Debbie A. Lawlor, Naveed Sattar, George Davey Smith, and Shah Ebrahim.  The associations of physical activity and adiposity with alanine aminotransferase and gamma-glutamyltransferase.  American Journal of Epidemiology 161(11):1081-1088, June 1, 2005.

Summary: Because recent studies have shown associations of alanine aminotransferase (ALT) and gamma-glutamyltransferase (GGT) with diabetes, this study examined the associations of obesity and physical activity with ALT and GGT in a random sample of British women (N = 3,789) aged 60-79 years (1999–2001). Both body mass index (BMI) and waist:hip ratio (WHR) were positively and linearly associated with ALT and GGT, independently of each other, physical activity, alcohol consumption, smoking, and social class in childhood and adulthood. In adjusted models, a one-standard-deviation (1 SD) increase in BMI was associated with a 0.46-units/liter (95% confidence interval [CI], 0.16-0.75) increase in ALT and a 2.14-units/liter (95% CI, 0.99-3.30) increase in GGT. Similar results for a 1 SD increase in WHR were 13.96 (95% CI, 10.44-17.48) for ALT and 39.44 (95% CI, 25.89-52.98) for GGT. Physical activity frequency was inversely and linearly associated with GGT in fully adjusted models, but the inverse association with ALT was attenuated towards the null after adjustment for BMI and WHR. Adjustment for ALT and GGT resulted in some lessening of the strong linear associations of BMI and WHR with diabetes. The results provide some support for the suggestion that the relation between obesity and diabetes is mediated, at least in part, by liver pathology. NIAAA Glossary Terms:  alanine aminotransferase, gamma glutamyl transferase, diabetes, obesity, physical activity, AOD consumption, alcoholic beverage, smoking, body mass index, female, elderly, physical activity, socioeconomic status, risk analysis, risk factors, relative risk, random sample, epidemiology, liver disorder, human study

Mark J. Pletcher, Paul Varosy, Catarina I. Kiefe, Cora E. Lewis, Stephen Sidney, and Stephen B. Hulley.  Alcohol consumption, binge drinking, and early coronary calcification: Findings from the Coronary Artery Risk Development in Young Adults (CARDIA) study.  American Journal of Epidemiology 161(5):423-433, March 2005.

Summary: This study evaluated the extent to which the apparently beneficial cardiovascular effects of moderate alcohol consumption are mediated by protection against atherosclerosis. Alcohol consumption, coronary heart disease risk factors, and coronary calcification (a marker of atherosclerosis) were measured during 15 years of follow-up in the Coronary Artery Risk Development in Young Adults (CARDIA) Study (1985–2001). The prevalence of coronary calcification after follow-up among the participants (N = 3,037; aged 33–45 years; 55% women, 45% black) was 8% for consumption of 0 drinks/week (n = 1,435), 9% for 1–6 drinks/week (n = 1,023), 13% for 7–13 drinks/week (n = 341), and 19% for ≥14 drinks/week (n = 238) (p < 0.001 for trend). Calcification was also more common among binge drinkers (odds ratio = 2.1; 95% confidence interval, 1.6-2.7). These associations persisted after adjustment for potential confounders (age, gender/ethnicity, income, physical activity, family history, body mass index, smoking) and intermediary factors (lipids, blood pressure, glucose, C-reactive protein, and fibrinogen). Stratification showed the dose-response relation most clearly in black men; only heavier alcohol consumption (≥14 drinks/week) was associated with coronary calcification in other race/sex subgroups. These surprising findings suggest the presence of proatherogenic effects of alcohol in young adults, especially black men, which may counterbalance high density lipoprotein cholesterol elevation and other possible benefits of alcohol consumption. NIAAA Glossary Terms:  alcoholic beverage, AOD consumption, AOD use pattern, AOD use frequency, binge AOD use, coronary artery disorder, atherosclerosis, calcium, biological markers, young adult, follow-up study, risk analysis, risk factors, protective factors, relative risk, prevalence, dose-response relationship, trend, confounding variables, gender differences, racial differences, Black, male, ethnic differences, high density lipoprotein, cholesterol, human study

Rosalind A. Breslow  and Barbara A. Smothers.  Drinking patterns and body mass index in never smokers: National Health Interview Survey, 1997–2001.  American Journal of Epidemiology 161(4):368-376, February 2005.

