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Update on Update on Alcohol and HealthAlcohol and Health

Alcohol and Health: Current EvidenceAlcohol and Health: Current Evidence

MayMay––June 2004June 2004


Screening inScreening in

brief intervention trials brief intervention trials targeting excessive targeting excessive drinkers in general drinkers in general

practice: practice:

systematic review and systematic review and meta-analysismeta-analysis

Beich A, et al. Beich A, et al. BMJBMJ. 2003;327(7414):536 – . 2003;327(7414):536 – 542 542


Objectives/MethodsObjectives/Methods

To examine the efficiency of screening and To examine the efficiency of screening and efficacy of subsequent brief intervention efficacy of subsequent brief intervention (BI) for risky drinkers(BI) for risky drinkers

Systematic review and meta-analysis of 8 Systematic review and meta-analysis of 8 randomized clinical trials that used randomized clinical trials that used screening as a precursor to BI for risky screening as a precursor to BI for risky drinkersdrinkers


ResultsResults 9% screened drank risky amounts; 3% received BI.9% screened drank risky amounts; 3% received BI.

Pooled absolute risk reduction= 10.5% (from 69% of patients Pooled absolute risk reduction= 10.5% (from 69% of patients drinking risky amounts to 57%)drinking risky amounts to 57%)

10 risky drinkers need BI to yield 1 patient no longer 10 risky drinkers need BI to yield 1 patient no longer drinking risky amounts.drinking risky amounts.

Screening 1000 patients and giving BI to 1/3 of patients with Screening 1000 patients and giving BI to 1/3 of patients with positive screens (the average in the studies reviewed) would positive screens (the average in the studies reviewed) would yield 2 –3 patients no longer drinking risky amounts.yield 2 –3 patients no longer drinking risky amounts.

Intervention Intervention group*group*

Control Control group*group*

Absolute risk Absolute risk reductionreduction

# needed # needed to treatto treat

600/1410 (43%)600/1410 (43%) 432/1374 432/1374 (31%)(31%)

10.5 (7.1 to 10.5 (7.1 to 13.9)13.9)

10 (7 to 14)10 (7 to 14)

*Proportion of sensible drinkers at follow-up


Conclusions/CommentsConclusions/Comments

Many must be screened for risky Many must be screened for risky drinking (like other conditions) to drinking (like other conditions) to identify the few who will benefit from identify the few who will benefit from intervention.intervention.

BI in general practice decreases BI in general practice decreases alcohol use by risky drinkers and is alcohol use by risky drinkers and is at least as effective as other at least as effective as other preventive health measures.preventive health measures.


Different measures of Different measures of alcohol consumption and risk alcohol consumption and risk

of of coronary heart disease and coronary heart disease and

all-cause mortality: all-cause mortality: 11-year follow-up of the 11-year follow-up of the Whitehall II Cohort StudyWhitehall II Cohort Study

Britton A, et al. Britton A, et al. AddictionAddiction. 2004;99:109 – 116 . 2004;99:109 – 116



To investigate the contributions of To investigate the contributions of alcohol consumption patterns on all-alcohol consumption patterns on all-cause mortality and CHDcause mortality and CHD

Analysis of self-reported drinking Analysis of self-reported drinking habits and CHD events (angina or habits and CHD events (angina or fatal/non-fatal myocardial infarction) offatal/non-fatal myocardial infarction) of

10,308 London-based civil servants 10,308 London-based civil servants followed for a median of 11 yearsfollowed for a median of 11 years


ResultsResults Relationship between average Relationship between average

consumption and all-cause mortality and consumption and all-cause mortality and CHD was U-shaped.CHD was U-shaped.

