BackgroundIncreased availability of low/er strength alcohol products has the potential to reduce alcohol consumption if they are marketed as substitutes for higher strength products rather than as additional products. The current study compares the main marketing messages conveyed by retailers and producers for low/er and regular strength wine and beer products.MethodsA content analysis of the marketing messages stated (in text) or depicted (in image) for low/er and regular strength wines and beers sold online on the websites of the four main UK retailers (Tesco, ASDA, Sainsbury’s, and Morrisons), and the producers of these products between February–March 2016.ResultsFour themes were identified: (a) suggested occasions for consumption, (b) health-related associations, (c) alcohol content, and (d) taste. Compared with regular strength products, low/er strength equivalents were more often marketed in association with occasions deemed to be suitable for their consumption including lunchtimes [wine: X2(1, n = 172) = 11.75, p = .001], outdoor events/barbeques [beer: X2(1, n = 96) = 11.16, p = .001] and on sport/fitness occasions [beer: X2(1, n = 96) = 7.55, p = .006]. Compared with regular strength wines and beers, low/er strength equivalents were more frequently marketed with images or text associated with health. These included images of fruit [wine: X2(1, n = 172) = 7.78, p = .005; beer: X2(1, n = 96) = 22.00, p < .001] and the provision of their energy (calorie) content [wine: X2(1, n = 172) = 47.97, p < .001; beer: X2(1, n = 96) = 15.10, p < .001]. Low/er strength products were also more often marketed with information about their alcohol content. There were few differences in the marketing messages regarding taste.ConclusionsLow/er strength wines and beers appear to be marketed not as substitutes for higher strength products but as ones that can be consumed on additional occasions with an added implication of healthiness.Electronic supplementary materialThe online version of this article (10.1186/s12889-018-5040-6) contains supplementary material, which is available to authorized users.
BackgroundMitochondrial neurogastrointestinal encephalopathy (MNGIE), due to mutations in TYMP, often presents with gastrointestinal symptoms. Two sisters, initially managed for Crohn’s disease based upon clinical, imaging and pathological findings, were later found to have MNGIE. The cases provide novel clinicopathological insight, for two further reasons: both sisters remain ambulant and in employment in their late 20s and 30s; diagnosis in one sister was made after a suspected azathioprine-precipitated acute illness.Case presentationA 25-year-old female presented with diarrhoea, vomiting, abdominal pain, and bloating. Faecal calprotectin, colonic biopsies and magnetic resonance enterography were consistent with a diagnosis of Crohn’s disease. Azathioprine initiation preceded admission with a sore throat, headache, myalgia, and pyrexia. Withdrawal led to rapid clinical improvement. MRI brain revealed persistent, extensive white matter changes. Elevated plasma and urine thymidine and deoxyuridine, and genetic testing for TYMP variants, confirmed MNGIE. Testing of the patient’s sister, also diagnosed with Crohn’s disease, revealed identical variants. In this context, retrospective review of colonic biopsies identified histological findings suggestive of MNGIE.ConclusionsAzathioprine interference in nucleic acid metabolism may interact with the mitochondrial DNA depletion of MNGIE. Nucleotide supplementation, proposed for treatment by manipulating mitochondrial nucleoside pools, may require caution. The late onset and mild phenotype observed confirms presentation can occur later in life, and may reflect residual thymidine phosphorylase activity. Clinicians should consider measuring plasma thymidine levels in suspected Crohn’s disease to rule out MNGIE, particularly if white matter abnormalities are identified on neuroimaging.
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