Summary: The relation between alcohol drinking patterns and body mass index (BMI) was investigated using pooled cross-sectional data from the 1997–2001 National Health Interview Surveys. Weighted analyses included 45,896 adult never smokers who were current alcohol drinkers. Height and weight were self-reported. In adjusted analyses, alcohol quantity and frequency had opposite associations with BMI. BMI increased significantly as quantity increased from 1 drink per drinking day to ≥4 drinks per drinking day; in men, it increased from 26.5 (95% confidence interval [CI], 26.3, 26.6) to 27.5 (95% CI, 27.4-27.7), and in women, it increased from 25.1 (95% CI, 25.0-25.2) to 25.9 (95% CI, 25.5-26.3). As frequency increased from low quintiles of drinking days/year to high quintiles, BMI significantly decreased; in men it decreased from 27.4 (95% CI, 27.2-27.6) to 26.3 (95% CI, 26.2-26.5), and in women it decreased from 26.2 (95% CI, 26.0-26.5) to 24.3 (95% CI, 24.2, 24.5). In stratified analyses of frequency trends within quantity categories, declines in BMI were more pronounced in women than in men, but all linear trends were inverse and significant (p trend < 0.001). In all respondents combined, persons who consumed the smallest quantity the most frequently were leanest, and those who consumed the greatest quantity the least frequently were heaviest. Thus alcohol may contribute to excess body weight among certain drinkers. NIAAA Glossary Terms:  body mass index, obesity, alcoholic beverage, AOD consumption, AOD use frequency, AOD use pattern, gender differences, trend, risk analysis, relative risk, epidemiology, human study

Tetsuya Mizoue, Taiki Yamaji, Shinji Tabata, Keizo Yamaguchi, Eiichi Shimizu, Masamichi Mineshita, Shinsaku Ogawa, and Suminori Kono.  Dietary patterns and colorectal adenomas in Japanese men: The Self-Defense Forces Health Study.  American Journal of Epidemiology 161(4):338-345, February 2005.

Summary: The association between dietary patterns and colorectal adenomas was investigated in 1,341 Japanese men who underwent total colonoscopy in 1999-2002. A 74-item food frequency questionnaire prior to colonoscopy was used to obtain information about diet. Factor analysis yielded three dietary patterns: (1) high-dairy, high-fruit and -vegetable, high-starch, low-alcohol pattern; (2) "animal food" pattern; and (3) Japanese pattern. Logistic regression analysis was used to estimate the odds ratio of having colorectal adenomas with the adjustment for potential confounding variables including body mass index, smoking, alcohol, and leisure-time physical activities. There was a significant inverse association with colorectal adenoma for the high-dairy, high-fruit and -vegetable, high-starch, low-alcohol pattern; the respective odds ratios for the second, third, and fourth quartiles were 0.97 (95% confidence interval [CI], 0.70-1.36), 0.71 (95% CI, 0.50-1.01), and 0.62 (95% CI, 0.43-0.90), compared with the lowest quartile (p for trend = 0.003). Similar associations were observed for larger adenomas or for each subsite of the colorectum. The Japanese and "animal food" patterns were not clearly associated with colorectal adenomas. A dietary pattern including greater consumption of dairy products and fruits and vegetables with low alcohol consumption may be associated with reduced risk of colorectal adenomas. NIAAA Glossary Terms:  adenoma, colon, rectum, diet, dietary custom, starches, proteins, Japan, male, alcoholic beverage, AOD consumption, light AOD use, regression analysis, trend, statistical estimation, risk analysis, risk factors, protective factors, relative risk, epidemiology, human study

Stacey A. Missmer, Susan E. Hankinson, Donna Spiegelman, Robert L. Barbieri, Lynn M. Marshall, and David J. Hunter.  Incidence of Laparoscopically Confirmed Endometriosis by Demographic, Anthropometric, and Lifestyle Factors.  American Journal of Epidemiology 160(8):784-796, 2004.

