[Gender and liver, nutritional and metabolic alterations of severe alcoholism: a study of 480 patients].
Servei de Medicina Interna, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, España. Medicina Clínica
(Impact Factor: 1.42).
To analyze gender differences in the hepatic, nutritional and metabolic complications associated with alcoholism.
Cross-sectional study in alcoholic patients admitted to detoxification in two university hospitals of Barcelona between 1999 and 2006. During admission, co-morbidity prior to admission was assessed and blood samples to analyze biological markers were collected. Demographic and anthropometric data, daily alcohol consumption and other drug use characteristics were also obtained at admission.
There were 566 admissions in 480 patients (375 males). Age at admission was 43 years (IQR: 36.3-49.0 years). Overall, 68.4% showed macrocytosis (MCV > 95 fl), 81.7% GGT>40 U/L and 57.7% AST>37 U/L. Regarding liver function tests, frequency of alkaline phosphatase > 120 U/L was significantly higher in women (18.5 vs 10.5%, p=0.037). However, the prevalence of hyperferritinemia (> 90 ng/mL) was significantly higher in alcoholic men (85.7% vs 62.2%) (p=0.000). Having multiple liver function test alterations was significantly higher in men (OR: 1.64, 95% CI: 1.01-2.65) (p=0.043). Women showed significant differences regarding the prevalence of macrocytosis (77.5% vs 65.8%, p=0.026), low serum creatinine (< 0.7 mg/100mL) (28.2 vs 14.6%, p=0.001), low serum ferritin (< 30 ng/mL) (10.8 vs 3.9%, p=0.020), as well as of multiple nutritional alterations (OR: 1.59, 95% CI: 1.02-2.48) (p=0.040). However, men had higher prevalence of anemia than women (32.3 vs 21.4%, p=0.032). Prevalence of type I obesity (BMI>30 kg/m(2)) was significantly higher in alcoholic women (29.2 vs 7.9%, p=0.007).
Hepatic, nutritional and metabolic complications of alcoholism in women are frequent, thus increasing the risk of developing adverse clinical outcomes.
Available from: Arantza Sanvisens
- "At discharge, the patients were asked to return for semiannual visits at the outpatient clinics. Additional admission details were published previously (Muga et al., 2007;Rivas et al., 2010;Sanvisens et al., 2011). For the purposes of the study, patients were classified into three categories according to the main substance of abuse at admission to drug treatment. "
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ABSTRACT: Mortality of alcohol and drug abusers is much higher than the general population. We aimed to characterize the role of the primary substance of abuse on the survival of patients admitted to treatment and to analyze changes in mortality over time.
Longitudinal study analyzing demographic, drug use, and biological data of 5023 patients admitted to three hospital-based treatment units in Barcelona, Spain, between 1985 and 2006. Vital status and causes of death were ascertained from clinical charts and the mortality register. Piecewise regression models were used to analyze changes in mortality.
The primary substances of dependence were heroin, cocaine, and alcohol in 3388 (67.5%), 945 (18.8%), and 690 patients (13.7%), respectively. The median follow-up after admission to treatment was 11.6 years (IQR: 6.6-16.1), 6.5 years (IQR: 3.9-10.6), and 4.8 years (IQR: 3.1-7.8) for the heroin-, cocaine-, and alcohol-dependent patients, respectively. For heroin-dependent patients, mortality rate decreased from 7.3×100person-years (p-y) in 1985 to 1.8×100p-y in 2008. For cocaine-dependent patients, mortality rate decreased from 10.7×100p-y in 1985 to <2.5×100p-y after 2004. The annual average decrease was 2% for alcohol-dependent patients, with the lowest mortality rate (3.3×100p-y) in 2008.
Significant reductions in mortality of alcohol and drug dependent patients are observed in recent years in Spain. Preventive interventions, treatment of substance dependence and antiretroviral therapy may have contributed to improve survival in this population.
- "Alcohol consumption was quantified in grams per day (10 g = 1 standard drink unit). Further details regarding the characteristics of admission for treatment have been published elsewhere (Sanvisens et al., 2011). "
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ABSTRACT: The association between alcohol use disorders and increased risk of mortality is well known; however, there have been few systematic evaluations of alcohol-related organ damage and its impact on survival in younger alcoholics. Therefore, we assessed medical comorbidity with a clinical index to identify subgroups of alcoholic patients at high risk of premature death.
Hospital-based cohort of alcohol-dependent patients admitted for detoxification between 1999 and 2008 in Barcelona, Spain. At admission, sociodemographic characteristics and a history of alcohol dependence and abuse of illegal drugs were obtained through clinical interviews and questionnaires. Medical comorbidity was assessed with the Cumulative Illness Rating Scale (Substance Abuse) (CIRS-SA). Dates and causes of death were obtained from clinical records and death registers. Survival was analyzed using Kaplan-Meier methods, and Cox regression models were used to analyze the risk factors for premature death.
Median age of the patients (686 total, 79.7% men) was 43.5 years (interquartile range [IQR], 37.8 to 50.4), average alcohol consumption was 200 g/d (IQR, 120 to 280 g/d), and duration of alcohol use disorder was 18 years (IQR, 11 to 24). Medical comorbidity by CIRS-SA at admission showed that the organs/systems most affected were liver (99%), respiratory (86%), and cardiovascular (58%). After median follow-up of 3.1 years (IQR, 1.5 to 5.1), 78 (11.4%) patients died with a mortality rate of 3.28 × 100 person-years; according to Kaplan-Meier estimates, 50% (95% confidence interval [95% CI], 24 to 69%) of patients with severe medical comorbidity died in the first decade after treatment. In multivariate analysis, severe medical comorbidity (hazard ratio [HR], 5.5; 95% CI, 3.02 to 10.07) and being treated with methadone at admission (HR, 2.60; 95% CI, 1.50 to 4.51) were independent risk factors for premature death.
Systematic assessment of alcohol-related organ damage is relevant for the identification and treatment of those at increased risk of death.
Available from: Fernanda de Carvalho Vidigal
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ABSTRACT: Obesity represents an important public health concern and has negative health and social consequences. Epidemiological and observational studies have contributed to highlighting the multifactorial and complex etiology of obesity. Among the social components of the obesity epidemic the following appear to be the most relevant: assortative mating, parental age, socio-economical status and educational level, body dissatisfaction, sleep conditions, sedentary environments by build neighborhood, energy saving devices, work occupation and alcohol consumption. The assortative mating and parental traits (age, education level) have shown an important influence on the weight of children. In turn, sleep deprivation may reduce the energy expenditure and increase food intake, which can explain a relation with obesity. Body dissatisfaction in childhood and adolescence seems to increase the risk of obesity in adulthood. The low physical activity and spent sedentary time can be associated with unfavorably built environment, including low walk ability, unsafe playgrounds and pedestrian pathways. Moreover, the obesity per se, over time, may reduce physical activity level and social ability as well as influence in assortative mating, and subsequent intergenerational obesity condition. All findings together demonstrated that social components of obesity are as complex as itself. In summary, more studies concerning social, cultural and environment traits are needed in order to assess the effect of excessive adiposity in its own occurrence and chronicity. In addition, it is urgent to include obesity prevention as a relevant topic on the public health agenda in developing countries.
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