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1.
Recommendations for Management and Treatment of Nonalcoholic Steatohepatitis.
Ratziu, V, Ghabril, M, Romero-Gomez, M, Svegliati-Baroni, G
Transplantation. 2019;(1):28-38
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Abstract
The prevalence of nonalcoholic liver disease (NAFLD) is increasing worldwide in conjunction with the epidemic increase in obesity and metabolic risk factors. Consequently, NAFLD has become a leading indication for liver transplantation. Although genetic factors play an important role in the pathogenesis of NAFLD, detrimental lifestyle trends favoring a calorically unrestricted diet rich in carbohydrates and unsaturated fat, prolonged sedentary periods or limited physical activity have major metabolic implications. In aggregate these physiological dysregulations constitute the main risk factors for the metabolic syndrome and NAFLD. The cornerstone of the treatment of NAFLD, is lifestyle changes, including modifications to diet and physical activity, to reduce body weight and liver fat, however adherence is notoriously poor and the epidemic of NAFLD continues to grow unimpeded. In the face of this unmet clinical need, the pharmacologic therapy of NAFLD has been expanding as the varied mechanistic pathways of NAFLD are elucidated. Beyond these approaches to treating NAFLD, the prevention of other liver diseases is additionally important. Chief among these is alcoholic liver disease, and heavy use is detrimental irrespective of underlying NAFLD. However, the impact of mild to moderate alcohol use in patients with mild or nonadvanced forms NAFLD is undefined. This article summarizes the results of the International Liver Transplantation Society consensus meeting on NAFLD in liver transplantation. It describes the available evidence and provides consensus guidance on the lifestyle and pharmacologic therapies of NAFLD, and the consensus position on alcohol use in patients with NAFLD.
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2.
Ingested asbestos in filtered beer, in addition to occupational exposure, as a causative factor in oesophageal adenocarcinoma.
Fitzgerald, RC, Rhodes, JM
British journal of cancer. 2019;(12):1099-1104
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Abstract
Oesophageal adenocarcinoma has become much more common over the past 50 years, particularly in Britain, with an unexplained male to female ratio of > 4:1. Given the use of asbestos filtration in commercial brewing and reports of its unregulated use in British public houses in the 1970's to clear draught beer "slops", we have assessed the hypothesis that ingested asbestos could be a causative factor for this increased incidence. Importantly, occupational asbestos exposure increases the risk of adenocarcinoma but not squamous cell carcinoma of the oesophagus. The presence of asbestos fibres was consistently reported in filtered beverages including beers in the 1970s and asbestos bodies have been found in gastrointestinal tissue, particularly oesophageal tissue, at autopsy. There is no reported association between the intake of alcohol and oesophageal adenocarcinoma but studies would mostly have missed exposure from draught beer before 1980. Oesophageal adenocarcinoma has some molecular similarities to pleural mesothelioma, a condition that is largely due to inhalation of asbestos fibres, including predominant loss of tumour suppressor genes rather than an increase of classical oncogenic drivers. Trends in incidence of oesophageal adenocarcinoma and mesothelioma are similar, rising rapidly over the past 50 years but now plateauing. Asbestos ingestion, either from beer consumed before around 1980, or from occupational exposure, seems a plausible causative factor for oesophageal adenocarcinoma. If this is indeed the case, its incidence should fall back to a low baseline by around 2050.
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3.
Effects of Moderate Alcohol Drinking in Patients with Nonalcoholic Fatty Liver Disease.
Kwon, I, Jun, DW, Moon, JH
Gut and liver. 2019;(3):308-314
Abstract
Whether moderate alcohol intake is beneficial remains an unsolved issue. Recent studies have suggested that moderate alcohol consumption is associated with beneficial effects related to the prevention of cardiovascular diseases. Moderate alcohol consumption leads to a higher risk of hepatocellular carcinoma in patients with chronic viral liver diseases. However, the effects of moderate alcohol intake in patients with nonalcoholic fatty liver disease are unclear. In this review, we analyzed, from various perspectives, the effect of moderate alcohol consumption in patients with nonalcoholic fatty liver disease. We reviewed four cohort studies and seven cross-sectional studies. The results showed that moderate alcohol consumption was negatively related to the incidence of nonalcoholic steatohepatitis and liver fibrosis. However, moderate alcohol consumption was positively associated with the incidence of hepatocellular carcinoma in patients with nonalcoholic fatty liver disease. The results of the analysis of the relationship between moderate alcohol consumption and the levels of triglycerides, total cholesterol, high-density lipoprotein, and hypertension were diverse. More clinical data are needed to draw a conclusion about the effects of moderate alcohol consumption in patients with nonalcoholic fatty liver disease.
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4.
Clarifying the neurobehavioral sequelae of moderate drinking lifestyles and acute alcohol effects with aging.