Summary: The relations of demographic, anthropometric, and lifestyle factors with endometriosis were investigated in the Nurses’ Health Study II prospective cohort. During 10 years of follow-up, laparoscopically confirmed endometriosis was reported in 1,721 women with no history of infertility. The incidence was greatest among women aged 25–29 years and lowest among women over 44 years (ptrend < 0.0001). In multivariate Cox proportional hazards models, African-American women had a lower rate of disease compared with Caucasian women (rate ratio = 0.6; 95% confidence interval [CI], 0.4-0.9). An inverse relation with body mass index at age 18 was also observed (for body mass index of >30 vs. 19–20.4 kg/m2: rate ratio = 0.8, 95% CI, 0.6-1.1; ptrend = 0.004) and with current alcohol intake (for more than 10 g/day vs. 0 g/day: rate ratio = 0.7, 95% CI, 0.6-0.8; ptrend < 0.0001) but no association with height, waist/hip ratio, or caffeine intake. An inverse relation with current body mass index and current cigarette smoking was observed only when cases were also infertile. It was concluded that age, race, body mass index, alcohol use, and cigarette smoking are associated with the incidence of endometriosis and that some of these relations may differ by infertility status at the time of laparoscopic diagnosis. NIAAA Glossary Terms:  AOD use, AOD intake per occasion, alcoholic beverage, reproductive system diagnosis, reproductive effects of AODU, endometrium, endoscopy, infertility, female, incidence, African American, White American, racial differences, age differences, prospective study, cohort study, follow-up study, body mass index, cigarette, smoking, multivariate analysis, epidemiology, statistical estimation, trend, risk analysis, relative risk, human study

Flávio D. Fuchs, Lloyd E. Chambless, Aaron R. Folsom, Marsha L. Eigenbrodt, Bruce B. Duncan, Adam Gilbert, and Moyses Szklo.  Association between Alcoholic Beverage Consumption and Incidence of Coronary Heart Disease in Whites and Blacks:
The Atherosclerosis Risk in Communities Study.  American Journal of Epidemiology 160(5):466-474, 2004.

Summary: The relation between consumption of alcoholic beverages and incidence of coronary heart disease (CHD) was evaluated in white and black participants in the Atherosclerosis Risk in Communities Study. The average duration of follow-up was 9.8 years. Cox proportional hazards regression models were used to analyze the association. A positive association was found between ethanol consumption and incident CHD for black men (adjusted hazard ratio [HR] = 1.13 for a 13 g/day increment in alcohol consumption; 95% confidence interval [CI], 1.01-1.28) and an inverse association was found for white men (HR = 0.88; 95% CI, 0.79-0.99). CHD was inversely associated with rare drinking (HR = 0.47; 95% CI, 0.28-0.80) and with consumption of ≥70 g of ethanol per week (HR = 0.49; 95% CI, 0.24-0.98) in white women and with consumption of ≥210 g/week (HR = 0.56; 95% CI, 0.33-0.95) in white men. In black men, the association was positive for consumption of 140-<210 g/week (HR = 2.61; 95% CI, 1.11-6.17). The contrasting findings in whites and black men in this cohort raise the question of whether the cardioprotective effect of alcohol is real or may be confounded by lifestyle characteristics of drinkers. NIAAA Glossary Terms:  alcoholic beverage, AOD consumption, AOD intake per occasion, AOD use pattern, AOD use frequency, coronary artery disorder, African American, White American, racial differences, gender differences, risk analysis, relative risk, statistical estimation, regression analysis, epidemiology, protective factors, protective drug effect, confounding variable, lifestyle, human study

Annie Britton, Archana Singh-Manoux, and Michael Marmot.  Alcohol Consumption and Cognitive Function in the Whitehall II Study.  American Journal of Epidemiology 160(3):240-247, 2004.

