Regional body fat distribution may represent an independent risk factor for several conditions, especially metabolic and cardiovascular diseases; recent findings have shown that abdominal fat accumulation can be an independent predictor of hepatic steatosis. Very few studies, mostly using selected clinical samples, have focused on the relationship between indices of abdominal visceral fat accumulation and the most commonly used biochemical liver tests, such as alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma-glutamyltransferase (GGT). The aim of the present study was to evaluate the relation between central fat accumulation, as assessed by abdominal height, relative weight, as determined by body mass index (BMI), and liver function tests (ALT, AST, and GGT) in a random sample of 2,704 residents of Erie and Niagara Counties in New York State, 35-80 years of age and free from known hepatic disease. Multiple linear regression models were used, with liver enzymes as dependent variables with abdominal height and BMI as independent variables, and the inclusion of several covariates (age, race, education, smoking status, pack-years of smoking, drinking status, and total ounces of ethanol in the past 30 days). Abdominal height was consistently a better correlate of ALT and GGT levels than BMI in both sexes. In addition, abdominal height was the most powerful independent predictor of ALT in both sexes as well as of GGT among women. In conclusion, these findings support a role for central adiposity independent from BMI in predicting increased levels of hepatic enzymes, likely as a result of unrecognized fatty liver. (HEPATOLOGY 2004;39:754 -763.) O besity is an important predictor of several diseases, 1 as well as one of the risk factors most frequently associated with increased liver enzymes. [2][3][4][5][6][7] In the last several years, many epidemiological studies strongly indicated that regional body fat distribution, with abdominal accumulation, irrespective of total body fat quantity, as assessed by body mass index (BMI), may represent a major independent risk factor for several conditions, especially metabolic and cardiovascular diseases. 8,9 Furthermore, recent findings have shown that central adiposity can be an independent predictor of hepatic steatosis (fatty liver), 10,11 a common clinical and histological condition frequently associated with alcohol consumption and excessive body weight. In addition, obesity seems to represent a better predictor of fatty liver than heavy drinking and the coexistence of both conditions (obesity and heavy drinking) may produce a very high risk of developing this condition. 12 Increased levels primarily of alanine aminotransferase (ALT) and triglycerides, and secondarily of gamma-glutamyltransferase (GGT), appear to be the most sensitive biochemical indicators of the presence of hepatic steatosis. 11,12 Despite the growing body of evidence on the importance of visceral adiposity and the independent role of weight with respect to alcohol consumption ...

No abstract

Abstract-Epidemiological studies have demonstrated a positive relationship between heavy alcohol use and hypertension, but few studies have directly addressed the role of drinking pattern. This study was designed to investigate the association of current alcohol consumption and aspects of drinking pattern with hypertension risk in a sample of 2609 white men and women from western New York, aged 35 to 80 years, and free from other cardiovascular diseases. Hypertension was defined by systolic blood pressure Ն140 Key Words: alcohol Ⅲ hypertension, alcohol-induced Ⅲ blood pressure Ⅲ epidemiology T he relationship between heavy alcohol consumption and blood pressure elevation is well documented. 1,2 In the majority of studies, the assessment of alcohol has been focused primarily on average quantity of alcohol consumed during a period of time. The many different and complex components of drinking, such as the frequency and setting of consumption, have not been sufficiently addressed. It has been suggested that the way in which alcohol is consumed may have important implications for health and, in particular, for cardiovascular disease and cardiovascular risk factors. [3][4][5][6] Few studies have specifically evaluated the possible effect of pattern of alcohol consumption on blood pressure elevation; 7-9 the majority of these studies have given attention to the role of drinking frequency, however, providing conflicting results. Only a study on a large sample of Italian men and women has examined the association between drinking pattern in relation to food consumption and hypertension risk, reporting a higher prevalence of hypertension in individuals consuming wine outside meals compared with drinkers of wine with meals. 7 This study was thus conducted to investigate the relationship between pattern of alcohol use and hypertension risk in a general-population sample of men and women. In particular, in addition to the amount of alcohol consumed, our study focused on frequency of drinking and in relation to food consumption and beverage preference (beer, wine, and liquor).

