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CORK Bibliography: Alcohol, Beneficial Effects

68 citations. January 2007 to present

Prepared: March 2010

Ammar KA; Samee S; Colligan R; Morse R; Faheem O; Shapiro M et al. Is self-reported "moderate" drinking in the cardiovascular benefit range associated with alcoholic behavior? A population based study. Journal of Addictive Diseases 28(3): 243-249, 2009. (19 refs.)

This article aims at identifying a threshold number of drinks per day beyond which there is a high risk of developing alcoholic behavior that would enable physicians to more confidently support the use of alcohol for cardiovascular risk prevention. In a randomly selected, population-based sample of 2,042 adults 45 years or older, we graded alcohol drinking behavior using the Self-Administered Alcoholism Screening Test, quantified alcohol amount by questionnaire, and assessed the prevalence of cardiovascular disease (coronary, peripheral, or cerebrovascular disease) by medical record review. Although optimal alcohol use (<= 2 drinks/day) was associated with reduced odds of cardiovascular disease, 43% of alcoholics and 82% of problem drinkers reported alcohol use in the optimal range as well. The association of alcohol use in the optimal range with alcohol-related behavioral problems supports the reluctance in physicians from recommending alcohol use for cardiovascular benefit, not withstanding the underreporting of alcohol use by alcoholics.

Austin GL; Galanko JA; Martin CF; Sandler RS. Moderate alcohol consumption protects against colorectal adenomas in smokers. Digestive Diseases and Sciences 53(1): 116-122, 2008. (27 refs.)

Background: Although some studies have shown an association between alcohol consumption and colorectal adenomas, the effect of moderate alcohol consumption is not well defined, nor is the interaction between alcohol and smoking. Aim: To investigate the relationship between different levels of alcohol consumption and colorectal adenomas and to determine whether smoking modifies this relationship. Methods Eligible patients who underwent a complete colonoscopy were included (179 cases and 466 controls). Alcohol consumption was obtained from a lifestyle questionnaire. Patients were divided into three groups: (1) Abstainers: 0 drinks/week; (2) Moderate drinkers: > 0 to < 7 drinks/week; (3) Heavy drinkers: > 7 drinks/week. Odds ratios (OR) were calculated using logistic regression, controlling for gender, age, body mass index, use of non-steroidal anti-inflammatory medications. Results were stratified by the number of years smoked. Results: The proportion of patients with adenomas was 29.6% in abstainers, 22.1% in moderate drinkers, and 36.7% in heavy drinkers. The relationship between alcohol consumption and colorectal adenomas varied significantly by smoking history. For individuals who had never smoked, heavy drinkers were at significantly increased odds of having an adenoma compared to moderate drinkers (OR 3.08; 95% CI: 1.50-6.32), while no difference was seen for abstainers (OR 0.99; 95% CI: 0.52-1.89). Similarly, among individuals who had smoked 1-14 years, heavy drinkers were at increased odds of having an adenoma compared to moderate drinkers (OR 2.61; 95% CI: 1.04-6.51), and no difference was seen for abstainers (OR 1.02; 95% CI: 0.33-3.10). Somewhat unexpectedly, among individuals who had smoked for 15 or more years, abstainers were at increased odds of having an adenoma compared to moderate drinkers (OR 2.04; 95% CI: 0.91-4.59), while heavy drinkers were not at increased odds of having an adenoma (OR 0.73; 95% CI: 0.27-1.97). Conclusions: Consumption of less than seven alcohol drinks per week does not increase the risk of having a colorectal adenoma. We found evidence in this study that moderate alcohol consumption among long-term smokers may potentially decrease the risk of an adenoma compared to abstainers.

Bau PFD; Bau CHD; Rosito GA; Manfroi WC; Fuchs FD. Alcohol consumption, cardiovascular health, and endothelial function markers. (review). Alcohol 41(7): 479-488, 2007. (108 refs.)

Cardiovascular diseases are among the worldwide leading causes of shorter life expectancy and loss of quality of life. Thus, any influence of diet or life habits on the cardiovascular system may have important implications for public health. Most world populations consume alcoholic beverages. Since alcohol may have both protective and harmful effects on cardiovascular health, the identification of biochemical mechanisms that could explain such paradoxical effects is warranted. The vascular endothelium is the target of important mediating pathways of differential ethanol concentrations, such as oxidative stress, lipoproteins, and insulin resistance. Alcohol-induced endothelial damage or protection may be related to the synthesis or action of several markers, such as nitric oxide, cortisol, endothelin-1, adhesion molecules, tumor necrosis factor alpha, interleukin-6, C-reactive protein, and haemostatic factors. The expression of these markers is consistent with the J-shaped curve between alcohol consumption and cardiovascular health. However, there is genetic and phenotypic heterogeneity in alcohol response, and despite the apparent beneficial biochemical effects of low doses of ethanol, there is not enough clinical and epidemiological evidence to allow the recommendation to consume alcoholic beverages for abstemious individuals. Considering the potential for addiction of alcoholic beverage consumption and other negative consequences of alcohol, it would be worthwhile to identify substances able to mimic the beneficial effects of low doses of ethanol without its adverse effects.

Bertelli AAA; Das DK. Grapes, wines, resveratrol, and heart health. (review). Journal of Cardiovascular Pharmacology 54(6): 468-476, 2009. (70 refs.)

Epidemiological and experimental studies have revealed that a mild to moderate drinking of wine, particularly red wine, attenuates the cardiovascular, cerebrovascular, and peripheral vascular risk. However, the experimental basis for such health benefits is not fully understood. The cardioprotective effect of wine has been attributed to both components of wine: the alcoholic portion and, more importantly, the alcohol-free portion containing antioxidants. Wines are manufactured from grapes, which also contain a large variety of antioxidants, including resveratrol, catechin, epicatechin, and proanthocyanidins. Resveratrol is mainly found in the grape skin, whereas proanthocyanidins are found only in the seeds. Recent studies have demonstrated that resveratrol and proanthocyanidin are the major compounds present in grapes and wines responsible for cardioprotection. The purpose of this review is to provide evidence that grapes, wines, and resveratrol are equally important in reducing the risk of morbidity and mortality due to cardiovascular complications. Both wines and grapes can attenuate cardiac diseases such as atherosclerosis and ischemic heart disease. Recently, wine was also found to increase life span by inducing longevity genes. It appears that resveratrol and proanthocyanidins, especially resveratrol, present in grapes and wines play a crucial role in cardioprotective abilities of grapes and wines.

Brown L; Kroon PA; Das DK; Das S; Tosaki A; Chan V et al. The biological responses to resveratrol and other polyphenols from alcoholic beverages. Alcoholism: Clinical and Experimental Research 33(9): 1513-1523, 2009. (119 refs.)

Although excessive consumption of ethanol in alcoholic beverages causes multi-organ damage, moderate consumption, particularly of red wine, is protective against all-cause mortality. These protective effects could be due to one or many components of the complex mixture of bioactive compounds present in red wine including flavonols, monomeric and polymeric flavan-3-ols, highly colored anthocyanins as well as phenolic acids and the stilbene polyphenol, resveratrol. The therapeutic potential of resveratrol, firstly in cancer chemoprevention and then later for cardioprotection, has stimulated many studies on the possible mechanisms of action. Further indications for resveratrol have been developed, including the prevention of age-related disorders such as neurodegenerative diseases, inflammation, diabetes, and cardiovascular disease. These improvements are remarkably similar yet there is an important dichotomy: low doses improve cell survival as in cardio- and neuro-protection yet high doses increase cell death as in cancer treatment. Fewer studies have examined the responses to other components of red wine, but the results have, in general, been similar to resveratrol. If the nonalcoholic constitutents of red wine are to become therapeutic agents, their ability to get to the sites of action needs to be understood. This mini-review summarizes recent studies on the possible mechanisms of action, potential therapeutic uses, and bioavailability of the nonalcoholic constituents of alcoholic beverages, in particular resveratrol and other polyphenols.

Carels RA; Young KM; Coit C; Clayton AM; Spencer A; Wagner M. Skipping meals and alcohol consumption: The regulation of energy intake and expenditure among weight loss participants. Appetite 51(3): 538-545, 2008. (32 refs.)

Research suggests that specific eating patterns (e.g., eating breakfast) may be related to favorable weight status. This investigation examined the relationship between eating patterns (i.e., skipping meals; consuming alcohol) and weight loss treatment Outcomes (weight loss, energy intake, energy expenditure, and duration of exercise). Fifty-four overweight or obese adults (BMI >= 27 kg/m(2)) participated in a self-help or therapist-assisted weight loss program. Daily energy intake from breakfast, lunch. dinner, and alcoholic beverages, total daily energy intake, total daily energy expenditure, physical activity, and weekly weight loss were assessed. On days that breakfast or dinner was skipped, or alcoholic beverages were not consumed, less total daily energy was consumed compared to days that breakfast, dinner, or alcoholic beverages were consumed. On days that breakfast or alcohol was consumed, daily energy expenditure (breakfast only) and duration of exercise were higher compared to days that breakfast or alcohol was not consumed. Individuals who skipped dinner or lunch more often had lower energy expenditure and exercise duration than individuals who skipped dinner or lunch less often. Individuals who consumed alcohol more often had high daily energy expenditure than individuals who consumed alcohol less often. Skipping meals or consuming alcoholic beverages was not associated with weekly weight loss. In this investigation, weight loss program participants may have compensated for excess energy intake from alcoholic beverages and meals with greater daily energy expenditure and longer exercise duration.

Chikritzhs T; Fillmore K; Stockwell T. A healthy dose of scepticism: Four good reasons to think again about protective effects of alcohol on coronary heart disease. (editorial). Drug and Alcohol Review 28(4): 441-444, 2009. (16 refs.)

Issues. Alcohol has been implicated in both the popular press and scientific literature as having a protective effect for at least a dozen conditions including coronary heart disease (CHD). Approach. Epidemiological evidence for an apparent protective effect of alcohol on CHD is now being challenged on a number of fronts. This paper is a synopsis of those various challenges as they currently stand. Key Findings. The argument that systematic misclassification of ex-drinkers and occasional drinkers to 'abstainer' categories among epidemiological studies might explain apparent protective effects of moderate alcohol consumption on CHD has recently been supported by new meta-analyses and independent research. The influence of uncontrolled or unknown factors on the relationship between alcohol and disease cannot be ruled out. Exclusion of participants on the basis of ill-health severely reduces study sample size and new analyses suggest that doing so might artificially create the appearance of protective effects. The ability of respondents to accurately recall their own alcohol consumption is in serious doubt and very few individuals maintain one single drinking level or style throughout life. The relationship between alcohol and some conditions might be a function of drinking patterns but few studies have addressed the issue. Implications. Popular perceptions regarding the strength of evidence for alcohol's protective effect on a growing number of conditions might be misguided. Conclusion. It is time for the wider research, health and medical community to seriously reflect on the quality of current evidence for apparent protective effects of alcohol on human disease.

Chikritzhs T; Fillmore KM; Stockwell T. Response to Dr Kari Pikolainen: The persistent, alternative argument to apparent cardioprotective effects of alcohol. Addiction 103(5): 855-856, 2008. (10 refs.)

Corbin WR; Morean ME; Benedict D. The Positive Drinking Consequences Questionnaire (PDCQ): Validation of a new assessment tool. Addictive Behaviors 33(1): 54-68, 2008. (44 refs.)

Expected and experienced negative consequences and expected positive consequences of alcohol use have been widely studied, while little attention has been given to experienced positive drinking consequences. Although existing studies suggest that positive consequences may be important [Park, C.L. (2004). Positive and negative consequences of alcohol consumption in college students. Addictive Behaviors, 29, 311-321.; Park, C.L. & Grant, C. (2005). Determinants of positive and negative consequences of alcohol consumption in college students: Alcohol use, gender, and psychological characteristics. Addictive Behaviors, 30, 755-765.], it is not clear if they are distinct from expected positive outcomes or uniquely associated with drinking behavior. The primary goal of the current study was to develop a measure that directly assessed specific, real life drinking consequences rather than relying on general past tense derivations ("I forgot my worries") of expectancy items. Such a measure is necessary to determine whether or not positive consequences are distinct from positive expectancies and to assess the unique contribution of positive drinking consequences to drinking behavior. Participants were 423 undergraduate students who completed an online survey; 277 drinkers (56.5% women) completed all data necessary for analyses. Principal components analysis of the Positive Drinking Consequences Questionnaire (PDCQ) identified a single-factor structure with good internal and split-half reliability. The PDCQ also demonstrated discriminant validity relative to a positive expectancy measure and incremental validity in relation to drinking behavior. Although additional studies with heavier drinking populations are needed, the PDCQ may ultimately serve as a valuable research and clinical assessment tool.