Moderate consumptionModerate consumption→ → lowest death & CHD lowest death & CHD ratesrates

All-cause mortalityAll-cause mortality CHDCHD

AbstinenceAbstinence RR men, 2.2RR men, 2.2

Non-significant for Non-significant for womenwomen

RR men, 1.8RR men, 1.8

RR women, 2RR women, 2

2 or more times/day 2 or more times/day

(vs. 1-2 times/week)(vs. 1-2 times/week)RR men, 2.4RR men, 2.4

RR women, 7RR women, 7No associationNo association

Usual amount per drinking Usual amount per drinking sessionsession

No associationNo association No associationNo association


Conclusions/CommentsConclusions/Comments Findings support a U-shaped relationship Findings support a U-shaped relationship

between average alcohol consumption and all-between average alcohol consumption and all-cause mortality and CHD.cause mortality and CHD.

Drinking frequency may be an independent Drinking frequency may be an independent predictor of all-cause mortality (further study is predictor of all-cause mortality (further study is needed).needed).

Drinking frequency may not have been Drinking frequency may not have been adequately separated from total volume of adequately separated from total volume of consumption in statistical analyses.consumption in statistical analyses.


Brief interventions for Brief interventions for hazardous drinkers hazardous drinkers

delivered in primary care delivered in primary care are equally effective in are equally effective in

men and womenmen and women

Ballesteros J, et al. Ballesteros J, et al. AddictionAddiction. 2004;99:103 – 108 . 2004;99:103 – 108



To examine whether BI in primary care for To examine whether BI in primary care for excessive, non-dependent drinkers is excessive, non-dependent drinkers is equally effective in men and womenequally effective in men and women

Meta-analysis of randomized controlled Meta-analysis of randomized controlled trials of BI in primary care settings that trials of BI in primary care settings that reported outcomes separately by sexreported outcomes separately by sex

Outcomes= consumption at 6- to 12-month follow-up Outcomes= consumption at 6- to 12-month follow-up 6 trials including 1980 men and 1001 women6 trials including 1980 men and 1001 women


ResultsResults

Reductions in drinking associated with Reductions in drinking associated with BI were similar for both men and BI were similar for both men and women.women.

As assessed in 4 studies, BI increased As assessed in 4 studies, BI increased odds of drinking below hazardous levels odds of drinking below hazardous levels (defined variably in each study). (defined variably in each study).

Men (OR 2.3; 95% CI, 1.8 – 2.9) Men (OR 2.3; 95% CI, 1.8 – 2.9) Women (OR 2.3; 95% CI, 1.6 – 3.2)Women (OR 2.3; 95% CI, 1.6 – 3.2)



BI moderates hazardous drinking BI moderates hazardous drinking equally well in men and women.equally well in men and women.

More studies are needed to More studies are needed to determine whether BI works equally determine whether BI works equally well for men and women of diverse well for men and women of diverse ethnic, racial, and national ethnic, racial, and national backgrounds.backgrounds.


Medical and psychiatric Medical and psychiatric conditions of alcohol conditions of alcohol and drug treatment and drug treatment patients in an HMOpatients in an HMO

Mertens JR, et al. Mertens JR, et al. Arch Intern MedArch Intern Med. 2003;163:2511 – . 2003;163:2511 – 2517 2517


Objectives/MethodsObjectives/Methods To assess the 12-month prevalence of co-To assess the 12-month prevalence of co-

occurring conditions in patients receiving occurring conditions in patients receiving treatment for alcohol and/or other drug (AOD) treatment for alcohol and/or other drug (AOD) problems through managed care programsproblems through managed care programs

Patient questionnaires and clinical records ofPatient questionnaires and clinical records of 747 patients entering treatment 747 patients entering treatment age- and sex-matched controls from the same age- and sex-matched controls from the same

large HMOlarge HMO


ResultsResults

Depression (29% vs. 3%)Depression (29% vs. 3%) Anxiety (17% vs. 2%)Anxiety (17% vs. 2%) Injury/overdoses (26% vs. Injury/overdoses (26% vs.

12%)12%) Major psychoses (7% vs. Major psychoses (7% vs.

0.4%)0.4%) Lower back pain (11% vs. Lower back pain (11% vs.

6%)6%)

Headache (9% vs. 4%)Headache (9% vs. 4%) Asthma (7% vs. 3%)Asthma (7% vs. 3%) Hypertension (7% vs. Hypertension (7% vs.

