Showing posts with label alcohol consumption. Show all posts
Showing posts with label alcohol consumption. Show all posts

Sunday, January 5, 2020

Study: Unhealthy Alcohol Use After HCV Therapy


FIG. 3. Association of alcohol use (unhealthy vs. nondrinking) with mortality and liver-related outcomes by SVR and cirrhosis status.

Click On Image To Enlarge

In summary, this large retrospective study of veterans who received DAA therapy showed that unhealthy alcohol use is associated with a higher risk of mortality and decompensated cirrhosis, with the mortality risk seemingly greatest among patients who did not achieve SVR after DAA therapy. The increased risk of decompensated cirrhosis and HCC associated with unhealthy alcohol use was also greater among patients who did not achieve SVR and who had cirrhosis. After DAA therapy, unhealthy alcohol use appeared to decline, albeit by a small percentage. We recommend that clinicians providing HCV treatment consider the time period before and during antiviral therapy as an opportunity to engage patients in long-term abstinence from alcohol use, to minimize posttreatment mortality and morbidity.

Monday, March 4, 2019

NIH study of brain energy patterns provides new insights into alcohol effects

NIH scientists present a new method for combining measures of brain activity (left) and glucose consumption (right) to study regional specialization and to better understand the effects of alcohol on the human brain.
Dr. Ehsan Shokri Kojori, NIAAA

NIH study of brain energy patterns provides new insights into alcohol effects
Assessing the patterns of energy use and neuronal activity simultaneously in the human brain improves our understanding of how alcohol affects the brain, according to new research by scientists at the National Institutes of Health. The new approach for characterizing brain energetic patterns could also be useful for studying other neuropsychiatric diseases. A report of the findings is now online in Nature Communications.

“The brain uses a lot of energy compared to other body organs, and the association between brain activity and energy utilization is an important marker of brain health,” said George F. Koob, Ph.D., director of the National Institute on Alcohol Abuse and Alcoholism (NIAAA), part of NIH, which funded the study. “This study introduces a new way of characterizing how brain activity is related to its consumption of glucose, which could be very useful in understanding how the brain uses energy in health and disease.”

The research was led by Dr. Ehsan Shokri-Kojori and Dr. Nora D. Volkow of the NIAAA Laboratory of Neuroimaging. Dr. Volkow is also the director of the National Institute on Drug Abuse at NIH. In previous studies they and their colleagues have shown that alcohol significantly affects brain glucose metabolism, a measure of energy use, as well as regional brain activity, which is assessed through changes in blood oxygenation.

“The findings from this study highlight the relevance of energetics for ensuring normal brain function and reveal how it is disrupted by excessive alcohol consumption,” says Dr. Volkow.

In their new study, the researchers combined human brain imaging techniques for measuring glucose metabolism and neuronal activity to derive new measures, which they termed power and cost.

“We measured power by observing to what extent brain regions are active and use energy,” explained Dr. Shokri-Kojori. “We measured cost of brain regions by observing to what extent their energy use exceeds their underlying activity.”

In a group of healthy volunteers, the researchers showed that different brain regions that serve distinct functions have notably different power and different cost. They then investigated the effects of alcohol on these new measures by assessing a group of people that included light drinkers and heavy drinkers and found that both acute and chronic exposure to alcohol affected power and cost of brain regions.

“In heavy drinkers, we saw less regional power for example in the thalamus, the sensory gateway, and frontal cortex of the brain, which is important for decision making,” said Dr. Shokri-Kojori. “These decreases in power were interpreted to reflect toxic effects of long-term exposure to alcohol on the brain cells.”

The researchers also found a decrease in power during acute alcohol exposure in the visual regions, which was related to disruption of visual processing. At the same time, visual regions had the most significant decreases in cost of activity during alcohol intoxication, which is consistent with the reliance of these regions on alternative energy sources such as acetate, a byproduct of alcohol metabolism.

They conclude that despite widespread decreases in glucose metabolism in heavy drinkers compared to light drinkers, heavy drinking shifts the brain toward less efficient energetic states. Future studies are needed to investigate the mechanisms contributing to this relative inefficiency.

“Studying energetic signatures of brain regions in different neuropsychiatric diseases is an important future direction, as the measures of power and cost may provide new multimodal biomarkers for such disorders,” says Dr. Shokri-Kojori.

The National Institute on Alcohol Abuse and Alcoholism (NIAAA), part of the National Institutes of Health, is the primary U.S. agency for conducting and supporting research on the causes, consequences, prevention, and treatment of alcohol use disorder. NIAAA also disseminates research findings to general, professional, and academic audiences. Additional alcohol research information and publications are available at:

About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit

Shokri-Kojori E, Tomasi D, Alipanahi B, Wiers CE, Wang GJ, Volkow ND (2019). Correspondence between cerebral glucose metabolism and BOLD reveals relative power and cost in human brain. Nat Commun. 10(1):690.

Saturday, February 2, 2019

Blog Updates - Common Liver Tests, Overview of Hepatitis A, B, and C

Common Liver Tests, Overview of Hepatitis A, B, and C
If you’re interested in useful information about viral hepatitis, check out the following blogs written by patient bloggers and healthcare professionals. Read articles covering an array of liver topics, from the difference between hepatitis A, B and C, to a supplement commonly taken by hepatitis patients. Additional posts include today's news, common liver tests, general food tips for a healthy liver, alcoholic liver disease and a warning about fruit juices sold in the U.S.  Make sure to check out coverage from this months HCV Special Conference as well.

News & Review 
Review a collection of noteworthy hepatitis C news articles in the latest issue of the Weekly Bull, published by the Canadian non-profit organization HepCBC.