De La Zerda DJ; Cohen O; Beygui RE; Kobashigawa J; Hekmat D; Laks H. Alcohol use in donors is a protective factor on recipients' outcome after heart transplantation. Transplantation 83(9): 1214-1218, 2007. (15 refs.)

Objective. The outcome of heart transplantation is highly influenced by good donor selection. Because a history of alcoholism is prevalent among potential heart donors, we sought to explore the effect of alcohol use in donors on the outcome of heart transplantation in the recipient. Method. A total of 437 consecutive patients underwent heart transplantation from January 2002 through September 2005. Patients' files were retrospectively studied. Mean follow-up period was 3.14-+/- 1.9 years (range, 3 days to 6.5 yrs). The cohort was divided into two subgroups. The alcoholic donor group (ADG) included 98 of 421 patients and the nonalcoholic donor group (NADG) included 323 of 421 patients. Mean age was 35.3 +/- 11.4 yrs (range, 18-66) for the ADG and 33 +/- 12.2 yrs (range, 18-62) for the NADG. Results. Mortality among the ADG was 7 of 98 (7.1%) and for NADG was 55 of 323 (17.1%) (P=0.015). The mean interval time between transplant and mortality was, for ADG, 27.7 +/- 20.6 months (range, 0.07-51) and for NADG, 16.4 +/- 19.6 months (range, 0.14-73) (P=0.031). Survival rate was significantly higher among the ADG at 72.8 +/- 1.9 months compared with NADG at 66.2 +/- 1.5 months (P=0.019). Overall rejection rate was 22 of 421 (5.2%); rejection rate was 17 of 323 (5.2%) in NADG and 5 of 98 (5.1%) in ADG. Rejection free survival was 74.6 +/- 0.85 with no significant difference between the two groups (P=0.85). Conclusion. The chronic alcoholism of donors was found to be a protective factor regarding the outcome after heart transplantation. Significant differences were found in mortality rate and survival after heart transplantation between the ADG and NADG. These data support the fact that it is safe to use donors' hearts regardless of a history of alcoholism.

de Lange DW; Verhoef S; Gorter G; Kraaijenhagen RJ; van de Wiel A; Akkerman JWN. Polyphenolic grape extract inhibits platelet activation through PECAM-1: An explanation for the French paradox. Alcoholism: Clinical and Experimental Research 31(8): 1308-1314, 2007. (42 refs.)

Background: Moderate and prolonged consumption of red wine is associated with decreased cardiovascular morbidity and mortality. Inhibition of platelet functions by ingredients in red wine is thought to be one of the causes. However, the molecular mechanism of this inhibition has remained unexplained. Materials and Methods: We measured aggregation, changes in cytosolic Ca2+ and tyrosine phosphorylation of the inhibitory receptor platelet endothelial cell adhesion molecule-1 (PECAM-1) in platelets stimulated with thrombin receptor (PAR-1) activating peptide (TRAP) and ADP and investigated the effects of alcohol-free polyphenolic grape extract (PGE), alcohol, and the polyphenols catechin, epi-catechin, resveratrol, trans-resveratrol, and gallic acid. Results: Polyphenolic grape extract induced dose-dependent inhibition of TRAP-induced and ADP-induced platelet aggregation and Ca2+ mobilization. Inhibition was accompanied by activation of PECAM-1. Apart from a slight inhibition by catechin, ethanol or other individual polyphenols failed to inhibit aggregation or activate PECAM-1. Conclusions: Red wine inhibits platelet functions through its PGE content, which stimulates the inhibitory receptor PECAM-1, thereby attenuating platelet activation.

de Lorgeril M; Salen P; Martin JL; Boucher F; de Leiris J. Interactions of wine drinking with omega-3 fatty acids in patients with coronary heart disease: A fish-like effect of moderate wine drinking. American Heart Journal 155(1): 175-181, 2008. (27 refs.)

Background: Moderate alcohol drinking and marine omega-3 fatty acids (omega 3) have both been associated with low mortality from coronary heart disease (CHD). However, there is little data evaluating the interactions of wine ethanol drinking with omega 3 in CHD patients. Methods The relationships between wine drinking and marine omega 3 were evaluated in a cross-sectional study in patients with CHD participating in a randomized trial testing the effect of a high alpha-linolenic acid (ALA, the main plant omega 3) diet. Daily ethanol intake was calculated as energy and expressed as a percentage of total energy. Plant and marine omega 3 in the diet were carefully evaluated in each patient in both groups. Results: Patients were classified according to their habitual consumption of ethanol. Patients in the "high ALA group" and controls ("low ALA group") were analyzed separately. Within each group, there was a progressive increase in marine omega 3 levels with increased alcohol intake, with a level of eicosapentanoic acid (EPA) that increased by 50% (P < .005) and 37% (P < .05) in the low and high ALA groups, respectively. After controlling for potential confounders (including dietary EPA) in a multivariate linear model, the association between wine ethanol and EPA remained significant in the low (P < .001) and high (P < .05) ALA groups. Conclusion: In these patients with CHD, moderate wine drinking was associated with higher marine omega 3 concentrations than no alcohol use. Although the data have to be confirmed in large groups, this effect of wine comparable to that of fish may partly explain the protective effects of wine drinking against CHD.

Djousse L; Gaziano JM. Alcohol consumption and heart failure in hypertensive US male physicians. American Journal of Cardiology 102(5): 593-597, 2008. (28 refs.)

Although alcohol drinking increases blood pressure and heavy drinking has been associated with alcoholic cardiomyopathy, little is known about the association between light to moderate drinking and risk of heart failure (HF) in hypertensive subjects. Thus, the association between light to moderate drinking and incident HF in 5,153 hypertensive male physicians who were free of stroke, myocardial infarction, or major cancers at baseline was prospectively examined. Alcohol consumption was self-reported and classified as < 1, 1 to 4, 5 to 7, and >= 8 drinks/week. HF was ascertained using follow-up questionnaires and validated using Framingham criteria. Average age was 58 years, and about 70% of subjects consumed 1 to 7 drinks/week. A total of 478 incident HF cases occurred in this cohort during follow-up. Compared with subjects consuming < 1 drink/week, hazard ratios for HF were 0.89 (95% confidence interval [CI] 0.70 to 1.12), 0.72 (95% CI 0.57 to 0.91), and 0.38 (95% CI 0.20 to 0.72) for alcohol consumption of 1 to 4, 5 to 7, and >= 8 drinks/week after adjustment for age, body mass index, smoking, randomization group, use of multivitamins, vegetable consumption, breakfast cereal, exercise, and history of atrial fibrillation, respectively (p for trend < 0.001). Similar results were obtained for subjects with HF with and without antecedent myocardial infarction and those without diabetes mellitus. In conclusion, our data suggested that light to moderate alcohol consumption was associated with a lower risk of HF in hypertensive male physicians.

Djousse L; Gaziano JM. Alcohol consumption and risk of heart failure in the Physicians' Health Study I. Circulation 115(1): 34-39, 2007. (31 refs.)

Background - Heart failure is the leading cause of hospitalization among the elderly, and 1 in 5 adults aged 40 years will develop heart failure in their lifetime. Data on the effects of moderate alcohol consumption on the risk of heart failure have been sparse and inconsistent. This study sought to evaluate the association between moderate alcohol consumption and incident heart failure. Methods and Results - A total of 21,601 participants of the Physicians' Health Study I who were free of heart failure and provided data on alcohol intake at baseline were prospectively followed up from 1982 to 2005. Incident heart failure cases were ascertained through annual follow-up questionnaires and validated with the use of Framingham criteria. During an average follow-up of 18.4 years, 904 incident cases of heart failure occurred. The crude incidence rates of heart failure were 25.0, 20.0, 24.3, and 20.6 cases per 10,000 person-years for alcohol categories of < 1, 1 to 4, 5 to 7, and > 7 drinks per week, respectively. Corresponding hazard ratios ( 95% CI) were 1.0 (reference), 0.90 (0.76 to 1.07), 0.84 (0.71 to 0.99), and 0.62 (0.41 to 0.96), respectively, with P for trend = 0.012 adjusted for age, body mass index, smoking, and history of valvular heart disease. There was no evidence for a strong association between moderate alcohol consumption and heart failure without antecedent coronary artery disease. Conclusions: Although heavy drinking should be discouraged, our data indicate that moderate drinking may lower the risk of heart failure. The lack of an association between moderate alcohol intake and heart failure without antecedent coronary artery disease suggests that possible benefits of moderate drinking on heart failure may be mediated through beneficial effects of alcohol on coronary artery disease.

Djousse L; Lee IM; Buring JE; Gaziano JM. Alcohol consumption and risk of cardiovascular disease and death in women: Potential mediating mechanisms. Circulation 120(3): 237-244, 2009. (48 refs.)

Background-Although an association between moderate alcohol consumption and decreased cardiovascular disease (CVD) and death has been reported, limited data are available on potential mediating mechanisms. We examined the association between alcohol and CVD and death in 26 399 women and estimated the proportion of reduced risk of CVD/death explained by a series of intermediate factors. Methods and Results-Alcohol consumption was self-reported at baseline, and CVD events and deaths were ascertained via follow-up questionnaires and medical records. Baseline levels of hemoglobin A1c, inflammatory markers, hemostatic factors, and lipids were measured. Blood pressure and hypercholesterolemia and treatment for lipids were self-reported. During a mean follow up of 12.2 years, 1039 CVD events and 785 deaths (153 CVD deaths) occurred. There was a J-shaped relation between alcohol consumption and incident CVD and total and CVD deaths in a multivariable model. Compared with abstainers, alcohol intake of 5 to 14.9 g/d was associated with 26%, 35%, and 51% lower risk of CVD, total death, and CVD death, respectively, in a multivariable model. For CVD risk reduction, lipids made the largest contribution to the lower risk of CVD (28.7%), followed by hemoglobin A1c/diabetes (25.3%), inflammatory/hemostatic factors (5%), and blood pressure factors (4.6%). All these mediating factors together explained 86.3%, 18.7%, and 21.8% of the observed lower risk of CVD, total death, and CVD death, respectively. Conclusions-These data suggest that alcohol effects on lipids and insulin sensitivity may account for a large proportion of the lower risk of CVD/death observed with moderate drinking under the assumption that the alcohol-CVD association is causal.

Evans A; Marques-Vidal P; Ducimetiere P; Montaye M; Arveiler D; Bingham A et al. Patterns of alcohol consumption and cardiovascular risk in northern Ireland and France. Annals of Epidemiology 17(5, Supplement S): S75-S80, 2007. (27 refs.)

The PRIME Study was begun in 1991 and recruited 10,600 men aged 50 to 59 years in the WHO MONICA Project centers of Belfast, Lille, Strasbourg and Toulouse. Although drinkers in France and Northern Ireland consumed almost identical amounts, the pattern of consumption was different. In Northern Ireland beer and spirits were the staple beverages, whereas in France it was predominantly red wine; in France, 90% of men drank at least one unit per week versus 61% in Northern Ireland. Frenchmen drank evenly throughout the week, whereas in Northern Ireland two thirds of the consumption took place on Friday and Saturday nights. In the 5-year follow up of PRIME in France, the usual cardiovascular protective effect of increasing consumption (up to 45 units per week) was shown and the level of significance for trend in consumption was highly significant (p = 0.006); in Northern Ireland, this pattern was less consistent and did not attain significance. It remains a matter of conjecture whether in Northern Ireland the beneficial effects of alcohol consumption were annulled by a pattern of drinking that increases blood pressure, a well-established risk factor for heart disease, or whether the protection in France resulted from the consumption of wine along with food.