3%)3%) Acid-related disorder Acid-related disorder

(5% vs. 2%)(5% vs. 2%) Arthritis (4% vs. 1%)Arthritis (4% vs. 1%)

Compared with controls, patients receiving treatment for AOD problems had a higher prevalence of the following:

Findings were similar among patients with Findings were similar among patients with alcohol dependence, who were also more likely to alcohol dependence, who were also more likely to have liver cirrhosis (1% vs. 0.1%).have liver cirrhosis (1% vs. 0.1%).



In private managed care (as in other In private managed care (as in other settings), common medical conditions are settings), common medical conditions are more prevalent among patients with AOD more prevalent among patients with AOD problems.problems.

These findings support the practice of These findings support the practice of screening for AOD problems in medical screening for AOD problems in medical clinics and for medical problems in AOD clinics and for medical problems in AOD treatment programs.treatment programs.


The TWEAK is weak for The TWEAK is weak for alcohol screening alcohol screening

among among female veterans affairs female veterans affairs

outpatientsoutpatientsBush KR, et al. Bush KR, et al. Alcohol Clin Exp ResAlcohol Clin Exp Res. 2003;27(12):1971 – . 2003;27(12):1971 – 1978 1978



To evaluate the TWEAK, AUDIT, and AUDIT-To evaluate the TWEAK, AUDIT, and AUDIT-C questionnaires to detect alcohol C questionnaires to detect alcohol problems in a female outpatient populationproblems in a female outpatient population

Self-administered TWEAK, AUDIT, and Self-administered TWEAK, AUDIT, and AUDIT-C questionnaires to 393 female AUDIT-C questionnaires to 393 female veteran outpatientsveteran outpatients Results were compared to an interview Results were compared to an interview

reference standard.reference standard.


ResultsResults 23% met criteria for hazardous drinking (i.e., 23% met criteria for hazardous drinking (i.e.,

amounts that placed them at risk for amounts that placed them at risk for consequences) and/or alcohol abuse or consequences) and/or alcohol abuse or dependence.dependence.

10% met criteria for active alcohol abuse or 10% met criteria for active alcohol abuse or dependence alone.dependence alone.

Each questionnaire had a greater sensitivity for Each questionnaire had a greater sensitivity for detecting active alcohol abuse or dependence than detecting active alcohol abuse or dependence than for detecting the whole spectrum including for detecting the whole spectrum including hazardous drinking, abuse, or dependence.hazardous drinking, abuse, or dependence.


Results (cont.)Results (cont.)

Screening Screening ThresholdThreshold

SensitivitySensitivity SpecificitySpecificity

TWEAKTWEAK 1 points1 points

22

33

44

0.440.44

0.320.32

0.200.20

0.170.17

0.890.89

0.920.92

0.990.99

1.001.00

AUDITAUDIT 22

33

44

55

0.870.87

0.700.70

0.470.47

0.350.35

0.710.71

0.860.86

0.920.92

0.980.98

AUDIT-CAUDIT-C 22

33

44

0.810.81

0.600.60

0.380.38

0.860.86

0.960.96

0.980.98

Detecting Hazardous Drinking and/or Active Alcohol Abuse or Dependence



Of the questionnaires tested, the AUDIT-C Of the questionnaires tested, the AUDIT-C appears to be the best for detecting hazardous appears to be the best for detecting hazardous drinking and alcohol use disorders in women.drinking and alcohol use disorders in women.

Findings need to be replicated in other groups Findings need to be replicated in other groups before widespread use is recommended.before widespread use is recommended.

The AUDIT-C’s brevity may help solve the The AUDIT-C’s brevity may help solve the greatest deficiency in screening– the failure to greatest deficiency in screening– the failure to use any validated questionnaire at all.use any validated questionnaire at all.