Feb 6 - 2019 Hepatitis C - Testing, Treatment Options, Stages of fibrosis and Care
Feb 5 - In Egypt, Viral Hepatitis Elimination Starts With a Village: An Interview With Dr. Ammal Metwally
CDC reports Oklahoma among top states with Hepatitis C deaths
Hepatitis C: Out-of-Pocket Cost Burden for Specialty Drugs in Medicare Part D in 2019
For 28 of the 30 studied specialty drugs used to treat four health conditions—cancer, hepatitis C, multiple sclerosis (MS), and rheumatoid arthritis (RA)—expected annual out-of-pocket costs for a single drug in 2019 range from $2,622 for Zepatier, a treatment for hepatitis C, to $16,551 for Idhifa, a leukemia drug.
Analysis Estimates Impact of Interventions on Global HCV Epidemic
FDA accepts new drug application for liver cancer T-cell therapy
Not content with billions of dollars in profits from the potent painkiller OxyContin, its maker explored expanding into an “attractive market” fueled by the drug’s popularity — treatment of opioid addiction, according to previously secret passages in a court document filed by the state of Massachusetts. In internal correspondence beginning in 2014, Purdue Pharma executives discussed how the sale of opioids and the treatment of opioid addiction are “naturally linked” and that the company should expand across “the pain and addiction spectrum,” according to redacted sections of the lawsuit by the Massachusetts attorney general. (Armstrong, 1/30)

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In medical emergencies around the world Médecins Sans Frontières / Doctors Without Borders (MSF) staff are working together to provide life-saving care. From doctors to nurses, administrators to mechanics, everyone has a role to play and a story to tell.

Pakistan: A new way of treating hepatitis C
Khurshid Ahmed
Feb 2, 2019
In Machar Colony, a slum area of Karachi, an Médecins Sans Frontières / Doctors Without Borders (MSF) team have been treating patients for Hepatitis C using a new line of drugs to combat the virus.

New drugs, known as Direct Acting Antivirals (DAAs) are now widely available in Pakistan, making it easy for primary healthcare workers like me and my colleagues – all nurses and general practitioners – to manage the majority of patients.
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Find Karen on Facebook or watch videos on her YouTube Page.
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Lucinda Porter is a nurse, speaker, advocate and patient devoted to increasing awareness about hepatitis C.

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It’s best to know ahead of time how your health care will be managed. Then, you will be in control of how much information you want. 
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Hep Forums: Started Epclusa today 2/1/2019
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Gastroenterology and Clinical Gastroenterology and Hepatology

Written by Dr. Kristine Novak
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Life Beyond Hep C is where faith, medical resources and patient support meet, helping Hep C patients and their families navigate through the entire journey of Hep C
Tests for Hepatitis C
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Canadian Liver Foundation
We strive to improve prevention and the quality of life of those living with liver disease by advocating for better screening, access to treatment, and patient care.

2019 - Canada’s Food Guide and your liver health
The Canadian Liver Foundation provided insight on this guide and how it can impact those living with liver disease. The new Food Guide also addresses concerns related to alcohol consumption and how this may impact the overall health of Canadians. This is highly relevant to Canadians with liver disease where caution should be considered. Although Health Canada’s Food Guide is restricted to diet, the Canadian Liver Foundation emphasizes that regular exercise and physical activity are essential components of the maintenance of good liver health and will enhance the benefits of a healthy diet.
View all blog updates, here...

Hepatitis B Foundation
The Hepatitis B Foundation is a national nonprofit organization dedicated to finding a cure and improving the quality of life for those affected by hepatitis B worldwide.
What is silymarin (milk thistle), and is it helpful for managing my hepatitis B and D? - Silymarin, an herb and extract of milk thistle seeds, is a supplement commonly taken by hepatitis patients across the world, yet its proven benefits remain controversial. It is not a treatment for hepatitis B or D, nor has it been shown to have any effect against fighting the viruses.

Three-part series; This is part one
What’s the Difference: Hepatitis B vs Hepatitis C?
Part two
What’s the Difference: Hepatitis A vs Hepatitis B
View all updates, here....

ADRLF (Al D. Rodriguez Liver Foundation)
Al D. Rodriguez Liver Foundation is a non-profit organization that provides resources, education and information related to screening, the prevention of and treatment for the Hepatitis Virus and Liver Cancer. 
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At we empower patients and caregivers to take control of Hepatitis C by providing a platform to learn, educate, and connect with peers and healthcare professionals.
Understanding Your Test Results: Liver Function Tests
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U.S. Department of Health & Human Services - Viral Hepatitis Blog
CDC, HRSA, & HHS gathered input about the next editions of the National HIV/AIDS Strategy and National Viral Hepatitis Action Plan a recent national conference. Also check out The US Department of Health & Human Services public health blog
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Kevin Pho is a practicing physician and most known for his blog KevinMD. Thousands of authors contribute to his blog: primary care doctors, surgeons, specialist physicians, nurses, medical students, policy experts. And of course, patients, who need the medical profession to hear their voices. 
If you are not in a high-risk category and feel the flu coming on, seeking treatment at an urgent care facility will not only help save you time and money, but it also keeps emergency rooms clear for those whose lives depend upon immediate treatment. Urgent cares also provide expert care for conditions such as colds, sore throats, ear infections, sprains, strains and more, often at lower costs and shorter wait times. 
View latest blog entry here...

The goal of our publications is to bring people around the world the most current health information that is authoritative, trustworthy, and accessible, drawing on the expertise of the 10,000+ faculty physicians at Harvard Medical School.

The flu is different from the common cold, but it’s not always easy to tell them apart, especially at the beginning. The flu usually comes on suddenly, and its symptoms can include fever, runny nose, cough, sore throat, headache, muscle aches,
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University of Michigan - Lab Blog
Providing physicians with virtual access to specialists can be lifesaving to liver disease patients.

In most cases, moderate drinking — one drink a day for women, two drinks a day for men — will not lead to alcoholic liver disease (ALD) but overindulging can. And for those already suffering from liver disease — some of whom may not know it — even small amounts of alcohol can exacerbate their liver damage.

Kevin Joy 
The seasonal return of two unpleasant viruses offers a reminder for good hygiene and vigilance. Here’s how to stop the spread of flu and increase norovirus prevention.