Ferreira MP; Weems MKS. Alcohol consumption by aging adults in the United States: Health benefits and detriments. (review). Journal of the American Dietetic Association 108(10): 1668-1676, 2008. (107 refs.)

The most rapidly growing segment of the US population is that of older adults (>= 65 years). Trends of aging adults (those aged >= 50 years) show that fewer women than men consume alcohol, women consume less alcohol than men, and total alcohol intake decreases after retirement. A U- or J-shaped relationship between alcohol intake and mortality exists among middle-aged (age 45 to 65 years) and older adults. Thus, alcohol can be considered either a tonic or a toxin in dose-dependent fashion. Active areas of research regarding the possible benefits of moderate alcohol consumption among aging individuals include oxidative stress, dementia, psychosocial functioning, dietary contributions, and disease prevention. Yet, due to the rising absolute number of older adults, there may be a silent epidemic of alcohol abuse in this group. Dietary effects of moderate and excessive alcohol consumption are reviewed along with mechanisms by which alcohol or phytochemicals modify physiology, mortality, and disease burden. Alcohol pharmacokinetics is considered alongside age-related sensitivities to alcohol, drug interactions, and disease-related physiological changes. International guidelines for alcohol consumption are reviewed and reveal that many nations lack guidelines specific to older adults. A review of national guidelines for alcohol consumption specific to older adults (eg, those offered by the National Institute on Alcohol Abuse) suggests that they may be too restrictive, given the current literature. There is need for greater quantification and qualification of per capita consumption, consumption patterns (quantity, frequency, and stratified combinations), and types of alcohol consumed by older adults in the United States.

Foerster M; Marques-Vidal P; Gmel G; Daeppen JB; Cornuz J; Hayoz D et al. Alcohol drinking and cardiovascular risk in a population with high mean alcohol consumption. American Journal of Cardiology 103(3): 361-368, 2009. (30 refs.)

Moderate alcohol consumption has been associated with lower coronary artery disease (CAD) risk. However, data on the CAD risk associated with high alcohol consumption are conflicting. The aim of this study was to examine the impact of heavier drinking on 10-year CAD risk in a population with high mean alcohol consumption. In a population-based study of 5,769 adults (aged 35 to 75 years) without cardiovascular disease in Switzerland, 1-week alcohol consumption was categorized as 0, 1 to 6, 7 to 13, 14 to 20, 21 to 27, 28 to 34, and >= 35 drinks/week or as nondrinkers. (0 drinks/week), moderate (1 to 13 drinks/week), high (14 to 34 drinks/week), and very high (>= 35 drinks/week). Blood pressure and lipids were measured, and 10-year CAD risk was calculated according to the Framingham risk score. Seventy-three percent (n = 4,214) of the participants consumed alcohol; 16% (n = 909) were high drinkers and 2% (n = 119) very high drinkers. In multivariate analysis, increasing alcohol consumption was associated with higher high-density lipoprotein cholesterol (from a mean +/- SE of 1.57 +/- 0.01 mmol/L in nondrinkers to 1.88 +/- 0.03 mmo/L in very high drinkers); triglycerides (1.17 +/- 1.01 to 1.32 +/- 1.05 mmol/L), and systolic and diastolic blood pressure (127.4 +/- 0.4 to 132.2 +/- 1.4 mm Hg and 78.7 +/- 0.3 to 81.7 +/- 0.9 mm Hg, respectively) (all p values for trend <0.001). Ten-year CAD risk increased from 4.31 +/- 0.10% to 4.90 +/- 0.37% (p = 0.03) with alcohol use, with a J-shaped relation. Increasing wine consumption was more related to high-density lipoprotein cholesterol levels, whereas beer and spirits were related to increased triglyceride levels. In conclusion, as measured by 10-year CAD risk, the protective effect of alcohol consumption disappears in very high drinkers, because the beneficial increase in high-density lipoprotein cholesterol is offset by the increases in blood pressure levels.

French MT; Zavala SK. The health benefits of moderate drinking revisited: Alcohol use and self-reported health status. American Journal of Health Promotion 21(6): 484-491, 2007. (60 refs.)

Purpose. To examine the association between alcohol use and self-reported health status. In particular, we sought to determine whether moderate drinkers are more likely to self-report above-average health status compared with other current drinkers, former drinkers, and lifetime abstainers. Design. Cross-sectional survey. Setting. Continental United States. Subjects. The sample adult conponent of the 2002 U.S. National Health Interview Survey (n = 31,044), representative of the U.S. noninstitutionalized civilian household population. Measures. Dichotomous measure of above average self-reported health status relative to all other health states. Several measures characterized alcohol use patterns (i.e., continuous and categorical measure of alcohol use, a proxy measure of problem drinking, former drinking, lifetime abstaining). Chronic health conditions and various demographic and lifestyle factors were included as covariates in all regression models. Results. For both men and women, current moderate drinkers had the highest odds (OR = 1.27 for men, p < .01; OR = 2.03, p < .01 of reporting above-average health status compared with other current drinkers, former drinkers, and lifetime abstainers. The odds dropped to 1.12 and 1.34, respectively, when all past-year drinkers were collapsed into a single group. Conclusion. Moderate alcohol consumption was associated with the highest odds of reporting above-average health status, even after controlling for chronic health conditions and demographic and lifestyle factors associated with health.

Fuchs FD; Chambless LE. Is the cardioprotective effect of alcohol real? (review). Alcohol 41(6): 399-402, 2007. (43 refs.)

A large number of investigations in experimental, clinical, and epidemiological settings have given support to the idea that consumption of moderate amounts of alcoholic beverages, particularly wine, protects against coronary heart disease (CHD). Biological effects of other components of wine in human beings, however, have been hardly demonstrated, and alcohol itself has several potential adverse effects on the cardiovascular system. Not all epidemiological surveys have found protection from alcoholic beverages and in African-Americans, alcohol consumption was a risk factor for the incidence of CHD. The possibility that the lower risk of drinkers of moderate amounts of wine or other beverages is secondary to a health cohort effect in whites is not negligible, and could be discarded only in a clinical trial. In view of the potential risks of alcohol, a more cautious view about the beneficial effects of alcoholic beverages is warranted.

Gronbaek M. Confounders of the relation between type of alcohol and cardiovascular disease. Annals of Epidemiology 17(5, Supplement S): S13-S15, 2007. (20 refs.)

There have been numerous reports from epidemiologic studies showing that moderate drinkers have lower rates of cardiovascular disease (CVD) than do those who drink heavily or not at all. A number of scientific reports from scientists around the world suggest confounding may play a role in the reported beneficial health effects associated with moderate drinking. Among potentially confounding variables for these reported associations are the frequency of alcohol consumption, drinking pattern (steady or binge drinking), type of beverage, and differences in the pattern of drinking associated with different types of beverages. In some papers, individuals who report primarily wine consumption have been shown to be at lower risk of CVD and total mortality, and there is evidence for greater beneficial effects from more frequent, regular drinking. However, other potential confounders include better cognitive function, higher socioeconomic status, better subjective health, and a healthier diet, including food purchases, all of which are more common in regular drinkers and wine drinkers. Thus, the question of whether the beneficial effects of beverage types differ, with additional benefits for wine, remains unresolved.

Harding R; Stockley CS. Communicating through government agencies. Annals of Epidemiology 17(5, Supplement S): S98-S102, 2007. (38 refs.)

A comparison of worldwide recommendations on alcohol consumption reveals wide disparity among countries. This could imply that many of the recommendations do not adequately accommodate the science, given that the science is equally valid worldwide. Such a view, however, would be an oversimplification of the problem that those who formulate such guidelines face. The objective of guidelines is to influence and change behavior among target populations. It follows, therefore, that several factors then become relevant: behavior that is thought to be in need of change, the culture and mindset of the target populations, and the kind of message that is likely to be effective. There are some tensions between advice intended only to reduce the prevalence of misuse and that which also seeks to reflect the evidence on the beneficial health effects of moderate consumption.

Harriss LR; English DR; Hopper JL; Powles J; Simpson JA; O'Dea K et al. Alcohol consumption and cardiovascular mortality accounting for possible misclassification of intake: II-year follow-up of the Melbourne Collaborative Cohort Study. Addiction 102(10): 1574-1585, 2007. (34 refs.)

Aims: To investigate the relationship between usual daily alcohol intake, beverage type and drinking frequency on cardiovascular (CVD) and coronary heart disease (CHD) mortality, accounting for systematic misclassification of intake. Design Prospective cohort study with mean follow-up of 11.4 years. Setting The Melbourne Collaborative Cohort Study, Australia. Participants A total of 38 200 volunteers (23 044 women) aged 40-69 years at baseline (1990-1994). Measurements Self-reported alcohol intake using beverage-specific quantity-frequency questions (usual intake) and drinking diary for previous week. Findings: Compared with life-time abstention, usual daily alcohol intake was associated with lower CVD and CHD mortality risk for women but not men. For women, the hazard ratio [HR (95% CI)] for CVD for those drinking > 20 g/day alcohol was 0.43 (0.19-0.95; P trend = 0.18), and for CHD, 0.19 (0.05-0.82; P trend = 0.24). Male former drinkers had over twice the mortality risk for CVD [HR = 2.58 (1.51-4.41)] and CHD [HR = 2.91 (1.59-5.33)]. Wine was the only beverage associated inversely with mortality for women. Compared with drinkers who consumed no alcohol in the week before baseline, drinking frequency was associated inversely with CVD and CHD mortality risk for men but not women. HR for men drinking 6-7 days/week was 0.49 (0.29-0.81; P trend = 0.02) for CVD, and 0.49 (0.26-0.92: P trend = 0.23) for CHD. Conclusions: Usual daily alcohol intake was associated with reduced CVD and CHD mortality for women but not men. This benefit appeared to be mainly from wine, although comparison of beverages was not possible. Drinking frequency was associated inversely with CVD and CHD death for men but not women.

Heath DB. Why we don't know more about the social benefits of moderate drinking. Annals of Epidemiology 17(5, Supplement S): S71-S74, 2007. (23 refs.)

The scientific literature about drinking shows that a preoccupation with the harms that occasionally befall those who drink too much or too fast is coupled with a virtual ignorance (in both senses of that term) about the benefits that more often accrue to the vast majority who are moderate drinkers. It is ironic that reviews of the subject that appear under the World Health Organization (WHO) imprint have paid almost no attention to two thirds of WHO's definition of health: "...mental and social well-being...," while focusing overwhelmingly on the physical aspects. This imbalance is so striking that in a recent WHO-affiliated publication the authors suggested that social consequences may be "the forgotten dimension." This, despite the fact that drinking plays very important roles in many societies with respect to such widely recognized and appreciated benefits as celebration, relaxation, sociability, enhancement of food, concretization of the social order, and time out, in addition to medical and therapeutic benefits. The time is ripe for increasing collaboration to investigate such social benefits in ways that would be of greater interest and of use to those who heretofore have neglected them.

Hendriks HFJ. Moderate alcohol consumption and insulin sensitivity: Observations and possible mechanisms. Annals of Epidemiology 17(5, Supplement S): S40-S42, 2007. (13 refs.)

Light to moderate alcohol consumption is associated with a reduced risk for cardiovascular diseases. Epidemiologic studies, like our analysis of the European Prospective Investigation into Cancer and Nutrition study, suggest that moderate alcohol consumption is also associated with a reduced risk of type 2 diabetes, reported for various populations. This risk reduction may be explained by an increase in insulin sensitivity after moderate alcohol consumption. Indeed, a positive association between alcohol consumption and insulin sensitivity is consistently reported in cross-sectional studies. Mechanisms for the effect of alcohol on insulin sensitivity may include modulation of changes in the endocrine functioning of fat tissue, modulation of the inflammatory status of several organs, and/or modulation of glucose and fatty acid metabolism.