Effectiveness of Effectiveness of opportunistic brief opportunistic brief interventions for interventions for

problem drinking in a problem drinking in a

general hospital setting: general hospital setting:

systematic reviewsystematic review

Emmen MJ, et al. Emmen MJ, et al. BMJBMJ. 2004;328(7435):318. 2004;328(7435):318


Objectives/MethodsObjectives/Methods To test the efficacy of brief intervention To test the efficacy of brief intervention

(BI) in general hospitals(BI) in general hospitals

Systematic review of 8 controlled trials Systematic review of 8 controlled trials comparing effects of BI to usual care in comparing effects of BI to usual care in 1597 men and women in general hospitals1597 men and women in general hospitals

2 studies with hospital outpatients; 6 with 2 studies with hospital outpatients; 6 with inpatients on orthopedics, medicine, and inpatients on orthopedics, medicine, and surgery services for various reasonssurgery services for various reasons

BIs ranged from education to simple advice to BIs ranged from education to simple advice to counseling (or a combination of these).counseling (or a combination of these).


ResultsResults

BI was associated withBI was associated with

decreases in alcohol-related problems in 4 decreases in alcohol-related problems in 4 of 6 studies;of 6 studies;

decrease in consumption in only 1 study decrease in consumption in only 1 study (which was of outpatients) of 7 studies;(which was of outpatients) of 7 studies;

significant decreases in serum gamma-significant decreases in serum gamma-glutamyltransferase levels in 2 of 4 glutamyltransferase levels in 2 of 4 studies.studies.



It is notable that any benefit was It is notable that any benefit was found in these studies, given their found in these studies, given their diversity.diversity.

Universal screening and intervention Universal screening and intervention for all general hospital inpatients for all general hospital inpatients may be effective, but evidence is may be effective, but evidence is inconclusive.inconclusive.


Drinking to cope in Drinking to cope in socially anxious socially anxious

individuals:individuals: a controlled study a controlled study

Thomas SE, et al. Thomas SE, et al. Alcohol Clin Exp Res.Alcohol Clin Exp Res. 2003;27(12):1937 2003;27(12):1937 – 1943 – 1943



To investigate whether people who are To investigate whether people who are socially anxious are more likely to drink to socially anxious are more likely to drink to cope with their social fears than are those cope with their social fears than are those without anxietywithout anxiety

Survey about alcohol use in social Survey about alcohol use in social situations administered to 23 patients w/ situations administered to 23 patients w/ high social anxiety and 23 matched high social anxiety and 23 matched controls w/out social anxietycontrols w/out social anxiety


ResultsResultsPeople with People with

social social anxietyanxiety

ControlsControls

Use alcohol to feel more comfortable Use alcohol to feel more comfortable

beforebefore social situations social situations74%74% 39%39%

Use alcohol to feel more comfortable Use alcohol to feel more comfortable

duringduring social situations social situations87%87% 61%61%

Avoid social situations at least some Avoid social situations at least some of the time if alcohol was unavailable of the time if alcohol was unavailable beforebefore a social situation a social situation

47%47% 0%0%

Avoid social situations at least some Avoid social situations at least some of the time if alcohol was unavailable of the time if alcohol was unavailable duringduring a social situation a social situation

55%55% 7%7%


Conclusions/CommentsConclusions/Comments People who are socially anxious intentionally People who are socially anxious intentionally

drink alcohol to cope with their social fears.drink alcohol to cope with their social fears.

Data do not explain whether the relationship Data do not explain whether the relationship between social anxiety and alcohol use is between social anxiety and alcohol use is causally related to developing dependence.causally related to developing dependence.

Given reported associations, primary care Given reported associations, primary care clinicians should consider social anxiety a clinicians should consider social anxiety a risk factor for alcohol problems.risk factor for alcohol problems.


Treatment of sleep Treatment of sleep disturbance in alcohol disturbance in alcohol

recovery: recovery: a national survey of a national survey of addiction medicine addiction medicine

physiciansphysicians

Friedmann PD, et al. Friedmann PD, et al. J Addict DisJ Addict Dis. 2003;22(2):91 . 2003;22(2):91 – 103 – 103



To investigate how physicians To investigate how physicians manage sleep disturbance in patients manage sleep disturbance in patients in recovery from alcoholismin recovery from alcoholism

Survey of a random sample of Survey of a random sample of physician members of the American physician members of the American Society of Addiction MedicineSociety of Addiction Medicine 311 respondents (62% response rate)311 respondents (62% response rate)


ResultsResultsPhysicians reported 65% of their patients Physicians reported 65% of their patients

ininthe first 3 months after detox had a sleepthe first 3 months after detox had a sleepdisturbance.disturbance.