To improve the diagnosis, treatment & support of Americans with fatty liver, NAFLD or NASH through awareness, education, screening and patient advocacy.
What I Wish I Had Known Sooner
When we finally figured out what was really going on, I found myself looking back and lamenting “If only I had known.”. Wayne and I have put together a list of some of the things we wish we had known at the start of our journey, in the hopes that it may be helpful and valuable to you.

Message Boards:
Living with Fatty Liver or NASH is a community of the Fatty Liver Foundation dedicated to supporting individuals who have been diagnosed or are at-risk of developing Fatty Liver or nonalcoholic steatohepatitis (NASH).

On This Blog
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Current research & media articles available on this blog:

Scope Blog
Scope is published by Stanford Medicine 
Stanford psychologist Ian Gotlib is examining how depression develops and working to identify potential opportunities for intervention.

JAMA - Medical News & Perspectives
Are Probiotics Money Down the Toilet? Or Worse?
Jennifer Abbasi
JAMA.Published online January 30, 2019.
With interest growing in natural therapies, the popularity of probiotics is on the rise. In 2012, almost 4 million US adults reported using probiotics or prebiotics—4 times more than in 2007. Probiotics were used in more than 50 000 hospitalizations in 139 US hospitals in 2012. And last year alone, US consumers spent an estimated $2.4 billion on the supplements.
Comment and opinion from readers, authors, and editors.
Tim Spector: Breakfast—the most important meal of the day?
The mantra of breakfast being the most important meal of the day has been ingrained in most of us from an early age—from our mother’s mouth as we were late for school to government campaigns to get us to “go to work on an egg.” Over the past 50 years we have been bombarded with messages extolling the health benefits of various processed cereals and porridge oats. The British fry-up is thought by many to be the country’s main contribution to world cuisine.

A new Consumer Reports study found that half of the fruit juices sold in the U.S. had elevated levels of arsenic, cadmium, and/or lead. Consumer Reports tested 45 drinks and found 21 contained enough of a single heavy metal or a combination of the metals to concern experts who worked with Consumer Reports on the study.

For the full list, including healthier alternatives, go to Consumer Reports' website.

Cedars-Sinai Blog
Committed to helping you build a healthy lifestyle for you and your family.
Q&A: Rheumatoid Arthritis
We take for granted that our immune system is always looking out for us.
But in the case of rheumatoid arthritis (RA)—an autoimmune condition that affects over 1 million adults in the US—the body’s defense system turns on us.

What’s the difference between an NP and a doctor?
Many medical offices and hospitals offer care provided by nurse practitioners, commonly referred to as NPs. These highly trained medical professionals can provide many primary care services or be part of your specialty care team.

Check back for updates!

Tuesday, January 22, 2019

Treating alcohol-related liver disease from a public health perspective

Also See
Journal of Hepatology February 2019
Alcohol-related liver disease: Time for action
Ramon Bataller, Gavin E. Arteel, Christophe Moreno, Vijay Shah
The overall landscape of clinical hepatology has markedly evolved in the last few years. Recent major advances in the management of viral hepatitis B and C with highly effective therapies are decreasing the proportion of patients with viral-related end-stage liver disease in many countries.1 Consequently, increasing attention is being paid to fatty liver diseases (both alcohol-related liver disease [ALD] and non-alcoholic fatty liver disease [NAFLD]) as the main current and future driver of liver-related health burdens.

Journal of Hepatology February 2019
Volume 70, Issue 2, Pages 223–236
Treating alcohol-related liver disease from a public health perspective
Theresa Hydes†, William Gilmore†, Nick Sheron, Ian Gilmore

Herein, we describe the evolving landscape of alcohol-related liver disease (ALD) including the current global burden of disease and cost to working-aged people in terms of death and disability, in addition to the larger spectrum of alcohol-related heath complications and its wider impact on society. We further review the most effective and cost-effective public health policies at both a population and individual level. Currently, abstinence is the only effective treatment for ALD, and yet because the majority of ALD remains undetected in the community abstinence is initiated too late to prevent premature death in the majority of cases. We therefore hope that this review will help inform clinicians of the “public health treatment options” for ALD to encourage engagement with policy makers and promote community-based hepatology as a speciality, expanding our patient cohort to allow early detection, and thereby a reduction in the enormous morbidity and mortality associated with this disease.

Full Article: 

Alcohol-Linked Disease Overtakes Hep C As Top Reason For Liver Transplant

Alcohol-Linked Disease Overtakes Hep C As Top Reason For Liver Transplant
By Rachel Bluth
An estimated 17,000 Americans are on the waiting list for a liver transplant, and there’s a strong chance that many of them have alcohol-associated liver disease. ALD now edges out hepatitis C as the No. 1 reason for liver transplants in the United States, according to research published Tuesday in JAMA Internal Medicine.

One reason for the shift, researchers said, is that hepatitis C, which used to be the leading cause of liver transplants, has become easier to treat with drugs.

Another could be an increasing openness within the transplant community to a candidate’s history of alcohol and addiction and when a candidate combating these issues can qualify for a liver.

For years, conventional wisdom suggested that people with a heavy drinking past who did not have a period of sobriety under their belts would not be good candidates to receive a new liver. But, of almost 33,000 liver transplant patients since 2002 who were studied, researchers from the University of California-San Francisco found 36.7 percent of them had ALD in 2016, up from 24.2 percent in 2002.

“Across the country, and we show in a prior study, people are changing their minds,” said Dr. Brian P. Lee, the study’s lead author and a UCSF gastroenterology and hepatology fellow. “More and more providers are willing to transplant patients with ALD.”

The debate, roiling for decades, culminated in 1997 when a group of doctors and medical societies and the U.S. surgeon general published a paper that recommended patients with alcoholic liver disease be sober at least six months before they could be considered for transplant.

This “six-month rule” became the gold standard. The idea was that a patient who could stay sober for that long had a lower chance of returning to harmful drinking behavior. There was also concern that the public would stop donating organs if they thought livers would be going to people with alcohol addictions.