Summary: The relation between alcohol consumption and cognitive function was investigated in a cohort study (4,272 men, 1,761 women). The median follow-up duration was 11 years. Measures of alcohol consumption were obtained at baseline (1985–1988) and four subsequent phases of data collection. Cognitive function (memory test, AH4 group test of intelligence, Mill-Hill vocabulary scale, phonemic and semantic fluency) was assessed at phase 5 (1997–1999), when participants were 46–68 years old. Of people who reported drinking alcohol in the past year, those who consumed at least one drink in the past week were significantly less likely to have poor cognitive function than those who did not. The beneficial effect extended to those drinking more than 240 grams a week (approximately 30 drinks), was was stronger for women than men, and was not limited to those with evidence of vascular disease. Similar associations were found in cross-sectional and longitudinal analyses. The relations were not explained by confounding by smoking and by physical and mental health and, to a large extent, were not mediated by cholesterol or blood pressure. However, the relations were weakened when social position was added to the model. It was concluded that for middle-aged subjects, increasing levels of alcohol consumption were associated with better function regarding some aspects of cognition. The authors advise against using these findings to encourage alcohol use. NIAAA Glossary Terms:  cognitive ability, alcoholic beverage, AOD consumption, AOD intake per occasion, AOD use frequency, middle-aged adult, elderly, intelligence test, vocabulary, language test, language ability, protective factors, protective drug effect, cohort study, follow-up study, longitudinal study, cross-sectional study, confounding variable, smoking, physical health, mental health, cholesterol, blood pressure, social class, gender differences, human study

Yan Liu, Ellen B. Gold, Bill L. Lasley, and Wesley O. Johnson.  Factors Affecting Menstrual Cycle Characteristics.  American Journal of Epidemiology 160(2):131-140, 2004.

Summary: Daily urinary metabolites of estrogen and progesterone and computer algorithms were used to assess ovulatory status and day of ovulation. The associations of risk factors with menstrual cycle characteristics were examined in 309 working women 20-44 years old, each of whom collected a median of five cycles of daily urine samples. Linear mixed models were used to assess continuous menstrual outcomes. Compared with women younger than 35, women aged 35 years or older had a significantly decreased adjusted mean cycle length (-0.94 days; 95% confidence interval [CI], -1.83 to -0.05) . Age modified the effects of smoking, physical activity, ethnicity, and alcohol consumption on mean follicular phase length. Asian women, compared with Caucasian women, had a significantly longer (1.65 days, 95% CI, 0.54-2.76) adjusted mean cycle length. Women who consumed alcoholic drinks had a significantly shorter (-1.26 days, 95% CI, -2.21 to -0.31) adjusted mean cycle length, compared to women who did not drink. Mean cycle and phase lengths were significantly associated with length of the prior luteal phase. These results indicate that potentially modifiable risk factors, as well as immutable host factors, are associated with menstrual cycle characteristics that may in turn be related to subsequent disease risk. NIAAA Glossary Terms:  alcoholic beverage, AOD use, AOD nonuse, menstrual cycle, estrogens, progesterone, ovulation, sex hormones, age differences, racial differences, Asian, White, smoking, physical activity, risk factors, genetic trait, urinalysis, comparative study, human study

Chuan-Yu Chen, Catherine M. Dormitzer, J. Bejarano, and James C. Anthony.  Religiosity and the Earliest Stages of Adolescent Drug Involvement in Seven Countries of Latin America.  American Journal of Epidemiology 159(12):1180-1188, 2004.

Summary: The role of religiosity (expressed as religious practice, religious devotion, and religious affiliation) in the earliest stages of drug involvement was assessed by studying recent-onset occurrence of first chances to try a drug and first actual drug use. The study was based on standardized questionnaire assessments of nationally representative samples of school-attending youths in Panama, the five Spanish heritage countries of Central America, and the Dominican Republic (N = 12,797). The data indicated that higher levels of religious practice are inversely associated with the earliest stages of tobacco and cannabis experiences (i.e., the first chance to try and the first actual use) but not with the earliest stages of alcohol use. For each unit increase in levels of religious practice behaviors, there was an associated reduced occurrence of the first chance to try tobacco (odds ratio = 0.76; 95% confidence interval, 0.62-0.94). Occurrence of first actual use of tobacco and cannabis was not associated with levels of religious practice behaviors among youths exposed to the opportunity to try these drugs. As such, these behaviors apparently have not strengthened resistance. Rather, autarcesis may be at work, functioning to shield youths from drug exposure opportunities. NIAAA Glossary Terms:  religious affiliation, spirituality and religion, behavior, AOD-exposed, early AODU onset, adolescence, protective factors, tobacco in any form, marijuana in any form, alcoholic beverage, Hispanic, Panama, Central America, Dominican Republic, survey, questionnaire, human study

Vincenzo Bagnardi, Antonella Zambon, Piero Quatto, and Giovanni Corrao.  Flexible Meta-Regression Functions for Modeling Aggregate Dose-Response Data, with an Application to Alcohol and Mortality.  American Journal of Epidemiology 159(11):1077-1086, 2004.