64% of physicians recommended meds to at 64% of physicians recommended meds to at least 1 patient to improve sleep.least 1 patient to improve sleep.

Only 22% offered meds to more than half of Only 22% offered meds to more than half of these patients.these patients.


Results (cont.)Results (cont.)Type of med Type of med prescribedprescribed

% of respondents% of respondents

TrazodoneTrazodone 38%38%

AntihistaminesAntihistamines 12%12%

Other sedating Other sedating antidepressantsantidepressants

7%7%

Non-Non-benzodiazepinesbenzodiazepines

4%4%

BenzodiazepinesBenzodiazepines 3%3%


Conclusions/CommentsConclusions/Comments Physicians appear reluctant to offer Physicians appear reluctant to offer

pharmacotherapy for sleep disturbance following pharmacotherapy for sleep disturbance following detox.detox.

Whether treatment of sleep disturbance in early Whether treatment of sleep disturbance in early recovery will lower the likelihood of recurrent recovery will lower the likelihood of recurrent drinking awaits empiric evaluation.drinking awaits empiric evaluation.

Despite its limitations, this study describes Despite its limitations, this study describes current practices and highlights our limited current practices and highlights our limited understanding of pharmacotherapy’s understanding of pharmacotherapy’s effectiveness for sleep disturbance post-detox.effectiveness for sleep disturbance post-detox.


Physicians’ attitudes Physicians’ attitudes regarding reporting regarding reporting

alcohol-impaired alcohol-impaired driversdrivers

Mello MJ, et al. Mello MJ, et al. Subst Abus.Subst Abus. 2003;24(4):233 – 242 2003;24(4):233 – 242


Objectives/MethodsObjectives/Methods To examine physicians’ attitudes about reporting To examine physicians’ attitudes about reporting

alcohol-impaired driversalcohol-impaired drivers

Questionnaire to physicians of 3 case scenarios Questionnaire to physicians of 3 case scenarios involving an alcohol-impaired male driver who involving an alcohol-impaired male driver who presents with minor injuries 1 hour after a motor presents with minor injuries 1 hour after a motor vehicle crash and has 1 of 3 levels of intoxication vehicle crash and has 1 of 3 levels of intoxication

clinical diagnosis of intoxicationclinical diagnosis of intoxication blood alcohol concentration (BAC) of 80 mg/dL blood alcohol concentration (BAC) of 80 mg/dL BAC of 240 mg/dLBAC of 240 mg/dL

261 responded; 49% response rate 261 responded; 49% response rate


ResultsResults Respondents preferred to report the driver to a Respondents preferred to report the driver to a

medical review board of the DMV than to police medical review board of the DMV than to police 66% vs. 36% if clinical diagnosis 66% vs. 36% if clinical diagnosis 63% vs. 32% if BAC 80 mg/dL 63% vs. 32% if BAC 80 mg/dL 81% vs. 53% if BAC 240 mg/dL 81% vs. 53% if BAC 240 mg/dL

Most common reasons for not reporting= Most common reasons for not reporting= physician-patient confidentiality and perceived physician-patient confidentiality and perceived threat of civil action threat of civil action

Comfort with reporting did not differ among Comfort with reporting did not differ among specialties (PCPs, emergency medicine physicians, specialties (PCPs, emergency medicine physicians, and general surgeons). and general surgeons).



Physicians are willing to report Physicians are willing to report alcohol-impaired drivers to authorities alcohol-impaired drivers to authorities but prefer using a DMV medical board but prefer using a DMV medical board rather than the police. rather than the police.

Physician preferences should be Physician preferences should be heeded when reporting systems in heeded when reporting systems in clinical settings are developed and clinical settings are developed and implemented. implemented.