Hijmering ML; de Lange DW; Lorsheyd A; Kraaijenhagen RJ; de Wiel AV. Binge drinking causes endothelial dysfunction, which is not prevented by wine polyphenols: a small trial in healthy volunteers. Netherlands Journal of Medicine 65(1): 29-35, 2007. (27 refs.)

Background: Binge drinking (the consumption of large quantities (> 5 units) of alcohol in a short period) is associated with increased cardiovascular mortality. Wine polyphenols are considered to be protective against cardiovascular diseases. We conducted an experimental study to evaluate the acute effects of alcohol consumption on flow-mediated vasodilation and general cardiovascular parameters, using beverages with high polyphenolic content (HPC) and low polyphenolic content (LPC). Methods: Two groups of ten volunteers were asked to drink two different kinds of beverages. In 45 minutes, three units of red wine or an alcoholic beverage with a low polyphenolic count were consumed. Then 45 minutes were allowed for complete uptake of the alcohol or polyphenolic compounds. Next, all volunteers underwent blood pressure readings, ECG and flow-mediated vasodilation. Blood samples were taken at the same time for routine chemistry, inflammation parameters and lipids. Then the entire cycle was repeated once (in total six units of alcohol in 180 minutes). Results: No differences were found between the two drinks. Alcohol itself dose-dependently increased forearm blood flow by vasodilation of both arterioles and distribution arteries. However, flow-mediated vasodilation (FMD) for the LPC group (n=10) decreased from 7-31 +/- 4-78 (% +/- SD) to 2.82 +/- 2.9 after three drinks and 1.21 +/- 3.25 after six drinks. The FMD values for the HPC group (n=10) decreased from 8.61 +/- 1.78 to 1.78 +/- 3.71 and 1.19 +/- 2.6. There were no significant changes between the LPC and the HPC group at the three time points. Conclusion: Although ethanol produces vasodilation at the level of the distribution artery as well as at an arteriolar level, it causes a decrease in flow-mediated vasodilation. This endothelial dysfunction is not corrected by the polyphenols present in wine.

Hosono S; Matsuo K; Kajiyama H; Hirose K; Suzuki T; Hiraki A et al. Reduced risk of endometrial cancer from alcohol drinking in Japanese. Cancer Science 99(6): 1195-1201, 2008. (38 refs.)

The role of alcohol consumption in the etiology of endometrial cancer has not been clarified. To examine the association between alcohol consumption and endometrial cancer risk, we conducted a case-control study with 148 histologically diagnosed incident endometrial cancer cases and 1468 matched non-cancer controls. Median consumption of alcohol was only 19.3 g/week among cases who drank and 28.2 g/week among controls who drank. These values are lower than in Western countries. Relative risk was analyzed in subjects classified into four groups according to weekly alcohol consumption (non-drinkers, 1-24 g/week, 25-175 g/week, and > 175 g/week). Confounder-adjusted odds ratios for those consuming alcohol at < 25 g/week, 25-175 g/week, and > 175 g/week compared to non-drinkers were 0.79 (95% confidence interval (CI), 0.49-1.28), 0.42 (95% CI, 0.23-0.79), and 0.47 (95% CI, 0.14-1.58), respectively. Further analysis was conducted concerning self-reported physical reaction to alcohol. Among women without flushing after drinking, a significant inverse association between risk and alcohol intake was seen (trend P = 0.001). In contrast, no protective effect of alcohol was seen among women who experience flushing after drinking. These results suggest the presence of an inverse association between alcohol drinking and endometrial cancer risk among Japanese women, and that this association is evident among those without flushing. Further investigation of these findings is warranted.

Hu JF; Chen Y; Mao Y; DesMeules M; Mery L. Alcohol drinking and renal cell carcinoma in Canadian men and women. Cancer Detection and Prevention 32(1): 7-14, 2008. (56 refs.)

Background: Epidemiologic studies have reported that moderate alcohol consumption is inversely associated with the risk of renal cell carcinoma (RCC), but sex-specific results are inconsistent. The present study examines the association between alcohol intake and the risk of RCC among men and women. Methods: Mailed questionnaires were completed by 1138 newly diagnosed, histologically confirmed RCC cases and 5039 population controls between 1994 and 1997 in eight Canadian provinces. A food frequency questionnaire provided data on eating habits and alcohol consumption 2 years before data collection. Other information included socio-economic status, lifestyle habits, alcohol use, and diet. Odds ratios (ORs) and 95% confidence intervals (CIs) were derived through unconditional logistic regression. Results: Total alcohol intake was inversely associated with RCC in men and in women; the OR for the highest intake group (>= 22.3 g/day among men and >= 7.9 g/day among women) versus the non-drinkers was 0.7 (95% CI, 0.5-0.9) for both sexes. Analysis of menopausal status produced ORs for the highest intake group versus the non-drinkers of 1.2 (95% CI, 0.7-2.1) among premenopausal women and 0.6 (95 % CI, 0.4-0.9) among postmenopausal women. Smoking and obesity were not important effect modifiers. Conclusion: Moderate alcohol consumption may be associated with a decreased risk of RCC in men and in women (mainly postmenopausal women).

Ikehara S; Iso H; Toyoshima H; Date C; Yamamoto A; Kikuchi S et al. Alcohol consumption and mortality from stroke and coronary heart disease among Japanese men and women: The Japan Collaborative Cohort Study. Stroke 39(11): 2936-2942, 2008. (35 refs.)

Background and Purpose: Previous studies have demonstrated the association between alcohol consumption and cardiovascular mortality. However, the sex-specific association between alcohol consumption and mortality from stroke and coronary heart disease remains unclear. Methods: Between 1988 and 1990, 34 776 men and 48 906 women aged 40 to 79 years completed a self-administered questionnaire including information about alcohol consumption. They were followed-up for a median duration of 14.2 years. Results-Of the 83 682 respondents, 1628 died from stroke and 736 died from coronary heart disease. For men, heavy drinking (>= 46.0 g ethanol/day) was associated with increased mortality from total, hemorrhagic, and ischemic strokes, whereas light-to-moderate drinking was associated with reduced mortality from total cardiovascular disease, compared with not drinking. The respective multivariable hazard ratios (95% CI) were 1.48 (1.22 to 1.80) for total stoke, 1.67 (1.17 to 2.38) for hemorrhagic stroke, 1.35 (1.04 to 1.75) for ischemic stroke, and 0.88 (0.78 to 1.00) for total cardiovascular disease. Women who were heavy drinkers (>= 46.0 g ethanol/day) showed increased mortality from coronary heart disease, and there was reduced mortality from total cardiovascular disease for drinkers of 0.1 to 22.9 g ethanol per day compared with mortality for nondrinkers. The respective multivariable hazard ratios (95% CI) for the 2 categories of drinkers were 4.10 (1.63 to 10.3) and 0.75 (0.62 to 0.91). Conclusions-Heavy alcohol consumption is associated with increased mortality from total stroke, particularly hemorrhagic stroke, and total cardiovascular disease for men, and from coronary heart disease for women, whereas light-to-moderate drinking may be associated with reduced mortality from cardiovascular disease for both sexes.

Jiang X; Castelao JE; Groshen S; Cortessis VK; Ross RK; Conti DV; Gago-Dominguez M. Alcohol consumption and risk of bladder cancer in Los Angeles County. International Journal of Cancer 121(4): 839-845, 2007. (58 refs.)

The role of alcoholic beverages in bladder carcinogenesis is still unclear, with conflicting evidence from different studies. We investigated the relationship between alcohol consumption and bladder cancer, and the potential interaction between alcohol consumption and other exposures. In a population-based case-control study conducted in Los Angeles County, 1,586 pairs of cases and their matched neighborhood controls were interviewed. Data were analyzed to determine whether bladder cancer risk differs by alcohol consumption, and whether different alcoholic beverages have different effects. The risk of bladder cancer decreased with increasing frequency (p for trend = 0.003) and duration of alcohol consumption (p for trend = 0.017). Subjects who drank more than 4 drinks per day had a 32% lower (odds ratio, 0.68; 95% confidence interval, 0.52-0.90) risk of bladder cancer than those who never drank any alcoholic beverage. Beer (p for trend = 0.002) and wine (p for trend = 0.054) consumption were associated with reduced risk of bladder cancer, while hard liquor was not. The reduction in risk was mostly seen among shorter-term smokers who urinated frequently. Alcohol consumption was strongly associated with a reduced risk of bladder cancer. The effect was modified by the type of alcoholic beverage, cigarette smoking and frequency of urination.

Kiviniemi TO; Saraste A; Toikka JO; Saraste M; Raitakari OT; Parkka JP et al. Effects of cognac on coronary flow reserve and plasma antioxidant status in healthy young men. Cardiovascular Ultrasound 6(e-article 25), 2008. (30 refs.)

Background: The cardioprotective effects of certain alcoholic beverages are partly related to their polyphenol content, which may improve the vasodilatory reactivity of arteries. Effect of cognac on coronary circulation, however, remains unknown. The purpose of this randomized controlled cross-over study was to determine whether moderate doses of cognac improve coronary reactivity as assessed with cold pressor testing (CPT) and coronary flow reserve (CFR) measument. Methods: Study group consisted of 23 subjects. Coronary flow velocity and epicardial diameter was assessed using transthoracic echocardiography at rest, during CPT and adenosine infusion-derived CFR measurements before drinking, after a moderate (1.2 +/- 0.1 dl) and an escalating high dose ( total amount 2.4 +/- 0.3 dl) of cognac. To explore the bioavailability of antioxidants, the antioxidant contents of cognac was measured and the absorption from the digestive tract was verified by plasma antioxidant capacity determination. Results: Serum alcohol levels increased to 1.2 +/- 0.2% and plasma antioxidant capacity from 301 +/- 43.9 mu mol/l to 320 +/- 25.0 mu mol/l by 7.6 +/- 11.8%, (p = 0.01) after high doses of cognac. There was no significant change in flow velocity during CPT after cognac ingestion compared to control day. CFR was 4.4 +/- 0.8, 4.1 +/- 0.9 (p = NS), and 4.5 +/- 1.2 (p = NS) before drinking and after moderate and high doses on cognac day, and 4.5 +/- 1.4, and 4.0 +/- 1.2 (p = NS) on control day. Conclusion: Cognac increased plasma antioxidant capacity, but it had no effect on coronary circulation in healthy young men.

Klatsky AL; Udaltsova N. Alcohol drinking and total mortality risk. Annals of Epidemiology 17(5, Supplement S): S63-S67, 2007. (19 refs.)

To evaluate further the relation between alcohol consumption and total mortality, we have carried out new Cox proportional hazards model analyses of 21,535 deaths through 2002 in the Kaiser Permanente study. This follow-up includes 2,618,523 person-years of observation, with a mean follow-up of 20.6 years. We adjusted for age, sex, ethnicity, body mass index, marital status, education, and smoking. New methodology was used to stratify light-moderate drinkers into groups felt more or less likely to include under-reporters. The analysis reconfirms that the relation of alcohol drinking to total mortality is J-shaped, with reduced risk (mainly because of less cardiovascular disease) for lighter drinkers and increased risk for persons reporting more than 3 drinks per day. Infrequent (occasional) drinkers have risk similar to that of lifelong abstainers, while former drinkers are at increased risk, especially for noncardiac death. The general shape of the relation of alcohol to mortality is similar for men and women. Age differences are substantial, with the apparent benefit from light-moderate drinking not seen before middle life. Our data indicate further that the apparent magnitude of benefit of lighter drinking is probably reduced by systematic underreporting.

Kloner RA; Rezkalla SH. To drink or not to drink? That is the question. (review). Circulation 116(11): 1306-1317, 2007. (137 refs.)

