • platelet activation significantly decreased in men but not in These decreases may partially explain the possible protective women; effects of alcohol on cardiovascular events. • most measures of platelet aggregation significantly decreased Joseph Conigliaro,
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