Alcohol consumption Alcohol consumption during pregnancy and during pregnancy and

the risk of preterm the risk of preterm deliverydelivery

Albertsen K, et al. Albertsen K, et al. Am J EpidemiolAm J Epidemiol. 2004;159(2):155 – . 2004;159(2):155 – 161 161


Objectives/MethodsObjectives/Methods To examine the relationship between To examine the relationship between

alcohol consumption during pregnancy and alcohol consumption during pregnancy and preterm deliverypreterm delivery

Data from 40,892 women in the Danish Data from 40,892 women in the Danish National Birth Cohort (a study of pregnant National Birth Cohort (a study of pregnant women and offspring) who women and offspring) who

completed a computer-assisted telephone completed a computer-assisted telephone interview while pregnant interview while pregnant

gave birth to a liveborn singletongave birth to a liveborn singleton


ResultsResults 1,880 preterm births (<37 weeks gestation)1,880 preterm births (<37 weeks gestation)

Drinks/weekDrinks/week RRRR (adjusted for risk (adjusted for risk

factors for preterm factors for preterm birth)birth)

95% CI95% CI

NondrinkersNondrinkers 1.001.00

0.50.5 0.920.92 0.81 – 1.050.81 – 1.05

1 – 1.51 – 1.5 0.910.91 0.80 – 1.040.80 – 1.04

2 – 3.52 – 3.5 0.800.80 0.68 – 0.960.68 – 0.96

4 – 6.54 – 6.5 1.151.15 0.84 – 1.570.84 – 1.57

77 1.771.77 0.94 – 3.310.94 – 3.31


Results (cont.)Results (cont.)

1 or more drinks/week increased risk 1 or more drinks/week increased risk of very preterm birth (<32 weeks of very preterm birth (<32 weeks gestation), but not significantly. gestation), but not significantly. e.g., RR 3.3 for 7 or more drinks/weeke.g., RR 3.3 for 7 or more drinks/week

Type of alcoholic beverage was not Type of alcoholic beverage was not associated with preterm birth.associated with preterm birth.


Conclusions/CommentsConclusions/Comments Increases in preterm birth associated with Increases in preterm birth associated with

consuming 4 or more drinks/week were not consuming 4 or more drinks/week were not statistically significant, but are consistent statistically significant, but are consistent with findings from some previous studies. with findings from some previous studies.

Advising pregnant women to abstain Advising pregnant women to abstain remains the safest approach. remains the safest approach.

But, patients who have an occasional drink But, patients who have an occasional drink during pregnancy may not be increasing their during pregnancy may not be increasing their risk of preterm birth. risk of preterm birth.


Sociodemographic factors Sociodemographic factors associated with comorbid associated with comorbid major depressive episodes major depressive episodes and alcohol dependence in and alcohol dependence in

the general populationthe general population

Wang JL, et al. Wang JL, et al. Can J PsychiatryCan J Psychiatry. 2004;49(1):37 – 44. 2004;49(1):37 – 44



To examine the association between To examine the association between alcohol dependence (AD) and major alcohol dependence (AD) and major depressive episodes (MDEs) in the general depressive episodes (MDEs) in the general populationpopulation

Analysis of interview data from 72,940 Analysis of interview data from 72,940 people aged 12 and older who participated people aged 12 and older who participated in the Canadian National Population Health in the Canadian National Population Health SurveySurvey


ResultsResults Of participants with MDEs, 9% had comorbid Of participants with MDEs, 9% had comorbid

AD (compared to 2% without MDE). AD (compared to 2% without MDE).

Of participants with AD, 20% reported having Of participants with AD, 20% reported having at least one MDE (compared to 4% without AD). at least one MDE (compared to 4% without AD).

Those with comorbidity were much more likely Those with comorbidity were much more likely than those with pure AD to use mental health than those with pure AD to use mental health services in the past year (47% vs. 8%, services in the past year (47% vs. 8%, respectively).respectively).