Numerous studies have used a J-shaped or U-shaped curve to describe the relationship between alcohol use and total mortality. The nadir of the curves based on recent meta-analysis suggested optimal benefit at approximately half a drink per day. Fewer than 4 drinks per day in men and fewer than 2 per day in women appeared to confer benefit. Reductions in cardiovascular death and nonfatal myocardial infarction were also associated with light to moderate alcohol intake. Although some studies suggested that wine had an advantage over other types of alcoholic beverages, other studies suggested that the type of drink was not important. Heavy drinking was associated with an increase in mortality, hypertension, alcoholic cardiomyopathy, cancer, and cerebrovascular events, including cerebrovascular hemorrhage. Paradoxically, light-to-moderate alcohol use actually reduced the development of heart failure and did not appear to exacerbate it in most patients who had underlying heart failure. Numerous mechanisms have been proposed to explain the benefit that light-to-moderate alcohol intake has on the heart, including an increase of high-density lipoprotein cholesterol, reduction in plasma viscosity and fibrinogen concentration, increase in fibrinolysis, decrease in platelet aggregation, improvement in endothelial function, reduction of inflammation, and promotion of antioxidant effects. Controversy exists on whether alcohol has a direct cardioprotective effect on ischemic myocardium. Studies from our laboratory do not support the concept that alcohol has a direct cardioprotective effect on ischemic/reperfused myocardium. Perhaps the time has come for a prospectively randomized trial to determine whether 1 drink per day (or perhaps 1 drink every other day) reduces mortality and major cardiovascular events.

Leighton F; Urquiaga I. Changes in cardiovascular risk factors associated with wine consumption in intervention studies in humans. Annals of Epidemiology 17(5, Supplement S): S32-S36, 2007. (34 refs.)

Evidence that links moderate wine consumption to cardiovascular health corresponds mostly to ecological observations. Intervention studies using moderate wine consumption with ischemic heart disease as the end point will probably not be available soon because they require long-term follow-up and adequately randomized experimental groups. In contrast, short-term studies focused on risk factors are feasible and should provide evidence suitable for a critical assessment of the apparent beneficial role of moderate drinking, as well as other lifestyle measures, on cardiovascular health. Our intervention studies suggest an increase in HDL-cholesterol, decrease in the omega-6/omega-3 ratio, and in some cases a slight increase in triglyceride levels from moderate drinking. Observed changes in hemostasis include reduced coagulation and increased fibrinolysis; effects on blood pressure have been inconsistent. There is a reduction in inflammatory markers and an increase in endothelial function. Effects of wine are greater for subjects on a Mediterranean diet than those on an occidental diet. Several key biochemical or physiological processes related to atherogenesis are positively modified by wine consumption. From our observations, we conclude that wine in moderation and as part of the diet is directly responsible for changes that may help decrease the risk of cardiovascular disease.

Letenneur L. Moderate alcohol consumption and risk of developing dementia in the elderly: The contribution of prospective studies. Annals of Epidemiology 17(5, Supplement S): S43-S45, 2007. (8 refs.)

Moderate alcohol consumption, after controlling for potential confounding factors, has been found to be associated with a lower risk of developing dementia in several prospective epidemiological studies from Europe, the United States, and China. When the type of alcoholic beverage consumed is analyzed, moderate wine intake has been systematically associated with lower risk. However, moderate consumption has very different definitions across studies, ranging from monthly or weekly drinking to 3 to 4 drinks per day. In addition, different results have been observed according to sex; some studies found the same effect in men and women, while others found either no association or a stronger association in women. All of these results lead to the conclusion that the observed association is fragile and needs further confirmation.

Lindberg ML; Amsterdam EA. Alcohol, wine and cardiovascular health. Clinical Cardiology 31(8): 347-351, 2008. (26 refs.)

Studies evaluating the health benefits of alcohol and wine have demonstrated that moderate consumption is associated with a decrease in all-cause and cardiovascular mortality. Various populations and alcoholic beverages exhibit this effect to different degrees. Alcoholic beverages exhibit multiple mechanisms that may favorably influence cardiac risk potential actions on platelets, antioxidants, fibrinolysis, and lipids. However, other data suggest that the perceived benefit of alcoholic beverages in general, and wine in particular, are the result of socioeconomic confounders. In the absence of more rigorous evidence, it is not currently possible to define the role of wine in human health.

Malenganisho W; Magnussen P; Vennervald BJ; Krarup H; Kaetel P; Siza J et al. Intake of alcoholic beverages is a predictor of iron status and hemoglobin in adult Tanzanians. Journal of Nutrition 137(9): 2140-2146, 2007. (40 refs.)

Iron deficiency is widespread in sub-Saharan Africa, but its predictors are not fully understood. We conducted a cross-sectional study among adults around Lake Victoria to describe iron status and asses the role of dietary and infectious predictors. Linear regression analyses were used to assess the role of infections and intake of meat, fish, fruit/vegetables, alcoholic beverages, and soil on hemoglobin and serum ferritin, while controlling for elevated serum alpha-antichymotrypsin (ACT). Among 1498 participants, the mean age was 33.3 (14-87) y with 53.9% females. More than one-half ate fish daily, 6% ate fruit/vegetables daily, and only 11% ate meat weekly. One-third consumed alcoholic beverages and one-fifth of females consumed soil. Hookworm (80.3%), Schistosoma mansoni (64.7%), and HIV (7.3%) infection were common. Anemia was found in 48.2% of females (<120 g/L hemoglobin) and 40.1% of males (<130 g/L hemoglobin), and 22.3% of females and 7.0% of males had depleted iron stores (serum ferritin <12 mu g/L). In multivariate analyses, alcoholic beverage consumption and HIV were positive, whereas soil eating and hookworm infection were negative predictors of serum ferritin. Alcoholic beverage consumption was a positive predictor of hemoglobin, and soil eating, HIV, and hookworm infection were negative predictors. Intakes of meat, fish, and fruit or vegetables were not predictors. Elevated serum ACT was a predictor of both hemoglobin and serum ferritin. Anemia and depleted iron stores were common, whereas iron overload was rare. In conclusion, the associations between alcoholic beverage intake and hemoglobin and iron status suggest that alcoholic beverages may contain micronutrients essential to erythropoiesis. The role of alcoholic beverage intake and other determinants of hemoglobin and iron status in low-income populations needs to be better elucidated.

Meinhold CL; Park Y; Stolzenberg-Solomon RZ; Hollenbeck AR; Schatzkin A; de Gonzalez AB. Alcohol intake and risk of thyroid cancer in the NIH-AARP Diet and Health Study. British Journal of Cancer 101(9): 1630-1634, 2009. (17 refs.)

BACKGROUND: Certain studies suggest that alcohol may reduce the risk of thyroid cancer in women, but the effect in men remains unclear. METHODS: We analysed the association between alcohol and thyroid cancer in a large (n = 490 159) prospective NIH-AARP Diet and Health Study with self-reported beer, wine, and liquor intakes. RESULTS: Over 7.5 years of follow-up ( median), 170 men and 200 women developed thyroid cancer. Overall, the thyroid cancer risk decreased with greater alcohol consumption (>= 2 drinks per day vs none, relative risk 0.57, 95% CI 0.36-0.89, P-trend = 0.01). CONCLUSIONS: These results suggest a potential protective role for alcohol consumption in thyroid cancer.

Molnar DS; Busseri MA; Perrier CPK; Sadava SW. A longitudinal examination of alcohol use and subjective well-being in an undergraduate sample. Journal of Studies on Alcohol and Drugs 70(5): 704-713, 2009. (71 refs.)

Objective: Notwithstanding well-established links between alcohol use and adverse alcohol-related consequences, evidence suggests that alcohol use among university students may also be associated with positive outcomes, including components of subjective well-being, which comprises life satisfaction, positive affect, and negative affect. Further, because alcohol use and consequences are separable factors, both need to be examined simultaneously to gauge the unique predictive role of alcohol use. We report findings from a longitudinal study of university students that addresses these important issues. Method: At the end of their first term at university (Time 1), 627 students (15% of all first-year students) completed a paper-and-pencil questionnaire in small group settings. Near the end of their third year (Time 2), 467 of the Time 1 respondents (75% follow-up rate) completed a subsequent survey on-line. The average (SD) longitudinal respondent was 18.83 (0.86) years old at Time 1, and 360 participants were female. Results : In cross-sectional and longitudinal structural equation models, adverse alcohol-related consequences predicted lower subjective well-being (lower life satisfaction, less frequent positive affect, more frequent negative affect). Independent of this effect, greater alcohol use (greater quantity/frequency, more frequent intoxication, heavy episodic drinking) predicted higher subjective well-being, both concurrently and prospectively. Conclusions: Among these university students, alcohol use was uniquely associated with a more positive sense of well-being. A more comprehensive understanding of the significance of alcohol use among university students requires attending to positive and negative outcomes associated with alcohol use and examining alcohol use and consequences as related but separable factors.

Mondaini N; Cai T; Gontero P; Gavazzi A; Lombardi G; Boddi V et al. Regular moderate intake of red wine is linked to a better women's sexual health. Journal of Sexual Medicine 6(10): 2772-2777, 2009. (26 refs.)

Introduction. While some evidence does exist for a positive correlation between moderate wine intake and men's sexual health, there is no study addressing the potential correlation between red wine intake and women's sexual function. Aim. The aim of our study was to assess whether there is a tie between daily red wine intake and sexual function in a sample of healthy Italian women, living in the Chianti area (Tuscany) not complaining of any sexual disorders. Methods. We recruited 798 women (age 18-50), living in the Chianti area (Tuscany), not complaining of any sexual disorders. We divided the participants into three groups: daily moderate (one to two glasses) red wine intake (group 1); teetotallers (group 2); and daily intake of more than two glasses of red wine and/or other types of alcoholic drinks (including white wine), as well as of those reporting occasional drinking (group 3). Main Outcome Measures. All participants completed anonymously the Female Sexual Function Index (FSFI) questionnaire and were asked to report on their amount and type of alcohol consumption. Results . Group 1 had significantly higher total (P = 0.001), as well as desire and lubrication domain (P = 0.001 and P = 0.001, respectively) FSFI scores than participants in groups 2 and 3. No significant differences between the groups were observed concerning sexual arousal, satisfaction, pain, and orgasm. Univariate analysis showed a significant correlation between age, alcohol consumption (P = 0.009), and a better score at questionnaire examination. During multivariate analysis, alcohol consumption was identified as an independent prognostic parameter (P = 0.002) in predicting the better score at questionnaire examination. Conclusions. The finding that regular moderate intake of red wine is associated with higher FSFI scores for both sexual desire, lubrication, and overall sexual function as compared to the teetotaller status is intriguing. While this finding needs to be interpreted with some caution, because of the small sample size, self-reported data, and the lack of support from laboratory exams, it nevertheless suggests a potential relationship between red wine consumption and better sexuality.

Morgan CJA; Muetzelfeldt L; Muetzelfeldt M; Nutt DJ; Curran HV. Harms associated with psychoactive substances: Findings of the UK National Drug Survey. Journal of Psychopharmacology 24(2): 147-153, 2010. (6 refs.)

Nutt and colleagues' 'rational' scale to assess the harms of commonly used drugs was based on ratings by a panel of experts. This survey aimed to assess drug users' views of the harms of drugs using the same scale. As users' drug choices are not solely based on harms, we additionally assessed perceived benefits. The survey was hosted at http: www.nationaldrugsurvey.org. UK residents reported their experience of 20 commonly used substances; those with direct experience of a substance rated its physical, dependence-related and social harms as well as benefits. A total of 1501 users completed the survey. There was no correlation between the classification of the 20 drugs under the Misuse of Drugs Act and ranking of harms by users. Despite being unclassified substances, alcohol, solvents and tobacco were rated within the top ten most harmful drugs. There was a remarkably high correlation (r = 0.896) overall between rankings by users' and by experts. Ecstasy, cannabis and LSD were ranked highest by users on both acute and chronic benefits. These findings imply that users are relatively well informed about the harms associated with the drugs they use. They also suggest that the current UK legal classification system is not acting to inform users of the harms of psychoactive substances.

Mukamal K. Alcohol intake and noncoronary cardiovascular diseases. Annals of Epidemiology 17(5, Supplement S): S8-S12, 2007. (63 refs.)