Summary: This article describes the use of fractional polynomials and cubic splines to represent smooth dose-response relations in summarizing meta-analytical aggregate data. Use of these two curve-fitting families can help prevent problems arising from inappropriate linearity assumptions. The methods are illustrated in the problem of estimating the shape of the dose-response curve between alcohol consumption and all-cause mortality risk, using aggregate data from 29 cohort studies investigating this issue (1966–2000). J-shaped curves with a nadir at approximately 5-7 g/day of alcohol consumption and a last protective dose of 47-60 g/day were consistently obtained from fractional polynomials and cubic splines. It is concluded that both curve-fitting families are useful in exploring dose-response epidemiologic questions with meta-analytical approaches, especially when important nonlinearity is anticipated. NIAAA Glossary Terms:  statistical modeling, statistical estimation, research and evaluation method, dose-response relationship, AOD consumption, mortality, risk analysis, cohort study, meta-analysis, epidemiology

Grant Colfax, Eric Vittinghoff, Marla J. Husnik, David McKirnan, Susan Buchbinder, Beryl Koblin, Connie Celum, Margaret Chesney, Yijian Huang, Kenneth Mayer, Sam Bozeman, Franklyn N. Judson, Kendall J. Bryant, and Thomas J. Coates, the EXPLORE Study Team.  Substance Use and Sexual Risk: A Participant- and Episode-level Analysis among a Cohort of Men Who Have Sex with Men.  American Journal of Epidemiology 159(10):1002-1012, 2004.

Summary: The authors of this study (the EXPLORE study, 1999-2001) investigated whether substance use during sex was independently associated with sexual risk during recent sexual episodes. The participants were 4,295 human immunodeficiency virus-negative men who have sex with men. The main outcome measure was serodiscordant unprotected anal sex (SDUA). Repeated-measures logistic models were used to examine the influence of participant-level characteristics. In assessing the influence of episode-level predictors on SDUA, the influence of participant-level characteristics, including 6-month substance use, was removed by using conditional logistic regression, in effect making each participant his own control. Adjustment was also made for partner characteristics. Heavy alcohol use was reported by 11% of the participants, use of poppers by 37%, cocaine sniffing by 19%, and use of amphetamines by 13%. In the participant-level analysis, use of poppers, amphetamines, and sniffed cocaine as well as heavy alcohol use in the prior 6 months were independently associated with SDUA. In the conditional analysis, consumption of 6 or more alcoholic drinks or use of poppers, amphetamines, or sniffed cocaine just before or during sex was independently associated with SDUA. It was concluded that programs aimed at preventing human immunodeficiency virus transmission should emphasize the influence of substance use during sex on increased risk behavior. NIAAA Glossary Terms:  homosexual, homosexual behavior, gay male, serologic test, individual-level statistical data, heavy AOD use, AOD intake per occasion, alcoholic beverage, illicit drug, cocaine, amphetamines, inhaled substance, regression analysis, predictive factor, HIV prevention, prevention program, prevention effort directed at people at risk, risk-taking behavior, self-report, controlled study, human study

Gayle C. Windham, Christian Bottomley, Cecilie Birner, and Laura Fenster.  Age at Menarche in Relation to Maternal Use of Tobacco, Alcohol, Coffee, and Tea during Pregnancy.  American Journal of Epidemiology 159(9):862-871, 2004.

Summary: The potential effects of common early life exposures on age at menarche were investigated using data collected in a follow-up study of pregnancies that occurred during the 1960s in California. Among 994 female offspring interviewed as adolescents, 98% had started menstruating at a mean age of 12.96 years. After adjustment, the mean age at menarche was a few months earlier among girls whose mothers smoked a pack or more of cigarettes daily during pregnancy compared with unexposed girls (difference = –0.22 years; 95% confidence interval [CI], -0.49 to 0.05) and earlier still among girls who were not white (difference = –0.52 years; 95% CI, -1.1 to 0.08). Girls with both high prenatal and childhood passive smoke exposure had an adjusted mean age at menarche about 4 months earlier than those unexposed. The daughter’s mean age at menarche varied little by maternal prenatal alcohol consumption. Daughters of tea consumers had a later mean age (difference = 0.41 years at >=3 cups (0.7 liter)/day; 95% CI, 0.03-0.80) and were more likely to start menarche later (>13 years) (odds ratio = 1.7; 95% CI, 0.91-3.2), but daughters of coffee consumers did not. The authors suggest that these findings may be related to hormonal effects and merit further investigation. NIAAA Glossary Terms:  menarche, adolescent, female, prenatal AOD exposure, prenatal alcohol exposure, postnatal AOD exposure, smoking, tea, coffee, risk factors, risk analysis, relative risk, hormones, controlled study, comparative study, human study