Results (cont.)Results (cont.)More likely to have both More likely to have both comorbid AD/MDE and pure comorbid AD/MDE and pure ADAD

People under age 25People under age 25

Those who are single, divorced, Those who are single, divorced, separated, or widowedseparated, or widowed

More likely to have comorbid More likely to have comorbid AD/MDE but not pure ADAD/MDE but not pure AD

People with a low family incomePeople with a low family income

Those living with a non-intact Those living with a non-intact familyfamily

Non-whitesNon-whites

Less likely to have comorbid Less likely to have comorbid AD/MDE or pure ADAD/MDE or pure AD

ImmigrantsImmigrants

Analyses adjusted for sex, education, and employment



This study confirms that AD and MDEs This study confirms that AD and MDEs often coexist and that certain people have often coexist and that certain people have a greater risk of comorbidity.a greater risk of comorbidity.

The risk factors for comorbidity reported The risk factors for comorbidity reported can help clinicians identify patients in can help clinicians identify patients in greatest need of mental health services, greatest need of mental health services, and hopefully increase receipt of and hopefully increase receipt of appropriate care. appropriate care.


Folate, methyl-related Folate, methyl-related nutrients, alcohol, and thenutrients, alcohol, and the

MTHFR 677CMTHFR 677C →→T T polymorphism affect cancer polymorphism affect cancer

risk: risk: intake recommendationsintake recommendations

Bailey LB. Bailey LB. J NutrJ Nutr. 2003;133:3748S – 3753S. 2003;133:3748S – 3753S


Objectives/MethodsObjectives/Methods To review the research to examine To review the research to examine

relationships between…relationships between…

cancer riskcancer risk folate and other methyl-related nutrients (i.e., folate and other methyl-related nutrients (i.e.,

methionine, vitamin B6, vitamin B12)methionine, vitamin B6, vitamin B12) alcohol alcohol a specific genetic polymorphism that affects a specific genetic polymorphism that affects

folate metabolism (MTHFR 677C folate metabolism (MTHFR 677C →→T) T)

……and to make intake recommendationsand to make intake recommendations


ResultsResultsThe review found thatThe review found that

women who drink alcohol and have a high folate women who drink alcohol and have a high folate intake are not at increased risk of breast cancer; intake are not at increased risk of breast cancer;

diets low in methionine and folate but high in diets low in methionine and folate but high in alcohol are associated with a higher risk of alcohol are associated with a higher risk of colorectal adenoma and cancer;colorectal adenoma and cancer;

people with the MTHFR 677Cpeople with the MTHFR 677CT polymorphism T polymorphism

who have adequate folate intake may have a who have adequate folate intake may have a lower risk of colorectal cancer but are especially lower risk of colorectal cancer but are especially sensitive to alcohol’s carcinogenic effects.sensitive to alcohol’s carcinogenic effects.


Results (cont.)Results (cont.) Intake recommendations includeIntake recommendations include

increasing intake of folate-rich foods (e.g., increasing intake of folate-rich foods (e.g., citrus fruits and juices, dark green leafy citrus fruits and juices, dark green leafy vegetables, dried beans and peas);vegetables, dried beans and peas);

increasing intake of methionine-rich foods increasing intake of methionine-rich foods (e.g., poultry, fish, low-fat dairy); and/or(e.g., poultry, fish, low-fat dairy); and/or

using folate supplements.using folate supplements.


Conclusions/CommentsConclusions/Comments Folate may reduce the risk of breast and Folate may reduce the risk of breast and

colorectal cancer in people who drink alcohol. colorectal cancer in people who drink alcohol.

Advise folate supplementation or increased Advise folate supplementation or increased consumption of foods rich in methyl-related consumption of foods rich in methyl-related nutrients for those who consume alcohol and nutrients for those who consume alcohol and have inadequate diets.have inadequate diets.

Because of possible folate toxicity, recommend Because of possible folate toxicity, recommend increased folate intake only to people with inadequate increased folate intake only to people with inadequate intake and, in particular, to those who also drink intake and, in particular, to those who also drink alcohol. alcohol.

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