The protective effects of moderate drinking: lies, damned lies, and… selection biases?

Selection biases may have led to beneficial effects of moderate drinking being over estimated; however, they are unlikely to entirely explain the J-shaped curve. Even if all beneficial effects were eliminated, our ranking of alcohol as a public health burden would not change, nor our efforts to limit its harm.European Research Council (Grant ID: ERC-StG-2012-309337_AlcoholLifecourse) and UK Medical Research Council/Alcohol Research UK (Grant ID: MR/M006638/1)This is the final version of the article. It first appeared from Wiley via http://dx.doi.org/10.1111/add.1358

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

BACKGROUND: The long-term impact of alcohol intake in midlife on developing depression is not clear. We aimed to investigate drinking pattern during midlife as a risk factor for developing depression during 28 years of follow-up. METHODS: We used data from a well characterised prospective cohort study (the Whitehall II study) of 7478 men and women (70% male) aged 35 to 55 years, and free from depression in 1985-1988, followed up regularly until 2013. Drinking pattern was defined in terms of usual and maximum amounts consumed within a single drinking session, total weekly volume of alcohol consumed and drinking frequency. Depression was assessed using the General Health Questionnaire Depression Subscale at multiple follow-up occasions (up to eight times in total). Associations between different drinking pattern components during midlife and depression were estimated using flexible parametric survival models. RESULTS: After adjustment for confounding factors only abstaining from alcohol during midlife was associated with an increased risk of developing depression during long-term observation. However, this association became non-significant after adjusting for baseline self-reported health. CONCLUSIONS: In this community dwelling population, drinking pattern during midlife was not associated with an increased risk of developing depression

Reliability of a retrospective decade-based life-course alcohol consumption questionnaire administered in later life.

BACKGROUND AND AIMS: Retrospective measures of alcohol intake are becoming increasingly popular; however, the reliability of such measures remains uncertain. This study assessed the reliability of a retrospective decade-based life-course alcohol consumption questionnaire, based on the standardized Alcohol Use Disorder Identification Test-Consumption (AUDIT-C) administered in older age in a well-characterized cohort study. DESIGN, SETTING, PARTICIPANTS AND MEASUREMENTS: A retrospective alcohol life-grid was administered to 5980 participants (72% male, mean age 70 years) in the Whitehall II study covering frequency of drinking, number of drinks in a typical drinking day and frequency of consuming six or more drinks in a single drinking occasion in the teens (16-19 years) through to the 80s. A subsample of 385 individuals completed a repeat survey to determine test-retest reliability. Retrospective measures were also compared with prospectively ascertained information and used to predict objectively measured systolic blood pressure to test their predictive validity. FINDINGS: Across all decades of life, test-retest reliability was generally good (κ range = 0.62-0.78 for frequency, 0.55-0.62 for usual number of drinks and 0.57-0.65 for frequency of consuming six or more drinks in a single occasion). The concordance between prospective and retrospective measures was consistently moderate to high. The life-grid method performed better than a single question in identifying life-time abstainers. Retrospective measures were also related to systolic blood pressure in the manner anticipated. CONCLUSION: A retrospective decade-based AUDIT-C grid administered in older age provides a relatively reliable measure of alcohol consumption across the life-course

The Role of Alcohol Consumption in Regulating Circulating Levels of Adiponectin: A Prospective Cohort Study.

CONTEXT: The role of alcohol intake in influencing longitudinal trajectories of adiponectin is unclear. OBJECTIVE: The objective of the study was to examine the association between alcohol intake and changes in the circulating levels of adiponectin over repeat measures. DESIGN, SETTING, AND PARTICIPANTS: A prospective cohort study of 2855 men and women (74% men with a mean age of 50 y at baseline) drawn from the Whitehall II study. Data from study phases 3 (1991-1993), 5 (1997-1999), and 7 (2002-2004) were used. MAIN OUTCOME MEASURE: Adiponectin serum concentrations (nanograms per milliliter) were measured, and alcohol intake was defined in terms of number of UK units (1 U = 8 g ethanol) consumed in the previous 7 days on three occasions. Cross-sectional associations between alcohol and adiponectin levels were calculated using linear regression. A bivariate dual-change score model was used to estimate the effect of alcohol intake on upcoming change in adiponectin. Models were adjusted for age, sex, ethnicity, and smoking status. RESULTS: Alcohol consumption was cross-sectionally associated with (log transformed) adiponectin levels (β ranging from .001 to .004, depending on phase and level of adjustment) but was not associated with changes in adiponectin levels over time [γ = -0.002 (SE 0.002), P = 0.246]. CONCLUSION: Alcohol intake is not associated with changes in circulating adiponectin levels in this cohort. This finding provides evidence that adiponectin levels are unlikely to mediate the relationship between moderate alcohol consumption and reduced risk of type 2 diabetes. It is important to consider dynamic longitudinal relationships rather than cross-sectional associations.This work was supported by European Research Council Grant ERC-StG-2012-309337_AlcoholLifecourse (principal investigator A.B, http://www.ucl.ac.uk/alcohol-lifecourse) and UK Medical Research Council/Alcohol Research UK Grant MR/M006638/1. The Whitehall II study is supported by grants from the Medical Research Council (Grant K013351); British Heart Foundation (Grant RG/07/008/23674); the Stroke Association; National Heart, Lung, and Blood Institute (Grant HL036310); and National Institute on Aging (Grants AG13196 and AG034454). The supporters had no role in the study design, the data collection and analysis, the decision to publish, or the preparation of the manuscript