“Neither of those attitudes are based on any facts or data,” said Dr. Robert Brown, director of the Center for Liver Disease and Transplantation at Weill Cornell and New York Presbyterian.

The changing attitude plays out at many transplant centers where what once was viewed as a hard-and-fast requirement for six months of sobriety is now more nuanced. Specifically, a team of doctors, psychologists and social workers look at a range of factors, including financial stability and family support, to determine if a patient will relapse after the transplant.

An analysis published in 2010 by researchers from the University of Pittsburgh and a 2011 study in France showed that, in any given year, there was little evidence to suggest six months of abstinence before the transplant decreased the chance of relapse.

The central point, experts say, does not necessarily come down to a patient’s record of sobriety before the procedure. Foremost is determining that a patient is unlikely to drink again after receiving a new liver — that he or she is “committed to lifelong abstinence,” said Lee.

Five years after transplantation, patients who were abstinent for six months and those who weren’t had about the same survival rates, according to Lee’s research. After 10 years, the patients who didn’t have six months of sobriety before the procedure had slightly worse survival rates. Lee said more research is needed to find out exactly why.

There is nothing magical about six months, according to Dr. Michael Lucey, medical director of the University of Wisconsin liver transplant program. He said it shows a poor understanding of alcohol abuse as a “very complex behavioral disorder.”

“Drinking isn’t a stable phenomenon,” Lucey said. “People with ALD may have long periods of drinking and abstinence.”

Although advocates are glad that policy is changing, it didn’t change swiftly enough to save Chelsea Oesterle.

Oesterle, who was 24 and had battled alcohol addiction since age 16, went to the emergency room in Peoria, Ill., in 2013, already in liver failure. Doctors told her in the first few days that survival depended on a transplant.

When it became clear she wasn’t going to get that transplant, her mother, Terri Oesterle, had her daughter transferred to another hospital, and between both facilities she spent six weeks hospitalized. During that time, she was never put on a transplant list.

The stigma around her daughter’s condition was palpable, her mother said. Doctors and nurses lectured her about quitting drinking.

“They kept telling her she had to go to rehab,” Terri Oesterle said. “She couldn’t even leave the hospital, how on earth was she supposed to go to a rehab program?”

One doctor point-blank asked Terri Oesterle why she thought her daughter deserved a liver over someone else.

“She was dismissed from the get-go,” Terri Oesterle said. “It’s just heart-wrenching because she was such a sensitive soul. She was so scared and hopeful.”

Chelsea Oesterle died in the hospital July 4, 2013.

Alcohol use disorder has often been thought of as a “self-inflicted” disease that results from bad habits or moral failing, Lucey said. That attitude is changing in the medical community, but vestiges remain.

“For some people, it’s not accepting that alcohol use disorder is an illness,” Lucey said.

While support for the changing approach is growing, Lee, the new study’s lead author, said it continues to be a polarizing issue.

“There are still detractors and still strong opposition,” he said. “Our study suggests that is certainly present, because regional differences are disparate.”

That troubles Lee, because it means a patient’s life is dependent on the attitudes of local providers, creating an unequal system. There’s “certainly value” in a national policy on the issue, he said.

The United Network for Organ Sharing (UNOS), the organization that manages the U.S. transplant list, nearly two decades ago wrestled with the idea of formalizing the six-month rule, but never took final action.

As a result, some centers have such a sobriety rule, others don’t. And even when a transplant center gives its approval, insurers often have their own set of requirements about how long a patient must be abstinent before they will cover the transplant.

Dr. David Klassen, chief medical officer for UNOS, agreed that the “rule” is arbitrary and not evidence-based, but said that it should be up to transplant centers to decide who gets listed for an organ.

“From our perspective, dictating medical care doesn’t lead to the best solutions or the best outcomes,” Klassen said. “I think transplant programs and society as a whole are moving in generally the same direction.”

Wednesday, January 2, 2019

Alcohol and the Liver: The Return of the Prodigal Son

Annals Of Hepatology

Alcohol and the Liver: The Return of the Prodigal Son
Octavio Campollo

Full-text article

Download Pdf

With the discovery of direct-acting antivirals and the prospective of viral hepatitis becoming curable, alcohol liver disease (ALD) is back to primetime. In the last 20 years, there have been many advances in the understanding of the biology, the psychology and the social and environmental factors associated with this long-known medical problem. Recent information about regional, ethnic, cultural and genetic factors seem to be relevant for the Latin American (LA) population. New approaches based on the new concepts and current information will render better results in the overall management of patients with this problem. Considering alcohol use disorder and ALD as part of the same entity managing it in a multidisciplinary approach seems to be best way to deal with this disease.

Tuesday, November 13, 2018

All adults should be screened for unhealthy alcohol use, new guidelines say

All adults should be screened for unhealthy alcohol use, new guidelines say
All adults should be screened for unhealthy alcohol use, new guidelines say. The negative consequences of too much alcohol include illness, injury, and death -- unhealthy alcohol use ranks as the third leading preventable cause of death in the US according to the task force. When pregnant women drink, birth defects and developmental problems in their children may follow.

By Susan Scutti, CNN
Updated 2:06 PM ET, Tue November 13, 2018
You can expect a "drinking checkup" when you visit the doctor. All adults, including pregnant women, should be screened for unhealthy alcohol use by their primary care physicians, the United States Preventive Services Task Force advises. For those patients who drink above the recommended limits, doctors should provide brief counseling to help them reduce their drinking, according to the new task force statement published Tuesday in the medical journal JAMA.