Aspects of drinking pattern may affect subjective health differentially in women and men. Overall, intoxication and liquor drinking are associated with poorer self-perceived health status than regular, moderate consumption of other alcoholic beverages.

No abstract

Alcohol drinking in light-to-moderate amounts has been associated with reduced coronary heart disease (CHD) risk. However, there is evidence that the way people consume alcohol (drinking pattern) may affect risk. Central adiposity, a known CHD risk factor may be one mechanism in the pathway between alcohol consumption and CHD risk. Our study examined whether various drinking patterns differentially affect fat distribution, particularly abdominal fat in women and men. In a randomly selected population-based cohort (n ϭ 2343), 35-79 y old, we assessed drinking pattern as reported for the past 30 d, including beverage type and amount, frequency of consumption, percentage of time drinking while eating and number of drinks consumed/drinking day. Central adiposity was determined using an abdominal caliper to measure supine height of the abdomen. Current drinkers tended to have smaller abdominal heights than nondrinkers (women, P Ͻ 0.0001; men, P ϭ 0.0559). For drinking pattern, frequency was inversely associated, but drinking intensity (drinks/drinking day) was positively associated with central adiposity in women (P trend for frequency, 0.0007; intensity, 0.0010) and men (P trend for frequency, 0.0005; intensity, 0.0004), even when age, education, physical activity, smoking status and amount of alcohol (g) were included in the models. When frequency and intensity were considered together, daily drinkers of Ͻ1 drink/drinking day had the smallest mean abdominal height measures with the largest measures in less than weekly drinkers who consumed 4 or more drinks/drinking day. These results support the hypothesis that drinking pattern affects the distribution of body fat, an important CHD risk factor.

Trauma-informed care (TIC) is a widely adopted organizational approach to health and human services. The current study occurred within a residential addiction treatment agency and has two aims: To operationalize the processes, an agency can take to become trauma informed and assesses the impact of a multiyear TIC implementation project on organizational climate, procedures, staff and resident satisfaction, and client retention in treatment. Pearson w 2 tests were computed to assess variation in client satisfaction and discharge status, while climate, procedures, and staff satisfaction were assessed by effect size differences. Following TIC implementation, there were positive changes in each of the five outcomes assessed. Workplace satisfaction, climate, and procedures improved by moderate to large effect sizes, while client satisfaction and the number of planned discharges improved significantly. The current study provides support for implementing TIC. Future research may continue to examine the influence of TIC implementation.

The association of lifetime alcohol drinking pattern with the prevalence of the metabolic syndrome is largely unknown. Analyses were conducted on a population-based sample in a cross-sectional study (N=2818, ages 35-79 years, 93% whites). Included were subjects who drank at least once a month for a period of at least six months during their lifetimes and were free of cardiovascular disease and cancer at the time of interview. Lifetime drinking measures included total years of drinking, total drinking days, volume (total drinks) and average intensity (#drinks/drinking day); frequency of intoxication and heavy drinking; and age drinking began and ended. Metabolic syndrome components included impaired fasting glucose (IFG), high triglycerides (HTG), low HDL cholesterol (LHDLC), abdominal obesity (ABO), and hypertension (HBP). Potential confounders examined were age, gender, race, family history of coronary heart disease or diabetes, years of education, lifetime and current cigarette smoking, current drinking status, physical activity, and dietary factors. Multiple logistic regressions indicated that average intensity was directly related to IFG, HTG, HBP, and metabolic syndrome overall (p for linear trend=0.03, 0.04, 0.003, and 0.009, respectively) and to ABO in women only (p for trend=0.0004). Prevalence ratios (95% CI) for the metabolic syndrome according to quartiles of intensity were 1.00 (lowest), 1.23 (0.91-1.67), 1.43 (1.06-1.91) and 1.60 (1.12-2.30). Total drinking days was inversely related to LHDLC (p for trend=0.0002) and to ABO in women only (p for trend<0.0001). It is concluded that lifetime drinking patterns are significantly related to the prevalence of the metabolic syndrome.