Moderate drinking has complex associations with cardiovascular diseases other than coronary heart disease. Recent cohort studies examining the relationship between alcohol use and ischemic stroke have shown a modest association, with risk ratios approximating 0.8 and the lowest risk among those who drink less than daily. In contrast, alcohol use is generally associated with an approximate dose-dependent risk for hemorrhagic stroke throughout the full range of intake. Several prospective studies of alcohol intake and congestive heart failure have found lower risk with moderate drinking. This risk is also dose dependent through the moderate range, but its underlying mechanism remains uncertain. Accounting for the lower risk of myocardial infarction associated with moderate intake does not eliminate the observed association. Cohort studies have found no association of long-term alcohol intake with risk of atrial fibrillation below levels of at least 3 standard drinks per day. Finally, two prospective studies have found lower risks of claudication or clinically more severe peripheral arterial disease among moderate drinkers, an association also supported by cross-sectional studies of alcohol intake and ankle-brachial index.

Mukamal KJ; Kennedy M; Cushman M; Kuller LH; Newman AB; Polak J et al. Alcohol consumption and lower extremity arterial disease among older adults - The cardiovascular Health Study. American Journal of Epidemiology 167(1): 34-41, 2008. (40 refs.)

Few studies of the relation of alcohol intake to lower-extremity arterial disease (LEAD) have included clinical events and objective measurements repeated longitudinally. As part of the Cardiovascular Health Study, a study of older adults from four US communities, 5,635 participants reported their use of beer, wine, and spirits yearly. Incident LEAD was identified by hospitalization surveillance. Technicians measured ankle-brachial index 6 years apart in 2,298 participants. A total of 172 cases of LEAD were documented during a mean of 7.5 years of follow-up between 1989 and 1999. Compared with abstention, the multivariable-adjusted hazard ratios were 1.10 (95% confidence interval (CI): 0.71, 1.71) for < 1 alcoholic drink per week, 0.56 (95% CI: 0.33, 0.95) for 1-13 drinks per week, and 1.02 (95% CI: 0.53, 1.97) for >= 14 drinks per week (p for quadratic trend = 0.04). These relations were consistent within strata of sex, age, and apolipoprotein E genotype, and neither lipids nor inflammatory markers appeared to be important intermediates. Change in ankle-brachial index showed a similar relation (p for quadratic trend = 0.01). Alcohol consumption of 1-13 drinks per week in older adults may be associated with lower risk of LEAD, but heavier drinking is not associated with lower risk.

Mukamal KJ; Rimm EB. Alcohol consumption: Risks and benefits. Current Atherosclerosis Reports 10(6): 536-543, 2008. (75 refs.)

Alcohol has had a long and complicated role in human society and health. Excessive use of alcohol causes enormous morbidity and mortality worldwide, but the health effects of alcohol use within recommended guidelines are diverse and complex. Established effects include increased high-density lipoprotein cholesterol and antithrombotic activity, providing plausible mechanisms for the observed association of moderate drinking with lower risk of coronary heart disease but higher risk of hemorrhagic stroke. However, moderate drinking increases sex steroid hormone levels and may interfere with folate metabolism, both of which are potential mechanisms for the observed associations of moderate drinking with several forms of cancer, particularly breast and colorectal. Genetic susceptibility to the effects of alcohol on cancer and coronary heart disease also differs across the population. Recommendations regarding moderate drinking must be individualized to reflect the potentially competing effects of alcohol on several chronic diseases.

Mukamal KJ; Rimm EB. Alcohol consumption: Risks and benefits. Current Atherosclerosis Reports 10(6): 536-543, 2008. (75 refs.)

Ngandu T; Helkala EL; Soininen H; Winblad B; Tuomilehto J; Nissinen A et al. Alcohol drinking and cognitive functions: Findings from the Cardiovascular Risk Factors Aging and Dementia (CAIDE) study. Dementia and Geriatric Cognitive Disorders 23(3): 140-149, 2007. (48 refs.)

Background: Moderate alcohol drinking is suggested to be beneficial for cognitive functions, but the results of previous studies have varied greatly. Little is known about the effects of midlife alcohol drinking on the cognitive functions later in life. Methods: Participants were derived from random, population-based samples studied in Eastern Finland in 1972, 1977, 1982, or 1987. A total of 1,341 participants were reexamined in 1998, after an average follow-up period of 21 years, at ages 65-79 years. Results: The participants who did not drink alcohol at midlife had a poorer performance in episodic memory, psychomotor speed, and executive function in late life as compared with infrequent and frequent drinkers, adjusted for sociodemographic and vascular factors. Also late-life nondrinkers had poorer psychomotor speed and executive function. These findings were evident especially among nonsmokers. Further, no interactions between apolipoprotein E4 and alcohol or sex and alcohol were found. Conclusions: Alcohol drinking both at midlife and later is favorably related to the function in several cognitive domains, including episodic memory, psychomotor speed, and executive function, in late life. However, it is not clear whether the association is causal, what is the possible mechanism, and what would be a safe limit of drinking for the best cognitive function.

O'Keefe JH; Bybee KA; Lavie CJ. Alcohol and cardiovascular health: The razor-sharp double-edged sword. Journal of the American College of Cardiology 50(11): 1009-1014, 2007. (52 refs.)

An extensive body of data shows concordant J-shaped associations between alcohol intake and a variety of adverse health outcomes, including coronary heart disease, diabetes, hypertension, congestive heart failure, stroke, dementia, Raynaud's phenomenon, and all-cause mortality. Light to moderate alcohol consumption (up to :1 drink daily for women and 1 or 2 drinks daily for men) is associated with cardio protective benefits, whereas increasingly excessive consumption results in proportional worsening of outcomes. Alcohol consumption confers cardiovascular protection predominately through improvements in insulin sensitivity and high-density lipoprotein cholesterol. The ethanol itself, rather than specific components of various alcoholic beverages, appears to be the major factor in conferring health benefits. Low-dose daily alcohol is associated with better health than less frequent consumption. Binge drinking, even among otherwise light drinkers, increases cardiovascular events and mortality. Alcohol should not be universally prescribed for health enhancement to nondrinking individuals owing to the lack of randomized outcome data and the potential for problem drinking.

O'Phelan K; McArthur DL; Chang CWJ; Green D; Hovda DA. The impact of substance abuse on mortality in patients with severe traumatic brain injury. Journal of Trauma, Injury, Infection and Critical Care 65(3): 674-677, 2008. (31 refs.)

Background. Drug and alcohol use are common in neurotrauma patients. Despite growing methamphetamine use there are few studies of the impact of methamphetamine use on outcome after traumatic brain injury (TBI). Methods: We conducted a retrospective review of 5-years of data from a trauma database. Inclusion criteria included severe TBI and diagnosis codes indicating head injury. The entire database was analyzed and then a subset of patients with complete toxicology data were examined separately. Primary outcome was mortality. Results. Four hundred eighty-three patients were included. Toxicology resuits were available for 52.6% of patients. Alcohol, amphetamines, and cannabis were the most commonly detected substances. Overall mortality was 50.9%. When the group with complete tox screen data were analyzed, a toxicology screen that was positive for alcohol or amphetamine was associated with decreased mortality with an odds ratio of 0.23 (CI: 0.10-0.56, p = 0.001) and 0.25 (CI: 0.08-0.79, p = 0.02), respectively. When the subset of patients for whom toxicology data were available was analyzed the amphetamine-positive group was more likely to use cannabis and less likely to use alcohol. Conclusions. We unexpectedly found alcohol and methamphetamine use to be associated with decreased mortality. Neurotoxic and possible neuroprotective mechanisms of these substances are discussed as well as possible interactions between cannabis and methamphetamine. The potential influence of psycho-social factors are also considered. Prospective studies are needed to further investigate the effects of drug and alcohol use on outcome after severe TBI.

Powers JR; Young AF. Longitudinal analysis of alcohol consumption and health of middle-aged women in Australia. Addiction 103(3): 424-432, 2008. (48 refs.)

Aims: To assess the prospective association between alcohol consumption and self-rated health: in particular whether there is a relationship between stable alcohol intake and health; whether health is affected by changes in alcohol consumption; whether having a chronic condition alters the relationships between stable and changing alcohol intake and health; and whether the health of longer-term abstainers is different from more recent and intermittent abstainers. Design: Longitudinal analysis of a prospective, population-based study. Settings Australia. Participants: A total of 13 585 randomly selected 45-50-year-old women surveyed in 1996, of whom 9396 (69%) were resurveyed in 1998, 2001 and 2004. Measurements: Estimates for the General Health subscale of the SF-36 for different levels of alcohol intake adjusted for having a chronic condition, depression, smoking and other factors. Findings Longitudinal models of consistent alcohol intake showed mean scores for general health of moderate drinkers were significantly better than that of non-drinkers [mean difference = 4.3, standard error (SE) = 0.61], occasional drinkers (mean difference = 3.1, SE = 0.52) and heavy drinkers (mean difference = 2.1, SE = 1.00). Among moderate drinkers, a decrease or variation in alcohol consumption was associated with a significant decline of three to four points in general health. Similar results were obtained when women with an existing chronic condition were excluded from these models. The health of recent abstainers and intermittent drinkers was the same as longer-term abstainers. Conclusions: Consistent moderate drinkers had the best health even after adjustment for having a chronic condition, depression and life-style factors. Poorer health was associated with decreased alcohol intake among occasional and moderate drinkers.

Rehm J; Patra J; Taylor B. Harm, benefits, and net effects on mortality of moderate drinking of alcohol among adults in Canada in 2002. Annals of Epidemiology 17(5, Supplement S): S81-S86, 2007. (28 refs.)

Alcohol is an important risk factor contributing to the burden of chronic diseases and injuries, but is also associated with some health benefits. This study estimates risks and benefits associated with moderate consumption of alcohol in terms of mortality for Canada in 2002 by age and sex. Distribution of exposure was taken from a Canadian survey and corrected for per capita consumption from production and sales data; risk relationships were taken from published literature to calculate alcohol-attributable fractions for moderate consumption. If moderate consumption is based on average volume alone, 866 net deaths in 2002 among those younger than 70 years of age were due to moderate consumption of alcohol (1.3% of all the deaths in this age group, consisting of 1653 deaths caused and 787 deaths prevented). When heavy drinking episodes were excluded, the net effect was beneficial (55 prevented deaths, 0.09% of all deaths); the net burden was higher for younger ages and the net benefits for older ages. The net impact of average moderate alcohol consumption on mortality depends on patterns of drinking. Beneficial net effects are seen only when heavy drinking occasions are excluded. Policies should strive to reduce the burden of moderate alcohol consumption while preserving the beneficial impacts.

Rimm EB; Moats C. Alcohol and coronary heart disease: Drinking patterns and mediators of effect. Annals of Epidemiology 17(5, Supplement S): S3-S7, 2007. (41 refs.)

An inverse association between alcohol consumption and coronary heart disease (CHD) has been shown in epidemiologic studies for more than 30 years; beneficial changes in high-density lipoprotein (HDL) cholesterol, clotting factors, insulin sensitivity, and inflammation provide biological plausibility. Recently, the importance of including drinking patterns in defining "moderate drinking" has been appreciated. A recent meta-analysis raised questions about systematic misclassification error in observational studies because of inclusion among "nondrinkers" of ex-drinkers and/or occasional drinkers. However, misclassification among a small percentage of nondrinkers cannot fully explain the inverse relation, and there is substantial evidence to refute the "sick Centre" hypothesis. Furthermore, it has been shown that moderate alcohol consumption reduces CHD and mortality in individuals with hypertension, diabetes, and existing CHD. To address the issue of residual confounding by healthy lifestyle in drinkers, in a large prospective study we restricted analysis to only "healthy" men (who did not smoke, exercised, ate a good diet, and were not obese). Within this group, men who drank moderately had a relative risk for CHD of 0.38 (95% Cl, 0.16-0.89) compared with abstainers, providing further evidence to support the hypothesis that the inverse association of alcohol to CHD is causal, and not confounded by healthy lifestyle behaviors.

Romeo J; Warnberg J; Nova E; Diaz LE; Gomez-Martinez S; Marcos A. Moderate alcohol consumption and the immune system: A review. British Journal of Nutrition 98(Supplement 1): S111-S115, 2007. (46 refs.)