Nixon, SJ, Lewis, B
International review of neurobiology. 2019;:39-78
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Abstract
Epidemiological estimates indicate not only an increase in the proportion of older adults, but also an increase in those who continue moderate alcohol consumption. Substantial literatures have attempted to characterize health benefits/risks of moderate drinking lifestyles. Not uncommonly, reports address outcomes in a single outcome, such as cardiovascular function or cognitive decline, rather than providing a broader overview of systems. In this narrative review, retaining focus on neurobiological considerations, we summarize key findings regarding moderate drinking and three health domains, cardiovascular health, Type 2 diabetes (T2D), and cognition. Interestingly, few investigators have studied bouts of low/moderate doses of alcohol consumption, a pattern consistent with moderate drinking lifestyles. Here, we address both moderate drinking as a lifestyle and as an acute event. Review of health-related correlates illustrates continuing inconsistencies. Although substantive reductions in risk for cardiovascular and T2D events are reported, robust conclusions remain elusive. Similarly, whereas moderate drinking is often associated with enhanced cognition and lower dementia risk, few benefits are noted in rates of decline or alterations in brain structure. The effect of sex/gender varies across health domains and by consumption levels. For example, women appear to differentially benefit from alcohol use in terms of T2D, but experience greater risk when considering aspects of cardiovascular function. Finally, we observe that socially relevant alcohol doses do not consistently impair performance in older adults. Rather, older drinkers demonstrate divergent, but not necessarily detrimental, patterns in neural activation and some behavioral measures relative to younger drinkers. Taken together, the epidemiological and laboratory studies reinforce the need for greater attention to key individual differences and for the conduct of systematic studies sensitive to age-related shifts in neurobiological systems.
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Changes in the Human Metabolome Associated With Alcohol Use: A Review.
Voutilainen, T, Kärkkäinen, O
Alcohol and alcoholism (Oxford, Oxfordshire). 2019;(3):225-234
Abstract
AIMS: The metabolome refers to the functional status of the cell, organ or the whole body. Metabolomic methods measure the metabolome (metabolite profile) which can be used to examine disease progression and treatment responses. Here, our aim was to review metabolomics studies examining effects of alcohol use in humans. METHODS We performed a literature search using PubMed and Web of Science for reports on changes in the human metabolite profile associated with alcohol use; we found a total of 23 articles published before end of 2018. RESULTS Most studies had investigated plasma, serum or urine samples; only four studies had examined other sample types (liver, faeces and broncho-alveolar lavage fluid). Levels of 51 metabolites were altered in two or more of the reviewed studies. Alcohol use was associated with changes in the levels of lipids and amino acids. In general, levels of fatty acids, phosphatidylcholine diacyls and steroid metabolites tended to increase, whereas those of phosphatidylcholine acyl-alkyls and hydroxysphingomyelins declined. Common alterations in circulatory levels of amino acids included decreased levels of glutamine, and increased levels of tyrosine and alanine. CONCLUSIONS More studies, especially with a longitudinal study design, or using more varied sample materials (e.g. organs or saliva), are needed to clarify alcohol-induced diseases and alterations at a target organ level. Hopefully, this will lead to the discovery of new treatments, improved recognition of individuals at high risk and identification of those subjects who would benefit most from certain treatments.
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Changes in Alcohol Use after Metabolic and Bariatric Surgery: Predictors and Mechanisms.
Ivezaj, V, Benoit, SC, Davis, J, Engel, S, Lloret-Linares, C, Mitchell, JE, Pepino, MY, Rogers, AM, Steffen, K, Sogg, S
Current psychiatry reports. 2019;(9):85
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Abstract
PURPOSE OF REVIEW This review synthesized the literature on predictors and mechanisms of post-bariatric alcohol problems, in order to guide future research on prevention and treatment targets. RECENT FINDINGS Consistent evidence suggests an elevated risk of developing problems with alcohol following bariatric surgery. While there is a paucity of empirical data on predictors of problematic alcohol use after bariatric surgery, being male, a younger age, smoking, regular alcohol consumption, pre-surgical alcohol use disorder, and a lower sense of belonging have predicted alcohol misuse post-operatively. This review synthesizes potential mechanisms including specific bariatric surgical procedures, peptides and reinforcement/reward pathways, pharmacokinetics, and genetic influences. Finally, potential misperceptions regarding mechanisms are explored. Certain bariatric procedures elevate the risk of alcohol misuse post-operatively. Future research should serve to elucidate the complexities of reward signaling, genetically mediated mechanisms, and pharmacokinetics in relation to alcohol use across gender and developmental period by surgery type.
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[Alcohol and Neurology].
