Hepatic and other medical disorders of alcoholism: from pathogenesis to treatment.
Department of Medicine, Mount Sinai School of Medicine, Bronx Veterans Affairs Medical Center, New York 10468, USA.
The medical risks of moderate and excessive alcohol consumption are reviewed. Current knowledge of metabolism of alcohol, including effects of moderate amounts, on hepatic metabolism and toxicity is summarized, with an evaluation of the relationship between the level of consumption and its effects on nutrients (including retinoids, carotenoids and folate), liver disease and other medical complications of alcoholism, including cardiovascular diseases and cancer. Putative benefits are also considered. Promising therapeutic approaches evolving from newly gained insight in the pathogenesis of medical complications of alcoholism are outlined.
First-time admissions with alcohol-related medical problems: a 10-year follow-up of a national sample of alcoholic patients.
Piette JD. Barnett PG. Moos RH.
Center for Health Care Evaluation, Department of Veterans Affairs Palo Alto Health Care System, Menlo Park, California 94025, USA.
OBJECTIVE: We estimated the rate of first-time hospital admission over 10 years with alcohol-related medical problems among a large national sample of patients with diagnosed alcohol abuse disorders. METHOD: We identified a nationwide cohort of all patients (N = 46,680) discharged in 1980 from all Department of Veterans Affairs (VA) medical centers with alcohol-related diagnoses. Two comparison cohorts also were identified: patients with musculoskeletal disorders (N = 18,231) and a random sample of nonalcoholic patients (N = 45,204). Using secondary databases, ICD-9-CM coded diagnostic information was collected for all VA inpatient admissions these patients experienced over the decade following their index hospitalizations. Admission rates within age strata and age/race standardized rates were computed. Adjusted rate ratios were estimated using Poisson regression. RESULTS: Alcoholic patients were at substantial risk of admission for multiple medical disorders. Admission rates varied for patients of different ages. Those who were between 50 and 59 years of age during their index hospital stay were at the highest risk of admission with an alcohol-related medical disease over the subsequent decade. CONCLUSIONS: The admission rates for these medical disorders among alcoholic patients provide an important baseline estimate of individual patients' risk profiles and may help providers set priorities among diagnostic tests.
Changes in liver cirrhosis death rates in different countries in relation to per capita alcohol consumption and Alcoholics Anonymous membership.
Smart RG. Mann RE. Suurvali H.
Addiction Research Foundation, Toronto, Ontario, Canada.
OBJECTIVE: This study examines how trends in liver cirrhosis relate to per capita alcohol consumption and Alcoholics Anonymous (AA) membership in 33 countries between 1965 and 1991. It was expected that reductions in liver cirrhosis deaths seen in many countries would be related to both decreased consumption and increased AA membership. METHOD: Data on liver cirrhosis death rates, alcohol consumption and AA membership were gathered from a variety of international sources. The data were analyzed with regression analyses (Ordinary Least Squares). RESULTS: Cirrhosis deaths and alcohol consumption levels were positively related in all analyses. In two of the four analyses, the negative relationship between cirrhosis deaths and AA group rates was marginally significant. CONCLUSIONS: Liver cirrhosis rates were strongly related to alcohol consumption and showed some relationship to AA group rates. The modest impact of AA may be due to the weakness of the true relationship but also to incompleteness in the cirrhosis and AA data in some countries.