Increasing evidence suggests that light to moderate amounts of polyphenol-rich alcoholic beverages like wine or beer could have health benefits. Scientists have long debated the effects of alcohol on immune function, showing on the one hand, that high doses of alcohol consumption can directly suppress a wide range of immune responses, and that alcohol abuse is associated with an increased incidence of a number of infectious diseases. On the other hand, moderate alcohol consumption seems to have a beneficial impact on the immune system compared to alcohol abuse or abstinence. Therefore, the link between alcohol consumption, immune response, as well as infectious and inflammatory processes remains not completely understood. With this in mind, it is important to realise that other factors, unrelated or indirectly related to immune function, like drinking patterns, beverage type, amount of alcohol, or gender differences, will affect the influence that alcohol consumption may have on the immune system. This review summarises published data describing the effects that light to moderate amounts of polyphenol-rich beverages like wine or beer seem to have on immunity in healthy adults.

Sadakane A; Gotoh T; Ishikawa S; Nakamura Y; Kayaba K. Amount and frequency of alcohol consumption and all-cause mortality in a Japanese population: The JMS Cohort Study. Journal of Epidemiology 19(3): 107-115, 2009

Background: Lower mortality has been reported in light-to-moderate alcohol drinkers. We examined the association between the amount and frequency of alcohol consumption and all-cause mortality in a Japanese population. Methods: We conducted a prospective cohort study among 8934 Japanese people (3444 men and 5490 women) who completed a baseline survey between 1992 and 1995. We confirmed the date and cause of death by referring to death certificates. The Cox proportional hazards model was used to evaluate the effect of alcohol consumption on risk for all-cause mortality, after adjustment for potential confounding factors. Results: We identified 637 (397 men and 240 women) deaths during the 12.0 years of mean follow-up. Among men, as compared with non-drinkers, the relative risk was higher in ex-drinkers (hazard ratio [HR], 1.18), lower in light drinkers (HR, 0.95) and moderate drinkers (HR, 0.91), and significantly higher in heavy drinkers (HR, 1.67; 95% confidence interval, 1.10-2.55). Among women, light, moderate, and heavy drinkers were grouped into current drinkers. The relative risk was slightly higher in current drinkers (HR, 1.23), and that in ex-drinkers was near 1.0 (HR, 0.97). In stratified analysis, the harmful effects of heavy drinking were more severe among male smokers and younger men. In terms of frequency, men who drank only on special occasions had the highest mortality (HR, 1.28), regardless of alcohol intake per drinking session. Conclusions: In men, a near J-shaped association was identified between alcohol consumption and all-cause mortality. Both the amount and frequency of alcohol consumption were related to mortality.

Smallwood R. Communicating with the public: Dilemmas of a chief medical officer. Annals of Epidemiology 17(5, Supplement S): S103-S107, 2007. (22 refs.)

Chief Medical Officers, or others directly responsible for the health of a population, have difficulty in dealing with alcohol. They must decide where to draw the line to minimize harm, as there is no doubt that alcohol abuse has serious adverse personal and social effects. The prohibition of alcohol, however, would likely be both unacceptable and unenforceable. In certain countries, unhealthy drinking habits, especially among the young (as in the United Kingdom) or among older adults (as in Russia), may call for more stringent harm-reduction strategies than in other countries. In Australia, drink driving rates have dropped markedly in recent decades, but excessive drinking by the young is increasing. Recommendations by health agencies have included increased taxation, training of health professionals, dealing with advertising, and improved regulation of licensed premises. In a setting where the public continually hears of the adverse effects of alcohol, there is little chance that potentially beneficial effects of moderate drinking will be considered in policy decisions. No society has yet solved the riddle of achieving the ideal balance where the majority can enjoy the social and health benefits of moderate drinking, while the harm that alcohol causes is minimized.

Solfrizzi V; D'Introno A; Colacicco AM; Capurso C; Del Parigi A; Baldassarre G; Italian Longitudinal Study Aging W. Alcohol consumption, mild cognitive impairment, and progression to dementia. Neurology 68(21): 1790-1799, 2007. (44 refs.)

Objective: To estimate the impact of alcohol consumption on the incidence of mild cognitive impairment and its progression to dementia. Methods: We evaluated the incidence of mild cognitive impairment in 1,445 non-cognitively impaired individuals and its progression to dementia in 121 patients with mild cognitive impairment, aged 65 to 84 years, participating in the Italian Longitudinal Study on Aging, with a 3.5-year follow-up. The level of alcohol consumption was ascertained in the year before the survey. Dementia and mild cognitive impairment were classified using current clinical criteria. Results: Patients with mild cognitive impairment who were moderate drinkers, i.e., those who consumed less than 1 drink/day (approximately 15 g of alcohol), had a lower rate of progression to dementia than abstainers (hazard ratio [HR] 0.15; 95% CI 0.03 to 0.78). Furthermore, moderate drinkers with mild cognitive impairment who consumed less than 1 drink/ day of wine showed a significantly lower rate of progression to dementia than abstainers (HR 0.15; 95% CI 0.03 to 0.77). Finally, there was no significant association between higher levels of drinking (>= 1 drink /day) and rate of progression to dementia in patients with mild cognitive impairment vs abstainers. No significant associations were found between any levels of drinking and the incidence of mild cognitive impairment in non-cognitively impaired individuals vs abstainers. Conclusions: In patients with mild cognitive impairment, up to 1 drink/day of alcohol or wine may decrease the rate of progression to dementia.

Stockwell T; Kerr WC. Is alcohol consumption good for you? Commentary on McIntosh. (editorial). Addiction Research & Theory 17(1): 91-95, 2009. (24 refs.)

This editorial is in response to the article "Is alcohol consumption good for you? Results from the 2005 Canadian Community Health Survey." Addiction Research & Theory 16(6): 553-563, 2008

Stuttaford T. The influence of print media on their readers' understanding of the benefits of moderate drinking. Annals of Epidemiology 17(5, Supplement S): S108-S109, 2007. (1 refs.)

Journalism reflects and reinforces popular opinion. It is from the circulation that the owner's dividends and the journalists' salaries are derived, and journalists are constantly reminded of this. Altering public opinion on health-related issues occurs through numerous interactions. Survey data suggest that the most effective mechanism for changing individual perceptions on health is through communication between patients and their primary care physician; the second most successful means for influencing individuals is through the print media. Moreover, the media provide the public with information on available solutions for minimizing the risks of health hazards. It is, therefore, a major responsibility of print media to keep people informed on various health issues. There are obstacles in producing the correct message to provide the public regarding alcohol, as there are both health risks and benefits. Although a quantifiable measure cannot be used to define moderate drinking for all-as recommendations vary by sex, age, race, and other factors-print media should contribute to the education of the public on the benefits and harms of moderate consumption. This will require nonhomogeneous messages for the public and greater efforts by editors to increase the availability of health-related stories in the press.

Suzuki K; Elkind MSV; Boden-Albala B; Jin ZZ; Berry G; Di Tullio MR et al. Moderate alcohol consumption is associated with better endothelial function: A cross sectional study. BMC Cardiovascular Disorders 9: article 8, 2009. (27 refs.)

Background: Moderate alcohol consumption is protective against coronary artery disease. Endothelial dysfunction contributes to atherosclerosis and the pathogenesis of cardiovascular disease. The effects of alcohol consumption on endothelial function may be relevant to these cardiovascular outcomes, but very few studies have examined the effect of alcohol consumption on endothelial function assessed by flow-mediated dilation (FMD) of the brachial artery in humans. Methods: In the population-based Northern Manhattan Study (NOMAS), we performed a cross-sectional analysis of lifetime alcohol intake and brachial artery FMD during reactive hyperemia using high-resolution B-mode ultrasound images among 884 stroke-free participants (mean age 66.8 years, women 56.6%, Hispanic 67.4%, black 17.4%, and white 15.2%). Results: The mean brachial FMD was 5.7% and the median was 5.5%. Compared to non-drinkers, those who drank >1 drink/month to 2 drinks/day were more likely to have FMD above the median FMD (5.5%) (unadjusted OR 1.7, 95% CI 1.2-2.4, p = 0.005). In multivariate analysis, the relationship between moderate alcohol consumption and FMD remained significant after adjusting for multiple traditional cardiovascular risk factors, including sex, race-ethnicity, body mass index, diabetes mellitus, coronary artery disease, Framingham risk score, medication use (adjusted OR 1.8, 95% CI 1.1-3.0, p = 0.03). No beneficial effect on FMD was seen for those who drank more than 2 drinks/day. Conclusion: In conclusion, consumption of up to 2 alcoholic beverages per day was independently associated with better FMD compared to no alcohol consumption in this multiethnic population. This effect on FMD may represent an important mechanism in explaining the protective effect of alcohol intake on cardiovascular disease.

Szabo G. Moderate drinking, inflammation, and liver disease. Annals of Epidemiology 17(5, Supplement S): S49-S54, 2007. (28 refs.)

It is well known that heavy drinking increases the risk of alcohol-related liver disease (ALD). Female gender, hepatitis C or B, obesity, and other cofactors increase susceptibility to ALD, so "safe" levels of alcohol consumption in regard to ALD vary among individuals. Inflammation is one mechanism by which alcohol causes liver damage. Increasing evidence suggests that in contrast to the proinflammatory activation by chronic excessive alcohol consumption, acute moderate alcohol administration has anti, inflammatory effects. Long-term alcohol administration results in increased baseline nuclear regulatory factor kappa B (NF-kappa B) activation in the livers of mice; in contrast, acute alcohol administration in mice attenuates lipopolysaccharide (LPS)-induced NF-kappa B activation in the liver and serum tumor necrosis factor alpha (TNF alpha) induction. Consistent with this notion, peripheral blood monocytes from patients with alcoholic hepatitis spontaneously produce increased amounts of TNF alpha and respond to ex vivo LPS stimulation with increased TNF alpha levels, while acute moderate alcohol consumption in normal volunteers results in the attenuation of TNF alpha production by various stimulants and attenuates monocyte production of other proinflammatory cytokines. To date, no evidence for a beneficial role of the anti-inflammatory effect of acute moderate alcohol consumption on the liver has been demonstrated, but this may contribute to the effect of alcohol on other organ systems.

Tivis LJ; Ceballos NA; Chastain G; Tivis RD. Alcohol and estrogen replacement therapy in postmenopausal women: Direct and mediated effects on cognitive component processes. Neuropsychobiology 58(2): 104-110, 2008. (49 refs.)

The literature remains contentious regarding the separate and combined effects of moderate drinking and estrogen replacement therapy (ERT) on cognition. In the current study, the authors sought to disentangle the predictive utility of alcohol use, ERT and their interaction on the episodic and semantic memory stores of postmenopausal women. It was predicted that relationships between moderate drinking, ERT and cognition would be attenuated by demographic and health-related factors. Postmenopausal women (n = 298) completed a battery of cognitive tests designed to assess speed and accuracy of episodic and knowledge-based cognitive processing. Potentially confounding variables were categorized and tested as mediators in hierarchical regression analyses. Moderate drinking was a weak predictor of episodic availability prior to removal of potential mediators. ERT use was a significant predictor of episodic and knowledge-based availability; no mediators were identified. Alcohol moderated ERT, as a combined alcohol/ERT variable was shown to be related to cognition. Neither moderate drinking nor ERT use was associated with cognitive speed. These findings suggest that positive relationships between alcohol and cognition are likely mediated by other variables, and should not be regarded as a benefit of drinking. Further, results support ERT as a predictor of knowledge-based and episodic availability, independent of mood stabilization or socioeconomic influences. Finally, alcohol and ERT appear to interact to impact both episodic and knowledge-based performance.

Vazquez-Agell M; Sacanella E; Tobias E; Monagas M; Antunez E; Zamora-Ros R; Andres-Lacueva C; Lamuela-Raventos RM; Fernandez-Sola J; Nicolas JM; Estruch R. Inflammatory markers of atherosclerosis are decreased after moderate consumption of cava (Sparkling wine) in men with low cardiovascular risk. Journal of Nutrition 137(10): 2279-2284, 2007. (40 refs.)