Heavy drinking days and mental health: an exploration of the dynamic 10-year longitudinal relationship in a prospective cohort of untreated heavy drinkers.

BACKGROUND: Identifying dominant processes that underlie the development of other processes is important when evaluating the temporal sequence between disorders. Such information not only improves our understanding of etiology but also allows for effective intervention strategies to be tailored. The temporal relationship between alcohol intake and mental health remains poorly understood, particularly in nonclinical samples. The purpose of this study was to disentangle the dominant temporal sequence between mental health and frequency of heavy drinking days. METHODS: We report a 10-year (1997 to 2007) prospective cohort study of 500 respondents (74% male) from the Birmingham Untreated Heavy Drinkers project. Participants were aged 25 to 55 years at baseline, drinking a minimum of 50/35 U.K. units of alcohol for men/women on a weekly basis, and were not seeking treatment for their alcohol use upon recruitment into the study. Heavy drinking days were defined as consuming 10/7+ U.K. units of alcohol in a single day for men/women. Mental health was assessed using the mental health component score of the SF-36 questionnaire. Dynamic longitudinal structural equation models were used to test competing theoretical models (frequency of heavy drinking days leading to changes in mental health scores and vice versa) and a reciprocal relationship (both mental health scores and the frequency of heavy drinking days influencing changes in each other). RESULTS: A model whereby mental health scores were predictors of change in the frequency of heavy drinking days was of best fit. In this model, mental health scores were negatively related to change in heavy drinking days (β -0.80, SE 0.28) indicating that those with higher mental health scores (i.e., better functioning) made larger reductions in the number of heavy drinking days over time. CONCLUSIONS: Mental health appears to be the stronger underlying process in the relationship between mental health and frequency of heavy drinking days

Alcohol Consumption and the Risk of Type 2 Diabetes: A Systematic Review and Dose-Response Meta-analysis of More Than 1.9 Million Individuals From 38 Observational Studies.

OBJECTIVE: Observational studies indicate that moderate levels of alcohol consumption may reduce the risk of type 2 diabetes. In addition to providing an updated summary of the existing literature, this meta-analysis explored whether reductions in risk may be the product of misclassification bias. RESEARCH DESIGN AND METHODS: A systematic search was undertaken, identifying studies that reported a temporal association between alcohol consumption and the risk of type 2 diabetes. No restrictions were placed upon the language or date of publication. Non-English publications were, where necessary, translated using online translation tools. Models were constructed using fractional polynomial regression to determine the best-fitting dose-response relationship between alcohol intake and type 2 diabetes, with a priori testing of sex and referent group interactions. RESULTS: Thirty-eight studies met the selection criteria, representing 1,902,605 participants and 125,926 cases of type 2 diabetes. A conventional noncurrent drinking category was reported by 33 studies, while five reported a never-drinking category. Relative to combined abstainers, reductions in the risk of type 2 diabetes were present at all levels of alcohol intake <63 g/day, with risks increasing above this threshold. Peak risk reduction was present between 10-14 g/day at an 18% decrease in hazards. Stratification of available data revealed that reductions in risk may be specific to women only and absent in studies that adopted a never-drinking abstention category or sampled an Asian population region. CONCLUSIONS: Reductions in risk among moderate alcohol drinkers may be confined to women and non-Asian populations. Although based on a minority of studies, there is also the possibility that reductions in risk may have been overestimated by studies using a referent group contaminated by less healthy former drinkers.C.K., S.B., and A.B. are funded by the European Research Council (ERC-StG-2012-309337_AlcoholLifecourse; principal investigator A.B. [http://www.ucl.ac.uk/alcohol-lifecourse]) and the U.K. Medical Research Council/Alcohol Research UK (MR/M006638/1)

Trajectories of alcohol consumption prior to the diagnosis of type 2 diabetes: a longitudinal case-cohort study.