I. H. M. Friesema, M. Y. Veenstra, P. J. Zwietering, J. A. Knottnerus, H. F. L. Garretsen, and P. H. H. M. Lemmen.  Measurement of Lifetime Alcohol Intake: Utility of a Self-administered Questionnaire.  American Journal of Epidemiology 159(8):809-817, 2004.

Summary: Because epidemiological studies showing that alcohol intake is cardioprotective may be seriously biased by systematic neglect of lifetime alcohol consumption, the authors of this 1996-2001 cohort study developed a self-administered Lifetime Drinking History questionnaire (LDH-q). The baseline questionnaire was completed by 16,211 Dutch men and women older than 45 years, and a random sample of 3,255 men and women was used to determine the reliability and validity of the LDH-q. Test-retest reliability was assessed by means of the intraclass correlation coefficient and kappa scores. Correlations between lifetime and current intake scores were used to assess discriminant and convergent validity. Both reliability and validity appeared to be reasonably high compared with results obtained using interview formats to measure lifetime alcohol intake. Reliability of the LDH-q was higher for men than for women, probably because of the more frequent and regular drinking of men. Indexes of validity were similar for men and women (0.75 and 0.70 respectively). The results show that the LDH-q can be useful in large-scale cohort studies. NIAAA Glossary Terms:  cohort study, AOD consumption, alcoholic beverage, questionnaire, study subject AODU history, validation study, validity (research methods), reliability (research methods), protective factors, heart disorder, gender differences, AOD use frequency, AOD use pattern, human study

Ulrik Kesmodel and Morten Frydenberg.  Binge Drinking during Pregnancy—Is It Possible to Obtain Valid Information on a Weekly Basis?  American Journal of Epidemiology 159(8):803-808, 2004.

Summary: It has been suggested that future research into the adverse effects of binge drinking in pregnancy should take into account the time of binge drinking. This study of a representative sample of 1,311 pregnant Danish women assessed the agreement between interview and questionnaire measures of binge drinking during the first half of pregnancy. Compared with self-administered questionnaires, the interview provided an overall higher response rate, a higher response rate to the specific questions about binge drinking, a higher proportion of women admitting to binge episodes, and better internal consistency. Agreement between the methods ranged between 76% and 100% irrespective of the definition of binge drinking. Self-administered questionnaires are generally easier and cheaper to administer than interviews and may be sufficient to get an overall impression of the distribution of binge drinking. However, if the goal is to obtain data on the association of binge episodes during specific weeks of pregnancy and adverse pregnancy outcomes, the results of this study suggest that personal interviews should be used if at all possible, particularly because of high internal consistency. NIAAA Glossary Terms:  binge AOD use, gestation stage, prenatal alcohol exposure, fetal alcohol syndrome (FAS), pregnancy outcome, interview, questionnaire, comparative study, assessment of variables and methods, reliability (research methods), research and evaluation method, human study

G. Borges, C. J. Cherpitel, L. Mondragón, V. Poznyak, M. Peden, and I. Gutierrez.  Episodic Alcohol Use and Risk of Nonfatal Injury.  American Journal of Epidemiology 159(6):565-571, 2004.