US Preventive Services Task Force Recommendation Statement 
November 13, 2018 
Screening and Behavioral Counseling Interventions to Reduce Unhealthy Alcohol Use in Adolescents and Adults
JAMA. 2018;320(18):1899-1909. doi:10.1001/jama.2018.16789
The USPSTF recommends screening for unhealthy alcohol use in primary care settings in adults 18 years or older, including pregnant women, and providing persons engaged in risky or hazardous drinking with brief behavioral counseling interventions to reduce unhealthy alcohol use. (B recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening and brief behavioral counseling interventions for alcohol use in primary care settings in adolescents aged 12 to 17 years. (I statement)

Thursday, October 11, 2018

Behind The Headlines - Young people turning their backs on alcohol

What is Behind the Headlines?
Each day the NHS Choices team selects health stories that are making headlines. These, along with the scientific articles behind the stories, are sent to Bazian, a leading provider of evidence-based healthcare information. Bazian's clinicians and scientists analyse the research and produce impartial evidence-based assessments, which are edited and published by NHS Choices.

Wednesday October 10 2018

"Shunning alcohol becomes 'mainstream' among young people as a third are now teetotal," reports The Independent.

A study involving nearly 10,000 young people in the UK found that the proportion of 16- to 24-year-olds who say they never drink alcohol rose from 18% in 2005 to 29% in 2015. The study also found that young people who did drink alcohol were drinking less nowadays and that binge drinking rates were falling.

The researchers said the drop in numbers of young people drinking suggested a shift in attitudes towards alcohol. They say this could be due to increased awareness of the health risks of alcohol, as well as changes in the way young people spend their leisure time.

The researchers observed a decrease in drinking in most groups of young people, including those in employment, in education, and with generally healthy lifestyles, and across all income groups.

However, there was no decrease among smokers, some ethnic groups and people with poor mental health. This may indicate a need to reach out with more support to certain groups.

Current UK guidelines advise men and women to drink no more than 14 units of alcohol a week; equivalent to 6 pints of average-strength beer or 10 small glasses of low-strength wine.

Find out about calculating units of alcohol.

Where did the story come from?
The researchers who carried out the study were from the Department of Epidemiology and Public Health, University College London.

The study was funded by grants from Alliance House Foundation, an organisation that promotes "temperance" or not drinking alcohol. It was published in the peer-reviewed medical journal BMC Public Health and is free to read online.

The story was widely reported. The Telegraph is one of several media outlets that speculated about the reasons for the drop in drinking, suggesting in its headline that "millennials are shunning alcohol" because they think "getting drunk is no longer cool".

But the study didn't actually look into the reasons for the decrease in drinking. More research is needed to investigate the reasons why young people are less likely to drink alcohol.

What kind of research was this?
This was an analysis of repeated cross-sectional surveys of people aged 16 to 24 in England.

The researchers wanted to see how alcohol consumption had changed over time among young people in different subgroups. They also wanted to see how the increase in non-drinking related to the amount of alcohol consumed by those young people who did drink.

Cross-sectional research shows a snapshot of people's behaviour at any one time. Although behaviour can then be linked with factors such as income levels or health habits, we cannot tell from cross-sectional research what causes the behaviour observed. In other words, this study can't tell us what's causing more young people to abstain from drinking.

What did the research involve?
Researchers used data from the Health Survey for England 2005 to 2015, an annual nationwide survey that asks questions about a wide range of health behaviours. For this study, researchers looked only at information from the 9,699 participants aged 16 to 24.

People were asked whether they drank alcohol. If they answered no, they were asked if they had ever consumed alcohol, had previously drunk alcohol or occasionally drank alcohol.

People who said they did drink alcohol were asked if they had done so in the past week, and how many units they had drunk on their heaviest drinking day.

The researchers also looked at:
body mass index (BMI)
smoking status
fruit and vegetable consumption
physical activity levels
wellbeing and mental health
whether the participants had any long-term illness

They looked at the results broken down by:
age group (16 to 17 or 18 to 24)
ethnic background
region where participants lived
whether they lived in a town, city or village
deprivation level of their local area
household social class
whether they were in full-time education or employed

What were the basic results? 
Overall the researchers found that between 2005 and 2015:
the numbers of people aged 16 to 24 who described themselves as non-drinkers rose from 18% to 29%
the numbers who had never drunk alcohol rose from 9% to 17%
the numbers who hadn't had a drink in the last week rose from 35% to 50%
the numbers who drank above recommended weekly limits fell from 43% to 28%
the numbers who had engaged in binge-drinking fell from 27% to 18%

The increase in non-drinking was seen in most subgroups, including both age groups and genders, north and south of the country, urban and rural areas, deprived and non-deprived areas, and those in and not in education or employment.

The numbers of non-drinkers rose among white young people but not among those from ethnic minorities. However, 68% of young people from ethnic minorities described themselves as non-drinkers in 2015, compared to 20% of white young people.

People with different health behaviours showed some difference in terms of drinking. Non-drinking increased among non-smokers but not among young people who smoked. It also increased among those who did high levels of physical activity, but not those who did less exercise.

This may suggest differences in health awareness, though non-drinking rates did increase in people with low fruit and vegetable consumption and regardless of BMI.

The researchers did not see an increase in non-drinking among people with lower scores of health and mental wellbeing.

How did the researchers interpret the results?
The researchers said their results "might suggest that the norms around non-drinking are changing, and this behaviour is becoming more mainstream among young people".

They said "increasing rates of non-drinking among young people are to be welcomed" and noted that the decline in drinking "may influence lower average consumption overall, which tends to reduce problematic drinking".

They said it is "difficult to pinpoint a single factor" behind the decline in drinking, but speculated it may be because of stricter licensing laws, increased awareness of the harms of alcohol, and changes in the way young people spend their leisure time – for example, using social media rather than meeting in a pub or bar.

We don't know for sure from this study why young people are increasingly turning away from drinking alcohol. However, the figures suggest a robust trend, which may or may not continue in future.

The decline in drinking could be due to increasing health awareness among young people and people making healthier lifestyle choices. From a public health point of view, this is probably good news, not least because the numbers of young people engaging in harmful binge drinking is also in decline.

The study has some limitations:
Some of the subgroups considered were quite small, which means the data for these groups may be less reliable. 

Although the participants were surveyed every year, not all of the health questions were asked each year. So in some years there's missing data for the amount of exercise people took, the amount of fruit and vegetables they ate, or for their mental health status. 