Dematteis, M, Pennel, L
Presse medicale (Paris, France : 1983). 2018;(7-8 Pt 1):643-654
Abstract
The nervous system is a particular target tissue for alcohol due to desired effects and numerous acute and chronic consequences. Acute consequences are due to episodes of overconsumption, withdrawal syndromes, or decompensation of nutritional deficiencies. Chronic consequences are dominated by sleep disorders, chronic pain and cognitive-behavioral disorders, stroke, and impairments of balance, peripheral nerves and muscles, resulting from direct toxicity and/or nutritional deficiencies. There is a bidirectional relationship requiring seeking: alcohol use as a causal or aggravating factor in any neurological disorder ; and neurological disorders in cases of alcohol use, especially when problematic. Management of alcohol-related neurological consequences can help reduce or stop alcohol consumption, prevent relapse, and improve patients' quality of life.
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Association between obstructive sleep apnea and alcohol, caffeine and tobacco: A meta-analysis.
Taveira, KVM, Kuntze, MM, Berretta, F, de Souza, BDM, Godolfim, LR, Demathe, T, De Luca Canto, G, Porporatti, AL
Journal of oral rehabilitation. 2018;(11):890-902
Abstract
The aim of this systematic review was to answer the focused question, "Is there an association between obstructive sleep apnea (OSA) and alcohol, caffeine or tobacco use?" Five electronic databases (Cinahl, Literatura Latth American and Caribbean, PubMed, Scopus, Web of Science) and 3 grey literature (Google Acadêmico, ProQuest, OpenGrey) were searched, as well as search on reference list of included papers and contacts with study authors. Observational studies were included. The Meta-Analysis of Statistics Assessment and Review Instrument (MAStARI) tool assessed the potential risk of bias (RoB) among the studies, while the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach determined the level of evidence. Meta-Analysis was performed with RevMan 5.3 software. Among 3,442 identified studies, 14 were included. Eleven studies were classified as moderate RoB and 3 as high RoB. Meta-analysis showed OSA has no association with tobacco and presented a positive association with alcohol. The odds ratio for OSA increased almost 1.33 times (95% confidence interval [CI]; 1.10-1.62) for alcohol users. There was insufficient published data to evaluate whether OSA is associated with caffeine. The overall quality of evidence ranged from low to very low. OSA was associated with the use of alcohol, however there is not enough evidence to confirm the association with tobacco or caffeine. Due to the very low GRADE level of evidence, caution should be applied when considering these findings.
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Wine and its metabolic effects. A comprehensive review of clinical trials.
Fragopoulou, E, Choleva, M, Antonopoulou, S, Demopoulos, CA
Metabolism: clinical and experimental. 2018;:102-119
Abstract
The introduction of the term "French Paradox" motivated an extensive and in-depth research into health benefits of moderate wine consumption. The superiority of wine is thought to be attributed to its micro-constituents and consequent effort was made to isolate and identify these bioactive compounds as well as to elucidate the mechanisms of their action. Controlled trials offer more concrete answers to several raised questions than observational studies. Under this perspective, clinical trials have been implemented, mainly in healthy volunteers and rarely in patients, in order to investigate the acute or chronic effect of wine consumption on metabolism and physio-pathological systems, which are mainly associated with cardiovascular diseases. The aim of this review is to update the knowledge about the acute and long term effect of wine consumption on lipid and glucose/insulin metabolism as well as on the inflammatory and haemostatic systems, based on the reported data of controlled clinical trials. In conclusion, the most repeated result of wine consumption is on lipid metabolism, attributed mainly to ethanol, while wine micro-constituents seem to have an important role mainly in haemostatic and inflammatory/endothelial systems.
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10.
The Impact of Diet and Lifestyle on Atrial Fibrillation.
Nalliah, CJ, Sanders, P, Kalman, JM
Current cardiology reports. 2018;(12):137
Abstract
PURPOSE OF REVIEW Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in humans, affecting more than 33 million people globally. Its association with complex, resource intensive medical conditions such as stroke, heart failure and dementia have had profound impacts across existing health care structures. The global prevalence of AF has enjoyed significant growth despite significant improvement in our armamentarium for arrhythmia treatment. RECENT FINDINGS Efforts aimed at curtailing the incidence, prevalence, or progression of AF have prompted re-evaluation of traditional frameworks for understanding and managing this debilitating disease. It is in this context that focus has shifted toward lifestyle-associated factors such as obesity, hypertension, sleep apnoea, exercise, alcohol and diet, as mechanistic drivers and putative targets for therapy. Compelling evidence exists for weight loss and management of associated risk factors to improve outcomes of AF treatment. This review will address the epidemiologic and mechanistic evidence that link lifestyle-associated factors with AF and in light of this analysis evaluate the clinical impacts of their upstream management. Traditional paradigms of AF are shifting in light of emerging evidence, such that risk factor modification has become positioned as the fourth pillar of AF management.