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Αλκοόλ.
Argirios Argiriou:
February 26, 2015
Association Between Moderate Alcohol Consumption and Mortality Benefits: Dwindling Evidence?
Paul S. Mueller, MD, MPH, FACP reviewing Knott CS et al. BMJ 2015 Feb 10.
In a large observational study, benefits were apparent only in certain subgroups.
Previous research has shown a J-shaped relation between alcohol consumption and all-cause mortality (i.e., moderate drinkers live longer than nondrinkers and heavy drinkers). However, in some studies, former heavy drinkers (who have poorer health than never drinkers) were categorized as nondrinkers; hence, the J-shaped relation might reflect confounding rather than a biological mechanism. Researchers reassessed the relation between alcohol consumption and all-cause mortality in nearly 53,000 adults who participated in a U.K. health survey. Analyses were stratified by sex and age group (50–64 and ≥65) and adjusted for multiple potential confounders such as body-mass index and smoking.
Compared with nondrinkers (a category that included former drinkers), alcohol consumption at levels ranging from <1 unit (a standard drink contains 1–2 units of alcohol) monthly to ≤20 weekly was associated significantly with lower all-cause mortality in both age and sex groups. However, compared with never drinkers (i.e., excluding former drinkers), mortality benefits were significant only among younger men (age, 50–64) who consumed 15–20 units weekly (hazard ratio, 0.5) or 0.1–1.5 units on the heaviest drinking day (HR, 0.4) and older women (age, ≥65) who consumed ≤10 units weekly (HR, ≈0.7).
COMMENT
The J-shaped relation between alcohol consumption and all-cause mortality might be attributable in part to including former drinkers in the referent group and lack of adjustment for confounders. In this study, when never drinkers were used as the referent group and results were adjusted for numerous confounders, moderate alcohol consumption was associated significantly with mortality benefits only in younger men and older women. These results call into question the widely held assumption that moderate alcohol consumption confers health benefits in most adults.
EDITOR DISCLOSURES AT TIME OF PUBLICATION
Disclosures for Paul S. Mueller, MD, MPH, FACP at time of publication
Consultant / advisory boardBoston Scientific (Patient Safety Advisory Board)
Leadership positions in professional societiesAmerican Osler Society (Vice President)
CITATION(S):
Knott CS et al. All cause mortality and the case for age specific alcohol consumption guidelines: Pooled analyses of up to 10 population based cohorts. BMJ 2015 Feb 10; 350:h384. (Δεν είναι ορατοί οι σύνδεσμοι (links).
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Denominator:
Μία από τις καλύτερες ανασκοπήσεις (ίσως η καλύτερη) που έχω διαβάσει ποτέ σχετικά με το θέμα:
Friedmann PD. Clinical practice. Alcohol use in adults. N Engl J Med 2013 Jan 25; 368:365. - See more at: Δεν είναι ορατοί οι σύνδεσμοι (links).
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Μπορείτε να το δείτε και από τη σελίδα του περιοδικού: Δεν είναι ορατοί οι σύνδεσμοι (links).
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Δυστυχώς δεν είναι ανοικτό σε όλους - αν είστε συνδρομητής ή αν ξέρετε κάποιοιν που είναι, αναζητήστε το.
Argirios Argiriou:
Αθήνα
Τα περισσότερα ποτά σε σχέση με τους προκατόχους του (Πιρς Μπρόσναν, Σον Κόνερι και Ρότζερ Μουρ) εμφανίζεται να πίνει ο Ντάνιελ Κρεγκ ως Τζέιμς Μποντ, σύμφωνα με δημοσίευμα του βρετανικού περιοδικού The Grocer.
Ειδικότερα, ο Κρεγκ πίνει 20 ποτά σε κάθε ταινία, ο Πιρς έπινε 12 ποτά ανά ταινία, ο Σον Κόνερι και ο Ρότζερ Μουρ έπιναν κατά μέσο όρο 11 ποτά, ενώ μόλις 4 ποτήρια κατανάλωνε ο Τίμοθι Ντάλτον.