Summary: The risk of injury in patients with and without alcohol dependence was compared in a case-crossover analysis of data on 705 injury patients from a hospital emergency department in Mexico City, Mexico, collected in 2002. The majority of the sample was male (60%) and over 30 years old (51%). A multiple matching approach took into account three control time periods (the day prior to the injury, the same day in the previous week, and the same day in the previous month). The estimated relative risk of injury for patients who reported having consumed alcohol within 6 hours prior to injury (17% of the sample) was 3.97 (95% confidence interval, 2.88-5.48). This increase in relative risk was concentrated within the first 2 hours after drinking, and there was a positive association of increasing risk with increasing number of drinks. The data suggested that relative risk estimates were the same for patients with and without alcohol use disorders. NIAAA Glossary Terms:  AODR injury, AOD dependence, AOD use, AOD use pattern, emergency care, risk analysis, relative risk, comparative study, dose-response relationship, statistical estimation, epidemiological indicators, alcohol use disorder classification, human study

Elizabeth A. Platz, Michael F. Leitzmann, Eric B. Rimm, Walter C. Willett, and Edward Giovannucci.  Alcohol Intake, Drinking Patterns, and Risk of Prostate Cancer in a Large Prospective Cohort Study.  American Journal of Epidemiology 159(5):444-453, 2004.

Summary: Previous studies of the association between alcohol drinking and prostate cancer have not examined drinking patterns, which may explain why the direction of the association remains equivocal. The authors of this study therefore prospectively evaluated the associations between these factors and risk of incident prostate cancer (n = 2,479) in a cohort of 47,843 men (1986-1998). The men completed a questionnaire at baseline that included information on consumption of specific types of alcohol and frequency of use. Hazard ratios were estimated using Cox proportional hazards regression for average alcohol intake and number of days per week on which alcohol was consumed stratified by average weekly intake (<105 g/week vs. ≥105 g/week). Compared with nondrinking, the hazard ratio for consumption increased slightly from an average of 5.0-14.9 g/day (hazard ratio [HR] = 1.05; 95% confidence interval [CI], 0.94-1.18) to 30.0-49.9 g/day (HR = 1.13; 95% CI, 0.96-1.33), but it was not increased at ≥50 g/day (HR = 1.00; 95% CI, 0.77-1.31) after adjustment for recent smoking and other factors. Compared with nondrinkers, risk was greatest among men who consumed an average of ≥105 g/week but who drank on only 1-2 days a week (HR = 1.64; 95% CI, 1.13-2.38). These results suggest that moderate or greater alcohol consumption is not a strong contributor to prostate cancer risk, except possibly in men who consume large amounts infrequently. NIAAA Glossary Terms:  prostate, cancer, alcoholic beverage, AOD use pattern, AOD use frequency, AOD intake per occasion, AOD nonuse, binge AOD use, moderate AOD use, heavy AOD use, questionnaire, controlled study, regression analysis, risk analysis, relative risk, human study

Linda Sharp  and Julian Little.  Polymorphisms in Genes Involved in Folate Metabolism and Colorectal Neoplasia: A HuGE Review.  American Journal of Epidemiology 159(5):423-443, 2004.

Summary: Epidemiologic and mechanistic evidence suggesting that folate is involved in colorectal neoplasia is reviewed. Some polymorphic genes involved in folate metabolism have been investigated in colorectal neoplasia, including methylenetetrahydrofolate reductase (MTHFR C677T and A1298C), methionine synthase (MTR A2756G), methionine synthase reductase (MTRR A66G), cystathionine ß-synthase (CBS exon 8, 68-base-pair insertion), and thymidylate synthase (TS enhancer region and 3' untranslated region). For MTHFR C677T and A1298C, the variant allele is associated with reduced enzyme activity in vitro. For the other polymorphisms, functional data are limited or inconsistent. Genotype frequencies for all of the polymorphisms show marked ethnic and geographic variation. In most studies, MTHFR 677TT (10 studies, >4,000 cases) and 1298CC (four studies, >1,500 cases) are associated with moderately reduced colorectal cancer risk. In four of five genotype-diet interaction studies, 677TT subjects who had higher folate levels (or a "high-methyl diet") had the lowest cancer risk. In two studies, 677TT homozygote subjects with the highest alcohol intake had the highest cancer risk. Findings from six studies of MTHFR C677T and adenomatous polyps are inconsistent. Only one or two studies have examined the other polymorphisms and they need to be replicated. Overall, the roles of folate-pathway genes, folate, and related dietary factors in colorectal neoplasia are complex. Research priorities are suggested. NIAAA Glossary Terms:  literature review, colon, rectum, neoplasm, folates, enzymes, genetic polymorphism, genotype, gene frequency, genetic correlation analysis, allele, ethnic differences, geographic analysis, regional differences  oxidoreductases, synthetases, risk factors, risk analysis, diet, human study

Katrine Albertsen, Anne-Marie Nybo Andersen, Jørn Olsen, and Morten Grønbæk.  Alcohol Consumption during Pregnancy and the Risk of Preterm Delivery.  American Journal of Epidemiology 159(2):155-161, 2004.