Atherosclerosis is considered a low-grade inflammatory disease. Polyphenol-rich alcoholic beverages (red wine) have shown a more pronounced antiinflammatory effect than polyphenol-free alcoholic beverages (gin). However, no studies to our knowledge have evaluated the antiinflammatory effects of alcoholic beverages with medium-level polyphenol content such as cava (sparkling wine). We enrolled 20 healthy men (aged 34 +/- 9 y) in a randomized crossover study to receive 30 g ethanol/d as cava or gin for 28 d. Before both interventions, subjects abstained from alcohol for 2 wk. Inflammatory biomarkers of atherosclerosis and expression of adhesion molecules on peripheral leukocytes were measured before and after each intervention. Likewise, dietary intake and exercise were also evaluated. Expression of lymphocyte function-associated antigen-1 (LFA-1), very late activation antigen-4 (VLA-4), Sialyl-Lewis(x) (SLe(x)), and CD40 on monocytes decreased after cava intake (all P < 0.05), whereas only SLe(x) was reduced after gin intake (P = 0.036). Circulating markers of atherosclerosis including vascular cell adhesion molecule-1, E-selectin, and P-selectin decreased after both interventions (all P < 0.05). High-sensitivity C-reactive protein, intercellular adhesion molecule-1 (ICAM-1), IL-6, monocyte chemoattractant protein-1 (MCP-1), and CD40L were diminished only after cava intake (all P < 0.05). The effects of cava on circulating CD40L, ICAM-1, and MCP-1, and monocyte surface expression of CD40, LFA-1, and VLA-4 were greater than those of gin (all P < 0.05). In conclusion, both cava and gin showed antiinflammatory properties; however, cava had a greater protective effect, probably due its polyphenol content.

Verbaten MN. Chronic effects of low to moderate alcohol consumption on structural and functional properties of the brain: Beneficial or not? (review). Human Psychopharmacology: Clinical and Experimental 24(3): 199-205, 2009. (36 refs.)

Objective: Some studies suggest that the effects of low to moderate drinking (about 1-3 standard glasses of alcohol per day) on the brain and cognitive rerformance are positive. In the present study this hypothesis is investigated. Methods For this purpose studies on the effects of low to moderate drinking on brain structure (Magnetic Resonance Induction (MRI) studies) and on cognitive performance were analysed and discussed Results In MRI studies, a linear negative effect of alcohol consumption on brain volume was found. Furthermore, a linear decrease in grey matter concurring with a linear increase in white matter volumes as a function of number of drinks was reported in males, but not in females. Only in elderly low to moderate drinkers (aged > 65 years) there appeared to be an U-shaped relationship between alcohol consumption and white matter integrity (grade) on the one hand and cognition on the other hand. Conclusions The changes reported in brain shrinkage, grey matter and white matter volume, as a result of low to moderate alcohol consumption sooner offer support for the contention that such drinking decreases brain health than for its beneficial effect. An exception might hold for elderly light and moderate drinkers where less white matter damage was found than in abstainers concurring with better cognitive performance. However, methodological problems impose limits on this conclusion.

Wakabayashi I; Groschner K. Modification of the association between alcohol drinking and non-HDL cholesterol by gender. Clinica Chimica Acta 404(2): 154-159, 2009. (33 refs.)

Background: Serum non-HDL cholesterol is a strong predictor of cardiovascular diseases. We studied the relationship between habitual alcohol drinking and non-HDL cholesterol. Methods: Healthy male subjects (n = 27,005) and female subjects (n = 16.805) were divided into 5 groups by average daily ethanol intake. Serum non-HDL cholesterol level and prevalence of serum high non-HDL cholesterol (>= 170 mg/dl) were compared among the groups. Results: Non-HDL cholesterol level and prevalence of high non-HDL cholesterol became lower as alcohol intake increased. The threshold alcohol intake in the drinker groups showing significantly lower non-HDL cholesterol level and significantly lower prevalence of high non-HDL cholesterol, compared with those in non-drinkers, was lower in women (< 10 g/d) than in men (>= 10 and <20 g/d). Odds ratios of each drinker group vs. the non-drinker group for high non-HDL cholesterol became lower as alcohol intake increased. The odds ratio of each drinker group vs. the non-drinker group for high non-HDL cholesterol tended to be lower in women than in men. Conclusions: The results suggest that even light drinking is sufficient to significantly lower serum non-HDL cholesterol and that this effect of alcohol drinking on non-HDL cholesterol is more pronounced in women than in men.

Wandell PE; de Faire U; Hellenius ML. High intake of alcohol is associated with newly diagnosed diabetes in 60 years old men and women. Nutrition, Metabolism & Cardiovascular Diseases 17(8): 598-608, 2007. (41 refs.)

Background and aims: Low or moderate alcohol intake has been found to be protective against the incidence of diabetes, while conflicting results have been found regarding high alcohol intake. This study aimed at evaluating the effect of alcohol intake on newly diagnosed diabetes among subjects aged 60 years in relation to anthropometric measurements, life-style and socio-economic factors. Methods and results: A population-based cross-sectional study of 4106 individuals, 1973 men and 2133 women, aged 60 years, in Stockholm County, Sweden. Medical history, socio-economic factors and life-style data were collected by a questionnaire and a medical examination including laboratory tests. High total intake of alcohol, i.e. >30 g/day vs. 0-30 g/day, was significantly noted more often in newly diagnosed diabetes in men (OR 2.72, 95% CI 1.70-4.34), even when adjusting for other factors, i.e. anthropometric measurements, life-style, socio-economic and dietary factors (adjusted OR 1.94, 95% CI 1.17-3.23); a high intake of spirits, i.e. >15 g/day vs. 0-15 g/day, was significantly more often observed among women (OR 3.97, 95% CI 1.50-10.50), however, it was not significant after adjustment (OR 2.23, 95% CI 0.67-7.42). Conclusion: High intake of alcohol among men was associated with increased risk of diabetes even when adjusting for other factors. reserved.

Wang J; Pan HF; Ye DQ; Su H; Li XP. Moderate alcohol drinking might be protective for systemic lupus erythematosus: a systematic review and meta-analysis. (review). Clinical Rheumatology 27(12): 1557-1563, 2008. (25 refs.)

Conflicting evidence for the effect of moderate alcohol drinking on the development of systemic lupus erythematosus (SLE) existed at present. In the current study, we performed an extensive search of relevant studies and performed a meta-analysis to obtain a more precise estimate. Thirty-eight studies were identified from electronic databases and chosen for detailed review, then six articles from six case-control studies with one cohort study were included in our meta-analyses. Meta-analyses were divided into two subgroups in which patients in the study of Washio et al. treated for less than 5 years (subgroup A) or less than 10 years (subgroup B) were involved, respectively. The odds ratio (OR) of moderate alcohol drinking in the meta-analyses of subgroup B for the development of SLE was significantly decreased (OR 0.723, 95% confidence interval (95% CI) 0.547-0.954), while moderate alcohol drinking in the meta-analysis of subgroup A did not demonstrate a decreased risk of SLE (OR 0.780, 95% CI 0.491-1.240). Meta-analyses of six case-control studies in the two subgroups both demonstrated that moderate alcohol drinking had a protective effect on the development of SLE. Taken together, our results show that moderate alcohol drinking might be protective for SLE.

Wright CA; Bruhn CM; Heymann H; Bamforth CW. Beer and wine consumers' perceptions of the nutritional value of alcoholic and nonalcoholic beverages. Journal of Food Science 73(1): H8-H11, 2008. (21 refs.)

In general beer has not been portrayed as part of a balanced diet. However, red wine has been promoted as a beneficial part of a nutritious diet. The evidence is that beer is at least the equal of wine from a nutritional perspective and in countering ailments such as coronary heart disease. This study used surveys to compare beer and wine consumers' perceptions of alcoholic and nonalcoholic beverages. The consumers ranked 7 beverages based upon perceived healthfulness both before and after they were exposed to nutritional information about the beverages. The ranked data were analyzed using analysis of variance. The variance due to the 3-way interaction of place of recruitment, beverage, and ranking was found to be significant at P < 0.05. There was no significant difference between genders. Overall, consumers of alcoholic beverages perceived red wine to be more healthful than the other 6 beverages, including beer and white wine. The perceived healthfulness of a beverage does not appear to be the main factor driving the choice of beverage. Nutritional information does impact consumers' perceptions of the healthfulness of beverages. Consumers who are predominately beer drinkers were more heavily influenced by nutritional information than consumers who were predominately wine drinkers. [NB. This research was funded by the American Society of Brewing Chemists.]

Wright CA; Bruhn CM; Heymann H; Bamforth CW. Beer consumers' perceptions of the health aspects of alcoholic beverages. Journal of Food Science 73(1): H12-H17, 2008. (13 refs.)

Consumers' perceptions about alcohol are shaped by numerous factors. This environment includes advertisements, public service announcements, product labels, various health claims, and warnings about the dangers of alcohol consumption. This study used focus groups and questionnaires to examine consumers' perceptions of alcoholic beverages based on their nutritional value and health benefits. The overall purpose of this study was to examine beer consumers' perceptions of the health attributes and content of alcoholic beverages. Volunteers were surveyed at large commercial breweries in California, Missouri, and New Hampshire. The anonymous, written survey was presented in a self-explanatory format and was completed in 5 to 10 min. The content and style of the survey were derived from focus groups conducted in California. The data are separated by location, gender, and over or un-nonparametric data form True/False or Yes/No questions were analyzed using chi-square. Although statistically significant variances did exist between survey location, gender, and age, general trends emerged in areas of inquiry. The findings indicate that a great opportunity exists to inform consumers about the health benefits derived from the moderated consumption of all alcoholic beverages. [NB. This research was funded by the American Society of Brewing Chemists.]

Zhou YJ; Yin RX; Deng YJ; Li YY; Wu JZ. Interactions between alcohol intake and the polymorphism of rs708272 on serum high-density lipoprotein cholesterol levels in the Guangxi Hei Yi Zhuang population. Alcohol 42(7): 583-591, 2008. (64 refs.)

Both alcohol consumption and the polymorphism of the cholesteryl ester transfer protein (CETP) TaqIB gene (rs708272) influence plasma high-density lipoprotein cholesterol (HDL-C) levels. However. their interactions on serum HDL-C levels is not well known, The present study was undertaken to detect the interactions between alcohol consumption and the rs708272 polymorphism on serum lipid levels in the Guangxi Hei Yi Zhuang population. Genotyping of the rs708272 in 342 nondrinkers and 416 drinkers aged 15-70 years was performed by polymerase chain reaction and restriction fragment length polymorphism. Interactions between rs708272 genotype and alcohol consumption was assessed using a cross-product term between genotypes and the aforementioned factor. Statistical significance was evaluated with analysis of co-variance. The frequency of B1 allele was 65.8% in nondrinkers and 64.7% in drinkers (P > .05). respectively. The frequencies of B1B1, B1B2, and B2B2 genotypes were 45.0%, 41.5%, and 13.5% in nondrinkers, and 41.3%. 46.6%. and 12.0% in drinkers (P > .05), respectively. The levels of HDL-C and apolipoprotein (Apo) A1 in nondrinkers were higher in B2B2 genotype than in B1B1 genotype (P < .05 for each), whereas triglyceride (TG) levels in drinkers were higher in B1B1 genotype than in B1B2 genotype (P < .05). The levels of TG, HDL-C, Apo A1 in B1B1 genotype, and HDL-C and Apo Al in B1B2 genotype were higher in drinker, than in nondrinkers (P < .05-.01), whereas the levels of low-density lipoprotein cholesterol (LDL-C) and Apo B in B2B2 genotype, and the levels of LDL-C in B1B1 genotype were lower in drinkers than in nondrinkers (P < .05-.01). The levels of HDL-C were positively correlated with female sex and genotype in nondrinkers (P < .001 for each), and were positively associated with age and alcohol consumption in drinkers (P < .005 and < .01, respectively). This study suggests that the BI carriers benefited more from alcohol consumption than the B2 carriers in increasing serum HDL-C and Apo Al levels, and lowering LDL-C levels.