Cross-sectional surveys show only a snapshot or series of snapshots in time, so we don't know how the findings relate to changing habits among individuals over time.

Despite the drop in numbers of young people drinking, 28% of young people still reported drinking above recommended levels on at least 1 day in the week they were surveyed, in 2015. The lack of change in drinking habits among young people who smoked was also notable. There are still issues to address and people who may benefit from more support to reduce their alcohol intake.

Current UK guidelines advise men and women to drink no more than 14 units of alcohol a week; equivalent to 6 pints of average-strength beer or 10 small glasses of low-strength wine.

Find out about calculating units of alcohol.

Analysis by Bazian
Edited by NHS Website

Monday, October 1, 2018

Risk factors for liver disease among adults of Mexican descent in the United States and Mexico

World J Gastroenterol. Oct 7, 2018; 24(37): 4281-4290
Published online Oct 7, 2018. doi: 10.3748/wjg.v24.i37.4281 

Risk factors for liver disease among adults of Mexican descent in the United States and Mexico
Yvonne N Flores, Zuo-Feng Zhang, Roshan Bastani, Mei Leng, Catherine M Crespi, Paula Ramírez-Palacios, Heather Stevens, Jorge Salmeron 


Core tip: United States (US) Latinos have greater morbidity and mortality from liver disease than non-Hispanic whites, and liver disease is the fifth leading cause of death in Mexico. Known risk factors for chronic liver disease include hepatitis B or C infection, heavy/binge drinking, obesity, diabetes, and metabolic syndrome. We found that Mexican-Americans in the US have a greater risk of obesity, diabetes and heavy/binge drinking than their counterparts in Mexico. The prevalence of heavy/binge drinking was alarmingly high among Mexican-Americans, with over 70% among males and over 50% among US-born females. Our results identify a high prevalence of specific risk factors that should be targeted to reduce the high rates of liver disease-related mortality in this population.

To compare the prevalence of chronic liver disease (CLD) risk factors in a representative sample of Mexican-Americans born in the United States (US) or Mexico, to a sample of adults in Mexico. 

Data for Mexican-Americans in the US were obtained from the 1999-2014 National Health and Nutrition Examination Survey (NHANES), which includes persons of Mexican origin living in the US (n = 4274). The NHANES sample was restricted to Mexican-American participants who were 20 years and older, born in the US or Mexico, not pregnant or breastfeeding, and with medical insurance. The data in Mexico were obtained from the 2004-2013 Health Worker Cohort Study in Cuernavaca, Mexico (n = 9485). The following known risk factors for liver disease/cancer were evaluated: elevated aminotransferase levels (elevated alanine aminotransferase was defined as > 40 IU/L for males and females; elevated aspartate aminotransferase was defined as > 40 IU/L for males and females), infection with hepatitis B or hepatitis C, metabolic syndrome, high total cholesterol, diabetes, obesity, abdominal obesity, and heavy alcohol use. The main independent variables for this study classified individuals by country of residence (i.e., Mexico vs the US) and place of birth (i.e., US-born vs Mexico-born). Regression analyses were used to investigate CLD risk factors. 

After adjusting for socio-demographic characteristics, Mexican-American males were more likely to be obese, diabetic, heavy/binge drinkers or have abdominal obesity than males in Mexico. The adjusted multivariate results for females also indicate that Mexican-American females were significantly more likely to be obese, diabetic, be heavy/binge drinkers or have abdominal obesity than Mexican females. The prevalence ratios and prevalence differences mirror the multivariate analysis findings for the aforementioned risk factors, showing a greater risk among US-born as compared to Mexico-born Mexican-Americans. 

In this study, Mexican-Americans in the US had more risk factors for CLD than their counterparts in Mexico. These findings can be used to design and implement more effective health promotion policies and programs to address the specific factors that put Mexicans at higher risk of developing CLD in both countries.

Full-text article available online:

Wednesday, September 26, 2018

Heavy drinkers and teetotalers alike may have heightened dementia risk

Of Interest
Alcohol use disorder therapy could improve chronic liver disease outcomes
Fuster D, Samet JH. N Engl J Med. 2018;doi:10.1056/NEJMra1715733.
September 26, 2018
Details from a recently published review discussed expanded use of alcohol use disorder medications and treatments in everyday clinical practice for patients with advanced liver disease.

In HCV, alcohol use increases infection exposure and persistence, causes more extensive liver damage than the infection alone, leads to faster progression of liver fibrosis and results in higher rates of mortality. These effects are common in HBV as well, although alcohol use in patients with HBV also demonstrated an increased risk for hepatocellular carcinoma.

Along with increased fibrosis progression and an increased risk for hepatocellular carcinoma, alcohol use in patients with NAFLD leads to a greater prevalence of steatosis and abnormal liver tests. In hereditary hemochromatosis, alcohol use increases fibrosis progression as well as iron overload.

“Assessment of alcohol use is appropriate for any person with liver disease, given the elevated risks of alcohol-related hepatotoxicity,” Fuster and Samet wrote. “In fact, there is no known safe threshold of alcohol consumption for patients with chronic liver disease, especially those with HCV infection, obesity, or the metabolic syndrome.”

Heavy drinkers and teetotalers alike may have heightened dementia risk 
Lisa Rapaport
(Reuters Health) - Middle-aged adults who avoid alcohol altogether, and those who consume the equivalent of seven glasses of wine or more a week are both more likely than light drinkers to develop dementia in their later years, a long-term study suggests.

Abstinence is also associated with a higher likelihood of having heart disease or diabetes, which explains part of the increased dementia risk for teetotalers, the study found. Abstinence may also be tied to dementia in people who stopped drinking due to misuse or addiction, Sabia said by email...

“Findings on abstainers should not motivate people who do not drink to start drinking alcohol due to the adverse effects of alcohol on mortality, cirrhosis of the liver and cancer,” Sabia noted. “In addition, given the detrimental effect of alcohol for several health outcomes, people who drink in an excessive manner should be encouraged to reduce their alcohol consumption.” 