BACKGROUND: Non-linear associations have been reported between baseline measures of alcohol consumption and type 2 diabetes (T2DM). However, given that drinking varies over the adult life course, we investigated whether differences existed in the longitudinal trajectory of alcohol consumption according to T2DM status. METHODS: For a case-cohort (916 incident cases; 7376 controls) of British civil servants nested within the Whitehall II cohort, the self-reported weekly volume of alcohol consumption was traced backwards from the date of diagnosis or censoring to the beginning of the study, covering a period of up to 28 years. Mean trajectories of alcohol intake were estimated separately by diagnosis status using random-effects models. RESULTS: Drinking increased linearly among male cases before diagnosis, but declined among male non-cases prior to censoring. At the time of diagnosis or censoring, consumption among those who developed T2DM was 33.4 g/week greater on average. These patterns were not apparent among women. Here, alcohol intake among female cases was consistently below that of non-cases, with the difference in consumption most pronounced around 15 years prior to diagnosis or censoring, at ∼28.0 g/week. Disparities by diagnosis status were attenuated following adjustment for potential confounders, including the frequency of consumption and metabolic factors. Drinking among male and female cases declined following diagnosis. CONCLUSIONS: Differences in the weekly volume of alcohol consumption are reported in the years leading up to diagnosis or censoring. Although male and female cases predominantly consumed alcohol at volumes lower than or equal to those who were not diagnosed, these disparities appear to be largely explained by a range of socio-demographic and lifestyle factors. Where disparities are observed between cases and non-cases, adjusted absolute differences are small in magnitude. The decision to drink alcohol should not be motivated by a perceived benefit to T2DM risk

Association of thirty-year alcohol consumption typologies and fatty liver: Findings from a large population cohort study.

OBJECTIVE: To evaluate the longitudinal relationship between repeated measures of alcohol consumption and risk of developing fatty liver. PATIENTS AND METHODS: This study includes 5407 men and women from a British population-based cohort, the Whitehall II study of civil servants, who self-reported alcohol consumption by questionnaire over approximately 30 years (1985-1989 through to 2012-2013). Drinking typologies during midlife were linked to measures of fatty liver (the fatty liver index, FLI) when participants were in older age (age range 60-84 years) and adjusted for age, socio-economic position, ethnicity, and smoking. RESULTS: Those who consistently drank heavily had two-fold higher odds of increased FLI compared to stable low-risk moderate drinkers after adjustment for covariates (men: OR = 2.04, 95%CI = 1.53-2.74; women: OR = 2.24, 95%CI = 1.08-4.55). Former drinkers also had an increased FLI compared to low-risk drinkers (men: OR = 2.09, 95%CI = 1.55-2.85; women: OR = 1.68, 95%CI = 1.08-2.67). There were non-significant differences in FLI between non-drinkers and stable low-risk drinkers. Among women, there was no increased risk for current heavy drinkers in cross sectional analyses. CONCLUSION: Drinking habits among adults during midlife affect the development of fatty liver, and sustained heavy drinking is associated with an increased FLI compared to stable low-risk drinkers. After the exclusion of former drinkers, there was no difference between non-drinkers and low-risk drinkers, which does not support a protective effect on fatty liver from low-risk drinking. Cross-sectional analyses among women did not find an increased risk of heavy drinking compared to low-risk drinkers, thus highlighting the need to take a longitudinal approach.AB, DON and SB were supported by grants from the European Research Council (ERC-StG-2012- 309337_AlcoholLifecourse, PI: Britton, http://www.ucl.ac.uk/alcohol-lifecourse) and UK Medical Research Council/Alcohol Research UK (MR/M006638/1). The UK Medical Research Council (MR/K013351/1; G0902037), British Heart Foundation (RG/13/2/30098), and the US National Institutes of Health (R01HL36310, R01AG013196) have supported collection of data in the Whitehall II Study. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript

Adverse Childhood Experiences and Alcohol Consumption in Midlife and Early Old-Age.

AIMS: To examine the individual and cumulative effects of adverse childhood experiences (ACEs) on alcohol consumption in midlife and early old-age, and the role of ACEs in 10-year drinking trajectories across midlife. METHODS: Data were from the Whitehall II study, a longitudinal British civil service-based cohort study (N = 7870, 69.5% male). Multinomial logistic regression was used to examine the individual and cumulative effects of ACEs on weekly alcohol consumption. Mixed-effect multilevel modelling was used to explore the relationship between ACEs and change in alcohol consumption longitudinally. RESULTS: Participants who were exposed to parental arguments/fights in childhood were 1.24 (95% CI 1.06, 1.45) times more likely to drink at hazardous levels in midlife (mean age 56 years) after controlling for covariates and other ACEs. For each additional exposure to an ACE, the risk of hazardous drinking versus moderate drinking was increased by 1.12 (95% CI 1.03, 1.21) after adjusting for sex, age, adult socio-economic status, ethnicity and marital status. No associations between ACEs and increased risk of hazardous drinking in early old-age (mean age 66 years) were found. In longitudinal analyses, ACEs did not significantly influence 10-year drinking trajectories across midlife. CONCLUSION: The effect of exposure to parental arguments on hazardous drinking persists into midlife