Σύμφωνα με το βρετανικό περιοδικό, οι εταιρείες που χρηματοδοτούν τις ταινίες επηρεάζουν σημαντικά και τις προτιμήσεις του διάσημου πράκτορα. Έτσι, οι θαυμαστές του «007» θα τον δουν στην νέα ταινία με τίτλο Spectre να εκδηλώνει ιδιαίτερη προτίμηση στη βότκα.
Οι χορηγοί φαίνεται να γνωρίζουν την επίδραση που έχει η εικόνα του «007» στο καταναλωτικό κοινό και είναι χαρακτηριστικό ότι οι πωλήσεις στο τζιν εκτοξεύθηκαν στη Μεγάλη Βρετανία από τη στιγμή που Ντάνιελ Κρεγκ απαρνήθηκε τη βότκα μαρτίνι το Vesper Martini (τζιν, βότκα και βερμούτ) στο Casino Royale.
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Argirios Argiriou:
September 17, 2015
Alcohol Drinking Patterns and Risk for Cancer.
Paul S. Mueller, MD, MPH, FACP reviewing Cao Y et al. BMJ 2015 Aug 18. Rehm J. BMJ 2015 Aug 18.
Even light-to-moderate alcohol consumption was associated with excess risk for alcohol-related cancers.
Are alcohol intake and risk for cancer related? In this analysis of long-term follow-up data from the Nurses' Health Study and the Health Professionals Follow-Up Study, researchers quantified risk for cancer across all levels of alcohol consumption in 88,000 women and 48,000 men. Investigators looked in particular at light-to-moderate alcohol intake, defined as <15 g daily for women and <30 g daily for men (in the U.S., a standard drink contains 14 g alcohol).
During follow-up of ≥30 years, 22% of women and 16% of men developed incident cancers. Adjusted for multiple variables (including smoking) and compared with nondrinkers, relative risks for total cancer in women ranged from 1.04 (with light-to-moderate intake) to 1.30 (with heavy intake [≥45 g daily]); for alcohol-related cancers, corresponding relative risks ranged from 1.13 to 1.66. These increases in relative risk, driven mainly by breast cancer, were similar for never smokers and ever smokers. Risk for total cancer in men who drank was elevated significantly only among those with daily alcohol intakes of 30 g to 44.9 g (RR, 1.15); in contrast, relative risks for alcohol-related cancers ranged from 1.26 (with light-to-moderate intake) to 1.62 (with heavy intake). Among men who were light-to-moderate drinkers, risk for alcohol-related cancer was elevated only among those who had ever smoked.
Comment
Given these findings, an editorialist recommends that daily alcohol consumption be limited to roughly one drink for women and two drinks for men (thresholds that are in line with most guidelines) and that people with family histories of cancer, especially women with family histories of breast cancer, should consider abstaining altogether.
Editor Disclosures at Time of Publication
Disclosures for Paul S. Mueller, MD, MPH, FACP at time of publication Consultant / advisory board Boston Scientific (Patient Safety Advisory Board) Editorial boards Medical Knowledge Self-Assessment Program (MKSAP 17 General Internal Medicine Committee); MKSAP 17 General Internal Medicine (author/contributor) Leadership positions in professional societies American Osler Society (Vice President)
Citation(s):
Cao Y et al. Light to moderate intake of alcohol, drinking patterns, and risk of cancer: Results from two prospective US cohort studies. BMJ 2015 Aug 18; 351:h4238. (Δεν είναι ορατοί οι σύνδεσμοι (links).
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Abstract/FREE Full Text
Rehm J.Light or moderate drinking is linked to alcohol related cancers, including breast cancer. BMJ 2015 Aug 18; 351:h4400. (Δεν είναι ορατοί οι σύνδεσμοι (links).
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Argirios Argiriou:
Läkartidningen (Το εβδομαδιαίο Περιοδικό των Σουηδών Ιατρών), 16-02-2016
SUMMARY in English.
The evidence for the beneficial health effects of moderate drinking is weaker than commonly perceived. No randomised controlled trials have been done. Observational studies suffer from unavoidable methodological limitations, chiefly from confounding and misclassification. Clinical advice to patients as well as public health recommendations should discourage initiation of alcohol consumption, as well as recommend the reduction of excessive drinking. The absence of health benefits strengthens the arguments for effective population-level policies, e.g. raising alcohol prices and restricting the physical availability of alcohol.
References:
[spoiler]REFERENSER
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