Recommended Reading
Alcohol abuse kills 3 million a year, most of them men: WHO
Of all deaths attributable to alcohol, 28% were due to injuries, such as those from traffic crashes, self-harm and interpersonal violence; 21% due to digestive disorders; 19% due to cardiovascular diseases, and the remainder due to infectious diseases, cancers, mental disorders and other health conditions...

Friday, September 21, 2018

Alcohol abuse kills 3 million a year, most of them men: WHO

Harmful use of alcohol kills more than 3 million people each year, most of them men.
More than 3 million people died as a result of harmful use of alcohol in 2016, according a report released by the World Health Organization (WHO) today. This represents 1 in 20 deaths. More than three quarters of these deaths were among men. Overall, the harmful use of alcohol causes more than 5% of the global disease burden.

WHO’s Global status report on alcohol and health 2018 presents a comprehensive picture of alcohol consumption and the disease burden attributable to alcohol worldwide. It also describes what countries are doing to reduce this burden.

“Far too many people, their families and communities suffer the consequences of the harmful use of alcohol through violence, injuries, mental health problems and diseases like cancer and stroke,” said Dr Tedros Adhanom Ghebreyesus, Director-General of WHO. “It’s time to step up action to prevent this serious threat to the development of healthy societies.”

Of all deaths attributable to alcohol, 28% were due to injuries, such as those from traffic crashes, self-harm and interpersonal violence; 21% due to digestive disorders; 19% due to cardiovascular diseases, and the remainder due to infectious diseases, cancers, mental disorders and other health conditions.

Despite some positive global trends in the prevalence of heavy episodic drinking and number of alcohol-related deaths since 2010, the overall burden of disease and injuries caused by the harmful use of alcohol is unacceptably high, particularly in the European Region and the Region of Americas.

Globally an estimated 237 million men and 46 million women suffer from alcohol-use disorders with the highest prevalence among men and women in the European region (14.8% and 3.5%) and the Region of Americas (11.5% and 5.1%). Alcohol-use disorders are more common in high-income countries.

Global consumption predicted to increase in the next 10 years
An estimated 2.3 billion people are current drinkers. Alcohol is consumed by more than half of the population in three WHO regions – the Americas, Europe and the Western Pacific. Europe has the highest per capita consumption in the world, even though its per capita consumption has decreased by more than 10% since 2010. Current trends and projections point to an expected increase in global alcohol per capita consumption in the next 10 years, particularly in the South-East Asia and Western Pacific Regions and the Region of the Americas.

How much alcohol are people drinking?
The average daily consumption of people who drink alcohol is 33 grams of pure alcohol a day, roughly equivalent to 2 glasses (each of 150 ml) of wine, a large (750 ml) bottle of beer or two shots (each of 40 ml) of spirits.

Worldwide, more than a quarter (27%) of all 15–19-year-olds are current drinkers. Rates of current drinking are highest among 15–19-year-olds in Europe (44%), followed by the Americas (38%) and the Western Pacific (38%). School surveys indicate that, in many countries, alcohol use starts before the age of 15 with very small differences between boys and girls.

Worldwide, 45% of total recorded alcohol is consumed in the form of spirits. Beer is the second alcoholic beverage in terms of pure alcohol consumed (34%) followed by wine (12%). Worldwide there have been only minor changes in preferences of alcoholic beverages since 2010. The largest changes took place in Europe, where consumption of spirits decreased by 3% whereas that of wine and beer increased.

In contrast, more than half (57%, or 3.1 billion people) of the global population aged 15 years and over had abstained from drinking alcohol in the previous 12 months.

More countries need to take action
“All countries can do much more to reduce the health and social costs of the harmful use of alcohol,” said Dr Vladimir Poznyak, Coordinator of WHO’s Management of Substance Abuse unit. “Proven, cost-effective actions include increasing taxes on alcoholic drinks, bans or restrictions on alcohol advertising, and restricting the physical availability of alcohol.”

Higher-income countries are more likely to have introduced these policies, raising issues of global health equity and underscoring the need for greater support to low- and middle-income countries.

Almost all (95%) countries have alcohol excise taxes, but fewer than half of them use other price strategies such as banning below-cost selling or volume discounts. The majority of countries have some type of restriction on beer advertising, with total bans most common for television and radio but less common for the internet and social media.

“We would like to see Member States implement creative solutions that will save lives, such as taxing alcohol and restricting advertising. We must do more to cut demand and reach the target set by governments of a 10% relative reduction in consumption of alcohol globally between 2010 and 2025,” added Dr Tedros.

Reducing the harmful use of alcohol will help achieve a number of health-related targets of the Sustainable Development Goals (SDGs), including those for maternal and child health, infectious diseases, noncommunicable diseases and mental health, injuries and poisonings.

Alcohol abuse kills 3 million a year, most of them men: WHO
Kate Kelland
(Reuters) - More than 3 million people died in 2016 due to drinking too much alcohol, meaning one in 20 deaths worldwide was linked to harmful drinking, the World Health Organization (WHO) said on Friday.

Of Interest
September 2018
Defining ‘Safe’ Alcohol Consumption, published online at
How much is too much?
This conversation is especially important in light of the BMJ study that uncovered a concerning trend in rising mortality among those aged 25-34 due to excessive alcohol consumption. While obesity and hepatitis C infection may contribute, the rise in liver disease among young Americans due to alcohol is particularly troubling.

Saturday, August 25, 2018

No Amount Of Alcohol Is Good For Your Health

NPR - Heard on All Things Considered
The Latest Scientific Advice On Drinking Alcohol: Don't
A new study published in The Lancet finds alcohol is associated with 2.8 million deaths each year worldwide. Researchers conclude that there is no safe level of alcohol and say the risks outweigh the potential benefits

No Amount Of Alcohol Is Good For Your Health, Global Study Says
August 24, 20183:42 PM ET
Samantha Raphelson
No amount of alcohol is safe, according to The Global Burden of Diseases study, which analyzed levels of alcohol use and its health effects in 195 countries from 1990 to 2016.