Summary: The objective was to evaluate the association between amount and type of alcohol consumed during pregnancy and the risk of preterm delivery and whether the relation differs in preterm deliveries at <32 weeks and preterm deliveries at 32 to <37 weeks of gestation. Data were obtained on 40,892 pregnant women participating in the first part of the Danish National Birth Cohort. The women completed a computer-assisted telephone interview between December 12, 1997, and December 31, 2000, and delivered a liveborn singleton. Preterm birth was reported by 1,880 women. Compared with women who abstained from alcohol during pregnancy, the relative risks (RR) for preterm delivery among women who consumed 4 to <7 drinks a week and ≥7 drinks a week during pregnancy were 1.15 (95% confidence interval [CI], 0.84-1.57) and 1.77 (95% CI, 0.94-3.31) respectively. No increased risk of preterm delivery was found at alcohol intakes below these levels. Among women who consumed ≥7 drinks a week, the relative risk of very preterm delivery was 3.26 (95% CI, 0.80-13.24) compared with nondrinkers. There were no differences in the associations between type of beverage and preterm delivery. NIAAA Glossary Terms:  pregnancy outcome, gestation stage, premature birth, prenatal alcohol exposure, alcoholic beverage, AOD consumption, AOD intake per occasion, AOD use, AOD abstinence, survey, interview, risk analysis, relative risk, human study

Paul Brennan, Sarah Lewis, Mia Hashibe, Douglas A. Bell, Paolo Boffetta, Christine Bouchardy, Neil Caporaso, Chu Chen, Christiane Coutelle, Scott R. Diehl, Richard B. Hayes, Andrew F. Olshan, Stephen M. Schwartz, Erich M. Sturgis, Qingyi Wei, Athanasios I. Zavras, and Simone Benhamou.  Pooled Analysis of Alcohol Dehydrogenase Genotypes and Head and Neck Cancer: A HuGE Review.  American Journal of Epidemiology 159(1):1-16, 2004.

Summary: Possession of the fast metabolizing alleles for alcohol dehydrogenase, ADH1B*2 and ADH1C*1, and the null allele for aldehyde dehydrogenase, ALDH2*2, results in increased acetylaldehyde levels. It has been hypothesized that the higher acetaldehyde lives increase the risk of head and neck cancer. The authors examined this association in a Human Genome Epidemiology (HuGE) literature review on these three genes and a pooled analysis of published studies on ADH1C. The majority of Asians had the fast ADH1B*2 and ADH1C*1 alleles, while the majority of Caucasians had the slow ADH1B*1/1 and ADH1C*1/2 genotypes. The ALDH2*2 null allele was observed frequently among Asians and rarely in other populations. In a pooled analysis of data from seven case-control studies with a total of 1,325 cases and 1,760 controls, an increased risk of head and neck cancer was not observed for the ADH1C*1/2 genotype (odds ratio [OR] = 1.00; 95% confidence interval [CI], 0.81-1.23) or the ADH1C*1/1 genotype (OR = 1.14; 95% CI, 0.92-1.41). Several studies reported increased relative risks of head and neck cancer for the ADH1B*1/1 and ALDH2*1/2 genotypes. Recommendations for future studies include larger sample sizes and incorporation of relevant alcohol dehydrogenase and aldehyde dehydrogenase genes simultaneously, as well as other genes. These considerations suggest the potential for the organization of a consortium of investigators conducting studies in this field. NIAAA Glossary Terms:  literature review, meta-analysis, cancer, head, neck, alcohol dehydrogenases, aldehyde dehydrogenases, ethanol metabolism, genetic polymorphism, genetic correlation analysis, genotype, allele, gene frequency, racial differences, Asian, White, risk factors, risk analysis, relative risk, case-control study, epidemiology, human study