The Lancet
Alcohol use and burden for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016
Open Access
Published: August 23, 2018

Linked Article
No level of alcohol consumption improves health

Alcohol use is a leading risk factor for death and disability, but its overall association with health remains complex given the possible protective effects of moderate alcohol consumption on some conditions. With our comprehensive approach to health accounting within the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we generated improved estimates of alcohol use and alcohol-attributable deaths and disability-adjusted life-years (DALYs) for 195 locations from 1990 to 2016, for both sexes and for 5-year age groups between the ages of 15 years and 95 years and older.

Using 694 data sources of individual and population-level alcohol consumption, along with 592 prospective and retrospective studies on the risk of alcohol use, we produced estimates of the prevalence of current drinking, abstention, the distribution of alcohol consumption among current drinkers in standard drinks daily (defined as 10 g of pure ethyl alcohol), and alcohol-attributable deaths and DALYs. We made several methodological improvements compared with previous estimates: first, we adjusted alcohol sales estimates to take into account tourist and unrecorded consumption; second, we did a new meta-analysis of relative risks for 23 health outcomes associated with alcohol use; and third, we developed a new method to quantify the level of alcohol consumption that minimises the overall risk to individual health.

Globally, alcohol use was the seventh leading risk factor for both deaths and DALYs in 2016, accounting for 2·2% (95% uncertainty interval [UI] 1·5–3·0) of age-standardised female deaths and 6·8% (5·8–8·0) of age-standardised male deaths. Among the population aged 15–49 years, alcohol use was the leading risk factor globally in 2016, with 3·8% (95% UI 3·2–4·3) of female deaths and 12·2% (10·8–13·6) of male deaths attributable to alcohol use. For the population aged 15–49 years, female attributable DALYs were 2·3% (95% UI 2·0–2·6) and male attributable DALYs were 8·9% (7·8–9·9). The three leading causes of attributable deaths in this age group were tuberculosis (1·4% [95% UI 1·0–1·7] of total deaths), road injuries (1·2% [0·7–1·9]), and self-harm (1·1% [0·6–1·5]). For populations aged 50 years and older, cancers accounted for a large proportion of total alcohol-attributable deaths in 2016, constituting 27·1% (95% UI 21·2–33·3) of total alcohol-attributable female deaths and 18·9% (15·3–22·6) of male deaths. The level of alcohol consumption that minimised harm across health outcomes was zero (95% UI 0·0–0·8) standard drinks per week.

Alcohol use is a leading risk factor for global disease burden and causes substantial health loss. We found that the risk of all-cause mortality, and of cancers specifically, rises with increasing levels of consumption, and the level of consumption that minimises health loss is zero. These results suggest that alcohol control policies might need to be revised worldwide, refocusing on efforts to lower overall population-level consumption.

Funding Bill & Melinda Gates Foundation.

Saturday, June 30, 2018

HepCure Webinar Series - Hep C & Fatty Liver, Treatment, Alcohol Use, Elderly Patients and More

Watch experts discuss important HCV related topics in this easy to access webinar series presented by HepCure.

June 26, 2018
Transplant & HCV
On Tuesday, June 26th, Dr. Thomas Schiano of Mount Sinai Medical Center presented on: “Transplant & HCV”
Watch, here….
Download Slides, here.....

June 19, 2018
Nonalcoholic Fatty Liver Disease and Hepatitis C
On June 19th Dr. Amon Asgharpour of the Icahn School of Medicine at Mount Sinai. Dr. Asgharpour presented “Nonalcoholic Fatty Liver Disease and Hepatitis C.”

Watch, here.….
Download Slides, here...…

Of Interest
Michael Carter
Published: 18 June 2018
Fatty liver improves rapidly after hepatitis C cure
Liver stiffness and liver fat (steatosis) in people with chronic hepatitis C virus (HCV) infection both improve significantly after treatment with direct-acting antivirals (DAAs) resulting in sustained virological response (SVR), investigators from Japan report in Alimentary Pharmacology and Therapeutics. Both measures of liver health were assessed six months after SVR. Improvement was associated with a reduction in ALT levels and an increase in platelet count.

On This Blog
June 18, 2018
Hepatitis C Weekend Video: NASH What Is It

July 1, 2018
In the July Issue of the patient-friendly HCV Advocate newsletter, Lucinda Porter, RN., writes a must read article about: Avoiding Fatty Liver.

June 2018
Hepatitis C and Alcohol
On Tuesday, June 5th, Peter Hauser, MD, Director of the National VA Telemental Health Hub Long Beach presented on: “Hepatitis C and Alcohol”.

Watch, here...
Download Slides, here....

May 2018 - HCV Treatment
“Ace the Case” 

Program presented last month led by Dr. Douglas Dieterich of the Icahn School of Medicine at Mount Sinai. This webinar is patient based, with question and answer participation.

Late relapse in people with HCC
Chemo On HCV
Treating Patients with HCV & Depression & More....
Watch, here.....

HCV in the Elderly Patient
On May 29th, Dr. Roxana Bodin of Westchester Medical Center Health presented on: “HCV in the Elderly Patient”

Watch, here...
Download Slides here.....

Of Special Interest
"Innovation as Usual: Sustainable Financing for Viral Hepatitis Elimination" with Dr. Henry Chang. This webinar will discuss the global target to eliminate viral hepatitis as a major public health problem by the year 2030.
Watch, here.....
Download Slides, here...

Additional Topics
The HCV-Opioid Syndemic in Appalachia: Evidence from a Cohort of Rural Drug Users
Hepatitis C in Children and Adolescents
Cirrhosis & HCV

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HepCure Patient App
The patient app is a free resource for patients with hepatitis C, which allows them to track medication adherence, symptoms, and gain access to resources. It is available to download for free on iOS (App Store) and Android (Google Play) operating systems. While the app can be used by patients independently from the dashboard, it can also be linked with the provider dashboard. Providers can push lab data to patients and track treatment adherence and symptom data input by patients in real time.
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